Immunizations

IMMUNIZATIONS

In the United States, vaccination programs that focus on infants and children have decreased the occurrence of many childhood diseases. However, many adolescents and adults are affected by vaccine-preventable diseases, such as influenza, varicella, hepatitis A, hepatitis B, measles, rubella, and pneumococcal pneumonia. Each year it is estimated that pneumococcal infection, influenza, and hepatitis B cause as many as 45,000 deaths in adults. Obstetrician–gynecologists and other clinicians who pro-vide general well-woman examinations and preconception care have opportunities in which to counsel women on the need for immunizations and can provide immunizations or referrals to vaccination clinics or services.

It may be helpful to ask new patients to provide pre-vious vaccination records. The clinician should attempt to gather a complete immunization history from each pa-tient, including risk factors indicating the need for immu-nization. If there are doubts about past immunizations, it is safest to assume that a patient has not been immunized and initiate the appropriate vaccination series. The rec-ommended vaccinations for women are listed in Box 2.1. Immunization recommendations change quickly; the most current recommendations can be accessed at the CDC’s National Immunization Program Web page (www.cdc. gov/vaccines).

The HPV vaccine is discussed in detail later, Cervical Neoplasia and Carcinoma. The American College of Obstetricians and Gynecologists recommends the initial vaccination for girls aged 11–12 years. Although obstetrician–gynecologists are not likely to care for many girls in this age group, they are critical to the widespread use of the vaccine for females aged 13–26. During a health care visit with a girl or woman in the age range for vacci-nation, an assessment of the patient’s HPV vaccine status should be conducted and documented in the patient record. The quadrivalent HPV vaccine is most effective when given before any exposure to HPV infection, but sexually active women can receive and benefit from the quadriva-lent vaccine.