Adult

Immunization
CLERK ESPINOSA, MIKAELA PATRICIA D.
July 05, 2023
Consultants: Dr. Arnel V. Herrera/ Dr. Julie T.
Tiu
OBJECTIVES
● To define Immunization

● To discuss the 2 Types of Immunization

● To discuss the different Adult Immunization

 Immunity

● is the ability of the body to tolerate the presence of

material indigenous to the body (self) and to eliminate
foreign material (non-self)

● this ability provides protection from infectious diseases,

usually indicated by the presence of an antibody
 Immunization

● Is the process of making a person immune or resistant to an

infectious disease, usually through vaccination

● Immunizations against specific infectious diseases protect

individuals against infection and thereby prevent
symptomatic illnesses
 Two types of Immunization

● Active immunization

● Passive immunization
Basic mechanism for acquiring
immunity

Active Immunity Passive Immunity

Acquisition of protection Produced by the person’s Transferred from another

own immune system person or animal

Duration of protection Permanent Temporary

Vaccine
A preparation that is used to stimulate the body’s immune
response against diseases. Vaccines are usually administered
through needle injections

Vaccination
The act of introducing a vaccine into the body to produce
protection from a specific disease
Vaccine Types
● Inactivated vaccines
● Live- attenuated vaccines
● Messenger RNA (mRNA) vaccines
● Subunit, recombinant, polysaccharide, and
conjugate vaccines
● Toxoid vaccines
Vaccines for
adults
 Influenza virus vaccine
● Trivalent influenza vaccine- contains 2 influenza A (AH1N1 and
AH3N2) strains and 1 influenza B virus

● Quadrivalent influenza vaccine- contains 4 influenza surface

antigens and both B viruses

Schedule: Yearly (February- June), single dose 0.5 mL

(Intramuscular)

Common adverse effects: Local tenderness and soreness

 Influenza virus vaccine

Pregnancy and breastfeeding: No evidence that

inactivated influenza vaccine causes damage to the fetus
- Inactivated Influenza vaccine can be administered to
those who are pregnant in the 2nd or 3rd trimester
Complications of influenza: Otitis media, Pneumonia,
Secondary bacterial pneumonia and exacerbations of
chronic respiratory disease
 Influenza virus vaccine
Target population:

Patients with
● Cancer
● HIV with CD4 count >100 cells/ul
● Bronchial asthma, COPD and cardiovascular disease
 Pneumococcal vaccine
Administration: Subcutaneous or Intramuscular
 Pneumococcal vaccine
Two types of pneumococcal vaccines available in the
Philippines

● 23- valent polysaccharide vaccine (PPSV23)- 0.5 mL,

Intramuscular or Subcutaneous

● 13- valent conjugate vaccine (PCV13)- 0.5 mL,

Intramuscular
 Pneumococcal vaccine
Schedule:
● Adult Filipinos >50 years of age who were previously given
PPSV23, may be given PCV13 vaccination AT LEAST 1 YEAR
AFTER
● Adult Filipinos who were previously vaccinated with PPSV23 at
<50 years old, but who are now 50 years old or more may
receive 1 DOSE OF PCV13 AT LEAST 1 YEAR AFTER, THEN
ANOTHER DOSE OF PPSV23 AFTER 1 YEAR OF THE PCV13
DOSE
● Adult Filipinos >50 years of age who were previously given
PPSV23, WITHOUT previous PCV13, may opt to be given
another dose of PPSV23 AFTER 5 YEARS. NO RE-
VACCINATION THEREAFTER
 Pneumococcal vaccine

Common adverse effects: Redness, swelling and soreness at

injection site
Fever, malaise and muscle pain can also occur, although this is
infrequent
Contraindications: Anaphylaxis to any vaccine component or a
previous dose

Pregnancy and breastfeeding:

Immunizations with PPSV23 can be given during pregnancy. No
adverse consequences have been reported among newborns whose
mothers were inadvertently vaccinated during pregnancy
 Hepatitis A virus vaccine
- Formalin- inactivated monovalent vaccine
- Hepatitis A vaccination can prevent hepatitis A infection
in immunocompromised individuals
Administration: Intramuscular, deltoid area
Schedule:
● The monovalent hepatitis A vaccine is given at a dose of
1440 ELISA units/ml/vial, given as a 2- dose regimen (0
and 6-12 months)
 Hepatitis A virus vaccine
Schedule:

● For combined hepatitis A and B vaccines:

- 3 doses administered IM at 0, 1 and 6 months
- Dose: 720 ELISA units (Hepatitis A) and 20 ug/ml Hepatitis B
- Booster dose: given at 1 year.

Common adverse effects:

Local: Injection site soreness, redness and swelling

Systemic: Headache, malaise, fatigue, nausea, and loss of appetite

 Hepatitis A virus vaccine
Target population:

● Adult immunocompetent individuals

● Vaccinate any person seeking protection from HAV infection
● Men having sex with men (MSM)
● Users of injection drugs
● Contacts of infected persons
● People with chronic liver disease
● Persons who receive clotting factor concentrates or with clotting factor
disorders
 Hepatitis A virus vaccine
Pregnancy and breastfeeding:
● If pregnant woman is exposed to hepatitis A, administration
of immune globulin is strongly recommended; this agent is
considered safe during pregnancy and is more than 85%
effective in preventing acute hepatitis infection
● Effect of the vaccine on breastfed infants through its
administration to their nursing mothers has not been
evaluated in clinical studies
How soon can protection be attained
after Hepatitis A vaccination?

Nearly 100% of people develop protective levels of

antibodies to the virus within 1 month after injection of a
single dose of vaccine
 Hepatitis B virus vaccine
- Monovalent recombinant Hepatitis B vaccine

Administration: Intramuscular, deltoid area

Schedule: Monovalent: 2 doses separated by no <4 weeks, and a 3rd

dose 4-6 months after the second dose (0, 1 and 6 months)

● 0-1-6 months- long term protection among high risk groups who do
not need immediate protection
● 0-2-6 weeks (0-14-42 days) + booster dose- high risk groups who
need immediate protection and rapid seroconversion
● 0-2-6 weeks (0-14-42 days) should receive a booster dose 1 year
after the 1st dose (if hepatitis B surface antibody titer is below
10mIu/ml
 Hepatitis B virus vaccine
Combined:

● 3 doses administered IM at 0,1 and 6 months

● Dose: 720 ELISA units (Hepatitis A) and 20 ug/ml Hepatitis B
● Booster dose should be given at 1 year

Common adverse effects: Pain, redness and soreness at the injection

and fever

Target population: Recommended for those >15 years old without

previous hepatitis B infections and negative for serum hepatitis B
markers
 Hepatitis B virus vaccine
Pregnancy and breastfeeding:

Vaccination should also be offered to any interested adult and strongly

recommended to those at risk. Risk factors for a pregnant woman
include having had sex with a man who has sex with men, having
multiple sexual partners, using or abusing intravenous drugs, having
occupational exposure, and being a household contact of acutely
infected persons or persons with a chronic carrier state.
 Herpes zoster vaccine
Live attenuated zoster Adjuvanted recombinant zoster virus (RZV)
vaccine (ZVL)

Description - Neomycin containing - 50 ug of recombinant VZV glycoprotein

recombinant live E formulated with AS01B adjuvant
attenuated tetravalent which is a proprietary adjuvant system
vaccine. containing MPL

Schedule Single dose 2 doses (0.5 ml each)

Administration 0.65 ml, subcutaneous in Intramuscularly, 2-6 months apart

deltoid area
 Herpes zoster vaccine

Live attenuated zoster Adjuvanted recombinant

vaccine (ZVL) zoster virus (RZV)

Common adverse effects Erythema, pain or Pain, myalgia, and fatigue-

tenderness, swelling, most common
pruritus or warmth Redness and swelling,
shivering, fever, and
gastrointestinal symptoms
may also occur
 Herpes zoster vaccine
Target population:

Live attenuated zoster vaccine (ZVL)

● Immunocompetent adults age 60 and above without prior history of herpes

zoster to prevent the disease
● May be given to immunocompetent adults (>60 years old) with prior history
of herpes zoster infection to prevent disease recurrence

Adjuvanted recombinant zoster virus (RZV)

● Prevention of herpes zoster in immunocompetent adults aged 50 and above

● Immunocompetent adults previously vaccinated with ZVL
 Measles-Mumps- Rubella (MMR)
vaccine
- Live attenuated strains of measles, mumps, rubella

One dose of th MMR vaccine is routinely recommended for

immunocompetent adults

One dose of the MMR vaccine within 72 hours is recommended as post-

exposure prophylaxis

Administration: Subcutaneous injection

Schedule: 1-2 doses, given at least 28 days apart (0.5 mL)

 Measles-Mumps- Rubella (MMR)
vaccine
Target population:

Prevention of measles, mumps and rubella

● 1 dose- adults not at high risk for exposure and transmission

● 2 doses- adults at high risk of transmission
● Prevention of rubella- 1 dose of MMR vaccine (>12 months)
● To all adults who have not received complete vaccination for measles,
mumps, r rubella during childhood
● Immunocompetent adults with prior history of the disease
● Adults who are at higher risk of infection
● Unvaccinated women planning to become pregnant should be vaccinated 3
months before conceiving.
 Measles-Mumps-Rubella (MMR)
vaccine
Common adverse effects:
Fever, transient rashes, and lymphadenopathy, or parotitis

Pregnancy and breastfeeding:

● Women should be counseled to avoid becoming pregnant for 28
days (4 months) after receipt of the MMR vaccine
● Postpartum administration of MMR vaccine to women should
be given immediately after delivery and tested at least 3 months
later
Human papillomavirus vaccine
Human papillomavirus vaccine
 Human papillomavirus vaccine
Bivalent Quadrivalent Nonavalent

0, 1, 6 months 0, 2, 6 months
Schedule

Intramuscular, deltoid area (0.5mL)

Administration

Common adverse Injection site related pain, swelling, and erythema

effects

Pregnant women are not recommended to receive HPV vaccine,

Pregnancy although there is no evidence that the vaccine poses harm.
 Tetanus, diphtheria, and pertussis
vaccine
Administration: Intramuscular, 0.5 mL

Dose Interval

Primary 1 Tdap

Primary 2 Td 4-8 weeks

Primary 3 Td 6-12 months

Booster Every 10 years

 Tetanus, diphtheria, and pertussis
vaccine
Pregnancy and breastfeeding:
● Pregnant women- at least 2 doses of tetanus toxoid- containing vaccine
with an interval of at least 4 weeks between doses and the 2nd dose at least
2 weeks before birth, the 3rd dose at least 6 months after the first dose

Target population:
● Adults who have not been vaccinated or are incompletely vaccinated
● Td vaccination every 10 years (19-64 years old), if the last vaccination was
at least 10 years ago
● Adults who have close contacts with an infant <12 months old
● Adults who sustained wounds assessed to be tetanus- prone
Tetanus, diphtheria, and pertussis
vaccine
 Typhoid vaccine
Administration: Intramuscular

Schedule: Single dose

1 dose should be given more than or equal to 2 weeks prior to expected
exposure
Booster dose- 1 dose IM every 3 years for travelers

Common adverse effects: Swelling and pain over the injection site, fever,
erythema

Precautions: Sanitation is still recommended to prevent typhoid fever

Moderate or severe acute illness
Bleeding disorders and taking anticoagulants
 Varicella virus vaccine
- live attenuated vaccine
Administration: Subcutaneous (0.5 mL)

Schedule: 2 doses, given 4 weeks apart

Common adverse events: Mild local reaction at the injection site

Target population:
● Should not be given routinely to immunocompetent adults
● Healthcare workers without history of varicella infection
● Maybe given as post exposure prophylaxis within 72 hours after
exposure
 Dengue virus vaccine
- recombinant live attenuated tetravalent vaccine
Dengue serotypes:
● DENV-1
● DENV-2
● DENV-3
● DENV-4
Administration: Subcutaneous (0.5 mL)

Schedule: 0, 6, 12 months

Local reaction: Most common is pain on injection site

Systemic reactions: Headache, myalgia, malaise

References
● Harrison’s 21st edition
● Clinical Practice Guidelines for Adult Immunization, 2018
● IM Platinum, 3rd edition
Thank you for
listening!