Snapshot An 85-year-old female is to be admitted to a nursing home. Her last immunization was a tetanus booster given 15 years ago and PPSV23 given three years ago after a bout of pneumonia. A 40-year-old pediatric nurse is starting a new job in October. He has no complaints. Past medical history includes chickenpox as a child. His last immunization was tetanus-diptheria booster seven years ago. Vaccination schedule Published by the CDC Pediatric Adolescent Adult Contraindications Types of vaccines Live, attenuated vaccines MMR measles, mumps, and rubella the only live, attenuated vaccine that can be given to HIV+ patients Vaccine may be given to HIV+ patients with CD4+ > 200; CD4+ < 200 is a contraindication to vaccination egg allergy is not a contraindication Sabin polio given orally chicken pox (VZV) smallpox yellow fever egg allergy is still a contraindication typhoid (oral) rotavirus Franciscella tularensis influenza nasally delievered may be used in healthy adults egg allergy is no longer a contraindication (supervision is necessary) Killed (inactivated) vaccines rabies influenza Salk polio given as an injection now the primary form of polio vaccination in U.S. salK = Killed HAV Vibrio cholerae Japanese encephalitis Recombinant vaccines HBV HBsAg antigen HPV types 6, 11, 16, and 18 Borrelia burgdorferi recombinant outer surface protein Toxoid vaccines tetanus diphtheria pertussis Subunit vaccines H. influenza capsular polysaccharide conjugated to diphtheria toxoid N. meningitidis Pneumococcal adult version is NOT conjugated and does NOT stimulate a helper T cell response the infant version IS conjugated and stimulates a helper T cell response typhoid (injected) Live, pathogenic vaccine adenovirus given in enteric-coated capsules Contraindications Egg allergic patients yellow fever Immunosuppressed patients live vaccines MMR is OK in HIV+ do not give oral polio to HIV patients or their contacts Pregnant patients live vaccines