Disease Prevention and Disease Screening

Varicella (chickenpox) and Herpes Zoster (shingles) VIS Varicella VIS Shingles

Do I need it? MAYBE

Who? Adult Varicella: Everyone age 13 and over who has never had chicken pox or evidence of immunity.

Zostavax (shingles shot): Adults over age 60.

What is evidence of immunity?

• Documentation of age-appropriate varicella vaccination;
  • Preschool-age children (i.e., age 12 months through 3 years): 1 dose
  • School-age children, adolescents, adults: 2 doses

• Laboratory evidence of immunity or laboratory confirmation of disease
• Birth in the United States before 1980 (Should not be considered evidence of immunity for health care personnel, pregnant women, and immunocompromised persons)
• Diagnosis or verification of a history of varicella or herpes zoster by a health care provider

How Often? Adult Varicella: 2 doses given 4-8 weeks apart — one time. Zostavax (shingles shot): Adults over age 60.

Which Vaccine? Varivax —adults without evidence of immunity HZV (Zostavax) — adults age 60

Why? Chickenpox is caused by a virus, the varicella-zoster virus. Chickenpox spreads from person to person by direct contact or through the air by coughing or sneezing. It is highly contagious. It can also be spread through direct contact with the fluid from a blister of a person infected with chickenpox, or from direct contact with a sore from a person with shingles. Many cases of chickenpox are mild, but deaths from this disease can occur. Before the vaccine became avail­able, about 100 people died every year in the United States from chickenpox. Most of these people were previously healthy. Chickenpox also accounted for about 11,000 hospitalizations each year. Because it is so easy to catch chickenpox, almost every adult in the United States has been infected. Until a vaccine became available, there were an esti­mated four million cases/year. Since the vaccine was licensed in 1995, the number of cases of chickenpox had fallen more than 90%.

• The most common symptoms of chickenpox are rash, fever, coughing, fussiness, headache, and loss of appetite. The rash usually develops on the scalp and body, and then spreads to the face, arms, and legs. The rash usually forms 200–500 itchy blisters in several successive crops. The illness lasts about 5–10 days. of tetanus are caused by the teta­nus toxin acting on the central nervous system. In the most common form of tetanus, the first sign is spasm of the jaw muscles, followed by stiffness of the neck, difficulty in swallowing, and stiffness of the abdominal muscles.

Shingles Both chickenpox and shingles are caused by the same virus, the varicella zoster virus (VZV). After a person has had chickenpox, the virus rests in the body’s nerves permanently. Approximately 30% of all people who have been infected with chickenpox will later develop herpes zoster, commonly known as zoster or shingles. Herpes zoster, or shingles, occurs when latent VZV reactivates and causes recurrent disease. It is not well understood why this happens in some people and not others. The risk of getting shingles increases as a person gets older. People who have medical con­ditions that keep the immune system from working properly, or people who receive immunosuppressive drugs are also at greater risk to get shingles.

• Shingles usually starts as a rash with blisters that scab after 3 to 5 days. The most frequently men­tioned symptom is pain. The rash and pain usually occur in a band on one side of the body, or clustered on one side of the face. The rash usually clears within 2 to 4 weeks.
  • Before the rash develops, there is often pain, itching, or tingling in the area where the rash will develop. Other symptoms of shingles can include fever, head­ache, chills, and upset stomach. For about one person in five, severe pain can con­tinue even after the rash clears up, a situation called post-herpetic neuralgia (PHN). As people get older, they are more likely to develop PHN, and it is more likely to be severe and long-lasting. The pain may be sharp or throbbing, and it may extend beyond the area of the original rash. The skin may be unusually sensitive to touch and to changes in temperature. PHN can last for months, or even years.

Human papillomavirus (HPV) VIS HPV Gardasil VIS HPV Cervarix

Do I need it? MAYBE

Who? Routine vaccination: HPV vaccine is recommended for girls and boys 11 or 12 years of age. It may be given starting at age 9.

• Catch-up vaccination is recommended for the following people who have not completed the 3-dose series:
  • Females 13 through 26 years of age.
  • Males 13 through 21 years of age.
  • This vaccine may be given to men 22 through 26 years of age who have not completed the 3-dose series.
  • It is recommended for men through age 26 who have sex with men or whose immune system is weakened because of HIV infection, other illness, or medications.

How Often? A three-dose series one time. The second dose should be with 1-2 months of the first dose. The third dose should be within 6 months of the first dose.

Which Vaccine? Gardasil (by Merck), protects against four HPV types: 6, 11, 16, 18. Garasil is licensed for males and females. Cervarix (by GlaxoSmithKline) protects against HPV types 16 and 18. About 70% of cervical cancers are caused by HPV types 16 and 18; more than 90% of anogenital warts are associated with HPV types 6 and 11.

Why? Human papillomavirus (HPV) is the name of a group of viruses that includes more than 100 different types. More than 40 of these viruses infect the geni­tal area, including the skin of the penis, vulva, or anus, and the lining of the vagina, cervix, or rectum. Some of these viruses are called "high-risk" types; they may cause abnormal Pap tests and can also lead to cancer of the cervix, vulva, vagina, anus, or penis. Others are called "low-risk" types; they may cause mild Pap test abnormalities or genital warts. HPV is the most common sexually-transmitted infec­tion in the United States. Approximately 20 million people are currently infected with HPV. At least 50% of sexually active men and women acquire genital HPV infection at some point in their lives.

• Most people who become infected with HPV have no symptoms. Some people get visible genital warts, or have pre-cancerous changes in the cervix, vulva, anus, or penis.
• Genital warts usually appear as soft, moist, pink, or flesh-colored swellings, usually in the genital area. They can be raised or flat, single or multiple, small or large, and sometimes cauliflower shaped. They can appear on the vulva, in or around the vagina or anus, on the cervix, and on the penis, scrotum, groin, or thigh. After sexual contact with an infected person, warts may appear within weeks or months, or not at all.

Hepatitis A (HAV) VIS Hepatitis A

Do I need it? MAYBE

Who? Some people should be routinely vaccinated with hepatitis A vaccine:

• All children between their first and second birthdays (12 through 23 months of age).
• Anyone 1 year of age and older traveling to or working in countries with high or intermediate prevalence of hepatitis A, such as those located in Central or South America, Mexico, Asia (except Japan), Africa, and eastern Europe. For more information see www.cdc. gov/travel.
• Children and adolescents 2 through 18 years of age who live in states or communities where routine vaccination has been implemented because of high disease incidence.
• Men who have sex with men.
• People who use street drugs.
• People with chronic liver disease.
• People who are treated with clotting factor concentrates.
• People who work with HAV-infected primates or who work with HAV in research laboratories.
• Members of households planning to adopt a child, or care for a newly arriving adopted child, from a country where hepatitis A is common.

Other people might get hepatitis A vaccine in certain situations (ask your doctor for more details):

• Unvaccinated children or adolescents in communities where outbreaks of hepatitis A are occurring.
• Unvaccinated people who have been exposed to hepatitis A virus.
• Anyone 1 year of age or older who wants protection from hepatitis A

How Often? A two-dose series. The second dose at least 6 months after the first dose. No current recommendation for booster doses.

Which Vaccine? Havrix adult (by GlaxoSmithKline) Vaccine for Hepatitis A. Twinrix combines the vaccine for Hepatitis A with the vaccine for Hepatitis B so that you are immunized against both viruses with one series, but requires a series of three shots.

Why? Hepatitis A is a liver disease caused by hepatitis A virus (HAV). There are multiple other viruses which cause liver disease. Two other common hepatitis viruses are Hepatitis B virus and Hepatitis C virus. Hepatitis A virus is spread from person to person by putting something in the mouth that has been con­taminated with the stool of a person infected with hepatitis A virus. This type of spread is called “fecal-oral.” This can happen in a variety of ways, such as when an infected person who prepares or handles food doesn’t wash his or her hands adequately af­ter using the toilet and then touches other people’s food. A person can also be infected by drinking water contaminated with hepatitis A or drinking beverages chilled with contaminated ice.

Most hepatitis A viral infections in the United States result from international travel, contact with a household member or sex partner who has hepatitis A, or illegal drug use. Casual contact, as in the office, factory, or school setting, does not spread the virus. Hepatitis A can be transmitted by sexual contact. Hepatitis A only causes acute (recently acquired) infection, not chronic infection. Relapsing hepati­tis A, as described above, goes away and is NOT a chronic infection. (Both hepatitis B and hepatitis C viruses can cause chronic infection.)

• People with hepatitis A can feel quite sick. If symp­toms are present, they usually occur suddenly and can include fever, tiredness, loss of appetite, nausea, abdominal discomfort, dark urine, and jaundice (yel­lowing of the skin and eyes).

Hepatitis B (HBV) VIS Hepatitis B

Do I need it? MAYBE

Who? You should get the hepatitis B vaccine if:

• You have sex with or live in the same house as a person with hepatitis B virus infection.
• You have sex with more than one partner.
• You seek care in a clinic for sexually transmitted diseases, HIV testing or treatment, or drug treatment.
• You are a man who has sex with other men.
• You inject drugs.
• You have a job that involves contact with human blood*.
• You are on the staff of, or a client in, an institution for the developmentally disabled*.
• You are a hemodialysis patient or have end-stage renal disease.
• You have HIV infection.
• You are a dialysis patient.
• You have chronic liver disease.
• You have diabetes and are under age 60.
• You live or travel for more than 6 months a year in countries where hepatitis B is common.
• You seek care in a clinic for sexually transmitted diseases, HIV testing, or drug treatment.
• You are a prisoner in a correctional facility.

How Often? A three-dose series. The second dose at one month after the first dose. The third dose and 6 months after the first dose. No current recommendation for booster doses.

Which Vaccine? Recombivax HB adult (by Merck) Vaccine for Hepatitis B. Twinrix combines the vaccine for Hepatitis A with the vaccine for Hepatitis B so that you are immunized against both viruses with one series, but requires a series of three shots.

Why? Hepatitis B is a liver disease caused by the hepatitis B virus. There are multiple other viruses which cause liver disease. Two other common hepatitis viruses are Hepatitis A virus and Hepatitis C virus. The virus is found in the blood or certain body flu­ids and is spread when blood or body fluid from an infected person enters the body of a person who is not infected. This can occur in a variety of ways including:

• Unprotected sexual contact

• Sharing drugs, needles, or “works” when using drugs

• Poor infection control practices in medical set­tings, particularly with equipment to test blood sugar

• Needle sticks or sharps exposures on the job

• From mother to baby during birth

• Contact with wounds or skin sores

• When an infected person bites another person

• Pre-chewing food for babies

• Sharing personal care items, such as razors or toothbrushes

Hepatitis B virus particles can be found on objects, even in the absence of visible blood. The virus can remain infectious and capable of spreading infection for at least seven days outside the human body. Hepatitis B is not spread through food or water, shar­ing eating utensils, hugging, kissing, coughing, and sneezing or by casual contact, such as in an office or factory setting.

• About 7 out of 10 adults who become infected with hepatitis B develop symptoms. Children under age 5 years rarely have symptoms. When people have symptoms, they usually appear between 60 and 150 days after onset of infection. People who have symp­toms generally feel quite ill and might need to be hospitalized.

Symptoms of hepatitis B might include the following:

• Yellowing of skin and whites of eyes

• Dark-colored urine

• Loss of appetite or nausea

• Bloated and tender belly

• Extreme tiredness

• Fever

• Pain in joints

• Hepatitis B can be very serious. Infection with this virus can cause chronic infection that can lead to cirrhosis and liver cancer. Many people in the United States die every year from hepatitis B-related liver disease. Fortunately, there is a vaccine to prevent acute (recently acquired) hepatitis B.

Measles, mumps, rubella VIS MMR

Do I need it? YES

Who? Some adults should also get MMR vaccine: Generally, anyone 18 years of age or older who was born after 1956 should get at least one dose of MMR vaccine, unless they can show that they have either been vaccinated or had all three diseases.

How Often? Once

Which Vaccine? MMR (Measles Mumps Rubella)

Why? Measles, mumps, and rubella are serious diseases. Before vaccines they were very common, especially among children.

Measles (rubeola) is caused by a virus. Measles is spread from person to person through the air by infectious droplets; it is highly contagious. Measles can be a serious disease, with 30% of re­ported cases experiencing one or more complica­tions. Death from measles occurred in approximately 2 per 1,000 reported cases in the United States from 1985 through 1992. Complications from measles are more common among very young children (younger than five years) and adults (older than 20 years). Before the vaccine was licensed in 1963, there were an estimated 3–4 million cases each year. Due to extensive vaccination efforts, the number of reported measles cases began a rapid decline during the 1990s. By 2004, only 37 cases were reported—a record low. However, new cases continue to be re­ported, primarily in populations that have refused vaccination for religious or personal belief reasons. In addition, measles is still common in many other countries and can be easily imported or contracted when traveling.

• Symptoms include fever, runny nose, cough, loss of appetite, “pink eye,” and a rash. The rash usually lasts 5–6 days and begins at the hairline, moves to the face and upper neck, and proceeds down the body.

Mumps is caused by a virus. Mumps spreads from person to person via droplets of saliva or mucus from the mouth, nose, or throat of an infected person, usually when the person coughs, sneezes, or talks. The virus may also be spread in­directly when someone with mumps touches items or surfaces without washing their hands and then someone else touches the same surface and rubs their mouth or nose. Mumps is less contagious than measles or chickenpox. Due to good immunization coverage, mumps is now rare in the United States. An estimated 212,000 cas­es occurred in 1964, while only 454 cases were re­ported in 2008. Large outbreaks of mumps occurred in the United States in 2006 and 2009–10 with more than 6,000 and 3,000 cases, respectively, reported in those years.

• Individuals with mumps usually first feel sick with nonspecific symptoms like headache, loss of appetite, and low-grade fever.
• The most well-known sign of mumps is "parotitis," the swelling of the salivary glands, or parotid glands, below the ear. Parotitis occurs only in 30%–40% of individuals infected with mumps. Some people with mumps have no signs or symptoms of illness; others may have respiratory symptoms or only nonspecific symptoms such as headache, loss of appetite, and low-grade fever.

Rubella (German Measles) is caused by a virus. Rubella spreads from person to person via airborne transmission or droplets shed from the respiratory secretions of infected people. Rubella is contagious but less so than measles and chickenpox. Rubella is usually a mild disease in children; adults tend to have more complications. The main concern with rubella disease, however, is the effect it has on an infected pregnant woman. Rubella infection in the first trimester of pregnancy can lead to fetal death, premature delivery, and serious birth defects.

• Children with rubella usually first break out in a rash, which starts on the face and progresses down the body. Older children and adults usually first suf­fer from low-grade fever, swollen glands in the neck or behind the ears, and upper respiratory infection before they develop a rash. Adult women often de­velop pain and stiffness in their finger, wrist, and knee joints, which may last up to a month. Up to half of people infected with rubella virus have no symptoms at all.

Meningoccocal VIS Meningoccocal

Do I need it? Maybe

Who? Routine vaccination: Two doses of MCV4 are recommended for adolescents 11 through 18 years of age: the first dose at 11 or 12 years of age, with a booster dose at age 16. Adolescents in this age group with HIV infection should get three doses: two doses two months apart at 11 or 12 years, plus a booster at age 16. If the first dose (or series) is given between 13 and 15 years of age, the booster should be given between 16 and 18. If the first dose (or series) is given after the 16th birthday, a booster is not needed.

Other people at increased risk:

• College freshmen living in dormitories.
• Laboratory personnel who are routinely exposed to meningococcal bacteria.
• U.S. military recruits.
• Anyone traveling to, or living in, a part of the world where meningococcal disease is common, such as parts of Africa.
• Anyone who has a damaged spleen, or whose spleen has been removed.
• Anyone who has persistent complement component deficiency (an immune system disorder).
• People who might have been exposed to meningitis during an outbreak.
• Children between 9 and 23 months of age, and anyone else with certain medical conditions need 2 doses for adequate protection. Ask your doctor about the number and timing of doses, and the need for booster doses.

How Often? 2 doses

Which Vaccine? MCV4 (meningococcal conjugate vaccine) is the preferred vaccine for people 55 years of age and younger. MPSV4 (meningococcal polysaccharide vaccine) has been available since the 1970s. It is the only meningococcal vaccine licensed for people older than 55

Why? Meningococcal disease is caused by the bacterium Neisseria meningitidis. This bacterium has at least 13 different serogroups. Five of these serogroups, A, B, C, Y, and W-135, cause almost all invasive disease. The relative importance of these five serogroups depends on geographic location and other factors. The disease is spread person-to-person through the exchange of respiratory and throat secretions (e.g., by coughing, kissing, or sharing eating utensils). Me­ningococcal bacteria can't live for more than a few minutes outside the body, so the disease is not spread as easily as the common cold or influenza. Meningococcal bacteria can make a person extremely ill by infecting the blood (septicemia) or by infecting the fluid of the spinal cord and around the brain (meningitis). Because this disease progresses quickly, it is important to be diagnosed and start treatment as soon as possible.

Meningococcal disease is very serious. About 9–12% of people with meningococcal disease die even with appropriate antibiotic treatment. Of those who re­cover, up to 20% suffer from some serious after-ef­fect, such as permanent hearing loss, limb loss, or brain damage.

• The most common symptoms are high fever, chills, lethargy, and a rash. If meningitis is present, the symptoms will also include headache and neck stiff­ness (which may not be present in infants); seizures may also occur. In overwhelming meningococcal in­fections, shock, coma, and death can follow within several hours, even with appropriate medical treat­ment.