Vaccines & Immunizations

"Immunization with the annual influenza and pneumococcal vaccines is important."

Tetanus and rabies vaccines. CDC: bites are dirty wounds ("Wounds containing dirt, soil, feces, or saliva (e.g., animal or human bites)"); give tetanus vaccine for an unknown, absent or incomplete primary series, or if the last dose was 5 or more years ago. Rabies (ACIP): "The deltoid area is the only acceptable site of vaccination for adults and older children. For younger children, the outer aspect of the thigh may be used. Vaccine should never be administered in the gluteal area." Pre-exposure vaccination is considered for "veterinarians, animal handlers, and laboratory workers" (StatPearls).

Pneumococcal vaccination. Per the ACG, via StatPearls, clinicians should consider "pneumococcal vaccination for all patients with celiac disease, particularly those who did not receive a complete pneumococcal vaccination series during childhood."

[HPVV] HPV vaccine (CDC/ACIP). "HPV vaccine is recommended for routine vaccination at 11 or 12 years old. Vaccination can be started at age 9." Catch-up "for everyone through age 26 years if not adequately vaccinated"; ages 27–45 by shared decision with a clinician. Two doses if the series starts before the 15th birthday, the second "6 to 12 months after the first dose" (two doses less than 5 months apart need a third). Three doses (0, 1–2 and 6 months) if started at 15–26, and for immunocompromised persons aged 9–26 including HIV. It "prevents new HPV infections but does not treat existing HPV infections or diseases." Adolescents should be seated or lying down during vaccination and for 15 minutes afterward (syncope). Contraindicated after a severe allergic reaction to a prior dose or component, and with immediate hypersensitivity to yeast; not recommended during pregnancy, but "pregnancy testing before vaccination is not needed."

CDC, interim clinical considerations updated Sept 23, 2026 (2026–2027 season): "A 2026-2027 COVID-19 vaccine is recommended for all adults ages 18 years and older in the United States for the prevention of COVID-19." "A 2026-2027 COVID-19 vaccine is also recommended for all children ages 6 months–17 years with moderate to severe immunocompromise; for all other children, a COVID-19 vaccine is recommended through shared clinical decision-making." CDC notes these recommendations continue "Because of legal uncertainties and inquiries." Recommendations change each season — check current CDC guidance. Long COVID prevention (CDC, Mar. 9, 2026): "Research shows COVID-19 vaccination is an effective tool in helping to prevent Long COVID, including in children," and providers should promote vaccines "as the best tool available to prevent Long COVID."

HPV vaccine. "In June 2020, the Food and Drug Administration granted accelerated approval of the HPV vaccine Gardasil 9 for the prevention of oropharyngeal and other head and neck cancers caused by HPV types 16, 18, 31, 33, 45, 52, and 58 in persons aged 9 through 45 years" (NCI). "Avoiding oral HPV infection can reduce the risk of HPV-associated head and neck cancers."

"vaccination against hepatitis A and B, particularly in individuals exposed to blood products" (StatPearls).

Prevention — Shingrix (recombinant, adjuvanted, nonlive). CDC recommends "2 doses of recombinant zoster vaccine (RZV) to prevent shingles and related complications in adults aged ≥50 years" and "for adults aged ≥19 years who are or will be immunodeficient or immunosuppressed" (the FDA label indication for at-risk adults starts at 18). Doses "separated by 2–6 months" (for immunocompromised adults who would benefit from a shorter schedule, the second dose "can be administered 1–2 months after the first"); if late, "Do not restart the vaccine series." Give it whether or not the person had shingles or Zostavax — but "you should not give Shingrix to patients who are experiencing an acute episode of herpes zoster." It is "not indicated for prevention of primary varicella infection (chickenpox)." Contraindicated after "a severe allergic reaction (e.g., anaphylaxis)"; label warns of a Guillain-Barré signal "during the 42 days following vaccination" and syncope.

Immunization replaces some of the protection the CD4 compartment can no longer provide, so the recommended list is broad: COVID-19, hepatitis A, hepatitis B, meningococcal ACWY, pneumococcal and HPV vaccines, plus annual inactivated or recombinant influenza vaccine. The safety rule is the CD4-dependent one: live attenuated vaccines are restricted, and MMR is contraindicated in patients with a CD4+ count below 200 cells/mm³ — a weakened live organism given to a depleted immune system can cause the disease it was meant to prevent. An immunization history is taken at diagnosis specifically to "determine which vaccines could offer future protection," and hepatitis serology at baseline identifies who needs hepatitis A and B coverage.

The main prevention. Everyone 6 months and older, with rare exceptions, every season; antibodies take about two weeks to develop. For people 65 and older, high-dose, recombinant or adjuvanted vaccines are preferentially recommended. Even when vaccinated people still get sick, vaccination was linked to 26% lower risk of ICU admission and 31% lower risk of death from flu.

No live vaccines around rituximab — "vaccination with live virus vaccines is not recommended before or during treatment." Survivors who had a splenectomy need vaccination as part of long-term follow-up.

Infection prevention — vaccination is part of the IMWG infection-prevention approach relayed by NCI.

By category — CDC Table 8-1. Non-live vaccines: "Inactivated vaccines should be administered whenever feasible" (StatPearls). Live vaccines: all contraindicated in complete and partial T-cell defects (SCID, DiGeorge, Wiskott-Aldrich); in severe antibody deficiencies (XLA, CVID) the contraindicated list is OPV, smallpox, LAIV, BCG, live typhoid (Ty21a), yellow fever, MMR, MMRV and dengue; in less severe antibody deficiencies (selective IgA, IgG subclass) only OPV, BCG, dengue and yellow fever — "Other live vaccines appear to be safe"; in CGD, live bacterial vaccines only — "Live viral vaccines likely safe and effective"; complement deficiency — CDC lists no contraindications and "All routine vaccines likely effective." CDC exception: "patients with B-cell deficiencies receiving immunoglobulins, who should not receive either live or non-live vaccines." Household contacts "should receive all age- and exposure-appropriate vaccines, with the exception of smallpox vaccine."

Patients with PAH should be vaccinated against influenza, SARS-CoV-2 and pneumococcus; NHLBI advises the flu shot every year at the start of flu season.

[Scleroderma] NIAMS: "Get regular flu and pneumonia vaccines as recommended by your doctor, especially if you are taking immune-suppressing medications or have lung disease."

Human papillomavirus vaccination is primary prevention for a cancer, and it belongs in the same conversation as screening — which is why it appears on a page about sexually transmitted infection at all. The vaccines class page owns the schedule, and the schedule is where the errors happen: the number of doses depends on age at the first dose and on immune status, not on current age. What belongs here is remembering to raise it.

Vaccinate before; no live vaccines. "Whenever possible, administer the complete vaccine series before transplantation." "Live vaccines should be avoided during tacrolimus treatment," and inactivated vaccines "may not elicit a sufficient immune response."

The prevention arm exists for A and B only — and B covers D. HAV vaccine: inactivated, 2 doses 6–18 months apart, seroconversion approaching 100%, protection about 4 weeks after dose 1; routine at 12–23 months with catch-up to 18 years, and for travelers, MSM, people who use drugs, people experiencing homelessness, chronic liver disease (including HBV, HCV, cirrhosis), HIV, and anyone who wants immunity (ACIP 2020). It doubles as post-exposure prophylaxis within 2 weeks for healthy people aged 12 months–40 years; immune globulin (± vaccine) covers those over 40, under 12 months, immunocompromised, or with chronic liver disease. HBV vaccine: recombinant, universal at birth and for all adults 19–59 (the 2022 ACIP recommendation, as restated by CDC 2023) — the standard adult series is 3 doses at 0, 1, and 6 months (ACIP 2018); testing should never delay vaccinating (CDC 2023). Post-vaccination anti-HBs (≥ 10 mIU/mL) is checked 1–2 months after the last dose in health care personnel and dialysis patients. HBIG is passive, temporary anti-HBs (3–6 months) for post-exposure use only, always paired with vaccine in the unvaccinated. There is no HCV vaccine and no HCV post-exposure prophylaxis.

The original β-lactams — bactericidal cell-wall inhibitors. The defining nursing job is screening for and recognizing allergy, from rash to anaphylaxis.

β-lactam cousins of penicillin, organized by generation — each generation trades some gram-positive reach for broader gram-negative coverage.

Powerful, broad-spectrum DNA-synthesis blockers — but a boxed warning for disabling tendon, nerve, and CNS effects means they’re reserved when alternatives exist.

Suppress viral replication rather than kill viruses outright. The nursing essentials: hydrate with acyclovir, start early (flu within 48 h), and remember most antivirals suppress — they don’t cure.

Powerful IV drugs for serious Gram-negative infection — but nephrotoxic and ototoxic. Levels matter.

Broad, generally safe protein-synthesis inhibitors — a penicillin-allergy alternative. Watch QT and CYP3A4.