Immunization

Adult immunization has not received the emphasis that has been directed toward vaccinating infants, children, and adolescents. Although vaccination is routine in pediatric practice, it is not commonplace in the practice of physicians who treat adults. Vaccines that should be considered in adult women include tetanus, influenza, MMR (measles, mumps, rubella), varicella-zoster, pneumococcus, meningiococcus, and hepatitis A and B. Indications for the specific vaccines and unique issues of vaccination in pregnancy are discussed below.

Adults should receive a booster dose of tetanus every 10 years. A primary series for unvaccinated adults is three doses: the first two doses given at least 4 weeks apart and the third dose, 6-12 months after the second.

Infection with the influenza virus produces more morbidity and mortality than any other infectious agent. Each year new strains of influenza circulate in the community, and protection requires annual vaccination. Influenza vaccination