The US Centers for Disease Control (CDC)’s ACIP has issued the latest adult immunization schedule in the CDC’s Morbidity and Mortality Weekly Report Recommendations and Reports. The CDC website has very easy to understand and downloadable immunization schedules for all age groups on their web site at: http://www.cdc.gov/vaccines/schedules/easy-to-read/index.html
The new recommendations include broader recommendations for human papillomavirus (HPV) and hepatitis B virus (HBV) vaccination. In addition, the adult schedule and the child and adolescent schedules are now designed to be combined and used together. Since October 2010, the annual ACIP review of the CDC’s Recommended Adult Immunization Schedule has used an evidence-based process considering the quality of evidence, the benefits and harms, the values and preferences of affected populations, and the economic effects of the immunizations. The ACIP intends the updated schedule to reflect current clinical recommendations for licensed vaccines, and to offer guidance to healthcare practitioners regarding the appropriate vaccines for their adult patients.
Specific changes from the 2011 recommendations include the following:
- Boys aged 11 to 12 years should receive routine vaccination with quadrivalent human papillomavirus (HPV4), with catch-up vaccination for boys and men aged 13 to 21 years.
- Adults younger than 60 years who have diabetes should receive HBV vaccination as soon as possible after the diagnosis of diabetes.
- Adults aged at least 60 years who have diabetes should receive HBV vaccination based on their need for assisted blood glucose monitoring, risk for acquiring hepatitis B infection, and likelihood of immune response to HBV vaccination.
- Pregnant women should receive the tetanus, diphtheria, and acellular pertussis (Tdap) booster, preferably after 20 weeks of gestation, to protect infants from pertussis by transfer of protective maternal antibodies.
- Adults should continue to receive influenza vaccination, even if they are allergic to eggs. However, adults with egg allergy should receive inactivated influenza vaccination, because safety data are available for this vaccination in this population.
- A new footnote adds links for the full ACIP vaccine recommendations and the specific vaccine recommendations for travelers.
- A new table summarizes precautions and contraindications for vaccines.
- The influenza vaccination footnote now states that all persons at least 6 months of age can receive trivalent inactivated influenza vaccine (TIV), and that healthcare personnel (HCP) who care for persons requiring a protected environment should receive TIV. HCP younger than 50 years who have no contraindications may receive either the live attenuated influenza vaccine or TIV. This footnote also includes age indications for 2 recently licensed formulations of TIV.
- The HPV vaccination footnote now explains that HPV vaccination is not specifically recommended for HCP, but that they should receive the vaccine if they are in the recommended age group. Men aged 22 to 26 years also may be vaccinated with HPV4 vaccine.
- The zoster vaccination footnote now indicates that zoster vaccination is not specifically recommended for HCP, but that they should receive the vaccine if they are in the recommended age group. Although the FDA has approved this vaccine for use in persons at least 50 years of age, ACIP continues to recommend that vaccination begin at 60 years of age.
- The measles, mumps, rubella (MMR) vaccination footnote refers readers to the ACIP MMR recommendations, as well as to the ACIP recommendations for the immunization of HCP regarding the use of MMR vaccine in outbreak settings.
- The pneumococcal polysaccharide vaccine (PPSV) vaccination footnote now includes additional examples of functional and anatomic asplenia.
- A footnote regarding revaccination with PPSV clarifies recommendations for persons at least 65 years of age who had been vaccinated with PPSV23 at least 5 years previously.
- The meningococcal vaccination footnote now includes military recruits in the group recommended to receive a single dose of meningococcal vaccine. It also indicates that first-year college students through 21 years of age who are living in residence halls should be vaccinated if they have not received a dose on or after their 16th birthday.