Women's health guidelines

Endnotes

1. The California Department of Public Health (CDPH) recommends COVID-19 vaccines for everyone six months to 18 years old, anyone with risk factors or who is in close contact with those with risk factors, and all who choose protection. COVID-19 vaccine and other vaccines may be administered on the same day.
2. Annual vaccination against influenza is recommended for all persons ages 6 months and older, including all adults.
3. Children through age 9 getting the flu vaccine for the first time – or who have received the flu vaccine – should get two doses at least four weeks apart.
4. The Hib (Haemophilus influenzae type b) vaccine is usually given in a series of two or three primary doses depending on brand. An additional booster dose at ages 12–15 months is recommended for children who completed the primary doses before their first birthday.
5. Individuals at risk for meningococcal disease include international travelers and college-bound students. These individuals should discuss the risks and benefits of vaccination with their doctor.
6. The CDPH recommends that for children younger than 4 years, parents be able to choose either the combined measles, mumps, rubella, and varicella vaccine (one injection); or separate MMR and varicella vaccines (two injections). Parents should consult with their child’s pediatrician as needed.
7. CDPH recommends the RSV vaccine during weeks 32 to 36 of pregnancy during September to January (if the RSV vaccine was not received during a prior pregnancy). For infants and toddlers, the CDPH recommends the RSV vaccine at the earliest opportunity between October 1 and March 31 for all infants younger than 8 months (if birthing parent did not receive vaccine during pregnancy), and for children ages 8 to 19 months if they are at higher risk for severe RSV.
8. Fluoride oral supplements should be discussed at preventive care visits if the primary water source is deficient in fluoride.
9. Selection of conditions based on “Newborn Screening: Toward a Uniform Screening Panel and System” as authored by the American College of Medical Genetics (ACMG) and commissioned by the Health Resources and Service Administration (HRSA).
10. All children 3 to 5 years old are at risk of vision abnormalities and should be screened; specific risk factors include strabismus, refractive errors, and media opacity.
11. Risk factors for hepatitis A should be discussed with your provider.
12. Risk factors for hepatitis B should be discussed with your provider.
13. Risk factors for pneumococcal infections should be discussed with your provider.
14. 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.
15. Brief behavioral counseling interventions were found to reduce unhealthy alcohol use in adults 18 years or older, including pregnant women. Effective behavioral counseling interventions vary in their specific components, administration, length, and number of interventions.
16. Sexually transmitted infections, also known as sexually transmitted diseases, include chlamydia, gonorrhea, herpes, HIV, HPV, syphilis, and others.
17. Risk factors for chlamydia and gonorrhea infection include history of chlamydial or other STIs, new or multiple sexual partners, inconsistent condom use, commercial sex work, and drug use.
18. Coverage includes:
    • Prescribed FDA-approved contraceptive drugs, devices, and products;
    • Device insertion and removal;
    • Sterilization procedures;
    • Contraceptive education and counseling including for continued adherence;
    • Related follow-up services;
    • Management of side effects;
    • For self-administered hormonal contraceptives, you may receive up to a 12-month supply.
19. All people of reproductive age are at potential risk for intimate partner violence and should be screened including those who are pregnant and postpartum. There are a variety of factors that increase the risk of intimate partner violence, such as exposure to violence as a child, young age, unemployment, substance abuse, marital difficulties, and economic hardships.
20. Unhealthy drug use screening should be implemented when services for accurate diagnosis, effective treatment, and appropriate care can be offered or referred.
21. Intensive behavioral counseling to promote a 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. The Diabetes Prevention Program, part of Wellvolution®, is a lifestyle medicine program through Blue Shield of California Promise Health Plan that focuses on diabetes prevention.
22. Tuberculosis and LTBI for asymptomatic adults at increased risk for infection.
23. Behavioral counseling to prevent STIs for sexually active adolescents and adults at increased risk for STIs.
24. 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.
25. For individuals born before 1957 with no evidence of immunity to measles, mumps, or rubella, consider two-dose series at least four weeks apart for measles and mumps or at least one dose for rubella. Check with your doctor for details regarding pregnancy.
26. 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.
27. 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).
28. Your doctor will assess your personal or family history of breast, ovarian, tubal, or peritoneal cancer or family history of breast cancer susceptibility 1 and 2 (BRCA1/2) gene mutations. People with a positive result on the risk assessment tool are recommended to receive genetic counseling and, if indicated after counseling, genetic testing.
29. Statin use for the primary prevention of cardiovascular disease in adults: The USPSTF recommends that adults without a history of cardiovascular disease (CVD) (e.g., 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: they are ages 40 to 75; they have one or more CVD risk factors (e.g., dyslipidemia, diabetes, hypertension, or smoking); and 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 medicines are a pharmacy benefit.
30. According to the U.S. Preventive Services Taskforce (USPSTF), colorectal cancer is the third leading cause of cancer death for both men and women. It is most frequently diagnosed among people ages 65–74 years. It is estimated that 10.5% of new colorectal cancer cases occur in persons younger than 50 years. There are several recommended screening tests for colorectal cancer. Your provider will consider a variety of factors to decide which test is best. Screenings include:
    • High sensitivity guaiac fecal occult blood test (HSgFOBT) or fecal immunochemical test (FIT) every year;
    • Stool DNA-FIT every 1 to 3 years;
    • Computed tomography colonography every 5 years;
    • Flexible sigmoidoscopy every 5 years;
    • Flexible sigmoidoscopy every 10 years with annual FIT;
    • Colonoscopy screening every 10 years; and
    • Colon cancer DNA blood test every 1 to 3 years.
31. Diabetes/prediabetes screening should be performed for adults ages 35 to 70 who are overweight and obese. Intensive behavioral counseling interventions to promote a healthy diet and physical activity for patients with abnormal blood glucose. Individuals with prediabetes may be referred for preventive interventions.
32. Hepatitis C screening for adults 18 to 79 years.
33. Osteoporotic fractures, particularly hip fractures, are associated with limitation of ambulation, chronic pain and disability, loss of independence, and quality of life. Women have higher rates of osteoporosis than men at any given age.
34. Fall 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.
35. Lung cancer screening for adults ages 50 to 80 years who have a 20-pack per year smoking history and currently smoke or who quit within the last 15 years.
36. Pregnant women who are at high risk for preeclampsia should use low-dose aspirin (81 mg/day) as preventive medicine after 12 weeks of gestation.
37. As many as 10% of pregnant women will get postpartum depression, according to the American Journal of Obstetrics and Gynecology, Volume 228, Issue 1, Supplement S122-S123, January 2023.