Washington Manual of Medical Therapeutics
Immunizations and Postexposure Therapies
Introduction
- Active immunization promotes the development of a durable primary immune response (B-cell proliferation, antibody response, T-cell sensitization) directed toward a specific pathogen such that subsequent exposure to that pathogen results in a secondary immune response that protects against infection (Table A-1).
- Passive immunization involves the administration of immune globulin resulting in transient protection against infection. It is usually employed in a host with limited capacity to mount a primary immune response, when exposure to a pathogen occurs in a previously unvaccinated host, or to protect against toxin-mediated disease.
- Postexposure prophylaxis is therapy given following exposure to a pathogen to prevent the development of disease. This can include active immunization, passive immunization, and/or antimicrobial therapy (Tables A-2 and A-3).
- Adverse events potentially related to vaccination should be reported through the Vaccine Adverse Event Reporting System at http://vaers.hhs.gov/ or 1-800-822-7967.
- More information, including adult vaccination schedules, recommendations regarding travel, and up-to-date guidelines, can be found at the Centers for Disease Control and Prevention (CDC) website, http://www.cdc.gov/. Additional guidance for specific clinical questions can be obtained by contacting the CDC via https://www.cdc.gov/cdc-info/ask-cdc.html or by phone at 1-800-232-4636 (1-800-CDC-INFO).
Table A-1: Selected Adult Immunization Recommendations in the United States
| Vaccine, Dose | Indications and Dosing | Contraindications | Precautions |
| Haemophilus influenzae type b (Hib) Hib conjugate vaccine: 0.5 mL IM | Unvaccinated adults with anatomic or functional asplenia (including sickle cell disease) or undergoing elective splenectomy (preferably 14 d before surgery): Administer 1 dose Hematopoietic stem cell transplant recipients 6–12 mo after successful transplant: Administer three doses (4 wk apart) | Severe allergic reaction to any vaccine component or after a previous dose | Moderate or severe acute illness with or without fever |
| Hepatitis A Single-antigen hepatitis A vaccine (HepA; Havrix, Vaqta): 1 mL IM Combined hepatitis A/hepatitis B vaccine (HepA-Hep B; Twinrix): 1 mL IM | Any adult seeking protection from hepatitis A virus (HAV) Specific indications: travel to countries with high or intermediate HAV endemicity (including infants ≥6 mo); chronic liver disease; HIV infection; men who have sex with men (MSM); injection or noninjection drug use; persons experiencing homelessness; laboratory workers exposed to HAV; persons who anticipate close personal contact with an adoptee from a country with high or intermediate HAV endemicity during the first 60 d after arrival in the United States; pregnancy (if at risk for infection or a severe outcome from infection during pregnancy); healthy persons ages ≥12 mo recently exposed to HAV (adults >40 y may also receive HAV immunoglobulin). Standard dosing:
| Severe allergic reaction to any vaccine component or after a previous dose | Moderate or severe acute illness with or without fever |
| Hepatitis B Single-antigen hepatitis B vaccine a) HepB; Recombivax HB, standard (10 μg/mL) and high-dose (40 μg/mL) formulations: 1 mL IM b) HepB; Engerix-B (20 μg/mL): 1 mL IM Recombinant hepatitis B vaccine with an immunoadjuvant (Heplisav-B): 20 μg/0.5 mL Combined hepatitis A/hepatitis B vaccine (HepA-Hep B; Twinrix): 1 mL IM | Any adult seeking protection from hepatitis B virus (HBV) Specific indications: chronic liver disease; HIV infection; percutaneous or mucosal risk of exposure to blood (e.g., household contacts of persons with chronic HBV infection; persons age <60 y with diabetes mellitus and those ≥60 y at discretion of treating clinician; adults with ESRD including those receiving dialysis; injection drug users; healthcare and public safety workers at risk for exposure to blood or body fluids); sexual exposure risk (e.g., sex partners of persons with chronic HBV infection; sexually active persons not in long-term, mutually monogamous relationship; persons seeking evaluation or treatment for a sexually transmitted disease; MSM); persons receiving care in settings where risk of HBV infection is high (e.g., facilities providing STD treatment, HIV testing and treatment, or drug abuse treatment and prevention services; healthcare settings targeting services to injection drug users or MSM; correctional facilities; ESRD and hemodialysis programs; institutions for persons with developmental disabilities); travelers to countries with high or intermediate HBV endemicity; pregnancy (if at risk for infection or a severe outcome from infection during pregnancy) Standard dosing: Standard-dose Recombivax HB, Engerix-B, or Twinrix: Administer three doses at 0, 1, and 6 mo Heplisav-B: Administer two doses at 0 and 1 mo (not recommended in pregnancy) HD patients or other immunocompromised: High-dose Recombivax HB: Administer three doses at 0, 1, and 6 mo Engerix-B: Administer four two-dose (2 mL) injections at 0, 1, 2, and 6 mo | Severe allergic reaction to any vaccine component or after a previous dose | Moderate or severe acute illness with or without fever |
| Human papillomavirus (HPV) 9-valent vaccine (9vHPV; Gardasil 9): 0.5 mL IM | All adults through age 26 y:
| Severe allergic reaction to any vaccine component or after a previous dose | Moderate or severe acute illness with or without fever; pregnancy |
| Influenza Inactivated or recombinant influenza vaccine (IIV or RIV): 0.5 mL IM (5 mL if multidose vial used) Live attenuated influenza vaccine (LAIV): 0.2 mL intranasal | Annual vaccination is recommended for all persons aged ≥6 mo without contraindications. Age 6 mo through 35 mo: IIV (LAIV option for age ≥ 2 y) Pregnancy: IIV or RIV Age ≥65 y: IIV or RIV All others: IIV, RIV, or LAIV (if age 2 through 49 y) Egg allergy: RIV4 preferred if age ≥ 18 yr. Cell culture-based IIV4 if age ≥4 y Healthcare personnel who receive LAIV should avoid providing care for severely immune-suppressed persons (i.e., requiring protective environment) until 7 d postvaccination | Severe allergic reaction to any vaccine component or after a previous dose Persons with a history of egg allergy of any severity may receive any licensed, recommended, and age-appropriate influenza vaccine LAIV: pregnancy, immune suppression (includes close contacts), children aged 2–4 y with asthma, children/adolescents on salicylate therapy (aspirin), persons who have taken influenza antiviral medications within previous 48 h | Moderate to severe illness with or without fever; history of Guillain-Barré syndrome (GBS) within 6 wk of previous influenza vaccination LAIV: asthma; chronic medical conditions that may predispose to higher risk of influenza-related complications (e.g., lung disease, cardiovascular disease, diabetes, renal or hepatic disease) |
| Measles, mumps, rubella Live measles, mumps, and rubella (MMR) vaccine: 0.5 mL SC | Anyone without evidence of immunity: Administer one dose Evidence of immunity:
Students in postsecondary educational institutions, international travelers, and household contacts of immune compromised persons: Administer two doses ≥28 d apart Women of childbearing age: Rubella immunity should be determined. If no immunity and nonpregnant, administer 1 dose of MMR; pregnant women with no rubella immunity: administer 1 dose on completion or termination of pregnancy and before discharge from the healthcare facility Healthcare personnel born in 1957 or later: If no documentation of vaccination or laboratory confirmation of immunity or disease, administer vaccination (two doses if measles or mumps nonimmune ≥28 d apart; one dose if rubella nonimmune) Adults who previously received ≤2 doses of MMR identified to be at increased risk for mumps during an outbreak: Administer one dose | Severe allergic reaction to any vaccine component or after a previous dose; current febrile respiratory or other febrile infection; known severe immunodeficiency (e.g., hematologic and solid tumors, receipt of chemotherapy, congenital immunodeficiency, long-term immunosuppressive therapy, HIV infection with CD4+ <200 cells/μL); pregnancy | Moderate or severe acute illness with or without fever; recent (≤11 mo) receipt of antibody-containing blood product; history of thrombocytopenia or thrombocytopenic purpura; need for tuberculin skin testing within 4 wk of vaccination (measles component may temporarily suppress reactivity) |
| Meningococcal (Neisseria meningitidis) Quadrivalent meningococcal conjugate vaccine-diphtheria toxoid carrier (MenACWY; Menactra, Menveo): 0.5 mL IM Meningococcal serogroup B vaccine (MenB-4C, Bexsero; MenB-FHbp, Trumenba): 0.5 mL IM | Adults with anatomical or functional asplenia, HIV infection, persistent complement component deficiency, or complement inhibitor (e.g., eculizumab, ravulizumab) use: Administer two doses of MenACWY ≥8 wk apart; revaccinate with 1 dose of MenACWY every 5 y if risk persists Adults traveling to living in countries where meningococcal disease is hyperendemic or epidemic, microbiologists routinely exposed to N. meningitidis, military recruits, first-year college students living in residence halls if no vaccination at age ≥16 y: Administer one dose of MenACWY; revaccinate with one dose of MenACWY every 5 y if risk persists Adults with anatomical or function asplenia, persistent complement component deficiency, complement inhibitor use, microbiologists routinely exposed to N. meningitidis, or at risk for meningococcal disease outbreak attributed to serogroup B: MenB-4C: Administer two doses ≥1 mo apart MenB-FHbp: Administer three doses at 0, 1–2, and 6 mo | Severe allergic reaction to any vaccine component or after a previous dose | Moderate or severe acute illness with or without fever |
| Pneumococcal (Streptococcus pneumoniae) 13-Valent pneumococcal conjugate vaccine (PCV13): 0.5 mL IM 23-Valent pneumococcal polysaccharide vaccine (PPSV23): 0.5 mL IM or SC | Immunocompetent adults ≥65 y:
Adults ≥19 y with immunocompromising condition, HIV infection, anatomic or functional asplenia, chronic kidney disease, or nephrotic syndrome: Administer one dose of PCV13, followed by one dose PPSV23 at ≥8 wk and second dose at ≥5 y after first PPSV23. If last PPSV23 received before age 65 y, at age 65 y, administer another dose of PPSV23 ≥5 y after last dose Adults 19–64 y with cerebrospinal fluid leak or cochlear implant: Administer one dose of PCV13, followed by one dose of PPSV23 at ≥8 wk. If PPSV23 received before age 65 y, at age 65 y, administer another dose of PPSV23 ≥5 y after last dose | Severe allergic reaction after a previous dose or to a vaccine component PCV13: severe allergic reaction to any vaccine containing diphtheria toxoid | Moderate or severe acute illness with or without fever |
| Tetanus, diphtheria, pertussis Tetanus and diphtheria toxoids vaccine (Td): 0.5 mL IM Tetanus, diphtheria, and acellular pertussis vaccine (Tdap; Adacel, Boostrix): 0.5 mL IM Other formulations (e.g., diphtheria and tetanus toxoids and acellular pertussis [DTaP]) not recommended for adult use | Everyone:
Adults not previously vaccinated: Administer three-dose series consisting of Tdap followed by Td or Tdap 4 wk later and Td or Tdap 6–12 mo later Postexposure prophylaxis: See Table A-2 | Severe allergic reaction to any vaccine component or after a previous dose Tdap: encephalopathy (e.g., coma, prolonged seizures) not attributable to other cause within 7 d of administration of previous dose | Moderate or severe acute illness with or without fever; GBS within 6 wk after previous dose of tetanus toxoid–containing vaccine; history of Arthus-type (type III) hypersensitivity reactions after previous dose of diphtheria toxoid–containing vaccine Tdap: progressive or unstable neurologic disorder, uncontrolled seizures, or progressive encephalopathy until treatment regimen established and condition stabilized |
| Varicella (chickenpox) Live varicella vaccine (VAR, Varivax): 0.5 mL SC | Anyone without evidence of immunity: Administer two doses (4–8 wk apart); if one dose given previously, only give second dose Evidence of immunity:
| Severe allergic reaction to any vaccine component or after a previous dose; known severe immunodeficiency (e.g., hematologic and solid tumors, receipt of chemotherapy, congenital immunodeficiency, long-term immunosuppressive therapy, HIV infection with CD4+ <200 cells/μL); pregnancy | Moderate or severe acute illness with or without fever; simultaneous or recent (≤2 wk) receipt of antibody-containing blood product; receipt of specific antivirals (i.e., acyclovir, famciclovir, valacyclovir) 24 h before vaccination; avoid antiviral use for 14 d after vaccination |
| Herpes zoster (shingles) Recombinant zoster vaccine (RZV; Shingrix): 0.5 mL IM Zoster vaccine live (ZVL; Zostavax): 0.65 mg SC | Adults ≥50 y: Administer two doses of RZV 2–6 mo apart regardless of prior episode of herpes zoster or receipt of ZVL (give RZV at least 2 mo after ZVL) Adults ≥60 y: Administer either two doses of RZV as above (preferred) or single dose of ZVL | Severe allergic reaction to a vaccine component ZVL: known severe immunodeficiency (e.g., hematologic and solid tumors, receipt of chemotherapy, congenital immunodeficiency, long-term immunosuppressive therapy, HIV infection with CD4+ <200 cells/μL); pregnancy | Moderate or severe acute illness with or without fever ZVL: receipt of specific antivirals (i.e., acyclovir, famciclovir, valacyclovir) 24 h before vaccination; avoid antiviral use for 14 d after vaccination |
| COVID-19 mRNA vaccine (Moderna; Spikevax) 0.5 mL IM (Pfizer-BioNTech; Comirnaty) 0.3 mL IM Viral vector (Johnson & Johnson’s Janssen) 0.5 mL IM | Everyone: Pfizer-BioNTech: Administer 2 doses three weeks apart in ages 12 and older Moderna: Administer 2 doses 4 wk apart in ages 18 and older J&J/Janssen: Administer 1 dose in ages 18 and older People with moderate to severe immune compromisea: consider an additional dose of mRNA vaccine at least 28 d after the initial two-dose primary series Boosters: Guidelines are in development, for most up-to-date recommendations please see cdc.gov/coronavirus/2019-ncov/vaccines/ | Severe or immediate allergic reaction after a previous dose or to a component of an mRNA COVID-19 vaccine | Moderate or severe acute illness; post marketing data demonstrated increased risks of myocarditis and pericarditis with a higher risk in males under 40 y of age, mostly with mRNA vaccines; a rare complication of thrombosis with thrombocytopenia syndrome (TTS) has been seen in women younger than 50 with J&J/Janssen1 |
Adapted from Centers for Disease Control and Prevention. Advisory Committee on Immunization Practices recommended adult immunization schedule for ages 19 years or older—United States, 2020. https://www.cdc.gov/vaccines/schedules/hcp/imz/adult.html
ESRD, end-stage renal disease
aNot limited to: moderate or severe primary immunodeficiency (e.g., DiGeorge syndrome, Wiskott-Aldrich syndrome); advanced/untreated HIV infection; active treatment for malignancies, solid-organ transplant; chimeric antigen receptor (CAR)-T-cell or hematopoietic stem cell transplant; immunosuppressive therapy (e.g., alkylating agents, antimetabolites, transplant-related immunosuppressive drugs, cancer chemotherapeutic agents, tumor-necrosis factor [TNF] blockers, and other biologic agents, and high-dose corticosteroids equivalent to prednisone ≥20 mg/day for ≥2 wk).
Table A-2: Selected Adult Postexposure Prophylaxis Recommendations
| Disease | Indications and Therapy |
| Anthrax | Indicated for all contacts. Either ciprofloxacin 500 mg PO q12h (preferred for pregnant women), or doxycycline 100 mg PO q12h for 60 d and anthrax vaccine absorbed (AVA) SC series (obtained from the CDC): First dose administered as soon as possible, second and third doses administered at 2 and 4 wk after the first dose. (Alternative antibiotic regimens available; see CDC website.) |
| Botulinum toxin | Close observation of exposed person; treat with heptavalent botulinum antitoxin (equine immunoglobulin) at first sign of illness (obtained via consultation with state health department). |
| Diphtheria | Indicated for close (e.g., household) contacts: Benzathine penicillin G 1.2 million units IM once or erythromycin (base) 500 mg PO q12h for 7–10 d and tetanus and diphtheria (Td) booster vaccine (see Table A-1). Diphtheria antitoxin (DAT) 10,000 units IM/IV (after appropriate sensitivity testing) used for prophylaxis only in exceptional circumstances, obtained in consultation with the CDC (770-488-7100). |
| Hepatitis A | Indicated for unvaccinated household and sexual contacts of infected individual; persons who have shared illicit drugs with the infected individual; coworkers of infected food handlers; all staff and children at day care centers caring for diapered children where ≥1 case has occurred or when cases occur in ≥2 households of center attendees; only classroom contacts in centers not caring for diapered children. For healthy persons <40 y: Administer single-antigen hepatitis A vaccine (see Table A-1). For persons ≥40 y, immune compromised, or with chronic liver disease: Administer single-antigen hepatitis A vaccine (see Table A-1) and immune globulin (IG), 0.1 mL/kg IM, once within 14 d of exposure. |
| Hepatitis B | Nonoccupational: If exposure source is known surface antigen positive, unvaccinated or incompletely vaccinated persons should receive vaccine (see Table A-1) and hepatitis B immune globulin (HBIG) 0.06 mL/kg IM once. Vaccinated persons without serologic confirmation of immunity should receive one vaccine dose. If exposure source antigen status is unknown, unvaccinated persons should receive the vaccine series, and incompletely vaccinated persons should receive the remaining doses. Vaccinated persons require no further treatment. Occupational: See Table A-3. |
| HIV | Nonoccupational: Indicated within 72 h of exposure to HIV-infected blood, urogenital secretions, or other body fluids (e.g., condomless sexual intercourse, needle sharing). Administer tenofovir-emtricitabine 300/200 mg (1 tablet) PO daily with raltegravir 400 mg PO q12h or dolutegravir 50 mg once daily for 28 d. Test for HIV at presentation and ensure follow-up for repeat HIV testing at 6 wk. See https://www.cdc.gov/hiv/pdf/programresources/cdc-hiv-npep-guidelines.pdf. If alternative regimens desired, recommend consultation with an HIV specialist. Occupational: See Table A-3. |
| Measles | Nonoccupational: If nonimmune (see Table A-1), give measles, mumps, rubella (MMR) vaccine within 72 h of initial exposure. For pregnant women (if nonimmune) or severely immunocompromised (regardless of prior immunity), give immunoglobulin 400 mg/kg IV (IVIG) once, within 6 d of exposure. Monitor for signs/symptoms for at least one incubation period. Occupational: See Table A-3. |
| Meningococcus (Neisseria meningitidis) | Indicated for close contacts of patients with invasive meningococcal disease, including household contacts, child care center contacts, and persons directly exposed to the patient’s oral secretions. Administer ciprofloxacin 500 mg PO once, rifampin 600 mg PO q12h for 2 d, or ceftriaxone 250 mg IM once (preferred in pregnancy). |
| Pertussis (Bordetella pertussis, whooping cough) | Indicated for close contacts of symptomatic patients (face-to-face exposure ≤3 ft), persons with direct contact with infected respiratory or oral secretions, persons with high risk of severe illness (e.g., immunocompromised, third trimester of pregnancy, asthma), or those who will have contact with high-risk persons (including infants age <12 mo). Administer a macrolide antibiotic (azithromycin 500 mg PO day 1, 250 mg PO daily days 2–5; erythromycin 500 mg PO q6h for 14 d; clarithromycin 500 mg PO q12h for 7 d) within 21 d of onset of cough in exposure source. |
| Plague | Indicated for close contacts of pneumonic plague patients (face-to-face exposure ≤3 ft) that have received ≤48 h of effective antibiotic therapy or persons with direct contact with infected body fluids or tissues (for pregnant women, weigh prophylactic benefits with antibiotic risks). Administer doxycycline 100 mg PO q12h or ciprofloxacin 500 mg PO q12h for 7 d. |
| Rabies | See Rabies Postexposure Prophylaxis section of this Appendix. |
| Tetanus | For clean, minor wounds: If vaccination history unknown or <3 doses tetanus toxoid-containing vaccine, give Tdap and complete catch-up vaccination (see Table A-1). If ≥3 doses and >10 y since last dose, give Tdap (if not yet received) or Td. For all other wounds: If vaccination history unknown or <3 doses tetanus toxoid-containing vaccine, give tetanus immune globulin 250 units IM once, as well as Tdap (at separate site) and complete catch-up vaccination. If ≥3 doses and >5 y since last dose, give Tdap (if not yet received) or Td. |
| Tularemia | Routine prophylaxis not recommended. If exposure in bioterrorism or mass casualty setting, give doxycycline 100 mg PO q12h or ciprofloxacin 500 mg PO q12h (preferred in pregnant women) for 14 d. |
| Smallpox | Indicated in setting of intentional release of smallpox (variola virus) for exposed persons and persons with contact with infectious materials from smallpox patients, weighing risks and benefits for those with relative contraindications. Administer smallpox (vaccinia) vaccine (ACAM2000; available from the CDC Drug Service at 404-639-3670) ideally within 3 d of exposure; vaccination 4–7 d after exposure may offer some protection. |
| Varicella | Indicated for exposed persons without evidence of immunity. Vaccinate (see Table A-1) within 3 d of exposure (possibly effective up to 5 d of postexposure). If contraindication to vaccination and at high risk of severe infection (e.g., pregnant women, immunocompromised, malignancy), give varicella-zoster immune globulin (VariZIG) 12.5 international units (IU)/kg IM once (minimum, 125 IU; maximum, 625 IU) within 10 d of exposure, which can be obtained from FFF Enterprises (800-843-7477, http://www.fffenterprises.com). |
CDC, Centers for Disease Control and Prevention; Tdap, tetanus, diphtheria, pertussis.
Table A-3: Selected Postexposure Guidelines for Healthcare Personnela
| Pathogen | Treatment |
| HIV | Indicated for exposure to HIV-infected blood, tissue, or body fluids (e.g., semen, vaginal secretions, amniotic fluid)b via percutaneous injury, contact with mucous membranes, or contact with nonintact skin. Administer as soon as possible within 72 h after exposure (can consider up to 1 wk in very–high risk cases). Preferred regimen is tenofovir-emtricitabine 300/200 mg (1 tablet) PO daily and raltegravir 400 mg PO bid for 28 d or until exposure source tests negative for HIV (unless acute seroconversion is suspected).c Test exposed workers at baseline, 6 wk, 12 wk, and 6 mo for HIV (baseline, 6 wk, and 4 mo if using fourth-generation test). Assistance with choosing a regimen may be obtained by calling the National Clinicians’ Post-Exposure Prophylaxis Hotline (PEPline) at 1-888-448-4911 (9 a.m.–2 a.m. ET) or consulting an HIV expert. |
| Hepatitis B | For percutaneous injury with blood or blood-contaminated fluids from known surface antigen–positive source: Unvaccinated healthcare worker: Administer hepatitis B immunoglobulin (HBIG), 0.06 mL/kg IM, within 96 h of exposure AND start hepatitis B vaccine series (see Table A-1). Vaccinated healthcare worker:
|
| Hepatitis C | Immunoglobulin and postexposure prophylaxis not effective. Ensure occupational health follow-up for baseline and subsequent follow-up testing. |
| Measles | If no documented evidence of immunity, give MMR vaccine within 72 h of initial exposure. For pregnant women (if nonimmune) or severely immunocompromised (regardless of prior immunity), give immunoglobulin 400 mg/kg IV (IVIG) once within 6 d of exposure. Monitor for signs/symptoms for at least one incubation period. Healthcare personnel without evidence of immunity should be off duty from day 5 after first exposure to day 21 after last exposure, regardless of whether prophylaxis was given. |
aAll blood and body fluid exposures should be reported to the occupational health department. Source patients should be tested for HIV (with consent), hepatitis B surface antigen (HbsAg), and hepatitis C antibody (anti-HCV).
bBody fluids not considered infectious include feces, urine, vomitus, saliva, and tears, unless these are visibly contaminated with blood.
cMultiple alternative antiretroviral regimens are available if exposed worker has contraindications to or is otherwise unable to use the preferred regimen, or if the exposure source is known to have resistant virus. See Infect Control Hosp Epidemiol. 2013;34:875. Consultation with an HIV specialist is recommended in such cases.
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Citation
Bhat, Pavat, et al., editors. "Immunizations and Postexposure Therapies." Washington Manual of Medical Therapeutics, 35th ed., Wolters Kluwer Health, 2016. The Washington Manual, www.unboundmedicine.com/washingtonmanual/view/Washington-Manual-of-Medical-Therapeutics/602787/all/Immunizations_and_Postexposure_Therapies.
Immunizations and Postexposure Therapies. In: Bhat PP, Dretler AA, Gdowski MM, et al, eds. Washington Manual of Medical Therapeutics. Wolters Kluwer Health; 2016. https://www.unboundmedicine.com/washingtonmanual/view/Washington-Manual-of-Medical-Therapeutics/602787/all/Immunizations_and_Postexposure_Therapies. Accessed November 30, 2023.
Immunizations and Postexposure Therapies. (2016). In Bhat, P., Dretler, A., Gdowski, M., Ramgopal, R., & Williams, D. (Eds.), Washington Manual of Medical Therapeutics (35th ed.). Wolters Kluwer Health. https://www.unboundmedicine.com/washingtonmanual/view/Washington-Manual-of-Medical-Therapeutics/602787/all/Immunizations_and_Postexposure_Therapies
Immunizations and Postexposure Therapies [Internet]. In: Bhat PP, Dretler AA, Gdowski MM, Ramgopal RR, Williams DD, editors. Washington Manual of Medical Therapeutics. Wolters Kluwer Health; 2016. [cited 2023 November 30]. Available from: https://www.unboundmedicine.com/washingtonmanual/view/Washington-Manual-of-Medical-Therapeutics/602787/all/Immunizations_and_Postexposure_Therapies.
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