Vaccination providers frequently encounter people who do not have adequate documentation of vaccinations. Providers should only accept written, dated records as evidence of vaccination. CDC recommends that, with the exception of influenza and pneumococcal polysaccharide vaccines, self-reported doses of vaccine without written documentation should generally not be accepted. The ACIP recommendation for administering a primary series of inactivated polio vaccine to an adult also indicates that adults may generally be presumed to have had a primary series of polio vaccine unless there is a specific reason to believe that they have not been vaccinated against polio. Professional judgment is also required when assessing adults without a record of hepatitis B vaccination: vaccination rates for hepatitis B in childhood have been high since the late 1990s and routine infant HepB vaccination began in 1991. In the absence of a record or of screening results demonstrating evidence of hepatitis B immunity or resolved or chronic infection, if there is any suspicion that the adult was unvaccinated, then vaccination is recommended.
An attempt to locate missing records should be made whenever possible by contacting previous healthcare providers, reviewing state or local immunization information systems (IIS, registries), and searching for a personally held record. However, if records cannot be located or are unavailable anywhere because of the patient’s circumstances, people without adequate documentation should be considered susceptible and should be started on the age-appropriate vaccination schedule. Serologic testing for immunity is an alternative to vaccination for certain antigens (e.g., measles, rubella, or hepatitis A).
In general, although it is not ideal, receiving extra doses of vaccine poses no medical problem. Receiving excessive doses of tetanus toxoid (DTaP, DT, Tdap, or Td) can increase the risk of a local adverse reaction, however. For details, consult the CDC’s “Best Practices for Immunization” chapter titled Timing and Spacing of Immunobiologics, available at www.cdc.gov/vaccines/hcp/imz-best-practices/timing-spacing-immunobiologics.html.
