Volume 111, Issue s106

The Centers for Disease Control and Prevention (CDC) has declared the decline in preventable diseases through vaccination to be 1 of the 10 great public health achievements in the past decade in the United States. Still, influenza epidemics occur every year in the United States and are associated with high rates of morbidity and mortality. A substantial portion of the US population chooses not to get vaccinated against influenza despite the illness and death associated with the disease. Low rates of vaccination are of particular concern in high-risk patients. The CDC's Advisory Committee on Immunization Practices has broadened its influenza vaccine recommendations to include all individuals older than 6 months. Education of patients about the value of influenza vaccination will help to increase vaccination rates.

Hens' eggs are a common food in the American diet. They are consumed as a primary food source and added as an ingredient to other foods. In individuals who are hypersensitive to eggs, egg-containing foods can cause mild to severe allergic reactions if ingested. These individuals may also have adverse reactions to vaccines produced on egg media. Vaccines that are created on egg media include those for measles, mumps, and rubella; rabies; yellow fever; and influenza. The authors discuss recent developments in the use of egg-containing vaccines in hypersensitive patients.

Despite the availability of a tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine in the United States since 2005, the vaccine remains underutilized and perhaps misunderstood by many physicians. Pertussis continues to be a major public health problem, with adults being the primary source of infectious transmission to unprotected infants. Consequently, the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices has expanded the indications for the Tdap vaccine. In addition, the vaccine can be safely administered regardless of the time since the patient's last tetanus-diphtheria booster. Widespread use of the Tdap vaccine—especially in health-care workers, adolescents, and adults aged 19 to 64 years—should greatly reduce the incidence of Bordetella pertussis infection in the United States. The recent Food and Drug Administration approval of the Tdap vaccine for individuals aged 65 years or older should increase the use of this vaccine.

Although vaccinations are most commonly associated with the pediatric population, it is important for healthcare professionals to be familiar with the vaccines that are recommended for adults. The authors discuss 3 vaccines—the measles, mumps, and rubella (MMR) vaccine, the varicella vaccine, and the herpes zoster vaccine—including information about the diseases and complications that they protect against. Two doses, separated by 4 weeks, of both the MMR and varicella vaccines are recommended for all adults who do not have immunization or contraindications. All adults aged 60 years or older should receive a single dose of the herpes zoster vaccine unless they have contraindications. These 3 vaccines offer protection from illnesses that can have serious sequelae and substantial public health implications.

Recent trends suggest that the prevalence of hepatitis infection has declined in populations vaccinated against the hepatitis viruses. Still, with an estimated 20,000 new infections annually in the United States from human hepatitis A virus, as many as 100,000 annual cases of acute infection from hepatitis B virus, and more than 1 million individuals with chronic hepatitis B virus infection, there is room for further improvement. Although hepatitis A virus infection causes debilitating symptoms and illness, it is typically not a protracted illness, and it usually resolves over weeks to months without further sequelae. By contrast, hepatitis B may convert to a chronic infection that leads to cirrhosis and hepatocellular carcinoma, underscoring the importance of vaccinations in at-risk individuals.

Meningococcal meningitis is a rare but often fatal disease. Throughout adolescence, the incidence of meningococcal meningitis increases, reaching a peak among individuals between the ages of 16 and 21 years. Vaccines are available to combat this deadly disease. Recently, the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices updated its recommendations on meningitis vaccination to improve outcomes and to prevent this disease in adolescents and other vulnerable populations, such as adults traveling internationally to epidemic areas. Improved meningitis vaccines and revised vaccination recommendations will help to create a healthier world.

Because Streptococcus pneumoniae continues to be an important cause of morbidity and mortality, especially among young children and elderly adults, Healthy People 2020 includes several objectives for decreasing invasive pneumococcal disease and increasing pneumococcal vaccine uptake. Current recommendations of the Advisory Committee on Immunization Practices regarding pneumococcal vaccination for adults have not changed appreciatively in several years. However, it is possible that ongoing research may lead to changes in these recommendations within the next few years. Since the licensure of the 7-valent pneumococcal conjugate vaccine for children in 2000, impressive decreases in pneumonia-related diseases caused by strains in the vaccine have been noted among all age groups receiving vaccination. Coupled with continued concerns about the efficacy of the 23-valent pneumococcal polysaccharide vaccine for adults, particularly in regard to nonbacteremic pneumonia, questions are raised about the potential efficacy and viability of conjugate vaccines for adults.

Optimal protection against preventable diseases for the pregnant woman and her fetus can be provided through vaccination prior to pregnancy. When indicated, however, the benefits of immunization during pregnancy and breastfeeding may outweigh the theoretical risks of potential adverse events. Several vaccinations recommended by the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention (CDC) can reduce maternal and fetal morbidity and mortality from preventable diseases. Physicians can maintain the highest standards of clinical practice by advocating for appropriate vaccinations in their female patients. The authors discuss current versions of CDC vaccination recommendations, contraindications, and precautions for pregnant and breastfeeding women.

A live attenuated vaccine to prevent herpes zoster, or shingles (Zostavax; Merck & Co Inc, Whitehouse Station, NJ), is approved by the US Food and Drug Administration (FDA) for use in adults aged 50 years or older. Studies show that this vaccine is safe when administered to immunocompetent adults. Investigations are being conducted to evaluate the long-term safety and efficacy of the vaccine in immunocompromised populations, including patients who are dependent on steroids. The Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention recommends that this vaccine be routinely administered only to patients aged 60 years or older. As more data regarding duration of immunity after vaccination become available and as concerns regarding supply of this vaccine are adequately addressed, the ACIP plans to reconsider its recommendations regarding its use in patients aged 50 to 59 years. The author provides an overview of the herpes zoster vaccine, focusing on the latest extension in use approved by the FDA and the recommendations of the ACIP.