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Impfschema für Erwachsene - Jahr 2010
Recommended Adult Immunization Schedule
United States, 2010
January 15, 2010 / 59(01);1-4
The Advisory Committee on Immunization Practices (ACIP) annually reviews
the recommended Adult Immunization Schedule to ensure that the schedule
reflects current recommendations for the licensed vaccines. In October
2009, ACIP approved the Adult Immunization Schedule for 2010, which
includes several changes. A bivalent human papillomavirus vaccine (HPV2)
was licensed for use in females in October 2009. ACIP recommends
vaccination of females with either HPV2 or the quadrivalent human
papillomavirus vaccine (HPV4). HPV4 was licensed for use in males in
October 2009, and ACIP issued a permissive recommendation for use in
males. Introductory sentences were added to the footnotes for measles,
mumps, rubella, influenza, pneumococcal, hepatitis A, hepatitis B, and
meningococcal vaccines. Clarifications were made to the footnotes for
measles, mumps, rubella, influenza, hepatitis A, meningococcal, and Haemophilus influenza type
b vaccines, and schedule information was added to the hepatitis B
vaccine footnote.
Additional information is available as follows: schedule (in English and
Spanish)
at
http://www.cdc.gov/vaccines/recs/schedules/adult-schedule.htm;
adult vaccination at http://www.cdc.gov/vaccines/default.htm;
ACIP statements for specific
vaccines at http://www.cdc.gov/vaccine/pubs/acip-list.htm;
and reporting adverse events at http://www.vaers.hhs.gov or
by telephone,
800-822-7967.
Changes for 2010
Footnotes (Figures 1 and 2)
-
The
human papillomavirus (HPV) footnote (#2) includes language that
a bivalent HPV vaccine (HPV2) has been licensed for use in females.
Either HPV2 or the quadrivalent human papillomavirus vaccine (HPV4)
can be used for vaccination of females aged 19 through 26 years. In
addition, language has been added to indicate that ACIP issued a
permissive recommendation for use of HPV4 in males.
-
The
measles, mumps, rubella (MMR) footnote (#5) has language added
to clarify which adults born during or after 1957 do not need 1 or
more doses of MMR vaccine for the measles and mumps components, and
clarifies which women should receive a dose of MMR vaccine. Also,
interval dosing information has been added to indicate when a second
dose of MMR vaccine should be administered. Language has been added
to highlight recommendations for vaccinating health-care personnel
born before 1957 routinely and during outbreaks.
-
The term “seasonal” has been added to the influenza footnote (#6).
-
The
hepatitis A footnote (#9) has language added to indicate that
unvaccinated persons who anticipate close contact with an
international adoptee should consider vaccination.
-
The
hepatitis B footnote (#10) has language added to include
schedule information for the 3-dose hepatitis B vaccine.
-
The
meningococcal vaccine footnote (#11) clarifies which vaccine
formulations are preferred for adults aged ≤55 years and ≥56 years,
and which vaccine formulation can be used for revaccination. New
examples have been added to demonstrate who should and should not be
considered for revaccination.
-
The selected conditions for Haemophilus
influenza type b
(Hib) footnote (#13) clarifies which high-risk persons may receive 1
dose of Hib vaccine.
The Recommended Adult Immunization Schedule has been approved by the
Advisory Committee on Immunization Practices, the American Academy
of Family Physicians, the American College of Obstetricians and
Gynecologists, and the American College of Physicians.
Suggested citation: Centers
for Disease Control and Prevention. Recommended adult immunization
schedule---United States, 2010. MMWR 2010;59(1).
FIGURE 1. Recommended adult immunization schedule, by vaccine and
age group - United States, 2010
Alternative Text: The
figure above shows the recommended adult immunization schedule, by
vaccine and age group for the United States in 2010.
FIGURE 2. Vaccines that might be indicated for adults, based on
medical and other indications - United States, 2010
Alternative Text: The
figure above shows vaccines that might be indicated for adults, based on
medical and other indications in the United States for 2010.
-
Tetanus, diphtheria, and acellular pertussis (Td/Tdap) vaccination
Tdap should replace a single dose of Td for adults aged 19--64 years
who have not received a dose of Tdap previously.
Adults with uncertain or incomplete history of primary vaccination
series with tetanus and diphtheria toxoid-containing vaccines should
begin or complete a primary vaccination series. A primary series for
adults is 3 doses of tetanus and diphtheria toxoid-containing
vaccines; administer the first 2 doses at least 4 weeks apart and
the third dose 6--12 months after the second; Tdap can substitute
for any one of the doses of Td in the 3-dose primary series. The
booster dose of tetanus and diphtheria toxoid-containing vaccine
should be administered to adults who have completed a primary series
and if the last vaccination was received >10
years previously. Tdap or Td vaccine may be used, as indicated.
If a woman is pregnant and received the last Td vaccination >10
years previously, administer Td during the second or third
trimester. If the woman received the last Td vaccination <10 years
previously, administer Tdap during the immediate postpartum period.
A dose of Tdap is recommended for postpartum women, close contacts
of infants aged <12 months, and all health-care personnel with
direct patient contact if they have not previously received Tdap. An
interval as short as 2 years from the last Td vaccination is
suggested; shorter intervals can be used. Td may be deferred during
pregnancy and Tdap substituted in the immediate postpartum period,
or Tdap can be administered instead of Td to a pregnant woman.
Consult the ACIP statement for recommendations for giving Td as
prophylaxis in wound management.
Human papillomavirus (HPV) vaccination
HPV vaccination is recommended at age 11 or 12 years with catch-up
vaccination at ages 13 through 26 years.
Ideally, vaccine should be administered before potential exposure to
HPV through sexual activity; however, females who are sexually
active should still be vaccinated consistent with age-based
recommendations. Sexually active females who have not been infected
with any of the four HPV vaccine types (types 6, 11, 16, 18, all of
which HPV4 prevents) or any of the two HPV vaccine types (types 16
and 18, both of which HPV2 prevents) receive the full benefit of the
vaccination. Vaccination is less beneficial for females who have
already been infected with one or more of the HPV vaccine types.
HPV4 or HPV2 can be administered to persons with a history of
genital warts, abnormal Papanicolaou test, or positive HPV DNA test,
because these conditions are not evidence of prior infection with
all vaccine HPV types.
HPV4 may be administered to males aged 9 through 26 years to reduce
their likelihood of acquiring genital warts. HPV4 would be most
effective when administered before exposure to HPV through sexual
contact.
A complete series for either HPV4 or HPV2 consists of 3 doses. The
second dose should be administered 1--2 months after the first dose;
the third dose should be administered 6 months after the first dose.
Although HPV vaccination is not specifically recommended for persons
with the medical indications described in Figure 2, "Vaccines that
might be indicated for adults based on medical and other
indications," it may be administered to these persons because the
HPV vaccine is not a live-virus vaccine. However, the immune
response and vaccine efficacy might be less for persons with the
medical indications described in Figure 2 than in persons who do not
have the medical indications described or who are immunocompetent.
Health-care personnel are not at increased risk because of
occupational exposure and should be vaccinated consistent with
age-based recommendations.
Varicella vaccination
All adults without evidence of immunity to varicella should receive
2 doses of single-antigen varicella vaccine if not previously
vaccinated or the second dose if they have received only 1 dose,
unless they have a medical contraindication. Special consideration
should be given to those who 1) have close contact with persons at
high risk for severe disease (e.g., health-care personnel and family
contacts of persons with immunocompromising conditions) or 2) are at
high risk for exposure or transmission (e.g., teachers; child-care
employees; residents and staff members of institutional settings,
including correctional institutions; college students; military
personnel; adolescents and adults living in households with
children; nonpregnant women of childbearing age; and international
travelers).
Evidence of immunity to varicella in adults includes any of the
following: 1) documentation of 2 doses of varicella vaccine at least
4 weeks apart; 2) U.S.-born before 1980 (although for health-care
personnel and pregnant women, birth before 1980 should not be
considered evidence of immunity); 3) history of varicella based on
diagnosis or verification of varicella by a health-care provider
(for a patient reporting a history of or having an atypical case, a
mild case, or both, health-care providers should seek either an
epidemiologic link with a typical varicella case or to a
laboratory-confirmed case or evidence of laboratory confirmation, if
it was performed at the time of acute disease); 4) history of herpes
zoster based on diagnosis or verification of herpes zoster by a
health-care provider; or 5) laboratory evidence of immunity or
laboratory confirmation of disease.
Pregnant women should be assessed for evidence of varicella
immunity. 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.
Herpes zoster vaccination
A single dose of zoster vaccine is recommended for adults aged >60
years regardless of whether they report a prior episode of herpes
zoster. Persons with chronic medical conditions may be vaccinated
unless their condition constitutes a contraindication.
Measles, mumps, rubella (MMR) vaccination
Adults born before 1957 generally are considered immune to measles
and mumps.
Measles component: Adults
born during or after 1957 should receive 1 or more doses of MMR
vaccine unless they have 1) a medical contraindication; 2)
documentation of vaccination with 1 or more doses of MMR vaccine; 3)
laboratory evidence of immunity; or 4) documentation of
physician-diagnosed measles.
A second dose of MMR vaccine, administered 4 weeks after the first
dose, is recommended for adults who 1) have been recently exposed to
measles or are in an outbreak setting; 2) have been vaccinated
previously with killed measles vaccine; 3) have been vaccinated with
an unknown type of measles vaccine during 1963--1967; 4) are
students in postsecondary educational institutions; 5) work in a
health-care facility; or 6) plan to travel internationally.
Mumps component: Adults
born during or after 1957 should receive 1 dose of MMR vaccine
unless they have 1) a medical contraindication; 2) documentation of
vaccination with 1 or more doses of MMR vaccine; 3) laboratory
evidence of immunity; or 4) documentation of physician-diagnosed
mumps.
A second dose of MMR vaccine, administered 4 weeks after the first
dose, is recommended for adults who 1) live in a community
experiencing a mumps outbreak and are in an affected age group; 2)
are students in postsecondary educational institutions; 3) work in a
health-care facility; or 4) plan to travel internationally.
Rubella component: 1
dose of MMR vaccine is recommended for women who do not have
documentation of rubella vaccination, or who lack laboratory
evidence of immunity. For women of childbearing age, regardless of
birth year, rubella immunity should be determined, and women should
be counseled regarding congenital rubella syndrome. Women who do not
have evidence of immunity should receive MMR vaccine upon completion
or termination of pregnancy and before discharge from the
health-care facility.
Health-care personnel born before 1957: For
unvaccinated health-care personnel born before 1957 who lack
laboratory evidence of measles, mumps, and/or rubella immunity or
laboratory confirmation of disease, health-care facilities should
consider vaccinating personnel with 2 doses of MMR vaccine at the
appropriate interval (for measles and mumps) and 1 dose of MMR
vaccine (for rubella), respectively.
During outbreaks, health-care facilities should recommend that
unvaccinated health-care personnel born before 1957, who lack
laboratory evidence of measles, mumps, and/or rubella immunity or
laboratory confirmation of disease, receive 2 doses of MMR vaccine
during an outbreak of measles or mumps, and 1 dose during an
outbreak of rubella.
Complete information about evidence of immunity is available at http://www.cdc.gov/vaccines/recs/provisional/default.htm.
Seasonal influenza vaccination
Vaccinate all persons aged >50
years and any younger persons who would like to decrease their risk
for influenza. Vaccinate persons aged 19 through 49 years with any
of the following indications.
Medical: Chronic
disorders of the cardiovascular or pulmonary systems, including
asthma; chronic metabolic diseases (including diabetes mellitus);
renal or hepatic dysfunction, hemoglobinopathies, or
immunocompromising conditions (including immunocompromising
conditions caused by medications or HIV); cognitive, neurologic, or
neuromuscular disorders; and pregnancy during the influenza season.
No data exist on the risk for severe or complicated influenza
disease among persons with asplenia; however, influenza is a risk
factor for secondary bacterial infections that can cause severe
disease among persons with asplenia.
Occupational: All
health-care personnel, including those employed by long-term care
and assisted-living facilities, and caregivers of children aged <5
years.
Other: Residents
of nursing homes and other long-term care and assisted-living
facilities; persons likely to transmit influenza to persons at high
risk (e.g., in-home household contacts and caregivers of children
aged <5 years, persons aged >50
years, and persons of all ages with high-risk conditions).
Healthy, nonpregnant adults aged <50 years without high-risk medical
conditions who are not contacts of severely immunocompromised
persons in special-care units may receive either intranasally
administered live, attenuated influenza vaccine (FluMist) or
inactivated vaccine. Other persons should receive the inactivated
vaccine.
Pneumococcal polysaccharide (PPSV) vaccination
Vaccinate all persons with the following indications.
Medical: Chronic
lung disease (including asthma); chronic cardiovascular diseases;
diabetes mellitus; chronic liver diseases, cirrhosis; chronic
alcoholism; functional or anatomic asplenia (e.g., sickle cell
disease or splenectomy [if elective spletnectomy is planned,
vaccinate at least 2 weeks before surgery]); immunocompromising
conditions (including chronic renal failure or nephrotic syndrome);
and cochlear implants and cerebrospinal fluid leaks. Vaccinate as
close to HIV diagnosis as possible.
Other: Residents
of nursing homes or long-term care facilities and persons who smoke
cigarettes. Routine use of PPSV is not recommended for American
Indians/Alaska Natives or persons aged <65 years unless they have
underlying medical conditions that are PPSV indications. However,
public health authorities may consider recommending PPSV for
American Indians/Alaska Natives and persons aged 50 through 64 years
who are living in areas where the risk for invasive pneumococcal
disease is increased.
Revaccination with PPSV
One-time revaccination after 5 years is recommended for persons with
chronic renal failure or nephrotic syndrome; functional or anatomic
asplenia (e.g., sickle cell disease or splenectomy); and for persons
with immunocompromising conditions. For persons aged >65
years, one-time revaccination is recommended if they were vaccinated >5
years previously and were aged <65 years at the time of primary
vaccination.
Hepatitis A vaccination
Vaccinate persons with any of the following indications and any
person seeking protection from hepatitis A virus (HAV) infection.
Behavioral: Men
who have sex with men and persons who use injection drugs.
Occupational: Persons
working with HAV-infected primates or with HAV in a research
laboratory setting.
Medical: Persons
with chronic liver disease and persons who receive clotting factor
concentrates.
Other: Persons
traveling to or working in countries that have high or intermediate
endemicity of hepatitis A (a list of countries is available at
http://wwwn.cdc.gov/travel/contentdiseases.aspx).
Unvaccinated persons who anticipate close personal contact (e.g.,
household contact or regular babysitting) with an international
adoptee from a country of high or intermediate endemicity during the
first 60 days after arrival of the adoptee in the United States
should consider vaccination. The first dose of the 2-dose hepatitis
A vaccine series should be administered as soon as adoption is
planned, ideally >2
weeks before the arrival of the adoptee.
Single-antigen vaccine formulations should be administered in a
2-dose schedule at either 0 and 6--12 months (Havrix), or 0 and
6--18 months (Vaqta). If the combined hepatitis A and hepatitis B
vaccine (Twinrix) is used, administer 3 doses at 0, 1, and 6 months;
alternatively, a 4-dose schedule, administered on days 0, 7, and
21--30 followed by a booster dose at month 12 may be used.
Hepatitis B vaccination
Vaccinate persons with any of the following indications and any
person seeking protection from hepatitis B virus (HBV) infection.
Behavioral: Sexually
active persons who are not in a long-term, mutually monogamous
relationship (e.g., persons with more than one sex partner during
the previous 6 months); persons seeking evaluation or treatment for
a sexually transmitted disease (STD); current or recent
injection-drug users; and men who have sex with men.
Occupational: Health-care
personnel and public-safety workers who are exposed to blood or
other potentially infectious body fluids.
Medical: Persons
with end-stage renal disease, including patients receiving
hemodialysis; persons with HIV infection; and persons with chronic
liver disease.
Other: Household
contacts and sex partners of persons with chronic HBV infection;
clients and staff members of institutions for persons with
developmental disabilities; and international travelers to countries
with high or intermediate prevalence of chronic HBV infection (a
list of countries is available at http://wwwn.cdc.gov/travel/contentdiseases.aspx).
Hepatitis B vaccination is recommended for all adults in the
following settings: STD treatment facilities; HIV testing and
treatment facilities; facilities providing drug-abuse treatment and
prevention services; health-care settings targeting services to
injection-drug users or men who have sex with men; correctional
facilities; end-stage renal disease programs and facilities for
chronic hemodialysis patients; and institutions and nonresidential
day-care facilities for persons with developmental disabilities.
Administer or complete a 3-dose series of hepatitis B vaccine to
those persons not previously vaccinated. The second dose should be
administered 1 month after the first dose; the third dose should be
administered at least 2 months after the second dose (and at least 4
months after the first dose). If the combined hepatitis A and
hepatitis B vaccine (Twinrix) is used, administer 3 doses at 0, 1,
and 6 months; alternatively, a 4-dose schedule, administered on days
0, 7, and 21--30 followed by a booster dose at month 12 may be used.
Adult patients receiving hemodialysis or with other
immunocompromising conditions should receive 1 dose of 40 µg/mL
(Recombivax HB) administered on a 3-dose schedule or 2 doses of 20 µg/mL
(Engerix-B) administered simultaneously on a 4-dose schedule at 0,
1, 2, and 6 months.
Meningococcal vaccination
Meningococcal vaccine should be administered to persons with the
following indications.
Medical: Adults
with anatomic or functional asplenia, or persistent complement
component deficiencies.
Other: First-year
college students living in dormitories; microbiologists routinely
exposed to isolates of Neisseria
meningitidis; military recruits; and persons who travel to or
live in countries in which meningococcal disease is hyperendemic or
epidemic (e.g., the "meningitis belt" of sub-Saharan Africa during
the dry season [December through June]), particularly if their
contact with local populations will be prolonged. Vaccination is
required by the government of Saudi Arabia for all travelers to
Mecca during the annual Hajj.
Meningococcal conjugate vaccine (MCV4) is preferred for adults with
any of the preceding indications who are aged ≤55 years;
meningococcal polysaccharide vaccine (MPSV4) is preferred for adults
aged >56
years. Revaccination with MCV4 after 5 years is recommended for
adults previously vaccinated with MCV4 or MPSV4 who remain at
increased risk for infection (e.g., adults with anatomic or
functional asplenia). Persons whose only risk factor is living in
on-campus housing are not recommended to receive an additional dose.
Immunocompromising conditions
Inactivated vaccines generally are acceptable (e.g., pneumococcal,
meningococcal, influenza [inactivated influenza vaccine]) and live
vaccines generally are avoided in persons with immune deficiencies
or immunocompromising conditions. Information on specific conditions
is available at
http://www.cdc.gov/vaccines/pubs/acip-list.htm.
Selected conditions for which Haemophilus
influenzae type
b (Hib) vaccine may be used
Hib vaccine generally is not recommended for persons aged >5
years. No efficacy data are available on which to base a
recommendation concerning use of Hib vaccine for older children and
adults. However, studies suggest good immunogenicity in patients who
have sickle cell disease, leukemia, or HIV infection or who have had
a splenectomy. Administering 1 dose of Hib vaccine to these
high-risk persons who have not previously received Hib vaccine is
not contraindicated.
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These schedules indicate the recommended age groups and
medical indications for which administration of
currently licensed vaccines is commonly indicated for
adults aged >19
years, as of January 1, 2009. Licensed combination
vaccines may be used whenever any components of the
combination are indicated and when the vaccine’s other
components are not contraindicated. For detailed
recommendations on all vaccines, including those that
are used primarily for travelers or are issued during
the year, consult the manufacturers’ package inserts and
the complete statements from the Advisory Committee on
Immunization Practices (ACIP)
(http://www.cdc.gov/vaccines/pubs/acip-list.htm).
Report all clinically significant postvaccination
reactions to the Vaccine Adverse Event Reporting System
(VAERS). Reporting forms and instructions on filing a
VAERS report are available at http://www.vaers.hhs.gov or
by telephone, 800-822-7967.
Information on how to file a Vaccine Injury Compensation
Program claim is available at http://www.hrsa.gov/vaccinecompensation or
by telephone, 800-338-2382. To file a claim for vaccine
injury, contact the U.S. Court of Federal Claims, 717
Madison Place, N.W., Washington, D.C. 20005; telephone,
202-357-6400.
Additional information about the vaccines in this
schedule, extent of available data, and
contraindications for vaccination is available at
http://www.cdc.gov/vaccines or
from the CDC-INFO Contact Center at 800-CDC-INFO
(800-232-4636) in English and Spanish, 24 hours a day, 7
days a week.
Use of trade names and commercial sources is for
identification only and does not imply endorsement by
the U.S. Department of Health and Human Services.
The recommendations in this schedule were approved by
ACIP, the American Academy of Family Physicians, the
American College of Obstetricians and Gynecologists, and
the American College of Physicians.
Department of Health and Human Services • Centers for
Disease Control and Prevention
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ÄRZTE
FÜR TIERE e. V. verfolgt zwei grundsätzliche Ziele:
den politischen Tierschutz und die Förderung tiergestützter
Therapieformen.
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