Preventive Medicine & Vaccines

Adult immunizations + cancer screening + lifestyle counseling.

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◆Adult vaccines

•Influenza: annual, age ≥6 months
•Tdap once + Td booster q10 years; Tdap each pregnancy
•MMR: born after 1957 if no immunity; 2 doses for HCW
•Varicella: no immunity; live — avoid in pregnancy and immunocompromised
•Zoster (Shingrix): age ≥50, even if prior shingles or Zostavax; 2 doses
•Pneumococcal: PCV20 (single dose) OR PCV15 followed by PPSV23 — age ≥65 OR younger with high risk (DM, asplenia, chronic disease)
•HPV: all 11–12 (catch-up to 26; shared decision 27–45)
•Meningococcal: age 11–12 with booster at 16; high-risk (asplenia, complement deficiency, college dorms, military)
•Hep A, Hep B per risk factors; universal HepB now recommended for adults 19–59
•RSV (Arexvy, Abrysvo): age ≥60 shared decision; pregnant 32–36 wk

•Smoking cessation: ask, advise, assess, assist (varenicline, NRT, bupropion), arrange
•Alcohol: USPSTF screens age ≥18
•Diet/exercise: 150 min moderate aerobic + 2 days strength training/week
•Aspirin for primary prevention: NO longer routinely recommended in adults ≥60 (USPSTF 2022)

◆Live vaccines (MMR, varicella, zoster — Zostavax, yellow fever, oral polio, BCG, nasal flu) — avoid in pregnancy + immunocompromised
◆Shingrix is recombinant (not live) — safe in immunocompromised
◆Avoid live vaccines for 4 weeks before pregnancy
◆Anaphylactic egg allergy: avoid yellow fever; flu vaccine is now considered safe even with egg allergy

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