The staff-assisted depression care support system required for adults is a multi-component system that goes beyond simple feedback of screening results.
In addition to staff support for scheduling follow-up visits and facilitating referrals, other higher-intensity interventions might include elements such as intensive clinician and office support staff training, support staff or specialty mental health provider participation in ongoing depression care, and several follow-up contacts.
Multiple studies have shown no adverse fetal effects from administration of the inactivated vaccine to the mother during pregnancy.
The AAFP and ACOG both recommend immunization for influenza in pregnant women during influenza season.
Pregnant women should not receive the live attenuated vaccine, however.Breastfeeding women should also be immunized, with either the trivalent inactivated or live attenuated influenza vaccine.
There is insufficient evidence to support use of the live attenuated influenza vaccine in children under the age of 2.
Children between 6 months and 2 years of age should only receive the trivalent inactivated influenza vaccine.
Children 6 months or older with evidence of, or a history of, reactive airways disease should not receive the live attenuated influenza vaccine.
For the pregnant patient with no identifiable risk factors, a tetanus booster is recommended.
Women who will be pregnant during influenza season should receive the inactived vaccine.
In addition, this particular patient should also receive hepatitis B vaccine because of her history of high-risk sexual behavior.
Tdap would both provide the needed tetanus booster and help to minimize the risk of spreading pertussis to nursing-home residents.
Did you know that pregnant women can safely receive inactivated viral or bacterial vaccines or toxoids?
As a general rule, live attenuated viral vaccines should be avoided in the immediate preconception and prenatal time periods (e.g., varicella, live attenuated influenza, MMR).
While there is no proven risk of adverse fetal effects, the CDC advises delaying administration of these live vaccines until after delivery due to the theoretical risk.
Varicella vaccine is recommended for all healthy adolescents and adults who have not received the vaccine and have no confirmed history of chickenpox (SOR A).
Two doses are required, given at least 4 weeks apart. Particular attention should be given to immunizing women of reproductive age, international travelers, and close contacts of immunosuppressed patients.
However, because the vaccine is a live virus, women of reproductive age should be counseled to delay conception for at least a month after receiving the second dose of the vaccine, and pregnant women should not receive the vaccine until after delivery.
Whereas the live attenuated vaccine was recommended by the CDC for persons over age 60, the recombinant vaccine is recommended for healthy adults 50 years of age and older. Recombinant vaccine is recommended for patients who have had shingles in the past, as well as those who received the live attenuated vaccine in the past.
The CDC recommends that patients wait at least 8 weeks after receiving the live attenuated vaccine before getting the recombinant vaccine.
Although it is not the preferred shingles vaccine, the CDC still recommends the live attenuated vaccine for healthy adults 60 years and older to prevent shingles.
It still has a role in certain cases, such as when a person prefers the older vaccine, is allergic to the recombinant vaccine, or requests immediate vaccination and the recombinant vaccine is unavailable.
Unlike the older herpes zoster vaccine that contains a live attenuated varicella virus, Shingrix is a non-live, recombinant subunit vaccine that combines a lyophilized varicella zoster virus glycoprotein E (gE) antigen and an adjuvant system.
It is administered in two doses of 0.5 mL each, with the second dose given 2–6 months after the initial dose.
It has been shown to be more than 90% effective in preventing herpes zoster and postherpetic neuralgia. Its protective effect remains at 85% for at least 4 years after administration.
As a result, it is the preferred shingles vaccine over the live attenuated virus vaccine, which reduces the risk of herpes zoster by 51% and the risk of postherpetic neuralgia by 67%.
Since recombinant vaccine is not a live vaccine, it is not contraindicated in immunocompromised persons.
However, it is not recommended by the ACIP at this time. The ACIP is expected to review the evidence for its use in immunocompromised persons and will modify vaccine policy as necessary.
The CDC does express the opinion that the recombinant vaccine can be given to someone who is taking low-dose immunosuppressive medication, is anticipating immunosuppression, or has recovered from an immunocompromising illness.
A reported history of zoster does not preclude vaccination, as repeat episodes of zoster have been confirmed in immunocompetent persons.
The exact risk for and severity of zoster after a previous episode are unknown, but some experts believe it may be similar to those with no history of zoster.
There is no laboratory test to confirm previous zoster infection, and reports of previous episodes may be erroneous.
Although the safety and efficacy of zoster vaccine have not been assessed in persons with a history of zoster, additional safety concerns are not expected in this group.