Diphtheria-Tetanus/Diphtheria (Td) and Tetanus/Diptheria/Pertussis (Tdap) Immunization
- VHA recommends tetanus and diphtheria immunization unless contraindicated with Td vaccine every 10 years for all adults aged 19 and older.
- VHA recommends Tdap vaccine (tetanus, diphtheria, and acellular pertussis):
- once for non-pregnant adults who have not previously received a dose of Tdap as an adult and repeated during every pregnancy, regardless of the interval since the most recent tetanus and/or diphtheria-containing vaccine, unless contraindicated, and then resume the every 10 year Td booster schedule.
Seasonal Influenza Immunization
VHA recommends annual influenza immunization for all adults aged 19 years and older, unless contraindicated, starting as soon as the vaccine becomes available in the late summer or early fall.
Hepatitis A Immunization
VHA recommends hepatitis A immunization (unless contraindicated) for previously unvaccinated adults who are at increased risk of contracting hepatitis A virus (HAV) infection and for any other adult who is seeking protection from HAV infection.
Increased risk includes:
- persons traveling to or working in countries that have high or intermediate endemicity of infection (see CDC travel information at: http://wwwnc.cdc.gov/travel/ for information about specific countries);
- close contacts of adopted children coming from area of high endemicity;
- men who have sex with men;
- users of injection or non-injection illicit drugs;
- persons with chronic liver disease (including those with Hepatitis B infection, Hepatitis C infection, liver cirrhosis (diagnosed by labs, imaging and/or biopsy), liver fibrosis and any patient with other clinical syndromes consistent with chronic liver disease (e.g.esophageal varices) and those awaiting or who have received liver transplant);
- persons who work with HAV-infected primates or with HAV in a research laboratory setting;
- persons aged 19 and older experiencing homelessness should be routinely immunized against HAV.
Contraindications: History of a severe allergic reaction to a previous dose of hepatitis A vaccine or to a vaccine component.
Hepatitis B Immunization
VHA recommends hepatitis B immunization for previously unvaccinated adults who are at increased risk for contracting hepatitis B virus (HBV) infection, who have chronic liver disease, or for any adult seeking protection from HBV infection, unless the vaccine is otherwise contraindicated.
Increased risk includes:
- have chronic liver disease;
- household contacts of HBV-infected persons;
- sexual contacts of HBV-infected persons;
- persons who have shared needles with HBV-infected persons;
- current or previous injection-drug use;
- sexually active persons with more than one sex partner (ie, in the past 6 months), or with a non-monogamous partner;
- men who have sex with men;
- persons seeking evaluation or treatment for a sexually transmitted infection (STI);
- persons with HIV infection;
- persons with diabetes who are under the age of 60 (the decision to vaccinate adults with diabetes who are older than 60 should consider the likelihood of acquiring HBV infection, including potential risk posed by assisted blood-glucose monitoring if stay in a care facility is anticipated, the likelihood of experiencing chronic sequelae if infected with HBV, and the declining immunologic response to vaccines that is associated with increased age);
- persons with end-stage renal disease on dialysis or expected to be on dialysis;
- healthcare personnel, public safety workers, and other persons with risk for exposure to blood or other potentially infectious body fluids;
- residents and staff in care facilities for developmentally disabled persons;
- residents in correctional facilities;
- travelers to countries with high or intermediate prevalence of HBV infection.
Contraindications: Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component.
Herpes Zoster (Shingles) Immunization
VHA recommends 2 doses of this vaccine for adults age 50 and older, unless contraindicated, with second dose 2-6 months after the first dose.
Contraindications: History of severe allergic reaction, such as anaphylaxis, to any component of the vaccine.
Human Papillomavirus (HPV) Immunization
VHA recommends HPV immunization (unless contraindicated) for women ages 19-26 and men ages 19-21 who have not been previously vaccinated and/or who have not completed the full 3 dose series.
VHA recommends HPV immunization (unless contraindicated) for men ages 22-26 who are:
- immunocompromised, including those with HIV or
- men who have sex with men (MSM) and who have not been previously vaccinated and/or who have not completed the full 3 dose series. Other men in this age group may receive the vaccine (permissive recommendation) on a case by case basis based on patient preference.
- History of immediate hypersensitivity to yeast
- History of hypersensitivity to any other vaccine component is a contraindication to vaccination.
VHA recommends vaccination for healthy adults, but with a variety of types of vaccinations, Veterans should ask their primary care provider about this.
Mumps, Measles, Rubella (MMR) Immunization
VHA recommends at least 1 dose of MMR vaccine against measles, mumps and rubella (unless contraindicated or already received) for all adults born during or after 1957, if there is not documented evidence of immunity.
VHA recommends a second dose of MMR vaccine (unless contraindicated) for adults born during or after 1957 who: 1) have been vaccinated previously with a killed or unknown type of measles vaccine; 2) are students in post-high school educational institutions; 3) work in a health care facility; 4) plan to travel internationally; 5) are close contacts of immunocompromised persons; or 6) have HIV with a CD4 count ≥200 lymphocytes/mm3 or a CD4+ T-lymphocyte percentage >15%. A second dose is not needed if there is adequate documentation of 2 doses of live vaccine, laboratory evidence of immunity or laboratory confirmation of disease.
- Pregnancy or planned pregnancy in the next 28 days to 3 months
- Persons with severe immune system dysfunction
- History of anaphylactic reaction to MMR vaccine
- History of anaphylactic reaction to topically or systemically administered neomycin
- Caution with people who have a history of anaphylactic reaction to gelatin or gelatin-containing products
Pneumococcal Immunization (pneumonia)
VHA recommends that all healthy adults aged 65 and older receive one dose each of 2 pneumonia vaccines, unless contraindicated, if they have not already received one dose before age 65. Adults aged 18-64 should ask their primary care provider as this vaccine is recommended for some in this age group.
- Severe allergic reaction (e.g. anaphylaxis) to a vaccine component.
- Re-vaccination is contraindicated for persons who had a severe reaction (e.g,. anaphylactic reaction or localized Arthus-type reaction) to the initial dose they received.
Varicella Immunization (Shingles/chickenpox)
VHA recommends chickenpox immunization with varicella vaccine unless contraindicated for all non-pregnant adults who lack documentation of vaccination and who have no evidence of immunity.
- Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component, including gelatin and neomycin. A history of contact dermatitis to neomycin is not a contraindication.
- Known severe immunodeficiency or altered immunity, including persons with: Any malignant condition, including blood dyscrasias, leukemia, lymphomas of any type, or other malignant neoplasms affecting the bone marrow or lymphatic systems.
- Cellular immunodeficiencies, hypogammaglobuminemia or dysgammaglobulinemia.
- HIV/AIDS who are severely immunocompromised.
- A family history of congenital or hereditary immunodeficiency in first-degree relatives (e.g., parents and siblings) unless the immune competence of the potential vaccine recipient has been clinically substantiated or verified by a laboratory.
- Those on high-dose systemic immunosuppressive therapy.
- Pregnancy: Because the effects of the varicella virus vaccine on the fetus are unknown, pregnant women should not be vaccinated. (Pregnant women who do not have evidence of immunity should receive the first dose of varicella vaccine upon completion or termination of pregnancy and before discharge from the health-care facility. The second dose should be administered 4–8 weeks after the first dose.)
- Active untreated tuberculosis.