P&T News: October 2002

Recommended Adult Immunization Schedule -United States, 2002-2003

Sarah Johnson, Pharm.D.
Peer Review Status: Internally Peer Reviewed R. Todd Wiblin MD, MS, Division of Infectious Diseases and Associate Hospital Epidemiologist.

Although the childhood immunization program in the United States has reduced the burden of vaccine-preventable disease substantially among children, substantial vaccine-preventable morbidity and mortality from disease such as hepatitis A, hepatitis B, influenza, and pneumococcal infections continue to occur among adults. In February 2002, the Advisory Committee on Immunization Practices (ACIP) approved for the first time a schedule for the routine vaccination of persons aged > 19 years. ACIP will review and approve annually both the recommended adult and childhood immunization schedules.

The Adult Immunization Schedule (pdf format) is based on published recommendations of ACIP1, American Academy of Family Physicians2, American College of Obstetricians and Gynecologists3, and the American College of Physicians-American Society of Internal Medicine with the Infectious Diseases Society of America4 and was developed by members of these organizations and Centers for Disease Control (CDC). The schedule presents a summary of vaccine indications by age group (Figure 1) and medical condition (Figure 2). Footnotes included in Figure 1 are summaries of the ACIP recommendations for specific vaccines since 1991. Figure 2 includes special considerations or contraindications for vaccinating persons with specific medical conditions. Licensed combination vaccines can be used whenever any components of the combination are indicated and the vaccine's other components are not contraindicated. Providers should consult manufacturers' package inserts for detailed recommendations.

Providers should report all postvaccination reactions to the Vaccine Adverse Event Reporting System (VAERS), telephone 1-800-822-7967, and the UIHC Drug Information Center.

Tetanus-diphtheria (Td); hepatitis B; measles, mumps, and rubella (MMR); and varicella vaccines are covered by the Vaccine Injury Compensation Program (VICP). Health-care providers are required to give adult patients copies of the Vaccine Information Statements developed by CDC before administering each dose of the vaccines covered by VICP.

References

  1. MMWR 1991;40(No. RR-12).
  2. American Academy of Family Physicians. Available at http://www.aafp.org/exam/table2.html and http://www.aafp.org/exam/table4.html.
  3. American College of Obstetricians and Gynecologists. ACOG Technical bulletin 160, October 1991. Washington, DC: American College of Obstetricians and Gynecologists, 1991.
  4. American College of Physicians. Guide for adult immunization. 3rd ed. Philadelphia, Pennsylvania: American College of Physicians, 1994.

References to Figure 1 and 2

  1. American College of Physicians. Guide for adult immunization. 3rd ed. Philadelphia, Pennsylvania: American College of Physicians, 1994.
  2. MMWR 2002;51(No. RR-3).
  3. MMWR 1997;46(No. RR-8).
  4. MMWR 1991;40(No. RR-13).
  5. MMWR 1999;48(No. RR-12).
  6. MMWR 1998;47(No. RR-8).
  7. MMWR 1996;45(No. RR-11).
  8. MMWR 1999;48(No. RR-6).
  9. MMWR 1997;46(No. RR-5).
  10. MMWR 1996;45:603-6.

Adapted from MMWR 2002;51:904-8.

PHARMACY AND THERAPEUTICS SUBCOMMITTEE ACTIONS

DRUGS ADDED TO STOCK

ARGATROBAN
Injection: 250 mg
Argatroban is a thrombin inhibitor indicated for use as an anticoagulant for patients with heparin-induced thrombocytopenia and as an anticoagulant in patients with heparin-induced thrombocytopenia undergoing percutaneous coronary intervention.

Note: The prescribing of argatroban is restricted to the Cardiac Catherization and to Adult and Pediatric Hematology/Oncology staff physicians.

BIVALIRUDIN
Injection: 250 mg
Bivalirudin (Angiomax® - Medicine Company) is a thrombin inhibitor indicated for use as an anticoagulant in patients with unstable angina undergoing PTCA.

Note: The prescribing of bivalirudin is restricted to the Cardiac Catherization and to Adult and Pediatric Hematology/Oncology staff physicians.

DACLIZUMAB
Injection: 25 mg vial
Daclizumab (Zenapax® - Roche) is a humanized monoclonal antibody indicate for the prophylaxis of acute organ rejection in patients receiving renal transplants.

ENTACAPONE
Tablets: 200 mg
Entacapone (Comtan® - Novartis) is a catechol-O-methyltransferase inhibitor indicated as adjunct therapy to levodopa/carbidopa to treat idiopathic Parkinson's disease in patients who experience the signs and symptoms of end-of-dose "wearing off."

EPIRUBICIN
Injection: 50 mg vial
Epirubicin (Ellence® - Pharmacia) injection is an antineoplastic indicated for the treatment of breast cancer.

LISINOPRIL
Tablets: 2.5 mg, 5 mg, 10 mg, 20 mg
Lisinopril (Prinivil®, Zestril®, generic) is an angiotensin converting enzyme inhibitor indicated for the management of hypertension, congestive heart failure, and post myocardial infarction.

OXALIPLATIN
Injection: 50 mg
Oxaliplatin (Eloxatin® - Sanofi-Synthelab) is an antineoplastic agent indicated for use in combination with 5-fluorouracil and leucovorin for the treatment of patients with metastatic carcinoma of the rectum or colon with progressive disease.

PRAMIPEXOLE
Tablets: 0.25mg, 0.5 mg, 1 mg, 1.5 mg
Pramipexole (Mirapex® - Pharmacia) is a dopamine receptor antagonist indicated for the treatment of Parkinson's disease.

TEGASEROD
Tablets: 2 mg, 6 mg
Tegaserod (Zelnorm® - Novartis) is a serotonin type-4 receptor partial agonist indicated for the short-term treatment of women with irritable bowel syndrome.
Note: The prescribing of tegaserod is limited to a 30-day supply plus one refill.

ZIPRASIDONE
Injection: 20 mg
Ziprasidone (Geodon® - Pfizer) injection is indicated for the management of schizophrenia.

Note: Since ziprasidone has been assoicated with QTc prolongation and numerous drug interactions, its use is restricted to prescribing by Psychiatry staff.

DRUGS DELETED FROM STOCK

DALTEPARIN INJECTION
Deleted by Pharmacy and Therapeutics Subcommittee action. Enoxaparin and unfractionated heparin are available.

LEPIRUDIN INJECTION (Refludan®)
Replaced with Argatroban® and bivalirudin (Angiomax®) injections.

THIORIDAZINE ORAL SOLUTION
Discontinued by all manufacturers. Thioridazine tablets are available.

ADDITIONAL ACTIONS

SECRETIN INJECTION
Secretin injection (SecroFlo®) has been re-introduced to the market.

INFLUENZA VIRUS VACCINATION: RECOMMENDATIONS FOR HEALTHCARE WORKERS

Persons Who Can Transmit Influenza to Those at High Risk

Persons who are clinically or subclinically infected can transmit influenza virus to persons at high risk for complications from influenza. Decreasing transmission of influenza from caregivers to persons at high risk might reduce influenza-related deaths among persons at high risk. Evidence from two studies suggests that vaccination of healthcare workers is associated with decreased deaths among nursing home patients.1,2 Vaccination of healthcare workers is recommended. The following groups should be vaccinated:3

The most important measure in the prevention and control of influenza is annual vaccination. Annual vaccination is necessary because immunity declines in the year following vaccination and the viruses that cause influenza frequently change. Adults develop peak antibody protection against influenza infection two weeks after vaccination.4

This year the vaccine will be administered to UIHC staff from October 24 to November 18. Exact dates and hours of vaccination are posted throughout UIHC. Vaccination will occur in Clinic A in Boyd Tower. There is no charge for the vaccine during this time period; however, staff will need to present their UIHC photo identification card and will be asked to complete a signed consent form.

References

  1. J Infect Dis 1997; 175:1-6.
  2. Lancet 2000; 355: 93-7.
  3. MMWR 2002;51(RR-3):1-31
  4. Vaccine 1997; 15:97-102.

Title Page