Preventive Medicine
Preventive Medicine & Vaccines
Preventive Medicine

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

◆Cancer screening

  • •Breast: mammogram q2 yr age 50–74 (USPSTF); now lowered to 40 in 2024 update
  • •Cervical: Pap age 21 q3y; 30–65 Pap + HPV q5y or Pap q3y
  • •Colorectal: age 45+ colonoscopy q10y or alternatives
  • •Lung: LDCT age 50–80, ≥20 pack-years, current or quit <15 years
  • •Prostate: shared decision PSA age 55–69
  • •Skin: clinical exam; no specific routine
  • •AAA: one-time US in men 65–75 who ever smoked
  • •Osteoporosis: DEXA at age 65 women (younger if risk factors); men 70+

◆Lifestyle counseling

  • •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)

High-yield pearls

  • ◆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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