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CDC Adult Schedule

NCLEX Review Guide: Infectious Diseases, Immunizations & CDC Adult Schedule

Infectious Disease Fundamentals

Chain of Infection

Infectious agent (pathogen) must be present and virulent enough to cause disease in susceptible host
Reservoir provides environment for pathogen survival and multiplication (humans, animals, environment)
Portal of exit allows pathogen to leave reservoir through respiratory, GI, GU, or integumentary systems
Mode of transmission includes contact (direct/indirect), droplet, airborne, or vector-borne spread
Portal of entry permits pathogen access to new host through same systems as exit portals
Susceptible host lacks immunity or resistance due to age, illness, immunosuppression, or stress

Key Points

Breaking any link in the chain prevents infection transmission
Hand hygiene is the most effective way to break the chain

Standard and Transmission-Based Precautions

Isolation Precautions

Precaution Type	PPE Required	Examples
Contact	Gown + Gloves	MRSA, VRE, C. diff
Droplet	Surgical Mask	Influenza, Pertussis
Airborne	N95 Respirator	TB, Measles, Varicella

Memory Aid: "My Tiny Virus"

Measles, Tuberculosis, Varicella = Airborne precautions

CDC Adult Immunization Schedule

Routine Adult Vaccines

Influenza: Annual vaccination for all adults ≥6 months without contraindications
Tdap/Td: Tdap once, then Td booster every 10 years; pregnant women get Tdap each pregnancy
MMR: Adults born 1957 or later need 1-2 doses if no evidence of immunity
Varicella: 2 doses for adults without evidence of immunity or disease history
Zoster (Shingles): Recombinant vaccine (Shingrix) for adults ≥50 years, 2 doses
Pneumococcal: PCV15 or PCV20 for adults ≥65; high-risk adults 19-64 years
HPV: 2-3 doses for adults through age 26; shared decision-making for ages 27-45

Important Alert: Live vaccines (MMR, Varicella, Zoster live) are contraindicated in immunocompromised patients and pregnancy

High-Risk Populations & Special Considerations

Immunocompromised Patients

Patients with HIV, cancer, organ transplant, or on immunosuppressive therapy require modified vaccine schedules
Avoid live vaccines in severely immunocompromised patients due to risk of vaccine-induced disease
May need additional doses or different vaccine formulations for optimal protection
Household contacts should receive live vaccines to create protective environment

Clinical Scenario

A 45-year-old patient with rheumatoid arthritis on methotrexate requests shingles vaccine. Recombinant zoster vaccine (Shingrix) is preferred as it's inactivated and safe for immunocompromised patients.

Commonly Confused Concepts

Concept	Key Difference	NCLEX Tip
Active vs Passive Immunity	Active: body produces antibodies; Passive: receives antibodies	Vaccines = Active; Immunoglobulins = Passive
Td vs Tdap	Td = tetanus/diphtheria; Tdap = adds pertussis	Tdap once in adulthood, then Td every 10 years
PCV vs PPSV	PCV = conjugate (better immunity); PPSV = polysaccharide	PCV first, then PPSV if indicated

Study Tips & Memory Aids

Vaccine Contraindications: "HELPS"

High fever, Egg allergy (some vaccines), Live vaccines in pregnancy, Previous severe reaction, Severe immunocompromise

Airborne Precautions: "MTV"

Measles, Tuberculosis, Varicella need negative pressure rooms and N95 masks

Always assess for contraindications before vaccine administration
Review current medications and health conditions
Obtain informed consent and document vaccination
Monitor for immediate adverse reactions (15-20 minutes)
Provide vaccine information statements (VIS)

Quick Check Knowledge Test

I can identify the six components of the chain of infection
I know which PPE is required for each isolation precaution type
I understand the CDC adult immunization schedule
I can differentiate between contraindications for live vs inactivated vaccines
I know special considerations for immunocompromised patients

Common Pitfall: Don't confuse droplet and airborne precautions - droplet uses surgical masks, airborne requires N95 respirators

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