Persons planning to travel outside the US should be up to date on routine vaccines and, depending on their destination, duration of travel, and planned activities, may also receive certain travel-specific vaccines. Tickborne encephalitis and dengue vaccines, which are not available in the US, are reviewed in a separate article available online. Detailed advice for travel to specific destinations is available from the Centers for Disease Control and Prevention (CDC) at www.cdc.gov/travel/destinations/list. Recommendations for administration of vaccines as part of routine...

The Advisory Committee on Immunization Practices (ACIP) recommends use of certain vaccines in adults residing in the US. Routine childhood immunization has reduced the overall incidence of some of these vaccine-preventable diseases, but many adults remain susceptible. Recommendations for vaccination against COVID-19, seasonal influenza, and monkeypox and vaccination of travelers have been reviewed separately.

Live-attenuated vaccines are generally contraindicated during pregnancy; inactivated vaccines can be given if indicated. A more detailed review of routine immunizations for adults will be available in the December issue of Treatment Guidelines from The Medical Letter.

Because of concerns about the possibility of bioterrorism involving smallpox, the US government is reinstituting smallpox vaccination (https://www.cdc.gov/smallpox/; www.idsociety.org/bt/toc.htm). Vaccination is currently expected to proceed in three phases: the military and hospital smallpox response teams first, other health care workers, police and firefighters second, and the general public in the third phase. Except for the military, vaccination will be...

A vaccine to prevent hepatitis A (Havrix - SmithKline Beecham), previously licensed in more than 40 countries, including Canada, is now available in the United States. A similar vaccine manufactured by Merck is investigational in the USA.

A live attenuated varicella vaccine (Varivax - Merck) has been approved for marketing by the US Food and Drug Administration. The Oka/Merck strain used in the vaccine is attenuated by passage in human and embryonic guinea pig cell cultures.

Human rabies continues to be rare in the USA, but animal rabies is becoming more common. An animal epizootic in the mid-Atlantic states, involving especially raccoons, has recently spread into the northeastern states.

Increased resistance of pneumococci to antimicrobial drugs may encourage more extensive use of pneumococcal polysaccharide vaccine.

The FDA has approved the marketing of RotaShield, a live oral vaccine for prevention of infantile rotavirus infection. Rotaviruses are segmented double-stranded RNA viruses that are the most common cause of severe diarrhea and dehydration in infants and young children.

Now that US Secretary of Defense has decided to vaccinate more than 2 million memebers of the US armed forces against anthrax, US physicians may be asked to answer some questions about the vaccine and the disease.