Vaccinations in adults

Current recommendations for the use of influenza vaccine in adults are based on a single injection. This may not be valid in case of a new pandemic caused by an antigenic shift of the influenza virus. Currently, the only group for whom a second dose is recommended comprises children who have never been immunized. However, when two-dose regimens in adults have been studied, the second dose of vaccine has not been associated with higher rates of reactions than the first. People who have a stronger local reaction after a first injection are more likely to have another such reaction after a second injection (31). 

Dorrefl L, Hassan 1, Marshall S, et al. Chnical and serological responses to an inactivated influenza vaccine in adults with HIV infection, diabetes, obstructive airways disease, elderly adults and healthy volunteers. Int J STD AIDS 1997 8 776-779. 

MH, Metselaar HJ, de Man RA, Osterhaus ADME. Efficacy of influenza vaccination in adult liver ttansplant recipients. (2000) 61, 85-93. 

K. Johansen, J. Hinkula, C. Istrate, E. Johansson, D. Poncet, L. Svens-son, Polyphosphazenes as adjuvants for inactivated and subunit rotavims vaccines in adult and infant mice, in Polyjliosphazenes for Biomedical Applications, John Wiley Sons, Inc, New Jersey, 2008, pp. 85-99. 

Blatter M, Friedland LR, Weston WM, Li P, Howe B. Immunogenicity and safety of a tetanus toxoid, reduced diphtheria toxoid and three-component acellular pertussis vaccine in adults 19-64 years of age. Vaccine 2009 27(5) 765-72. 

Another study looked at the quadrivalent vaccine in adults, with safety as the secondary outcome. They found it to be well tolerated with no safety concerns when compared with bivalent vaccines. Pain was the most common solicited AE, albeit with no difference between vaccine groups [29 ]. 

A European open-label multicenter study of the Tdap-IPV given concomitantly or sequentially with a trivalent inactivated split influenza virus vaccine in adults over years of age, showed that both vaccines when given concomitantly were immunogenic and well tolerated with no increase in AE profile [107 ]. 

Peeters M, Regner S, Vaman T, Devaster JM, Rombo L. Safety and immunogenicity of an AS03-adjuvanted A(HlNl)pmd09 vaccine administered simultaneously or sequentially with a seasonal bivalent vaccine in adults 61 years or older data from two multicentre randomised trials. Vaccine 2012 30(45) 6483-91. 

Scheifele DW, Ward BJ, Dionne M, Vanderkooi OG, Loeb M, Coleman BL, et al. Compatibibty of AS03-adjuvanted HlNlpdm09 and seasonal bivalent influenza vaccines in adults results of a randomized, conboUed trial. Vaccine 2012 30(32) 4728-32. 

Pepin S, Donazzolo Y, Jambrecina A, Salamand C, Saville M. Safety and immunogenicity of a quadrivalent inactivated influenza vaccine in adults. Vaccine 2013 31(47) 5572-8. 

ViUa D, Gubbay J, Sutherland DR, Laister R, McGeer A, Cooper C, et al. Evaluation of 2009 pandemic HlNl influenza vaccination in adults with lymphoid malignancies receiving chemotherapy or following autologous stem ceU transplant. Leuk Lymphoma 2013 54(7) 1387-95. 

Tseng HF, Liu A, Sy L, Marcy SM, Fireman B, Weintraub E, et al. Safety of zoster vaccine in adults from a large managed-care cohort a vaccine safety dataUnk study. J Intern Med 2012 271(5) 510-20. 

Pine MJ, Smith MA, Carson CA, et al. Efficacy of pneumococcal vaccination in adults a meta-analysis of randomized controlled trials. Arch Intern Med 1994 154 2666-2677. 

Boroono JM, McLean AA, Vella PP, et al. Vaccination and revaccination with polyvalent pneumococcal polysacchande vaccines in adults and infants. Proc Soc Exp BioL Med 1978 157 148-154. 

Despite the availability of an effective and safe vaccine against hepatitis B for more than two decades, HBV infection is stiU a major health problem worldwide. More than two billion individuals have been infected with HBV, and chronic infection affects approximately 350 million patients (Lavanchy 2004). While HBV infection in adults is mostly asymptomatic and self-Umiting in >80% of the cases, transmission at a younger age is associated with a high risk of chronic infection. Vertical transmission of HBV leads to chronic infection of the newborns in up to 90% of the cases. 

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... 

The most common adverse effects in adults include injection site reactions (e.g., tenderness, pain, and warmth), headaches within 5 days after vaccination, and fatigue. Local reactions may be minimized by using an appropriate needle length based on the person s age and size and by administering the injection intramuscularly in the deltoid muscle. Children may also have feeding disturbances. Hepatitis A vaccine given... 

There are two pneumococcal vaccines, a 7-valent conjugated vaccine for children younger than 6 years of age and a 23-purified-capsular polysaccharide antigen vaccine for adults. The 23 capsular types in the vaccine represent at least 85% to 90% of the serotypes that cause invasive pneumococcal infections among children and adults in the United States.41 After vaccination, an antigen-specific antibody response, indicated by a twofold or greater rise in serotype-specific antibody, develops within 2 to 3 weeks in 80% or more of healthy young adults.42... 

H. influenzae type b conjugate vaccine is a recommended routine childhood vaccine given at 2,4, 6, and 12 to 15 months of age. Adolescents and adults with functional or anatomic asplenia should also receive a booster dose of H. influenzae type b vaccine. The currently available vaccines are labeled for pediatric use, but can be used in adults when vaccination is indicated. There are several H. influenzae type b vaccines on... 

Hepatitis B virus is a blood-borne or sexually transmitted virus. Most acute infections occur in adults, while chronic infections usually occur in individuals infected as infants or children. However, about 10% of adults who contract hepatitis B virus will fail to clear their infection and develop chronic hepatitis B infection. Individuals with chronic hepatitis B infection are at risk for cirrhosis or hepatocellular carcinoma. Vaccination with hepatitis B vaccine is the most effective way to prevent hepatitis B infection.6... 

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... 

The vaccination rate in adults is much lower than that in children. Only 50% to 60% of adults who meet criteria have received pneumococcal or influenza vaccination. Comprehensive initiatives need to be implemented to increase the adult vaccination rate. Some proven concepts are providing reminders to patients that vaccines are due and implementation of standing orders for vaccines. This latter concept allows nurses and pharmacists to screen patients to see if pneumococcal, influenza, or other vaccines are needed and to vaccinate without a physician s order. 

Employees of residential care facilities for high-risk patients / Household members of persons in high-risk groups Immunization of children aged 6 to 59 months is recommended. Influenza vaccine should be offered to anyone wishing to avoid influenza infection. Individuals who should not be vaccinated are those with anaphylactic hypersensitivity to eggs or other components of the vaccine or adults with febrile illness (until the fever abates). 

Kiecolt-Glaser, J.K. et al., Chronic stress alters the immune response to influenza virus vaccine in older adults, Proc. Natl. Acad. Sci. U.S.A., 93, 3043, 1996. 

Bums, V.E. et al., Life events, perceived stress and antibody response to influenza vaccination in young, healthy adults, J. Psychomat. Res., 55, 569, 2003. 

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