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Hepatitis B:

Who should get this vaccine?

Hepatitis B vaccine, usually a three-dose series, is recommended for all children 0-18 years of age. It is recommended for infants beginning at birth in the hospital. All older children who did not get all the recommended doses of hepatitis B vaccine as an infant should complete their vaccine series as soon as possible. Most states require hepatitis B vaccine for school entry. Adolescents who are just starting their series will need two or three doses, depending on their age and the brand of vaccine used. Adults at increased risk of acquiring HBV infection should also be vaccinated. In addition, the vaccine can be given to any person who desires protection from hepatitis B.

What side effects have been reported with this vaccine?

Of those children experiencing a side effect, most will have only a very mild reaction, such as soreness at the injection site (fewer than one out of three children) or low-grade fever. Adults are slightly more likely to experience such mild symptoms. Serious allergic reactions following hepatitis B vaccination are rare.

Hepatitis A:

Who should get this vaccine?

Many people are recommended to receive hepatitis A vaccine, including people at increased risk for exposure to HAV infection and people who are more likely to get seriously ill if infected with HAV. According to CDC recommendations, people who should be vaccinated include:
• All children at age 1 year (12-23 months)
• People age 12 months or older who are traveling to or working in an area of the world except the United States, Canada, Western Europe, Japan, New Zealand, and Australia
• Men who have sex with men
• Users of illegal drugs, both oral and injecting
• People who have blood clotting disorders
• People who work with HAV-infected primates or with HAV in a research laboratory setting (no other groups have been shown to be at increased risk for HAV infection because of occupational exposure)
• People with chronic liver disease
• Any person who wishes to be immune to hepatitis A
Hepatitis A vaccine is not routinely recommended for healthcare workers, sewage workers, or daycare providers. Children who are not vaccinated by age two years should be vaccinated as soon as feasible.

What side effects have been reported with this vaccine?

The most common side effect is a sore arm, which happens to one out of two adults and one out of five children. Less common side effects include headache, loss of appetite, low-grade fever, or tiredness. When these problems happen, they usually start 3-5 days after vaccination and usually last for one or two days. A very rare but serious side effect is a generalized allergic reaction. If this happens, it typically occurs within a few minutes to a few hours following the injection.

Who should get this vaccine?

The HPV vaccine is recommended for girls age 11-12 years, but can be administered to girls as young as age 9 years. The vaccine also is recommended for females age 13-26 years who have not yet received or completed the vaccine series. The vaccine should be given as a series of three injections over a six-month period. The second and third doses should be given two and six months after the first dose. The vaccine can be administered at the same visit as other needed vaccines. It is best if the vaccine is given before onset of sexual activity. However, females who are sexually active also may benefit from vaccination. Females who have not been infected with any vaccine HPV type would receive the full benefit of vaccination and those who already have been infected with one or more HPV type would still get protection from the vaccine types they have not acquired. Few young women are infected with all four HPV types in the vaccine. HPV vaccine can be given to females who have an abnormal Pap test or genital warts. However, the vaccine will not have any helpful effect on existing Pap test abnormalities, HPV infection, or genital warts.

What side effects have been reported with this vaccine?

Mild problems may occur with HPV vaccine, including pain at the injection site (8 people in 10), redness or swelling at injection site (1 person in 4), mild fever (1 person in 10), itching at the injection site (1 person in 30), moderate fever (102°F) (1 person in 65). These symptoms do not last long and go away on their own. Like all vaccines, HPV vaccine will be monitored for more serious or unusual side effects. Influenza:

Who should get influenza vaccine?

Many groups of people can benefit from being protected from influenza. Annual vaccination with inactivated vaccine is recommended for the following groups: • All persons age 6 months or older wanting to reduce the likelihood of becoming ill with influenza or of transmitting it to others with influenza or of transmitting influenza to others
• Everyone age 50 years or older
• Children and teens age 6 months through 18 years
• Residents of long-term care facilities, nursing homes, and other chronic-care facilities
• Adults and children who have chronic pulmonary (including asthma), cardiovascular (except hypertension), renal, hepatic, hematological or metabolic disorders (including diabetes mellitus)
• Anyone who has a condition (e.g., spinal cord injury or seizure disorder) that can affect their ability to cough out their respiratory secretions or that can increase the risk for aspiration
• Anyone whose immune system is weakened because of the following: HIV/AIDS or other diseases that affect the immune system, long-term treatment with drugs such as steroids, or cancer treatment with x-rays or drugs
• Children and adolescents age 6 months-18 years on long-term aspirin treatment (who could develop Reye's syndrome if they catch influenza)
• Women who will be pregnant during the influenza season
• Healthcare personnel
• Healthy household contacts (including children) and caregivers of children younger than age 5 years and/or adults age 50 years and older
• Healthy household contacts (including children) and caregivers of persons with medical conditions that put them at higher risk for severe complications from influenza
The live nasal spray vaccine may only be used in healthy, nonpregnant persons age 2 through 49 years. Children younger than age two years, persons age 50 and older, and anyone with a chronic medical condition (listed above) should receive inactivated influenza vaccine (injectable), NOT live influenza vaccine.

How often should this vaccine be given?

Influenza vaccine is given once a year because immunity decreases after a year and because each year's vaccine is formulated to prevent only that year's anticipated influenza viruses.

Meningococcal:

Who should get the meningococcal vaccine?

IMCV is recommended for all children at their routine preadolescent check-up at 11-12 years of age. For those who never got a dose previously, a dose is recommended at high school entry or at about age 15 years. Any other adolescent or teen who wants to decrease their risk of meningococcal disease can also get the vaccine. Vaccination is recommended for other people at increased risk of meningococcal disease; this includes: • College freshmen living in dormitories.
• Individuals who have a damaged or missing spleen.
• Persons with terminal complement component deficiency (an immune system disorder).
• Persons working with meningococcus bacteria in laboratories.
• Travelers to certain countries in sub-Saharan Africa as well to other countries for which meningococcal vaccine is recommended.
• U.S. military recruits.
• Anyone who might have been exposed to meningitis during an outbreak.
MCV is the preferred vaccine for persons ages 11 through 55 years in these risk groups, but MPSV can be used if MCV is not available. MPSV should be used for children 2-10 years old and adults over 55, who have risk factors for the disease.

Pneumococcal Vaccine:

Who should get the pneumococcal polysaccharide vaccine (PPV)?

I• All adults age 65 years or older • Anyone age two years or older who has a long-term health problem such as cardiovascular disease, sickle cell anemia, alcoholism, lung disease, diabetes, cirrhosis, or leaks of cerebrospinal fluid
• Anyone who has or is getting a cochlear implant
• Anyone age two years or older who has a disease or condition that lowers the body's resistance to infection, such as Hodgkin's disease, kidney failure, nephrotic syndrome, lymphoma, leukemia, multiple myeloma, HIV infection or AIDS, damaged spleen or no spleen, or organ transplant
• Anyone age two years or older who is taking any drug or treatment that lowers the body's resistance to infection, such as long-term steroids, certain cancer drugs, or radiation therapy
• Alaska Natives and certain Native American populations

Varicella Zoster: (Shingles Vaccine)

Who should get this vaccine?

On October 25, 2006, the Advisory Committee on Immunization Practices recommended that all adults age 60 years and older receive one dose of zoster vaccine, including persons who have already had an episode of shingles. Vaccination can be done during a routine healthcare visit.

How effective is this vaccine?

Zoster vaccine was studied in approximately 38,000 individuals throughout the United States who were age 60 years and older as part of its pre-licensure testing. Half received the vaccine and half received a placebo. Study participants were followed for an average of three years to see if they developed shingles and, if they did, how long the pain lasted. Researchers found that the vaccine reduced the occurrence of shingles by about 50% among persons age 60 years and older. The vaccine most effective for those age 60-69 years (64%); effectiveness declined with increasing age to 41% for those age 70-79 years and 18% for those age 80 years and older.

Who should NOT receive zoster vaccine?

• People who are allergic to the antibiotic neomycin, or any component of the vaccine (including gelatin) should not receive this vaccine.
• Zostavax is a live vaccine and should not be given to individuals who have a weakened immune system caused by treatments that they are taking such as radiation or corticosteroids, or due to conditions such as HIV/AIDS, cancer of the lymph, bone, or blood.
• Pregnant women should not receive this vaccine. In addition, people who are in close contact with pregnant women who have not had chickenpox should talk to their healthcare provider before receiving zoster vaccine.

Is the cost of shingles vaccine covered by Medicare?

Zostavax will not be covered under Medicare Part B (which covers influenza and pneumococcal polysaccharide vaccine). The vaccine will instead be reimbursed through the Medicare Part D program. Beneficiaries should contact their Part D plan for more information.