Table 2.
Recommendations for vaccinations in adults with key chronic diseases provided by various guidelines across the world.66-88
| Vaccine | Guidelines | Adults with a chronic disease |
||||
|---|---|---|---|---|---|---|
| CVD | CRD | Diabetes | CKD | |||
| Influenza | Globala | WHO | All with chronic medical conditions | |||
| US | CDC | All | All with chronic pulmonary disorders (including asthma) | All with metabolic disorders (including diabetes) | All with renal disorders | |
| EUb,c | ECDC | All | All | All with chronic metabolic disorders | All with chronic renal and hepatic diseases | |
| UK | PHE | All with chronic medical conditions | ||||
| NHS/NICE | All with CHD or HF | All with respiratory conditions | All | All | ||
| India | IMA | All with chronic cardiorespiratory disease | - | - | ||
|
Pneumococcal Pneumococcal conjugate vaccine: PCV13 Pneumococcal polysaccharide vaccine: PPV23 |
Globald | WHO | No recommendations for routine vaccination in adults | |||
| US | CDC | All with CHD (PPV23 1 dose) | All with chronic lung disease, including COPD, emphysema and asthma (PPV23 1 dose) | All (PPV23 1 dose) | All (PCV13 1 dose and PPV23 2 doses) | |
| UKe | PHE | All with chronic medical conditions (PPV23) | ||||
| NHS/NICE | All with CHD (PPV23 1 dose) | All (PPV23 1 dose) | All (PPV23 1 dose) | All (PPV23 2 doses) | ||
| India | IMA | All with CHDs (PCV13 1 dose and PPV23 2 doses) | All with chronic lung disease (including COPD, emphysema and asthma; PCV13 1 dose and PPV23 2 doses) | All (PCV13 1 dose and PPV23 2 doses) | All (PCV13 1 dose and PPV23 2 doses) | |
| Herpes zosterf | US | CDC | People with chronic medical conditions may be vaccinated unless a contraindication existsg | |||
| Hepatitis B | Global | WHO | - | - | All | High-risk individuals who receive dialysis |
| US | CDC | - | Consider in adults with lung disease if patient has a specific risk factor for hepatitis B | All At the discretion of the treating physician in adults aged ≥60 years with diabetes |
All | |
| UKh | PHE | - | - | All | All (stage 4/5) | |
| Tdap | US | CDC | All | All with lung disease | All | All |
| HPV | US | CDC | - | All with lung disease if aged ≤26 years; maybe in adults aged 27–45 years after discussion with HCP | All with diabetes if aged ≤26 years; maybe in adults aged 27–45 years after discussion with HCP | Adult through age 26 years, less benefit for those aged 27–45 years |
| MMR | US | CDC | - | Consider in adults with lung disease if born in 1957 or later | Consider in adults with diabetes if born in 1957 or later | All with CKD if born in 1957 or later or do not have immunity |
| Varicella | US | CDC | - | Consider in adults with lung disease | Consider in adults with diabetes | All with CKD if born in 1980 or later or do not have immunity |
Other vaccines, such as Hib, Tdap, HPV and meningitis, are recommended in adults with specific risk or conditions.
CDC, Centers for Disease Control and Prevention; CHD, coronary heart disease; CKD, chronic kidney disease; COPD, chronic obstructive pulmonary disease; CRD, chronic respiratory disease; CVD, cardiovascular disease; ECDC, European Centre for Disease Prevention and Control; ESC, European Society of Cardiology; GINA, Global Initiative for Asthma; GOLD, Global Initiative for Chronic Obstructive Lung Disease; HBV, hepatitis B virus; HCP, healthcare professional; HF, heart failure; HPV, human papillomavirus; IMA, India Medical Association; MMR, measles, mumps and rubella; NHS, National Health Service; NICE, National Institute for Health and Care Excellence; PHE, Public Health England; Tdap, tetanus, diphtheria, pertussis; WHO, World Health Organization.
aGINA guidelines advise administering influenza vaccination in all persons with moderate-to-severe asthma and GOLD guidelines recommend influenza vaccination in all persons with COPD; bIndividual countries within Europe may have their own guidelines; cWHO Europe guidelines note that all persons with CHD are a priority group and ESC guidelines state to consider influenza vaccination in all persons with CHD; dGINA guidelines state that there is insufficient evidence to recommend routine pneumococcal vaccination in people with asthma; GOLD guidelines recommend the PCV13 and PPV23 vaccine in adults >65 years of age and the PPV23 vaccine for younger COPD patients with significant comorbid conditions including CHD or lung disease; eESC guidelines recommend pneumococcal vaccination in patients with HF; fIn the UK, PHE, NHS and NICE guidelines recommend herpes zoster vaccination in all adults >70 years of age; gFor patients with CKD, herpes zoster vaccine is recommended only if they are aged ≥60 years; hWHO Europe recommends hepatitis B vaccination in all adults considered to be at high risk of HBV infection, NHS recommendations note that patients with CKD should be considered for hepatitis B vaccination, and NICE recommends the vaccination in all patients with chronic renal failure; - no specific guidelines provided.