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HomeMy WebLinkAboutBlue Shield Preventative Guidelinesblueshieldca.com Preventive Health Guidelines The power of prevention The power of prevention Put our preventive health guidelines into practice. Your family’s health could depend on it. You’ve heard the old saying about an ounce of prevention. Your doctors know that preventive screenings and tests often are the best first steps in preventing illness. They also allow for rapid response at early onset of health problems, when treatments can be most effective. To take advantage of the power of prevention, you and your entire family need to stay current with the recommended screenings and tests appropriate for your age, gender, medical history, current health and family history. We have compiled the following guidelines to help you keep track of what’s needed and when. It’s just one more way we’re working to make your health easier to maintain. For children ages 0 to 2 Immunizations Shot number in a series 1 2 3 4 DTaP (diphtheria, tetanus, acellular pertussis) 2 4 6 15–18 months Flu, annual For children 6 months and older 2,18 Hepatitis A 12–23 months (second dose at least 6 months after first) Hepatitis B 0 (birth)1–2 6–18 months Hib (Haemophilus influenzae type b) 2 4 6 12–15 months IPV (inactivated poliovirus vaccine) 2 4 6–18 months Meningococcal Age 2 months–18 months 2 4 6 12 months MMR (measles, mumps, rubella) First dose at 12–15 months, second dose at ages 4–6 Pneumococcal (pneumonia)2 4 6 12–15 months RotaRix (rotavirus), or 2 4 months RotaTeq (rotavirus)2 4 6 months Varicella (chicken pox)12–15 months, second dose at ages 4–6 Screenings/counseling/services Autism Children 18–30 months old Blood tests 24–48 hours after birth1 Flouride use Discuss use or prescribe supplement for age 6 months and older24 Gonococcal ophthalmia Topical eye medication administered during initial newborn care Hearing loss One- or two-step screening process for newborns Height and weight Periodically Iron deficiency anemia Children age 6–12 months at average or increased risk Lead Risk assessment for children up to age 18 identified as at risk for lead poisoning Sickle cell disease screening Risk assessment and testing if risk identified Tuberculosis Risk assessment and testing if risk identified Topics you may want to discuss with your doctor Safety • Use a checklist to “babyproof” your home. • Check your home for the presence of lead paint. Nutrition • Breast-feeding and iron- enriched formula and food for infants. Dental health • Do not put your baby or toddler to bed with a bottle containing juice, milk or other sugary liquid. Do not prop a bottle in a baby’s or toddler’s mouth. Clean your baby’s gums and teeth daily. • Use a clean, moist washcloth to wipe gums. Use a soft toothbrush with water only, beginning with eruption of first tooth. • Age 6 months to preschool: Discuss with your dentist about taking an oral fluoride supplement if water is deficient in fluoride. • Age 2: Begin brushing child’s teeth with pea-size amount of fluoride toothpaste. Autism • Assessment at 18 and 30 months by your child’s doctor. Injury prevention for: infants and young children A special message about SIDS. Sudden infant death syndrome (SIDS) is the leading cause of death for infants. Put infants to sleep on their backs to decrease the risk of SIDS. Take these steps to “babyproof” your home and give your child a safe environment: • Use the right car seat for your vehicle and for your child’s weight. Read the car seat and vehicle manufacturer’s instructions about installation and use. Use a rear-facing car seat until your child is at least 1 year old and weighs at least 20 pounds. • Keep medicines, cleaning solutions and other dangerous substances in childproof containers, locked up and out of reach of children. • Use safety gates across stairways (top and bottom) and guards on windows above the first floor. • Keep hot-water heater temperatures below 120° F. • Keep unused electrical outlets covered with plastic guards. • Provide constant supervision for babies using a baby walker. Block the access to stairways and to objects that can fall (such as lamps) or cause burns (such as stoves or electric heaters). • Keep objects and foods that can cause choking away from your child. This includes things like coins, balloons, small toy parts, hot dogs (unmashed), peanuts and hard candy. • Use fences that go all the way around pools, and keep gates to pools locked. Immunizations DTaP (diphtheria, tetanus, acellular pertussis) Ages 4–6 Flu, annual Recommended2,18 Hepatitis A For children not previously vaccinated and risk factors are present Hepatitis B For children who did not complete the immunization series between 0–18 months IPV (inactivated poliovirus vaccine) Ages 4–6 MMR (measles, mumps, rubella) Second dose at ages 4–6 Pneumococcal (pneumonia)For children with risk factors 6 or an incomplete schedule (ages 2–5) Varicella (chicken pox)Second dose at ages 4–6 Screenings/counseling/services Height, weight, vision, BMI and hearing At annual exam Flouride use Discuss use or prescribe supplement for age 5 and younger24 Iron deficiency anemia Children newborn to age 21 Lead Risk assessment for children up to age 18 identified as at risk for lead poisoning Obesity Screening, counseling and behavioral interventions for children age 6 and older Skin cancer Behavioral counseling for minimizing exposure to ultraviolet radiation for children age 10 and older at high risk Tuberculosis Risk assessment and testing if risk identified Topics you may want to discuss with your doctor Safety • Use a checklist to “child- proof” your home. • Check your home for the presence of lead paint. Exercise • Ages 0–5: Participate in physical activity as a family, such as taking walks or playing at the playground. Limit television to less than two hours a day. • Age 6 and up: Regular physical activity can reduce the risks of coronary heart disease, osteoporosis, obesity and diabetes. Nutrition • Eat a healthy diet. Limit fat and calories. Eat fruits, vegetables, beans and whole grains every day. Dental health • Ask your dentist when and how to floss child’s teeth. • Age 5: Talk to your dentist about dental sealants. Other topics for discussion • Well-child visits are a good time to talk to your doctor about any concerns you have with your child’s health, growth or behavior. Be aware of your child’s recommended weight: Use our online tools to calculate your child’s body mass index (BMI) by logging in to blueshieldca.com and searching for BMI. For children ages 3 to 10 Injury prevention for: Older children • Children should use a booster seat in the car’s back seat until they are at least 8 years old or weigh at least 80 pounds. • Older children should use car seat belts and sit in the back seat at all times. • Make sure your child wears a helmet while rollerblading or riding a bicycle. Make sure your child uses protective equipment for rollerblading and skateboarding (helmet, wrist and knee pads). • Warn your child of the dangers of using alcohol and drugs. Many driving and sports-related injuries are caused by the use of alcohol and drugs. For all ages • Use smoke detectors in your home.Change the batteries every year, and check once a month to see that they work. • If you have a gun in your home, make sure that the gun and ammunition are locked up separately and kept out of children’s reach. • Never drive after drinking alcohol. • Use car seat belts at all times. • Teach your child traffic safety. Children under 9 years old need supervision when crossing streets. • Teach your children how and when to call 911. • Learn basic life-saving skills (CPR). • Post the number for the Poison Control Center – (800) 222-1222 – near your phone. Also, write it in the space on your home “Important Information” list. The number is the same in every U.S. location. Do not try to treat poisoning until you have called the Poison Control Center. Immunizations Flu, annual Recommended2 Hepatitis A For individuals not previously vaccinated and risk factors are present Hepatitis B For individuals not previously vaccinated HPV (human papillomavirus) A three-shot series at pre-adolescent visit (ages 11–12); may also be given to females ages 9–26 and males ages 9–26 Meningococcal At pre-adolescent visit (ages 11–12); administer to college-bound students living in a dorm if not previously immunized8 MMR (measles, mumps, rubella) At pre-adolescent visit (ages 11–12 ) if missing second dose Pneumococcal (pneumonia)For children with risk factors6 Tdap booster (tetanus, diphtheria, pertussis) For children ages 11–12 who have completed the recommended DTaP immunization series17 Varicella (chicken pox)At pre-adolescent visit (ages 11–12) if missing second dose Screenings/counseling/services Alcohol misuse Behavioral counseling Blood pressure, height, weight, BMI and hearing At annual exam Cervical cancer Recommended for women who have been sexually active Chlamydia Recommended for all sexually active women under age 25 and for women at increased risk for infection11 Contraception FDA-approved contraceptive methods for females, education and counseling32 Depression For all adolescents Domestic violence and abuse Screening for interpersonal and domestic violence for adolescents, women, and women of childbearing age34 Gonorrhea Recommended for all sexually active women who are at increased risk for infection11 Healthy diet and physical activity Behavioral counseling27 Hepatitis B Screening for HBV infection in persons at high risk of infection29 Hepatitis C Screening for HBV infection in persons at high risk of infection30 HIV For all adolescents at increased risk for HIV infection 23 Iron deficiency anemia Children newborn to age 21 Lead Risk assessment for children up to age 18 identified as at risk for lead poisoning Obesity Screening, counseling and behavioral interventions Sexually transmitted infections Behavioral counseling as needed26 Skin cancer Behavioral counseling for minimizing exposure to ultraviolet radiation for adolescents at high risk Syphilis For individuals at increased risk for infection12 Tobacco use and cessation Screening for tobacco use and cessation intervention Tuberculosis Risk assessment and testing if risk identified Topics you may want to discuss with your doctor Exercise • Regular physical activity (at least 30 minutes per day starting at age 11) can reduce the risks of coronary heart disease, osteoporosis, obesity and diabetes. Nutrition • Eat a healthy diet. Limit fat and calories. Eat fruits, vegetables, beans and whole grains every day. • Optimal calcium intake for adolescents and young adults is estimated to be 1,200 to 1,500 mg/day. Sexual health • Sexually transmitted infection (STI)/HIV prevention,16 practice safe sex (use condoms) or abstinence. • Avoid unintended pregnancy; use contraception. Substance use disorder • Use of alcohol, tobacco (cigarettes or chewing), inhalants and other drugs among adolescents is a major concern for parents. Let the doctor know if you have any concerns about your child. Dental health • Floss and brush with fluoride toothpaste daily. Seek dental care regularly. Other topics for discussion • It is a good idea to let your teenager have private time with the doctor to ask any questions he or she may not feel comfortable asking you. For children ages 11 to 19 Promoting your pre-teen’s and adolescent’s social and emotional development Parents need to offer open, positive communication while providing clear and fair rules and consistent guidance. Let your child find his or her own path while staying within the boundaries you have set. • Be a good role model for how to handle disagreements, such as by talking calmly. • Praise him or her for successfully avoiding a confrontation, such as by saying, “I’m proud of you for staying calm.” • Supervise the websites and computer games that your child uses. • Set limits on use of computers,telephones, texting and TV after a set evening hour to help your child get regular sleep. • Talk to your child about healthy relationships. Dating abuse does occur among preteens and teens. • Be a role model for healthy eating and regular physical exercise. Immunizations Flu, annual Recommended2 Hepatitis A For individuals with risk factors; for individuals seeking protection3 Hepatitis B For individuals with risk factors; for individuals seeking protection4 HPV (human papillomavirus)For all women age 26 and younger if not previously immunized Meningococcal College-bound students living in a dorm if not previously immunized8 MMR (measles, mumps, rubella) Once, without proof of immunity or if no previous second dose5 Pneumococcal (pneumonia)For individuals with risk factors7 Td booster (tetanus, diphtheria) Recommended once every 10 years15 Varicella (chicken pox)Recommended for adults without evidence of immunity; should receive 2 shots10 Screenings/counseling/services Alcohol misuse Behavioral counseling Blood pressure, depression, height, weight and BMI At well visit, annually Breast cancer Recommend mammogram every 1–2 years beginning at age 40; BRCA/BART testing is covered if medically necessary20 Breast cancer chemoprevention Recommended for women at high risk for breast cancer and low risk for adverse effects from chemoprevention Cervical cancer Recommend for women who have been sexually active and have a cervix Chlamydia Recommended for all sexually active women under age 25 and for women at increased risk for infection11 Contraception FDA-approved female contraceptive methods, education and counseling32 Depression For all adults Diabetes Recommend type 2 diabetes screening for individuals with sustained blood pressure greater than 135/80 mm Hg22 Domestic violence and abuse Screening for interpersonal and domestic violence for adolescents, women, and women of childbearing age34 Gonorrhea Recommend for all sexually active women who are at increased risk for infection11 Healthy diet and physical activity Behavioral counseling27 Hepatitis B Screening for HBV infection in persons at high risk of infection29 Hepatitis C Screening for HBV infection in persons at high risk of infection30 HIV For all adults at increased risk23 HPV Recommended for all sexually active women age 30 and older in conjunction with cervical cancer screening (Pap smear) Latent tuberculosis infection (LTBI) Screening for asymptomatic adults at increased risk for infection33 Lipid disorder Recommended for individuals at increased risk9 Obesity Screening, counseling and behavioral interventions Sexually transmitted infections Behavioral counseling as needed26 Skin cancer Behavioral counseling for minimizing exposure to ultraviolet radiation for young adults to age 24 at high risk Syphilis Routine screening for pregnant women and individuals at increased risk for infection12 Tobacco use and cessation Screening for tobacco use and cessation intervention Topics you may want to discuss with your doctor Exercise • Regular physical activity (at least 30 minutes per day) can reduce the risks of coronary heart disease, osteoporosis, obesity and diabetes. • Over 40: Consult physician before starting new vigorous physical activity. Nutrition • Know your body mass index (BMI), blood pressure and cholesterol level. Modify your diet accordingly. • Eat a healthy diet. Limit fat and calories. Eat fruits, vegetables, beans and whole grains every day. • Optimal calcium intake for women between ages 25 and 50 is estimated to be 1,000 mg/day. • Vitamin D is important for bone and muscle development, function and preservation. Sexual health • Sexually transmitted infection (STI)/HIV prevention,16 practice safer sex (use condoms) or abstinence. • Avoid unintended pregnancy; use contraception. Substance use disorder • Stop smoking. Limit alcohol consumption. Avoid alcohol or drug use while driving. Dental health • Floss and brush with fluoride toothpaste daily. Seek dental care regularly. If you are pregnant, please refer to the “For pregnant women” page for pregnancy-related recommendations. For women ages 20 to 49 Immunizations Flu, annual Recommended2 Hepatitis A For individuals with risk factors; for individuals seeking protection3 Hepatitis B For individuals with risk factors; for individuals seeking protection4 HPV (human papillomavirus)For all men age 26 and younger if not previously immunized Meningococcal College-bound students living in a dorm if not previously immunized8 MMR (measles, mumps, rubella) Once, without proof of immunity or if no previous second dose5 Pneumococcal (pneumonia) For individuals with risk factors7 Td booster (tetanus, diphtheria) Recommended once every 10 years15 Varicella (chicken pox)Recommended for adults without evidence of immunity; should receive two shots10 Screenings/counseling/services Alcohol misuse Behavioral counseling Blood pressure, depression, height, weight and BMI At annual exam Cardiovascular disease Statin use for primary prevention in adults 35 Depression For all adults Diabetes Recommend type 2 diabetes screening for individuals with sustained blood pressure greater than 135/80 mm Hg22 Healthy diet and physical activity Behavioral counseling27 Hepatitis B Screening for HBV infection in persons at high risk of infection29 Hepatitis C Screening for HBV infection in persons at high risk of infection30 HIV For all adults at increased risk 23 Latent tuberculosis infection (LTBI) Screening for asymptomatic adults at increased risk for infection33 Lipid disorder Screening periodically, starting at age 35; age 20 if at increased risk9 Obesity Screening, counseling and behavioral interventions Prostate cancer Beginning at age 40 if at increased risk 25 Sexually transmitted infections Behavioral counseling as needed26 Skin cancer Behavioral counseling for minimizing exposure to ultraviolet radiation for young adults to age 24 at high risk Syphilis, chlamydia and gonorrhea Routine screening for individuals at increased risk for infection11,12 Tobacco use and cessation Screening for tobacco use and cessation intervention Topics you may want to discuss with your doctor Exercise • Regular physical activity (at least 30 minutes per day) can reduce the risks of coronary heart disease, osteoporosis, obesity and diabetes. • Men over 40: Consult physician before starting new vigorous physical activity. Nutrition • Know your body mass index (BMI), blood pressure and cholesterol level. Modify your diet accordingly. • Vitamin D is important for bone and muscle development, function and preservation. Sexual health • Sexually transmitted infection (STI)/HIV prevention,16 practice safer sex (use condoms) or abstinence. Substance use disorder • Stop smoking. Limit alcohol consumption. • Avoid alcohol or drug use while driving. Dental health • Floss and brush with fluoride toothpaste daily. Seek dental care regularly. “Know your numbers.” We encourage you to learn your “numbers” at your doctor visit and work toward the optimal goals through exercise and a healthy diet. Heart health factors Optimal goals Total cholesterol Less than 200 mg/dL LDL “bad” cholesterol Less than 100 mg/dL HDL “good” cholesterol 50 mg/dL or higher Triglycerides Less than 150 mg/dL Blood pressure Less than 120/80 mmHg Fasting glucose Less than 100 mg/dL Body mass index (BMI) Less than 25 kg/m2 Exercise Minimum of 30 minutes most days of the week For men ages 20 to 49 Immunizations Flu, annual Recommended2 Hepatitis A For individuals with risk factors; for individuals seeking protection3 Hepatitis B For individuals with risk factors; for individuals seeking protection4 MMR (measles, mumps, rubella) Once, without proof of immunity or if no previous second dose5 Pneumococcal (pneumonia) Recommended for individuals age 65 and older; and individuals under age 65 with risk factors7 Td booster (tetanus, diphtheria) Recommended once every 10 years15 Varicella (chicken pox)Recommended for adults without evidence of immunity; should receive two shots10 Zoster (shingles)Recommended for all adults age 60 and older Screenings/counseling/services AAA (abdominal aortic aneurysm) For ages 65–75 who have ever smoked, one-time screening for AAA by ultrasonography Alcohol misuse Behavioral counseling Aspirin Visit to discuss potential benefit of use19 Blood pressure, depression, height, weight, BMI and hearing At annual exam Breast cancer Recommend mammogram every 1–2 years beginning at age 40; BRCA/BART testing is covered if medically necessary20 Breast cancer chemoprevention Covered for individuals at high risk for breast cancer and low risk for adverse effects from chemoprevention Cardiovascular disease Statin use for primary prevention in adults 35 Cervical cancer At least every 3 years if cervix present; after age 65, Pap tests can be discontinued if previous tests have been normal Colorectal cancer Recommended for adults ages 50–7521 Depression For all adults Diabetes Recommend type 2 diabetes screening for individuals with sustained blood pressure greater than 135/80 mm Hg22 Domestic violence and abuse Screening for interpersonal and domestic violence for adolescents, women, and women of childbearing age34 Fall prevention Age 65 or older28 Gonorrhea and chlamydia Recommended for individuals who are at increased risk for infection11 Healthy diet and physical activity Behavioral counseling27 HIV For all adults at increased risk for HIV infection23 HPV Recommended for all sexually active individuals age 65 and younger Latent tuberculosis infection (LTBI) Screening for asymptomatic adults at increased risk for infection33 Lipid disorder Screening periodically Lung cancer Screening for lung cancer in persons with smoking history31 Obesity Screening, counseling and behavioral interventions Osteoporosis Recommend routine screening for women age 65 and older; routine screening for men age 70 and older – beginning age can be reduced for individuals at increased risk13 Prostate cancer Prostate-specific antigen (PSA) test and digital rectal exam.May or may not be appropriate. Discuss with your doctor to see if it is more beneficial than harmful in your case Sexually transmitted infections Behavioral counseling as needed26 Syphilis Recommended for individuals at increased risk for infection12 Tobacco use and cessation Screening for tobacco use and cessation intervention Topics you may want to discuss with your doctor Nutrition • Eat a healthy diet. Limit fat and calories. Eat fruits, vegetables, beans and whole grains every day. • Optimal calcium intake is estimated to be 1,500 mg/day for postmenopausal women not on estrogen therapy. • Vitamin D is important for bone and muscle development, function and preservation. Sexual health • Sexually transmitted infection (STI)/HIV prevention,16 practice safer sex (use condoms) or abstinence. Substance use disorder • Stop smoking. Limit alcohol consumption. Avoid alcohol or drug use while driving. Dental health • Floss and brush with fluoride toothpaste daily. Seek dental care regularly. Other topics for discussion • Fall prevention. • Possible risks and benefits of hormone replacement therapy (HRT) for post- menopausal women. • Risks for and possible benefits of prostate cancer screening in men to determine what is best for you. • The dangers of drug interactions. • Physical activity. • Glaucoma eye exam by an eye care professional (i.e., an ophthalmologist, optometrist) for those age 65 and older. For heart health, adults should exercise regularly (at least 30 minutes a day on most days), which can help reduce the risks of coronary heart disease, osteoporosis, obesity and diabetes. Consult your physician before starting a new vigorous physical activity. For men and women age 50 and older Screenings/counseling/services Alcohol misuse Behavioral counseling Aspirin Low-dose aspirin use for the prevention of morbidity and mortality from preeclampsia14 Asymptomatic bacteriuria 12–16 weeks gestation or first prenatal visit if after 16 weeks gestation Breast-feeding counseling Promote breast-feeding to pregnant or postpartum women. Provide comprehensive lactation support and breast- feeding equipment. Chlamydia During first prenatal visit and second screening during the third trimester for those at increased risk11 Depression For all adults Folic acid Discuss use of 0.4 to 0.8 mg daily Gestational diabetes Women between 24- to 28-week gestations and the first prenatal visit for pregnancy. Women identified to be at increased risk for diabetes. Gonorrhea First prenatal visit and second screening during the third trimester if at increased risk11 Hepatitis B First prenatal visit29 HIV First prenatal visit23 Rh (D) incompatibility First prenatal visit and repeat testing at 24- to 28-week gestation unless the biological father is known to be Rh (D) negative for unsensitized Rh (D) negative pregnant women Syphilis First prenatal visit, second screening during the third trimester, and at delivery for those at increased risk12 Tobacco use and cessation Screening for tobacco use and tobacco-cessation intervention Having a baby? Be aware that while almost all women get the “baby blues” after childbirth, as many as 10% will get postpartum depression. For more information visit our website, blueshieldca.com, and search “postpartum depression” or see your healthcare provider. For pregnant women Recommendations for a healthy pregnancy Prenatal care Begin within 14 days of confirming pregnancy. Dietary supplements Women of childbearing age should take 0.4 to 0.8 mg of folic acid daily to decrease the risk of fetal birth defects of the brain or spine; recommended calcium intake for pregnant or nursing women: 1,000 milligrams daily. Screenings and diagnostics Blood pressure and weight check at all visits: urine test, obstetrical history and physical, screenings for asymptomatic bacteriuria, chlamydia, gestational diabetes, Group B streptococcal bacteria, Hepatitis B, syphilis, gonorrhea, hematocrit, rubella, varicella, Rh (D) incompatibility; HIV counseling and screening, ultrasonography, screening for alpha fetoprotein (SB 75 alpha feto protein), chorionic villus screening (CVS) or amniocentesis (for women age 35 and older), blood test for certain birth defects, prior vaccinations (including flu shots), fundal height, fetal heart tones, discuss preterm labor risk, history of genital herpes, nutrition, smoking cessation, domestic abuse, mental health as an initial intervention service after screening for interpersonal and domestic violence, and other medication and drug use. Discussion topics at prenatal care visits Prior vaccinations (including flu shots), history of genital herpes, nutrition, smoking cessation, other medication and drug use. Postpartum care To be performed within three to seven weeks following delivery. Postpartum exam to include weight, blood pressure, breast and abdomen exam, or pelvic exam. Endnotes 1. Blood test for newborns may include congenital hypothyroidism, phenylketonuria and sickle cell disease. 2. Annual vaccination against influenza is recommended for all persons age 6 months and older, including all adults. Healthy, nonpregnant adults under age 50 without high-risk medical conditions can receive either intranasally administered live, attenuated influenza vaccine, or inactivated vaccine. Other persons should receive the inactivated vaccine. Adults age 65 and older can receive the standard influenza vaccine or the high-dose influenza vaccine. 3. Risk factors for hepatitis A should be discussed with your provider. 4. Risk factors for hepatitis B should be discussed with your provider. 5. Measles component: Adults born before 1957 can be considered immune to measles. Adults born on or after 1957 should receive one or more doses of MMR, depending on their immune status. Also, a second dose of MMR may be necessary if exposed, traveling internationally, and other factors. Rubella component: Women with unreliable vaccination history should check with their provider. Check with your doctor for details regarding pregnancy. 6. Administer pneumococcal vaccine to children with certain underlying medical conditions, including a cochlear implant. A single revaccination should be administered after five years to children with functional or anatomic asplenia or an immunocompromising condition. 7. One dose for adults at risk, including those with chronic lung diseases (including asthma and COPD); cardiovascular diseases, diabetes mellitus, chronic liver disease, chronic renal failure, sickle cell disease, and immunocompromising conditions. Vaccination is also recommended in adults who smoke cigarettes and residents of nursing homes and long-term care facilities. Vaccination is not recommended in Alaska Native or American Indian persons unless they have another risk factor present. A second pneumococcal dose may be necessary for people age 65 and older who received the vaccine more than five years previously and were younger than 65 at the time of the primary vaccination. A one-time revaccination is recommended after five years for people with certain medical conditions, including immunosuppressive conditions and people who have undergone chemotherapy. 8. Individuals at risk for meningococcal disease include international travelers, college-bound students or anyone with a damaged or removed spleen or with terminal complement component deficiency. These individuals should discuss the risks and benefits of vaccination with their doctor. 9. Lipid disorders risk factors for men ages 20–35 or women age 20 and older include diabetes, previous personal history of congestive heart disease or non-coronary atherosclerosis, family history of cardiovascular disease before age 50 in male relatives and age 60 in female relatives, tobacco use, and obesity (BMI ≥ 30). 10. Individuals at risk for varicella infection include those who have close contact with persons at high risk for severe disease (healthcare workers and family contacts of immunocompromised persons) or are at high risk for exposure or transmission (e.g., teachers of young children; childcare employees; residents and staff members of institutional settings, including correctional institutions; college students; military personnel; adolescents and adults living in households with children; nonpregnant women of childbearing age; and international travelers). 11. Risk factors for chlamydia and gonorrhea infection include history of chlamydial or other sexually transmitted infections, new or multiple sexual partners, inconsistent condom use, commercial sex work and drug use. 12. Risk factors for syphilis infection include all adolescents and adults who receive health care in a high-prevalence or high-risk clinical setting, men who have had sex with men, commercial sex workers, and those in adult correctional facilities. Individuals being treated for sexually transmitted diseases may be more likely than others to engage in high-risk behavior. 13. Increased risks for osteoporosis include women ages 60 to 64 with all of the following risks for osteoporotic fractures: lower body weight (weight < 70 kg) and no current use of estrogen therapy. 14. Pregnant women who are at high risk for preeclampsia use low-dose aspirin (81 mg/d) as preventive medication after 12 weeks of gestation. 15. People in contact with infants under 12 months of age and healthcare personnel can be given the Td vaccine as soon as feasible. It is recommended that Tdap should replace a single dose of Td for adults under age 65 if they have not previously received a dose of Tdap. 16. Sexually transmitted infections, also known as sexually transmitted diseases, include chlamydia, gonorrhea, herpes, HIV, HPV, syphilis and others. See infection-specific notes for information on risk factors for sexually transmitted infections. 17. The Tdap (tetanus, diphtheria, acellular pertussis) booster is recommended in children ages 11 to 12 who have completed the childhood DTaP immunization series and have not yet received a tetanus and diphtheria (Td) booster dose. 18. Children through age 9 getting flu vaccine for the first time – or who received flu vaccine – should get two doses, at least four weeks apart. 19. Low-dose aspirin use for the primary prevention of cardiovascular disease (CVD) and colorectal cancer (CRC) in adults ages 50 to 59 years who have a 10% or greater 10-year CVD risk, are not at increased risk for bleeding, have a life expectancy of at least 10 years, and are willing to take low-dose aspirin daily for at least 10 years. 20. For breast cancer screening, BRCA mutation referral for genetic risk assessment and evaluation for breast and ovarian susceptibility is recommended for women with family history associated with an increased risk for deleterious mutations in BRCA1 or BRCA2 genes. BRCA/BART testing, if medically necessary. Please see Blue Shield of California medical policy on Genetic Testing for Hereditary Breast and/or Ovarian Cancer. 21. Colorectal cancer screenings include fecal occult blood annually, sigmoidoscopy every five years, and colonoscopy every 10 years. Beginning age and screening interval can be reduced for patients at increased risk. Multi-targeted stool DNA testing every three years. 22. Diabetes screening should be performed for adults with blood pressure 135/80 or lower if knowledge of diabetes status would help inform decisions about coronary heart disease prevention strategies. Diabetes screening should be performed for adults ages 40 to 70 who are overweight and obese. Intensive behavioral counseling interventions to promote a healthful diet and physical activity for patients with abnormal blood glucose. 23. Individuals at risk for HIV infection include all adolescents and adults who receive health care in high-prevalence or high-risk clinical setting; men who have had sex with men after 1975; individuals having unprotected sex with multiple partners; past or present injection drug users; commercial sex workers; individuals whose past or present sex partners were HIV infected, bisexual, or injection drug users; individuals being treated for sexually transmitted diseases; individuals with a history of blood transfusion between 1978 and 1985; and individuals who requested an HIV test despite reporting no individual risk factors. 24. Fluoride oral supplement should be discussed at preventive care visit if primary water source is deficient in fluoride. 25. Increased risk factors for prostate cancer include African-American men and men with family history of prostate cancer. 26. Behavioral counseling to prevent sexually transmitted infections is for sexually active adolescents and adults who meet the following criteria: current sexually transmitted infections, sexually transmitted infections within the past year, multiple current sexual partners, and in non-monogamous relationships if they reside in a community with a high rate of sexually transmitted infections. 27. Intensive behavioral counseling to promote healthy diet and physical activity is recommended for all adults who have hyperlipidemia or have any known risk factors for cardiovascular and diet-related chronic disease. Diabetes Prevention Program – Blue Shield’s lifestyle medicine program focused on diabetes prevention. 28. Falls prevention counseling for older adults to exercise or physical therapy to prevent falls in community-dwelling adults age 65 and older who are at increased risk for falls. Vitamin D supplementation to prevent falls. 29. Hepatitis B screening for non-pregnant adolescents and adults for hepatitis B virus infection at high risk for infection; pregnant women at their first prenatal visit. 30. Hepatitis C screening for adults for hepatitis C virus infection at high risk for infection. 31. Lung cancer screening for adults ages 55 to 80 who have a smoking history. 32. For self-administered hormonal contraceptives, you may receive up to a 12-month supply. 33. Tuberculosis and latent tuberculosis infection (LTBI) for asymptomatic adults at increased risk for infection. 34. Screening and counseling for interpersonal and domestic violence is a covered service for adolescents, women, and women of childbearing age at least annually, and, when needed, those who screen positive are provided or referred to initial intervention services. Mental health is an initial intervention service after screening for interpersonal and domestic violence. 35. Statin use for the primary prevention of cardiovascular disease in adults – The USPSTF recommends that adults without a history of cardiovascular disease (CVD) (i.e., symptomatic coronary artery disease or ischemic stroke) use a low- to moderate-dose statin for the prevention of CVD events and mortality when all of the following criteria are met: 1) they are ages 40 to 75; 2) they have one or more CVD risk factors (i.e., dyslipidemia, diabetes, hypertension or smoking); and 3) they have a calculated 10-year risk of a cardiovascular event of 10% or greater. Identification of dyslipidemia and calculation of 10-year CVD event risk requires universal lipids screening in adults ages 40 to 75. Statin medications are a pharmacy benefit.Blue Shield of California is an independent member of the Blue Shield Association CHI14295-AB1316 (12/17) The Diabetes Prevention Program is provided by Solera Health, an independent company. Blue Shield and the Shield symbol are registered trademarks of the BlueCross BlueShield Association, an association of independent Blue Cross and Blue Shield plans. These are Blue Shield of California’s Preventive Health Guidelines, which are based on nationally recognized guidelines. Members must refer to their Evidence of Coverage or Certificate of Insurance or Policy for plan/policy coverage of preventive health benefits.