Treatment Guidelines from The Medical Letter
Issue 112
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Adult Immunizations

Vaccines recommended for routine use in US adults are reviewed here. Vaccines for travel have been reviewed separately.1


Live attenuated vaccines use a weakened form of the pathogen, which replicates after administration to induce an immune response. Compared to inactivated vaccines, live attenuated vaccines tend to have higher rates of adverse effects, particularly fever, but generally produce longer-lasting immunity.

Inactivated vaccines are prepared from whole bacteria or virus, or a fractional antigenic component of one. Fractional vaccines are usually either protein- or polysaccharide-based. Protein-based vaccines typically include subunits of microbiologic protein or inactivated bacterial toxins (toxoids). Polysaccharide-based vaccines are generally less immunogenic than protein-based vaccines; they may be conjugated to a protein ... more      

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