1. MENINGOCOCCAL POLYSACCHARIDE For those at risk 10-65 yo without evidence of immunity 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 PNEUMOCOCCAL POLYSACCHARIDE Single dose, revaccinate after 5yrs Adolescents/adults: 2 doses (0,1 mos) Anyone starting at 6mos For all susceptible esp. >50yo, for those without previous vaccine, give PCV13 followed by PPSV23 after 8wks;if 2nd dose of PPSV23 is required, give 5 yrs after Allergy to phenol/thimerosal, moderate-severe illness +/- fever Anaphylaxis with a prior dose, moderate-severe illness +/- fever, age<6mos, active GuillanBarre syndrome, egg allergy Single IM dose 1x/yr (Feb-June) Pregnancy/lactation not contraindication Single dose, revaccinate after 5 yrs for high risk patient Contraindicated Given if needed Given at any trimester 1dose during each pregnancy at 27-36wks HPV4 (0,2,6 or 0,1,4) HPV2 (0,1,6) 3 doses: 0,1,6-12mos Booster every 10yrs If found to be pregnant, remaining doses given after delivery Severe allergy to a prior dose Moderate-severe illness +/-fever’ allergy to thimerosal, allergy to prior dose, bleeding disorders TETANUS, DIPHTHERIA, PERTUSSIS HPV4 & HPV2 routinely given to females 9-19yo; catch up vaccination: 19-45yo for HPV4, 19-55yo for HPV2, HPV4 also given to males 9-26yo Td every 10yrs; TDaP recommended as one-time substitute dose for persons aged 10-64yo HUMAN PAPILLOMA VIRUS Contraindicated Pregnancy/lactation not contraindicated 2 doses (0,1 mos) 3doses (0,1,6);accelerated 4 doses (0,7,21days,12 mos) Given if needed Pregnancy, allergy to prior dose, malignant conditions of bone marrow/lymphatic system, 1°/acquired immunodeficiency, on high dose immunosuppressants/low dose steroids >2wks 2doses (0,6-12mos) Allergy to a vaccine component, not given to those highly febrile Allergy to a vaccine component, not given to those highly febrile Universal immunization of all infants, adolescents, adults Recommended for all adults/adolescents with no evidence of immunity VARICELLA HEPATITIS B For all living in areas of high prevalence (eg. Asia) HEPATITIS A

2. Indications Contraindications Dose Pregnancy Perforated hole Injectable Vaccine Administration Guidelines for Adolescents & Adults Vaccine Storage Route Site Hepatitis A R IM Deltoid Hepatitis B R IM Deltoid HPV R IM Deltoid Influenza R IM Deltoid MMR R* SC Lateral upper arm Meningococcal R IM Deltoid Pneumococcal R SC Lateral upper arm IM Deltoid Td/TDaP RIM Deltoid Varicella R SC Lateral upper arm *can freeze lyophlized MMR powder but not diluent R-refrigerator F-freeze IM-intramuscular SC-subcutaneous 2013 POGS IFW RECOMMENDATIONS

3. MENINGOCOCCAL POLYSACCHARIDE 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 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 PNEUMOCOCCAL POLYSACCHARIDE 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 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 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 TETANUS, DIPHTHERIA, PERTUSSIS Persons who are or will be sexually active HUMAN PAPILLOMA VIRUS 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 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 VARICELLA HEPATITIS B HEPATITIS A

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 buttock • Maintain vaccine administration record in patient’s chart including date, site, and 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