Vaccinations adult immunizations

Cost—benefit analyses for adult immunizations have also been performed. Influenza immunization during the period from 1971 to 1977 resulted in over 13 million more years of life at a cost of only 63 per year of life gained. Productivity gains were estimated to have a value of 250 x 10 (148). Projected costs of pneumonia have been calculated at 3.6 times the cost of vaccination, or a savings of 141 per person is achieved among those at risk for developing pneumonia or over the age of 50 years (149). 

When an adult or child is receiving a vaccine for immunization, the nurse explains to the patient or a family member the possible reactions that may occur, for example, soreness at the injection site or fever. 

Most vaccines are administered in two- to four-shot series in order to elicit the best protection. Childhood and adult immunization schedules are revised frequently and published annually by the CDC Advisory Committee on Immunization Practices. Current immunization schedules can be found at www.cdc.gov/nip/. The childhood schedule is published in January and the adult schedule in October of each year. Recommendations will be published throughout the year in the Morbidity and Mortality Weekly Report (MMWR) as new vaccines are licensed or new information necessitates a change in previous recommendations. 

Figure 1. Recommended adult immunization schedule, by vaccine and age group United States, October 2007-September 2008...

Data from the VAERS on arthritic reactions (arthralgia, arthrosis, arthritis, and joint disease) after rubella immunization during 1991-98 have been analysed (Table 3) (122). Hepatitis A vaccine-associated arthritic reactions reported to VAERS during 1997-98 were used as controls. The analysis confirmed that rubella vaccine is associated with a large number of arthritic reactions. Among the female subjects given rubella vaccine, these reactions occurred primarily in the adult women. The incidence of arthritic reactions was 126 per million rubella immunizations, whereas the hepatitis A vaccine adult control group had an incidence rate of 3.2 per million immunizations. 

Hepatitis A virus (HAV) accounts for about one fourth to one third the cases of clinical acute hepatitis in the United States and 20% to 25% worldwide. Although most commonly an infection of children and adolescents, the disease tends to be more virulent in middle-aged and older people. Most sporadic cases occur from person-to-person contact, such as occurs in children in day care centers. Epidemics have been associated with waterborne and food-borne contamination. Ingestion of raw shellfish from contaminated waters has caused both sporadic and epidemic cases. Although not as common a cause of liver infection as hepatitis B, it is more frequently associated with jaundice when occurring in adults than either hepatitis B or C an estimated 50% to 70% of infected adults develop jaundice. In contrast, hepatitis A infection in children is rarely associated with jaundice, and thus is usually not detected clinically. The incidence of the disease is declining in the developed world with introduction of hepatitis A vaccine complete immunization of less than half the at-risk population has been shown to reduce incidence of acute hepatitis A infection by more than 90% in areas of high endemicity. Universal vaccination of... 

Adult immunizations are important to document as well and include vaccines such as pneumococcusl (for elderly and those at risk for pneumonia), influenza, hepatitis B, and tetanus. Although not an immunization, skin testing for tuberculosis might also be included under this section in high-risk patients (elderly, health care worker, or immunocompromised patient). 

National Immunization Program Center for Disease Control and Prevention s National Center for Infectious Diseases Viral Hepatitis Immunization Action Coalition Allied Vaccine Group National Coalition for Adult Immunization... 

These intervention strategies can be considered as passive immunotherapy it may, however, be possible to actively immunize atopic individuals since there is evidence that neonatal or adult immunization with IgE can stimulate the formation of therapeutically useful anti-IgE auto-antibodies in animal systems (342). Their action suggests that the identification of structural determinants in IgE, which participate directly in IgE-receptor interaction, may form the basis for the development of peptide immunogens to induce the formation of antibodies, which can bind specifically to the receptor-binding sites of IgE in the circulation and to membrane IgE on B cells. Used as vaccines, such peptides could have a direct application in the treatment of all IgE-mediated allergies. 

Vaccines are used in either the general population of children or adults or for special groups. Recommendations for vaccine usage are made by the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control. The Committee on Infectious Diseases of the American Academy of Pediatrics (Redbook Committee) also makes recommendations for infants through adolescents, and the American Academy of Family Physicians makes recommendations for adults. An excellent review of vaccine history, development, usage, and related regulatory issues is available (2). 

Poliomyelitis. Two vaccines are Hcensed for the control of poliomyelitis in the United States. The Hve, attenuated oral polio vims (OPV) vaccine can be used for the immunization of normal children. The killed or inactivated vaccine is recommended for immunization of adults at increased... 

For active immunization against Japanese encephalitis for individuals older than 1 year Same as for BCG vaccine Three doses given to adults and children > 3 years 1 mLSC on days 0, 7, and 30 children 1-3 years 0.5 mLSC on days 0, 7, and 30... 

The ideal of any vaccine is to provide life-long protection to the individual against disease. Immunological memory (Chapter 14) depends upon the survival of cloned populations of small B and T lymphocytes (memory cells). These small lymphocytes have a lifespan in the body of ca. 15-20 years. Thus, if the immune system is not boosted, either by natural exposure to the organism or by re-immunization, then immunity gained in childhood will be attenuated or lost completely by the age of 30. Those vaccines which provide only poor protection against disease have proportionately reduced time-spans of effectiveness. Yellow fever vaccination, which is highly effective, must therefore be repeated at 10-year intervals, whilst typhoid vaccines are only effective for 1-3 years. Whether or not immunization in childhood is boosted at adolescence or in adult life depends on the relative risks associated with the infection as a function of age. 

The hepatitis A vaccine may provide effective immunity for 8 years in adults and children. Additionally, kinetic models have theorized that immunity with the vaccine may be longer than 20 years, but this has not been confirmed in clinical trials.1... 

Children with SCD should receive the required immunizations as recommended by the American Academy of Pediatrics and the Advisory Committee on Immunization Practices.15 Additionally, influenza vaccine should be administered yearly to SCD patients 6 months of age and older, including adult patients. Any SCD patient who is scheduled for splenectomy should receive the vaccine for meningococcal disease if over 2 years of age.16... 

In the 1940s, diphtheria toxoid was combined with tetanus toxoid and whole cell pertussis vaccines, and later with the acellular pertussis vaccine. The diphtheria toxoid, tetanus toxoid, and acellular pertussis vaccine are part of the routine childhood immunization schedule. Diphtheria toxoid is also combined with tetanus toxoid and is commonly used as a booster vaccine. The pediatric product (DT) has a higher amount of diphtheria toxoid than does the adult product (Td). Diphtheria toxoid is not available as an individual vaccine. 

Measles, mumps, and rubella vaccines are available as single component vaccines or as combinations. Most authorities recommend use of the measles, mumps, and rubella combination vaccine and discourage use of the single- or double-component vaccines. Two doses of the measles, mumps, and rubella vaccine are recommended for all individuals born after 1957. The first dose should be administered soon after the first birthday and the second prior to entering school. For high-risk adolescents and adults who do not have adequate immunity, two doses of the vaccine should be separated by a minimum of 28 days.8... 

The 23-valent pneumococcal polysaccharide vaccine contains 23 serotypes that are responsible for causing more than 80% of invasive S. pneumoniae infections in adults. The vaccine includes those serotypes that are associated with drug resistance. Use of the vaccine will not prevent the development of antibiotic-resistant S. pneumoniae, but is likely to prevent infection from drug-resistant strains. The 23-valent pneumococcal polysaccharide vaccine has demonstrated good immunogenicity in adults, but an individual will not develop immunity to all 23 serotypes following vaccination.10... 

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