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Adult vaccination in primary care
An adult's vaccines are decided by four questions — age, chronic disease and immunosuppression, pregnancy, and exposure or travel — and a live vaccine is forbidden in pregnancy and in significant immunosuppression.
Why it matters in the exam
Exam questions describe one patient and ask which vaccine is missing or forbidden: a pregnant woman and pertussis, a 65-year-old and pneumococcal vaccine, an unvaccinated child exposed to chickenpox, a dirty wound and tetanus, or a healthy child living with an immunosuppressed relative.
You must tell inactivated vaccines (safe in pregnancy and immunosuppression) from live attenuated ones (measles-mumps-rubella, varicella, oral polio), and remember that post-exposure vaccination works only within a short window.
In family medicine checking the vaccine record is part of every periodic visit: an adult who comes to renew prescriptions is a chance to ask about influenza, pneumococcal, tetanus and zoster vaccines, and before travel — about travel vaccines too. Questions about travel abroad also appear, for example an infant travelling to an area with a measles outbreak.
Key points
- Influenza for everyone from 6 months, every season; in pregnancy — allowed in any trimester.
- Tdap in every pregnancy, preferably at 27–36 weeks.
- Tetanus: booster every 10 years; dirty wound — after 5 years; fewer than 3 doses — immunoglobulin as well.
- Live vaccines are forbidden in pregnancy and immunosuppression.
- After varicella exposure — vaccine within 3–5 days, immunoglobulin for high-risk contacts within 10 days.
Summary table
| Vaccine | For whom | Dose and timing | Exam note |
|---|---|---|---|
| Influenza | Everyone over 6 months, especially over 65, in pregnancy and with chronic disease | One dose every season | Inactivated — allowed in any trimester |
| Pertussis (Tdap) | Every woman in every pregnancy | One dose, preferably at 27–36 weeks | Maternal antibodies pass through the placenta and shield the newborn during early infancy |
| Tetanus (Td) | Every adult | Booster every 10 years; dirty wound — if more than 5 years have passed | Fewer than 3 previous doses and a dirty wound — immunoglobulin as well |
| Pneumococcal | From 65, and chronic disease or immunosuppression at any age | Conjugate vaccine followed by polysaccharide vaccine according to the Ministry of Health schedule | Common question: the order of the vaccines and the interval |
| Herpes zoster (recombinant) | From 50, and immunosuppressed patients from 18 | 2 doses 2–6 months apart | Not live — allowed in immunosuppression |
| Varicella | Adults without immunity; after exposure | 2 doses 4–8 weeks apart; after exposure — within 3–5 days | Live — forbidden in pregnancy and immunosuppression; high-risk contacts — immunoglobulin within 10 days |
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Sources
- Israel Ministry of Health, current edition — Vaccination guide (adult vaccines, vaccines in pregnancy, post-exposure prophylaxis)
- CDC Advisory Committee on Immunization Practices, 2024 — Adult immunization schedule
- WHO, 2022 — Position papers on pertussis, varicella and HPV vaccines
Sources are given for further reading; the text is written afresh and not copied from them.
Reviewed by the Examqo AI Professor · 2026-11-06. The text may contain errors; when in doubt, check the source.