• My Dashboard My Education Find an Ophthalmologist
  • Home
  • For Ophthalmologists
    • Meetings
      • AAO 2021
        • Meeting Information
          • Past and Future Meetings
          • Contact Information
          • Virtual Meeting Guide
          • Policies and Disclaimers
        • Program
          • Program Search
          • Program Highlights
          • Program Committees
          • CME
          • Meeting Archives
        • Expo
        • Registration
        • Hotels & Travel
          • Hotel Reservation Information
          • New Orleans
          • International Attendees
          • Hotel Meeting Space
        • Presenter Central
          • Presenter Central
          • Abstract Selection Process
          • Submission Policies
          • Subject Classification/Topics
          • Instruction Courses and Skills Transfer Labs
          • Papers and Posters
          • Videos
          • Grand Rounds Symposium
          • Program Participant and Faculty Guidelines
          • Faculty Development Program
        • Exhibitors
          • Exhibitor Central
          • Exhibitor Portal Information
          • New Exhibiting Companies
          • Exhibitor Resources
      • Mid-Year Forum
        • Registration and Travel
        • Congressional Advocacy Day
        • Advocacy Ambassador Program
        • Program
        • Schedule
        • Sponsored Attendees
        • News
      • Ophthalmology Business Summit
      • Codequest
        • Codequest Instructors
        • Claim Codequest CME or CEU Credit
      • Eyecelerator
    • Clinical Education
      • COVID-19
      • Education
        • Browse All Education
        • Courses
        • Cases
        • Learning Plans
        • Interactive
        • Focal Points
        • Wills Eye Manual
        • Disease Reviews
        • Clinical Webinars
        • Diagnose This
        • Self-Assessments
        • Educational Centers
          • Glaucoma Education Center
          • Pediatric Ophthalmology Education Center
          • Laser Surgery Education Center
          • Myopia Resources
          • Oculofacial Plastic Surgery Center
          • Redmond Ethics Center
      • Journals
      • Guidelines
        • Browse All Practice Guidelines
        • Preferred Practice Patterns
        • Clinical Statements
        • Compendium Guidelines
        • Complementary Therapy Assessments
        • Medical Information Technology
        • Ophthalmic Technology Assessments
        • Patient Safety Statements
        • Choosing Wisely
        • Low Vision
        • Eye Care for Older Adults
        • Eye Disease Statistics
        • About the Hoskins Center
      • Multimedia Library
        • Browse All Videos and Audio
        • Clinical and Surgical Videos
        • Presentations and Lectures
        • 1-Minute Videos
        • Master Class Videos
        • Basic Skills Videos
        • Interviews
        • Audio and Podcasts
        • Images
        • Submit an Image
        • Submit a Video
      • News
        • Browse All Clinical News
        • Editors' Choice
        • Headlines
        • Current Insight
      • CME Central
        • Browse All CME Activities
        • Claim CME Credit and View Transcript
        • CME Planning Resources
        • Complete Your Financial Disclosure
        • Joint Sponsorship Portal
        • LEO Continuing Education Recognition Award
        • Safe ER/LA Opioid Prescribing
        • Check Your Industry Payment Records
      • MOC
      • Resident Education
        • All Resident Education
        • OKAP and Board Exam Resources
          • OKAP Exam
          • Board Prep Resources
          • OKAP and Board Review Presentations
          • Study Flashcards
        • Resident Courses
        • Resident Videos
        • Cataract Master
        • Simulation in Resident Education
        • Pediatric Ophthalmology Education Center
        • News and Advice from YO Info
    • Membership
      • Join
      • Renew
      • Current Member
      • Volunteer
      • Physician Wellness
      • Member Directory
      • Member Obituaries
      • AAOE Membership
    • Advocacy
      • Advocacy News
      • Get Involved
        • Ways to Give
        • How to Get Involved
        • Congressional Advocacy
        • Support the Academy's Agenda
        • Research Legislation
        • Find Your Legislators
        • I Am an Advocate
        • Advocacy at Home
        • Advocate Tools
        • Best Practices for Advocating at Home
        • Social Media Toolkit
        • Letter to Editor
        • Town Hall Guide
        • Guide to Engaging With New Lawmakers
        • Resources
        • Attending a Political Fundraiser
      • OPHTHPAC
        • About Us
        • Join OPHTHPAC
        • OPHTHPAC Blog
      • Surgical Scope Fund
        • Support Surgery By Surgeons
        • Surgery By Surgeons Blog
    • Publications
      • EyeNet Magazine
        • Latest Issue
        • Archive
        • Subscribe
        • Advertise
        • Write For Us
        • Corporate Lunches
        • Contact
        • MIPS 2019
        • MIPS 2020
      • Focal Points
      • Ophthalmology
      • Ophthalmology Glaucoma
      • Ophthalmology Retina
      • YO Info
      • Scope
    • Subspecialties
      • Cataract/Anterior Segment
      • Comprehensive Ophthalmology
      • Cornea/External Disease
      • Glaucoma
      • Neuro-Ophthalmology/Orbit
      • Ocular Pathology/Oncology
      • Oculoplastics/Orbit
      • Pediatric Ophthalmology/Strabismus
      • Refractive Management/Intervention
      • Retina/Vitreous
      • Uveitis
    • IRIS Registry
      • About
      • Using the Registry
        • User Guide
        • Medicare Reporting
        • Maintenance of Certification
        • Non-EHR Reporting
      • Sign Up
        • Application Process
        • Why Participate
        • Once You've Applied: Getting Started
        • What Practices Are Saying About the Registry
      • Requirements
        • EHR Systems
        • Data & Technical Needs
      • Research
      • Registry Dashboard
      • News
    • Medicare Information
  • For Practice Management
    • Coding
      • Codequest
      • Ask the Coding Experts
      • Coding Updates and Resources
      • Coding for Injectable Drugs
      • ICD-10-CM
        • News and Advice
      • Ophthalmic Coding Specialist (OCS) Exam
    • Regulatory
      • Medicare Participation Options
      • Audits
      • Medicare Advantage Plans
        • Termination Appeal Letter
      • New Medicare Card
      • Provider Enrollment, Chain and Ownership System (PECOS)
      • HIPAA Resources
    • Practice Operations
      • Practice Management Advice
      • Lean Management
      • Cybersecurity
      • Private Equity
      • EHRs
        • Overview
        • Planning and Preparation
        • Vendor Selection
        • Implementation and Evaluation
        • Patient Portals
        • Resources
        • Ratings
    • Events
      • Annual Meeting
      • Business Summit
      • Codequest Courses
    • Leadership
      • AAOE Board of Directors
      • Leadership Program (OPAL)
    • Listservs
    • Resources
      • Practice Management Resource Library
      • Coronavirus Resources
      • Patient Education
      • Practice Forms Library
        • Practice Forms Library - Examination
        • Practice Forms Library - Financial
        • Practice Forms Library - HIPAA
        • Practice Forms Library - Human Resources
        • Practice Forms Library - Job Descriptions
        • Practice Forms Library - Patient Forms
        • Practice Forms Library - Protocols
        • Practice Forms Library - Surgery
      • Practice Analytics
        • Benchmarking Tool
        • Salary Survey
      • Consultant Directory
      • Ophthalmology Job Center
      • Practice Management for Retina
      • Reopening and Recovery
    • Get Involved
    • Medicare
      • Quality
        • Overview
        • Reporting
        • Measures
      • Promoting Interoperability
        • Overview
        • Measures
        • Attestation
        • Hardships and Exceptions
        • Audits
        • News and Advice
      • Improvement Activities
        • Overview
        • List of Improvement Activities
        • Attestation
        • Audits
      • Cost
      • Avoid a Penalty
      • Resources
        • 2019 to 2020 MIPS Changes
        • MIPS Solo and Small Practice Survival Guide
        • MIPS Glossary
        • MIPS Resources on EyeNet
        • MIPS Extreme Hardship Exceptions
        • Solo and Small-Practice Roadmap
        • MIPS Manual
        • MIPS Large Practice Roadmap
        • IRIS Registry User Guide
        • CMS Websites
        • 2020 MIPS Payments: Understanding Remittance Advice Codes
        • Final Checklist for EHR/Non-EHR 2019 MIPS Reporting
        • MIPS Tips
        • MIPS Archive
    • Membership
  • For Public & Patients
    • Eye Health A-Z
    • Symptoms
    • Glasses & Contacts
    • Tips & Prevention
    • News
    • Ask an Ophthalmologist
    • Patient Stories
    • No Cost Eye Exams
    • Español
      • A - Z de Salud Ocular
      • Síntomas
      • Anteojos y Lentes de Contacto
      • Consejos y Prevención
      • Noticias
      • Relatos de Pacientes
      • Exámenes de la vista sin costo
      • English
  • AAO 2021
    • Meeting Information
      • Past and Future Meetings
      • Contact Information
      • Virtual Meeting Help
      • Virtual Meeting Guide
      • Policies and Disclaimers
    • Program
      • Program Search
      • Program Highlights
      • Program Committees
      • CME
      • Meeting Archives
    • Expo
    • Registration
    • Hotels & Travel
      • Hotel Reservation Information
      • New Orleans
      • International Attendees
      • Hotel Meeting Space
    • Presenter Central
      • Presenter Central
      • Abstract Selection Process
      • Submission Policies
      • Subject Classification/Topics
      • Instruction Courses and Skills Transfer Labs
      • Papers and Posters
      • Videos
      • Grand Rounds Symposium
      • Program Participant and Faculty Guidelines
      • Faculty Development Program
    • Exhibitors
      • Exhibitor Central
      • Exhibitor Portal Information
      • New Exhibiting Companies
      • Exhibitor Resources
  • About
    • Who We Are
      • What We Do
      • About Ophthalmology
      • The Eye Care Team
      • Ethics and the Academy
      • History
      • Museum of Vision
      • Values
    • Governance
      • Council
      • Board of Trustees
      • Committees
      • Academy Past Presidents
      • Secretariats
      • Elections
      • Academy Blog
      • Academy Staff Leadership
    • Leadership Development
    • Awards
      • Laureate Recognition Award
      • Outstanding Advocate Award
      • Outstanding Humanitarian Service Award
      • International Blindness Prevention Award
      • Distinguished Service Award
      • Guests of Honor
      • Secretariat Award
      • Straatsma Award
      • Achievement Award Program
      • Artemis Award
      • EnergEYES Award
      • International Education Award
      • International Scholar Award
      • Commitment to Advocacy Award
      • Visionary Society Award
    • Financial Relationships
    • Policy Statements
    • Related Organizations
      • Subspecialty/Specialized Interest Society Directory
      • State Society Directory
      • Subspecialty/Specialized Interest Society Meetings
      • State Society Meetings
      • Resources for Societies
    • Year in Review
      • 2019 Year in Review
  • Foundation
    • About
      • Funding Allocations and Sources
      • 2019-2020 Annual Report
      • Annual Report Archives
      • News From the Chair
      • Foundation Staff
    • Our Impact
      • Partners for Sight
      • Donor Spotlights
      • Global Ophthalmic Community
      • Sponsorships
      • Patients and the Public
    • Giving Options
      • Our Supporters
      • Estate and Planned Giving
      • Ophthalmic Business Council
    • Orbital Gala
      • Why Attend
      • Photo Recap
      • Corporate Support Opportunities
      • Tribute Gifts
      • Silent Auction
      • Corporate Sponsors
    • Donate
    • Museum of the Eye Campaign
      • Museum Supporters
  • Museum of the Eye
    • Visit
    • Events
    • Explore
      • Research and Resources
      • Collection Search
      • Previous Exhibits
      • Oral Histories
      • Biographies
    • Volunteer
    • Mailing List
    • Donate
    • About the Museum
      • Museum Blog
  • Young Ophthalmologists
    • YO Info
    • Learn to Bill
    • Engage with the Academy
  • Senior Ophthalmologists
    • Scope
    • Practice Transitions
  • International Ophthalmologists
    • Global Programs and Resources for National Societies
    • Awards
    • Global Outreach
  • Residents
  • Medical Students
×
Log In Create an Account
  • For Ophthalmologists
  • For Practice Management
  • For Public & Patients
  • About
  • Foundation
  • Museum of the Eye
  • COVID-19
  • Journals
  • Education
    • Education
    • Courses
    • Cases
    • Learning Plans
    • Interactive
    • Focal Points
    • Wills Eye Manual
    • Disease Reviews
    • Clinical Webinars
    • Diagnose This
    • Self-Assessments
    • Education Centers
      • Glaucoma Education Center
      • Pediatric Ophthalmology Education Center
      • Laser Surgery Education Center
      • Oculofacial Plastic Surgery Center
      • Redmond Ethics Center
      • Myopia Resources
  • Guidelines
    • Practice Guidelines
    • Preferred Practice Patterns
    • Clinical Statements
    • Ophthalmic Technology Assessments
    • Patient Safety Statements
    • Complementary Therapy Assessments
    • Compendium Guidelines
    • Medical Information Technology
    • Low Vision
    • Choosing Wisely
    • Eye Care for Older Adults
    • Eye Disease Statistics
    • About the Hoskins Center
    • Artificial Intelligence
    • Premium IOLs
  • Multimedia
    • Multimedia Library
    • Video
      • 1-Minute Videos
      • Presentations and Lectures
      • Master Class Videos
      • Basic Skills Videos
      • Clinical and Surgical Videos
      • Interviews
      • Resident Lectures
      • Submit a Video
    • Audio and Podcasts
    • Images
      • Submit an Image
  • News
    • Clinical News
    • Editors' Choice
    • Headlines
    • Current Insight
  • CME
    • CME Central
    • Claim CME Credit and View Transcript
    • CME Planning Resources
    • Complete Your Financial Disclosure
    • Joint Sponsorship Portal
    • LEO Continuing Education Recognition Award
    • Safe ER/LA Opioid Prescribing
    • Check Your Industry Payment Records
  • MOC
  • Residents
    • Resident Education
    • OKAP and Board Exam Resources
      • OKAP Exam
      • Board Prep Resources
      • OKAP and Board Review Presentations
      • Study Flashcards
    • Resident Courses
    • Resident Videos
    • Cataract Master
    • Simulation in Resident Education
    • Diversity and Inclusion Education
    • Pediatric Ophthalmology Education Center
    • News and Advice from YO Info
    • Clinical Education /
    • Book Excerpts /
    • Basic and Clinical Science Course - Excerpt
  • 2020–2021 BCSC Basic and Clinical Science Course™

    Go to Academy Store Learn more and Purchase.

    1 Update on General Medicine

    Chapter 12: Preventive Medicine

    Immunization

    The development of immunization as a means of preventing the spread of infectious disease began in 1796, when Edward Jenner injected cowpox virus, which causes a mild disease, into a child to prevent smallpox, a severe, potentially fatal illness. Immunization today still relies on Jenner’s inoculation methods to protect against disease. There are 2 types of immunization: active and passive.

    In active immunization, the recipient develops an acquired immune response to inactivated or killed viruses, viral subtractions, bacterial toxoids or antigens, or synthetic vaccines. Once the immune response to a particular pathogen has developed, it protects the host against infection. The persistence of acquired immunity depends on the perpetuation of cell strains responsive to the target antigenic stimulus; for certain immunogens, booster inoculations may be required.

    In general, live, attenuated vaccines produce longer-lasting immunity; however, they are contraindicated in immunocompromised persons or pregnant women because the pathogen can potentially replicate in the host. Ideally, active immunization should be completed before exposure; however, life-saving postexposure immunity can be developed by combining active and passive immunization.

    Passive immunization depends on the transfer of immunoglobulin in serum from a host with active immunity to a susceptible host. Passive immunity does not result in active immunity and sometimes even blocks the development of active immunity. Passive immunity is short-lived and does not confer long-term immunity; however, it confers immediate protection on the recipient who has been exposed to the pathogen. Pooled human globulin, antitoxins, and human globulin with high antibody titers for specific diseases are the usual products available for passive immunization.

    The current recommended US immunization schedules, developed by the Advisory Committee on Immunization Practices—including immunization schedules for persons aged 0–18 years, the catch-up schedule for individuals aged 4 months to 18 years, and the adult schedule—can be found on the CDC website (www.cdc.gov/vaccines/schedules/index.html). The catch-up protocols are for children who have missed some of the recommended immunization doses.

    Immunization should be avoided in persons who have allergic reactions to the vaccine or its components. Idiopathic autoantibody or cross-reacting antibody development may occur after vaccination, resulting in systemic disease such as Guillain-Barré syndrome, a rare but devastating complication of vaccination. Immunization should be avoided during a febrile illness. Multidose immunization schedules that are interrupted can be resumed; however, doses given outside the schedule should not be counted toward completion of the vaccination sequence.

    For patients who are pregnant, immunization against tetanus, diphtheria, and influenza is indicated; immunization against other diseases (hepatitis, pneumococcal or meningococcal disease) is indicated if a patient is at high risk of exposure. Additional immunizations may be considered but must be weighed against rare potential risks to the fetus.

    The following sections are based on the more extensive recommended immunization schedules in the United States. In other parts of the world, immunizations are performed based on World Health Organization (WHO) guidelines, national programs, or recommendations by multinational organizations such as the European Centre for Disease Prevention and Control (ECDC). As a general rule, national immunization schedules for children are quite similar, but recommended immunizations for adults vary widely between countries (Table 12-2 lists a sampling). For more information on the immunization schedules of EU nations, see the ECDC website (https://vaccine-schedule.ecdc.europa.eu).

    • Chlibek R, Anca I, André F, et al. Adult vaccination in 11 Central European countries—calendars are not just for children. Vaccine. 2012;30(9):1529–1540.

    • Robinson CL, Romero JR, Kempe A, Pellegrini C, Szilagyi P. Advisory Committee on Immunization Practices recommended immunization schedule for children and adolescents aged 18 years or younger—United States, 2018. MMWR Morb Mortal Wkly Rep. 2018;67(5):156–157.

    • US Centers for Disease Control and Prevention. Recommended immunization schedules for adults aged 19 years or older, United States 2019. www.cdc.gov/vaccines/schedules/hcp/adult.html. Updated February 5, 2019. Accessed February 22, 2019.

    Hepatitis

    There are 3 main types of hepatitis viruses. Infection with hepatitis A virus (HAV) is the leading cause of viral hepatitis in the United States. HAV is usually transmitted orally and may be acquired from contaminated water supplies and unwashed or undercooked foods. Vaccination against HAV infection is recommended for children aged 12–23 months and for persons at high risk of exposure to HAV (eg, travelers to endemic areas, patients with blood clotting factor disorders, military personnel, drug abusers, family contacts of infected patients, laboratory workers exposed to the virus). In the United States, 2 preparations are available (Vaqta, Havrix), each consisting of viral antigens purified from human cell cultures.

    Approximately 250,000 cases of hepatitis B occur annually in the United States. Between 6% and 10% of adult patients with hepatitis B become carriers, and chronic active hepatitis occurs in 25% of these carriers. Of the patients with chronic active disease, 20% will die of cirrhosis and 5% will die of hepatocellular carcinoma. Worldwide, 250 million persons are chronic carriers.

    In the United States, the available recombinant vaccines based on the hepatitis B virus (HBV) surface antigen are Engerix-B and Recombivax HB. In adults, HBV vaccine is usually administered in a series of 3 doses, and 90% of recipients develop protective antibody levels (>10 milli-international units/ml [mIU/mL]), which persist for at least 3 years and may be protective for up to 30 years. Booster injections are advised for persons whose antibody levels are less than 10 mIU/mL. A second vaccination results in the development of protective antibodies in 50% of the initial nonresponders.

    Table 12-2 2017 National Adult Immunization Recommendations: A Samplinga

    Vaccination before exposure to HBV is recommended and cost-effective for all infants and children and for individuals in certain high-risk groups: health care workers, hemodialysis patients, diabetic adults over age 60, residents and staff of long-term care facilities, household and sexual contacts of chronic carriers of HBV, hemophiliacs, users of illicit injectable drugs, prison inmates, sexually active homosexual men, and HIV-seropositive individuals. Vaccination can be combined with passive immunization for postexposure prophylaxis without affecting the development of active immunity. The incorporation of the vaccine into childhood immunization schedules has resulted in a decrease in the number of new hepatitis B cases reported annually, and there has also been a significant reduction in the number of hepatocellular carcinoma cases reported in children. Some of the available combination vaccines protect against not only hepatitis B, but also hepatitis A, diphtheria, pertussis, tetanus, and polio.

    Postexposure prophylaxis with hepatitis B immunoglobulin should be considered when there is perinatal exposure of an infant born to a carrier, accidental percutaneous or permucosal exposure to blood that is positive for the HBV surface antigen, or sexual exposure (within 14 days) to a carrier of HBV. Hepatitis B immunoglobulin should be given as soon as possible after exposure; the recombinant HBV vaccine should be concurrently administered in an accelerated dosing schedule.

    Patients with chronic hepatitis B infection and evidence of liver disease may improve after treatment with antiviral medications. If indicated, Interferon or nucleos(t)ide analogues (tenofovir or entecavir) are effective and have a lower incidence of viral resistance than lamivudine.

    Hepatitis C is the leading indication for liver transplantation in the United States. The CDC has recommended that all adults in the United States born between 1945 and 1965 have a one-time test for hepatitis C. Early intervention in chronically infected individuals, including treatment and alcohol counseling, can slow the progression of disease. Vaccines against hepatitis C and E are being developed. See Chapter 14 for additional discussion of hepatitis C and other forms of the hepatitis virus.

    • Smith BD, Morgan RL, Beckett GA, Falck-Ytter Y, Holtzman D, Ward JW. Hepatitis C virus testing of persons born during 1945–1965: recommendations from the Centers for Disease Control and Prevention. Ann Intern Med. 2012;157(11):817–822.

    • Terrault NA, Bzowej NH, Chang KM, et al; American Association for the Study of Liver Diseases. AASLD guidelines for treatment of chronic hepatitis B. Hepatology. 2016;63(1): 261–283.

    Excerpted from BCSC 2020-2021 series: Section 1 - Update on General Medicine. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.

  • Most Commented
    Loading, please wait...
    There are no comments available.
    Most Viewed
    Loading, please wait...
    Most Viewed content is not available.
  • The Academy Store
    2021 North Carolina Codequest (Recording)
    2021 Tennessee Codequest (Recording)
    2021 Multistate Codequest (Recorded Feb. 5)
    2021 Michigan Codequest (Recording)
    Focal Points 2020 Complete Set
    2021 Coding Coach: Complete Ophthalmic Coding Reference 
    2021 CPT: Complete Pocket Ophthalmic Reference
    2021 Retina Coding: Complete Reference Guide
    2021 Fundamentals of Ophthalmic Coding
    2021 CPT Professional Edition 
    2021 HCPCS Level ll Professional Edition
    2021 Coding Assistant: Cataract and Anterior Segment
    2021 Coding Assistant: Cornea
    2021 Coding Assistant: Glaucoma
    2021 Coding Assistant: Oculofacial
    2021 Coding Assistant: Pediatrics/Strabismus
    2021 Coding Assistant for Subspecialties 
    Recorded Webinar: 2021 Ophthalmology Coding Update
    Webinar: 2021 Ophthalmology Coding Update
    Ophthalmology Journal
    Ophthalmology Retina Journal
    Focal Points Member Benefit
    2021 ICD-10-CM for Ophthalmology: The Complete Reference 
    Conquering New E-M Documentation Guidelines for Ophthalmology
    2020-2021 Basic and Clinical Science Course Complete Set
    2020-2021 Basic and Clinical Science Course Residency Set
    2020-2021 Basic and Clinical Science Course, Section 01: Update on General Medicine
    2020-2021 Basic and Clinical Science Course, Section 02: Fundamentals and Principles of Ophthalmology
    2020-2021 Basic and Clinical Science Course, Section 03: Clinical Optics
    2020-2021 Basic and Clinical Science Course, Section 04: Ophthalmic Pathology and Intraocular Tumors
 
  • Contact Us
  • About the Academy
  • Jobs at the Academy
  • Financial Relationships with Industry
  • Medical Disclaimer
  • Privacy Policy
  • Terms of Service
  • Help
  • For Advertisers
  • For Media
  • Ophthalmology Job Center

OUR SITES

  • EyeWiki
  • International Society of Refractive Surgery

FOLLOW THE ACADEMY

Medical Professionals

  • Facebook
  • Twitter
  • LinkedIn
  • YouTube

Public & Patients

  • Facebook
  • Twitter
  • Instagram
  • YouTube

Museum of the Eye

  • Facebook
  • Twitter
  • Instagram
  • Trip Advisor
  • Yelp
© American Academy of Ophthalmology 2021