Travel in countries with hyperendemic or epidemic meningococcal disease, or microbiologists routinely exposed to Neisseria meningitidis: 1 dose MenACWY (Menactra, Menveo, or MenQuadfi) and revaccinate every 5 years if risk remains.Anatomical or functional asplenia (including sickle cell disease), HIV infection, persistent complement component deficiency, complement inhibitor (e.g., eculizumab, ravulizumab) use: 2-dose series MenACWY-D (Menactra, Menveo, or MenQuadfi) at least 8 weeks apart and revaccinate every 5 years if risk remains.Born in 1957 or later with no evidence of immunity to measles, mumps, or rubella: 2-dose series at least 4 weeks apart for measles or mumps or at least 1 dose for rubella.B orn before 1957 with no evidence of immunity to measles, mumps, or rubella: Consider 2-dose series at least 4 weeks apart for measles or mumps or 1 dose for rubella.Students in postsecondary educational institutions, international travelers, and household or close, personal contacts of immunocompromised persons with no evidence of immunity to measles, mumps, or rubella: 2-dose series at least 4 weeks apart if previously did not receive any doses of MMR or 1 dose if previously received 1 dose MMR.Severe immunocompromising conditions: MMR contraindicated.HIV infection with CD4 percentages ≥15% and CD4 count ≥200 cells/mm3 for at least 6 months and no evidence of immunity to measles, mumps, or rubella: 2-dose series at least 4 weeks apart MMR contraindicated for HIV infection with CD4 percentage Nonpregnant women of childbearing age with no evidence of immunity to rubella: 1 dose.Pregnancy with no evidence of immunity to rubella: MMR contraindicated during pregnancy after pregnancy (before discharge from health care facility), 1 dose.* Note: Anyone age 60 years or older who does not meet risk-based recommendations may still receive Hepatitis B vaccination. Travel in countries with high or intermediate endemic hepatitis B.Percutaneous or mucosal risk for exposure to blood (e.g., household contacts of HBsAg-positive persons residents and staff of facilities for developmentally disabled persons health care and public safety personnel with reasonably anticipated risk for exposure to blood or blood-contaminated body fluids hemodialysis, peritoneal dialysis, home dialysis, and predialysis patients patients with diabetes). ![]() Sexual exposure risk (e.g., sex partners of hepatitis B surface antigen -positive persons sexually active persons not in mutually monogamous relationships persons seeking evaluation or treatment for a sexually transmitted infection men who have sex with men).Chronic liver disease (e.g., persons with hepatitis C, cirrhosis, fatty liver disease, alcoholic liver disease, autoimmune hepatitis, alanine aminotransferase or aspartate aminotransferase level greater than twice upper limit of normal).Age 60 years or older* and at risk for hepatitis B virus infection: 2-dose (Heplisav-B) or 3-dose (Engerix-B, Recombivax HB) series or 3-dose series HepA-HepB (Twinrix) as above.Settings for exposure, including health care settings targeting services to injection or noninjection drug users or group homes and nonresidential day care facilities for developmentally disabled persons (individual risk factor screening not required).Pregnancy if at risk for infection or severe outcome from infection during pregnancy. ![]() Close, personal contact with international adoptee (e.g., household or regular babysitting) in first 60 days after arrival from country with high or intermediate endemic hepatitis A (administer dose 1 as soon as adoption is planned, at least 2 weeks before adoptee’s arrival).Travel in countries with high or intermediate endemic hepatitis A (HepA-HepB may be administered on an accelerated schedule of 3 doses at 0, 7, and 21–30 days, followed by a booster dose at 12 months). ![]()
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