Immunizations (adult): Clinical sciences

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Introduction0:00–0:46

Immunizations, also known as vaccines, stimulate the immune system to produce antibodies against specific microorganisms.
These antibodies not only disable pathogens but also remain in the body to provide long-term immunity, decrease the likelihood of infection, and decrease the severity of infection.
Adult vaccinations are commonly administered during annual wellness visits according to the patient’s age. However, some special considerations such as international travel, pregnancy, and immunocompromised status may alter the usual sequence of immunization.
Now, if your patient presents for routine vaccination, first assess their age. For patients 19 to 26 years old, offer the one- or two-dose COVID-19 series.

19 to 26 Years0:46–10:29

This vaccine protects against variants of the SARS-CoV-2 virus, which can cause acute nose, lung, or throat infections, and sometimes respiratory distress, viral pneumonia, and even myocarditis.
If previously vaccinated against COVID-19, give them a single dose as a booster. Next, patients should receive their influenza vaccine, also known as the flu shot.
This annual vaccine helps to protect from influenza, an acute respiratory illness that can progress to viral pneumonia. Moving on, if your patient has not already received their completed Hepatitis B and HPV vaccinations, administer these as well.
Hepatitis B immunizations are given in a multi-dose series and help protect against liver disease caused by acute or chronic hepatitis B infection.
On the other hand, the two- or three-dose HPV vaccine series protects against the human papillomavirus. This virus can cause genital warts as well as various forms of genital and throat cancers.
Next up is the Tdap vaccine, which stands for Tetanus, Diphtheria, and activated Pertussis. And you guessed it, it protects against the bacteria Clostridium tetani, Corynebacterium diphtheriae, and Bordetella pertussis.
As a reminder, Clostridium tetani produces the tetanus toxin that affects neuromuscular transmission and results in painful muscle contractions and spasms.
Corynebacterium diphtheriae produces the diphtheria toxin that affects mucous membranes of the throat and nose and can lead to severe upper airway obstruction and respiratory distress.
This condition is also known as diphtheria. Lastly, Bordetella pertussis produces the pertussis toxin that typically results in specific paroxysmal coughing called whooping cough.
Adult patients should receive a Tdap vaccine every ten years. Alternatively, after the first Tdap immunization, they can receive the Td vaccine every ten years as a booster.
Keep in mind Td vaccination protects against tetanus and diphtheria only. Let’s take a break with a clinical pearl!!
Besides the usual booster every 10 years, you can give Tdap or Td vaccines in special circumstances, like pregnancy and wound management.
For each pregnancy, patients should receive one Tdap vaccine. For wound management, patients with severe wounds should have a Tdap or Td vaccine if their last immunization was over five years ago.
However, patients with minor clean wounds should only have a Tdap or Td vaccine if it has been longer than ten years since their last booster.
Patients with a wound of any severity who are uncertain when their last booster was received should get the Tdap or Td vaccine prophylactically.
Moreover, all previously unvaccinated patients with wounds should receive the Tdap vaccine instead of Td. Okay, let’s go back to vaccines for your 19 to 26-year-old patient.
Next up is the RSV vaccine which protects from respiratory syncytial virus, an acute respiratory illness. While the viral infection is usually mild in younger adults, in older adults with chronic medical conditions and infants, it can progress to respiratory distress.
To protect against RSV transmission to infants, it is recommended to give one dose of the vaccine to patients who are 32 to 36 weeks pregnant during the fall or winter.
Moving on to the VAR vaccine. This vaccine protects against primary varicella-zoster infection, commonly called chickenpox, which causes an itchy generalized vesicular rash and can lead to pneumonia or encephalitis.
Chickenpox is most commonly seen in children and teenagers but can also occur in adults so give this vaccine series to nonpregnant adults with no history of previous varicella-zoster infection.
Next up is the MenACWY vaccine, which protects against the A, C, W, and Y subtypes of the bacteria Neisseria meningitidis, all of which can cause meningitis and lead to seizures or death.
High-risk patients include college students ages 16 to 23, travelers to endemic regions, and immunocompromised patients with asplenia or HIV.
Okay, now that we’ve reviewed vaccines for healthy 19 to 26-year-olds, let’s take a look at vaccines needed for this same age range but who are immunocompromised.
First up is the RZV vaccine which protects against herpes zoster, a rash of painful vesicles on one side of the body, more commonly known as shingles.
Shingles results from the reactivation of a previous varicella-zoster infection. It typically affects younger adults with compromised immune systems or older adults.
Administer this vaccine series to patients with compromised immune systems, such as patients with HIV or AIDS. Second, there is the Hib vaccine.
It protects against Haemophilus influenzae type B infection, a bacteria that can affect the lungs, brain, and spinal cord.
Give this vaccine to patients who have asplenia or a history of hematopoietic stem cell transplants. Then, there’s PCV, a conjugated pneumococcal vaccine that protects against Streptococcus pneumoniae, a pneumonia-causing bacteria that can cause bacteremia or meningitis.
Patients under 65 who have a compromised immune system, diabetes, alcoholism, heart disease, or lung disease should receive a single dose of the PCV vaccine.
Next up is the Hepatitis A vaccine, which protects from liver disease that can progress to liver failure from hepatitis A infection.
Give this series to patients who are immunocompromised, take illicit drugs, or travel to countries with high rates of hepatitis A.
Then, there is the MMR vaccine, which protects against measles, mumps, and rubella. Measles presents with a morbilliform rash, fever, and respiratory symptoms, and it could lead to pneumonia or encephalitis.
Mumps causes parotid gland swelling and, if severe, hearing loss or orchitis. Rubella causes mild fever and a pink maculopapular rash, however, in pregnancy, this virus can cause miscarriages or severe congenital disabilities.
Here’s a high-yield fact! MMR and VAR vaccines are live vaccines and not safe to provide to pregnant or severely immunocompromised adults.
However, if your patient is traveling or in healthcare, they should receive the MMR vaccine. It is also given to nonpregnant adult patients if their serology is negative for MMR antibodies.
Finally, the Mpox vaccine protects against the monkeypox viral infection, which causes a painful papulovesicular rash with fever, and potential blindness, pneumonia, or encephalitis.
Give this vaccine series to adult patients who have high-risk sexual behaviors or a sexually transmitted infection in the last six months.
Now, let’s talk about vaccines for 27 to 49-year-old patients. These adults should receive their updated COVID-19 and annual influenza vaccines.

27 to 49 Years10:29–11:50

Also, give the Tdap or Td booster every ten years; RSV vaccine between 26 and 32 weeks of pregnancy; and a VAR vaccine if they are nonpregnant with negative serologic testing.
Next, you might need to provide HepB vaccination if they’ve never had it or did not complete the series. As for the HPV vaccination, discuss giving it to patients up to age 45 if they haven’t received it yet.
But don’t offer it to patients over 45 since most adults over this age have already been exposed to the virus. For shingles, this age group should receive the RZV vaccine only if immunocompromised.
Again, give the same immunizations for immunocompromised patients including RZV, Hib, PCV, hepatitis A, MMR, and Mpox vaccines.

50 to 64 Years11:50–13:20

Okay, let’s move on to patients between 50 to 64 years old. Again, update their COVID-19 and annual influenza vaccines.
In this age group, all patients, healthy and immunocompromised, should receive the RZV vaccine series to protect against shingles.
Additionally, make sure they receive a Tdap or Td vaccine every ten years. For adults 60 years or older, determine if your patient might benefit from one dose of the RSV vaccine, especially if they have chronic lung disease, kidney disorders, diabetes mellitus, cardiovascular disease, or severely compromised immune system.
Now, patients who are under the age of 60 without complete HepB vaccination should receive the series. Moreover, give HepB vaccination to patients who are over 60 and have high-risk health conditions, like chronic liver disease, illicit drug use, high-risk sexual behaviors, or incarceration.
Once again, give immunizations for immunocompromised patients including Hib, PCV, hepatitis A, MMR, and Mpox vaccines. Lastly, let’s discuss vaccination for adults ages 65 and older.

65 Years and Older13:20–14:19

Give updated COVID-19 and annual influenza vaccines, and give the pneumococcal vaccine if they have not previously received it or if their immunization status is unknown.
They should also receive a Tdap or Td vaccine every ten years. Next, give the RSV vaccine and hepatitis B vaccination if high-risk.
Patients in this age group who have not completed their RZV vaccination should do it now. Finally, give any indicated additional immunizations for immunocompromised patients including Hib, PCV, hepatitis A, MMR, and Mpox vaccines.
Alright, as a quick recap… Routine vaccinations help prevent serious illness and health complications, so most adults should receive them according to a standardized schedule based on their age and immunocompromised status.

Review14:19–14:37