Continuing Medical Education (CME)

Adult Preventive Health Care: Immunizations

Introduction to this self-study CME activity

Purpose

All adults may eventually require the following immunizations: herpes zoster, influenza, pneumococcal, and tetanus.  Adults may require the following immunizations: hepatitis B, hepatitis A, human papilloma virus, measles, mumps, rubella, varicella, and meningoccoccal.  To help physicians provide appropriate immunizations to their adult patients, this self-study activity provides information on priority populations, initial vaccination, and revaccination regarding each of these common immunizations for adults.  The first three pages of guideline summarize initial vaccination and revaccination.

New to the 2009 revision:

Pneumococcal polysaccharide vaccine (PPSV23)

• Recommend for persons aged 19 through 64 years old who either (a) smoke cigarettes or (b) have asthma.
• Limited recommendation based only on race (Alaskan Native or American Indian) to those younger than 65 years old who live in areas in which risk of invasive pneumococcal disease is increased.

Human papilloma virus (HPV) vaccine (Gardasil®)

• The minimum interval between administering dose one and dose three must be at least 24 weeks.
• If a woman turns 27 years old after the first dose is administered but before the third dose is given, complete the series using the recommended intervals between doses.

Combined hepatitis A and hepatitis B vaccine (Twinrix)

• An option for accelerated dosing schedule when more rapid stimulation needed for immune response (three doses on days 0, 7, and 21-30).
• Administering two doses of Twinrix and one dose of hepatitis B vaccine is not sufficient and will not complete a series for both hepatitis A and hepatitis B vaccination. Twinrix contains less hepatitis A antigen than a single antigen hepatitis A vaccine has, therefore three doses of hepatitis A are needed when using this product.

Audience

This self-study activity is appropriate for primary care clinicians and other health care providers providing preventive health care for adults.

Authors

Team Leaders
	Margie Andreae, MD Pediatrics and Communicable Diseases Candia Laughlin, RN, MS Ambulatory Care Nursing
Team Members
	Mary Barry-Bodine, RN, BSN Nursing, Health Centers Susan Blitz, MD, MPH General Internal Medicine Sherry L. DeLoach, PharmD Pharmacy Services Susan Engert, MD, MPH Pediatrics and Communicable Diseases Susan D. Garrett, CPhT Pharmacy Services Linda McGrath, BSN, RN UMHHC Immunization Coordinator Jean Malouin, MD, MPH    Family Medicine
Consultant
	Sandro K. Cinti, MD    Infectious Disease
Author Disclosures
	None of the team members nor the consultant have financial relationships with commercial companies whose products are discussed in this CME activity. .

Other Acknowledgements

UMHS Guidelines Oversight Team: William E. Chavey, MD R. Van Harrison, PhD Connie J. Standiford, MD Literature search services: Taubman Medical Library Production of Internet format and web site maintenance: Ellen Patrick-Dunlavey, MA

CME Accreditation and Credit Designation

The University of Michigan Medical School is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

The University of Michigan Medical School designates this educational activity for a maximum of 1 AMA/PRA Category 1 Credits™.  Physicians should only claim credit commensurate with the extent of their participation in the activity.

This CME activity was released March 2009 with credit available through April 2012.

Method of Participation

1. View the web pages. You may print the self-study text to read off-line.
2. Complete the on-line learning assessment test.  It will be electronically scored and the correct answers returned immediately for your review.
3. Complete the electronic credit request and activity evaluation.  An electronic certificate of participation will be provided immediately.
4. Print the certificate of participation for your personal records.

 

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