1. MENINGOCOCCAL PNEUMOCOCCAL TETANUS, DIPHTHERIA, PERTUSSIS VARICELLA HEPATITIS A HEPATITIS B HUMAN PAPILLOMA VIRUS Anyone starting at 6 mos old 10-65 y/o without evidence of immunity For those at risk For all susceptible esp. >50yo, For those without previous vaccine, give PCV13 followed by PPSV23 after 8wks; if 2 nd dose of PPSV23 is required, give 5 yrs after. For those who had a previous dose of PPSV23, wait 1 year or more before giving PCV13. Td every 10yrs; TDaP recommended as one-time substitute dose for persons aged 10-64y/o All adults/adolescents with no evidence of immunity For all living in areas of high prevalence (eg. Asia) Universal immunization ofall infants, adolescents, adults HPV4 & HPV2 to females 9-19y/o; catch up vaccination: 19-45y/o for HPV4, 19-55y/o for HPV2, HPV4 to males 9-26y/o Anaphylaxis with a prior dose, moderate-severe illness +/- fever, age<6mos, active Guillan Barre syndrome, egg allergy Allergy to a prior dose, allergy to gelatin/neomycin, pregnancy, those on large doses of steroids Allergy to one component, defer if with moderate -severe illness Allergy to phenol/thimerosal, moderate-severe illness +/- fever Moderate-severe illness +/-fever allergy to thimerosal, allergy to prior dose, bleeding disorders Pregnancy, allergy to prior dose, malignant conditions of bone marrow/lymphatic system, 1°/acquired immunodeficiency, on high dose immunosuppressants/low dose steroids >2wks Allergy to a vaccine component, not given to those highly febrile Severe allergy to a prior dose Single dose 1x/yr (Feb-June) 2 doses (0,1 mos) Single dose, revaccinate after 5yrs Single dose, PPSV23 or PCV 13(preferred); PPSV23 revaccination after 5 years for high risk patients 3 doses: 0,1,6-12mos Booster every 10yrs 2 doses (0,1 mos) 2 doses (0,6-12mos) 3 doses (0,1,6); accelerated 4 doses (0,7,21days,12 mos) If <15 y/o HPV 2/4 (0,6-12 mos) if >15 y/o: HPV4 (0,2,6) HPV2 (0,1,6 ) Given at any trimester Contraindicated Given if needed Given if needed 1dose during each pregnancy at 27-36wks Contraindicated Given if needed Pregnancy/lactation not contraindicated If found to be pregnant, remaining doses given after delivery Allergy to a vaccine component, not given to those highly febrile 1 dose Contraindicated Allergy to gelatin, neomycin, a vaccine component, HIV/AIDS, steroids, cancer treatment, Leukemia, lymphoma, highly febrile ZOSTER INFLUENZA MEASLES, MUMPS, RUBELLA Persons > 60 y/o; history of shingles

2. Indications Contraindications Dose Pregnancy Perforated hole Injectable Vaccine Administration Guidelines for Adolescents & Adults VaccineStorage RouteSite Hepatitis A R IM Deltoid Hepatitis B R IM Deltoid HPV R IM Deltoid Influenza R IM Deltoid MMR F* SC Lateral upper arm Meningococcal R IM Deltoid Pneumococcal R SC Lateral upper arm IM Deltoid Td/TDaP R IM Deltoid Varicella F* SC Lateral upper arm Zoster F SC Lateral upper arm *can freeze lyophlized powder but not diluent R-refrigerator F-freeze IM-intramuscular SC-subcutaneous 2014 POGS IFW RECOMMENDATIONS

3. MENINGOCOCCAL POLYSACCHARIDE PNEUMOCOCCAL POLYSACCHARIDE TETANUS, DIPHTHERIA, PERTUSSIS VARICELLA HEPATITIS A HEPATITIS B HUMAN PAPILLOMA VIRUS Persons with chronic illnesses; women who will be pregnant during the influenza season; health care workers; residents of nursing homes or long term care facilities; persons likely to transmit influenza to persons at high risk Persons > 50 y/o; persons with chronic illnesses; asplenia; immunocompromised patients; persons receiving chemotherapy, antimetabolites, high dose long term corticosteroids; residents of long term care facilities Td: adults including pregnant women with uncertain histories of a complete primary vaccination series or whose last vaccination was 10 years or more Tdap: 10-64 y/o, pregnant women who have not received Tdap; health care workers and those in a high risk pertussis environment Persons who do not have a reliable history of varicella infection, previous vaccination, or serological evidence of prior varicella zoster virus infection; adolescents and adults who previously received only one dose Persons with clotting disorders or chronic liver disease; men who have sex with men; illegal drug users; persons with occupational risk; persons travelling to or working in endemic areas Persons with > 1 sex partner in the past 6 months; STI clinic clients; household contacts and sexual partners of individuals with chronic Hepatitis B infection; men who have sex with men; injection-drug users; persons in institutions for the disabled; health care workers; HIV infection; travellers to endemic areas; inmates of correctional facilities Persons who are or will be sexually active Previously unvaccinated adolescents (prior to high school entry); students in dormitories; microbiologists; military recruits; persons travelling to or living in hyperendemic/endemic areas; asplenia; complement component deficiencies Persons born in or after 1957 without prior proof of immunity or documentation of one or more dose; persons with recent exposure to measles or mumps or in an outbreak setting; persons who were previously vaccinated with killed measles vaccine; persons who were vaccinated between 1963-1967; college students; those in postsecondary education institutions; health care workers; international travellers; women who lack laboratory evidence of immunity HERPES ZOSTER Persons 60 years old and above, those with a prior history of shingles

4. WHO IS AT RISK? General Principles of Vaccination: Vaccination is ideally universal in coverage. Vaccination is a primary healthcare service. Can be given by any at all healthcare encounters. General Considerations for Vaccination: Never administer vaccines in the buttock Maintain vaccine administration record in patient’s chart including date, site, route of administration, manufacturer and lot number of vaccine Simultaneous administration of vaccines is not contraindicated. The presence of a pregnant woman or immunosuppressed person in the household is not a reason to withhold an indicated vaccine to a family member. If a live attenuated vaccine is not given simultaneously with another vaccine, a 4-wk interval should be used between vaccinations. IMMUNIZATIONS