Human Papillomavirus (HPV)
Gardasil26 protects both female and male patients against HPV infection; Cervarix27 is indicated only for female patients. Either quadrivalent vaccine or bivalent vaccine is recommended for female patients.12
In women ages 26 and younger, Gardasil (0.5 mL IM, administered in the deltoid at 0 month, 2 months, and 6 months) provides protection against diseases caused by HPV types 6, 11, 16, and 18 (including cervical, vaginal, and vulvar cancer caused by HPV types 16 and 18). In men ages 26 and younger, Gardasil provides protection against genital warts caused by HPV types 6 and 11.26
Cervarix,27 administered at 0 month, 1 month, and 6 months (0.5 mL IM in the deltoid), provides protection for women ages 25 and younger against cervical cancer and precancerous lesions caused by HPV types 16 and 18.
Caution: Patients should be advised to sit or lie down when the HPV vaccine is administered, and they should be observed for the subsequent 15 minutes. Syncope can occur after vaccination—most commonly among adolescents and young adults.28 Convulsive syncope has been reported.
Meningococcal Disease
Two vaccines are available to protect against meningococcal disease: Menactra29 (meningococcal groups A, C, Y, and W-135 polysaccharide diphtheria toxoids conjugate vaccine); and Menveo30 (meningococcal groups A, C, Y, and W-135 oligosaccharide diphtheria CRM197 conjugate vaccine). Both are administered in the deltoid, 0.5 mL IM.
The following patients should be considered for vaccination:
• College freshmen living in dormitories, as well as college students with immune deficiencies, as they are at higher risk for meningococcal disease
• Patients who travel to or reside in countries in which Neisseria meningitidis is epidemic (particularly those with the potential for prolonged contact with the local population)
• Travelers to Saudi Arabia for pilgrimage to Mecca (the Hajj)
• Patients with anatomical or functional asplenia (two-dose series).
A two-dose series of meningococcal conjugate vaccine is also recommended for adults with persistent complement component deficiencies, and for those with HIV infection who are vaccinated.12
Hepatitis A
Two hepatitis A vaccines (both inactivated) can be used interchangeably: Havrix31 and Vaqta.32 Dosing for both vaccines in 18-year-old patients is 0.5 mL IM in the deltoid at 0 months, then at 6 to 12 months. In patients ages 19 and older, administration is the same, with the exception of increased dosing (1.0 mL IM).
Vaccination against hepatitis A is recommended for men who have sex with men, and for all adult patients who12:
• Travel to or work in areas where risk for hepatitis A transmission is high (especially those who take frequent trips or experience prolonged stays)
• Use injection drugs
• Have chronic liver disease
• Receive clotting factor concentrates for treatment of a blood-clotting disorder
• May have been exposed to hepatitis A in the previous two weeks
• Wish to be vaccinated against hepatitis A to avoid future infection.
Hepatitis B
Recombivax HB33 and Engerix-B34 are the two vaccines available to protect patients against hepatitis B (HBV), and they can be used interchangeably.12 In patients from birth through age 19, Recombivax HB33 or Engerix-B34 is given as 0.5 mL IM in the deltoid at 0, 1, and 6 months; patients ages 20 and older receive an increased dose (1.0 mL IM), with administration otherwise the same. According to the manufacturer of Recombivax HB,33 patients age 11 through 15 may be given either three doses of 0.5 mL or two doses of 1.0 mL.
The following adults are advised to undergo vaccination for HBV:
• At-risk, unvaccinated adults
• Those requesting protection against HBV infection
• Those planning to travel to areas where HBV is common
• Household contacts of a patient with chronic HBV infection, and sexual partners of a patient with HBV infection
• Adults with chronic liver disease
• Men who have sex with men
• Sexually active adults who are not in a long-term, mutually monogamous relationship
• Adults who are being evaluated or treated for a sexually transmitted disease, including HIV infection
• Health care or public safety workers who may be exposed to blood or blood-contaminated body fluids
• Workers and residents in facilities for developmentally disabled persons
• Patients undergoing or anticipating dialysis
• Adults who inject illegal drugs or who have done so recently.12
CONTRAINDICATIONS AND PRECAUTIONS FOR VACCINES COMMONLY USED IN ADULTS
See Table 5,8,22 for a summary of contraindications and precautions from ACIP and the Immunization Action Coalition that are associated with vaccinations mentioned in this article. A more complete summary can be found at www.im munize.org/catg.d/p3072a.pdf.
