Adult immunization recommendations updated.

Updated adult immunization recommendations for the October 2007 through September 2008 season include the addition of zoster vaccine and the differentiation of HIV patients based on their CD4+ T-lymphocyte counts.

Developed by the Advisory Committee on Immunization Practices, the schedule can be viewed at www.cdc.gov/vaccines/recs/schedules/adult-schedule.htm or the Oct. 19 issue of the Morbidity and Mortality Weekly Report (2007;56:RR-4).

Zoster vaccine has been added as a new recommendation covering persons aged 60 years or more, regardless of prior history of herpes zoster. Contraindications for this vaccine have been specified for pregnancy, immunocompromising conditions, and HIV patients with CD4+ T-lymphocyte counts under 200 cells/mcL. The vaccine is neither recommended nor contraindicated for HIV patients with higher CD4+ T-lymphocyte counts.

The recommendation for varicella vaccine has been extended to include all age groups, including adults, in whom there is no evidence of varicella immunity. This recommendation includes persons infected with HIV if their CD4+ T-lymphocyte counts are at least 200 cells/mcL; the vaccine is contraindicated in HIV-infected patients with lower counts, as well as in pregnant women and in patients with other immunocompromising conditions.

Evidence of varicella immunity is defined as fulfilling any of these criteria:

* Documentation of two doses of varicella vaccine at least 4 weeks apart.

* Birth in the United States before 1980--not including health care personnel, immunocompromised persons, or pregnant women.

* History of varicella infection verified by a health care provider.

* History of herpes zoster infection verified by a health care provider.

* Laboratory evidence of immunity or disease confirmation.

The recommendations also specify that health care personnel can receive either a trivalent inactivated influenza virus vaccine or a live, attenuated virus vaccine.

BY KATE JOHNSON

Montreal Bureau