ACIP Issues 2012 Adult Immunization Schedule

February 1, 2012 — The US Centers for Disease Control
(CDC)'s Advisory Committee on Immunization Practices (ACIP) has issued the 2012
adult immunization schedule, published online January 31 in the Annals of Internal
Medicine. The schedule was also published simultaneously in the CDC's Morbidity
and Mortality Weekly Report Recommendations and Reports.

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.

An accompanying editorial by Sandra Adamson Fryhofer, MD, from
Emory University in Atlanta, Georgia, describes the rationale behind the 2012
changes and notes that the American College of Physicians has established its
first Adult Immunization Technical Advisory Committee.

"The College has representation at all ACIP meetings
and on many ACIP vaccine working groups," Dr. Fryhofer writes.
"Vaccines are vital to ensuring our nation's health. The newly released
fourth edition of the ACP Guide to Adult Immunization can help physicians
incorporate and improve vaccination strategies in their own practices."

Relevant financial relationships of the ACIP and Dr. Fryhofer can be viewed on the ACP Web site.

Ann Intern Med.
2012;156:211-217

 

2012 Adult Immunization Schedule: The Key Changes

Sandra Adamson Fryhofer, MD

The topic is key changes in the 2012 adult immunization schedule, which was published in Annals of Internal Medicine.^[1,2]

Here is why it matters.

Vaccinations are vital to our nation's heath. The Advisory Committee on Immunization Practices (ACIP) has now adopted an evidence-based process for reviewing data and economic impact.

Human Papillomavirus

For specific recommendation changes, let's start with the human papillomavirus (HPV) vaccine, which is no longer just for girls. The new HPV recommendation: routine vaccination for males aged 11 through 21 years. (Routine vaccination for females is recommended for those aged 11 through 26 years). Female vaccination rates are now low, which makes male vaccination more cost-effective. Routine HPV vaccination in men who have sex with men is recommended through age 26 years; it is cost-effective, regardless of coverage rates in females.

Hepatitis B

Hepatitis B vaccination is now recommended routinely for adults with diabetes who are younger than age 60 years. Those with diabetes age 23 through 59 years have more than twice the risk for contracting hepatitis B compared with people without diabetes. Those with diabetes who are age 60 years or older may be vaccinated at physician discretion.

Tdap and Pertussis Protection

Recommendations for adult tetanus, diphtheria, and pertussis (Tdap) vaccination concern pertussis protection and, specifically, cocooning infants and young children by vaccinating family and household contacts, including those over age 65 years. The new change is when to vaccinate pregnant mothers, which should be during pregnancy, after 20 weeks' gestation. Timing the vaccination this way will allow the mother's antibodies to pass on to the fetus.

Influenza

In the latest recommendations, egg allergy is no longer a contraindication to the influenza vaccination, although egg-allergic patients must get the inactivated shot because that is what has been studied. In addition, the new intradermal influenza vaccine, with its microinjector apparatus and ultrafine needle, is an option for adults aged 18 through 64 years. Finally, everyone over 6 months old should be vaccinated for flu, and this includes healthcare workers.

Another heads-up: the American College of Physicians has just released the fourth edition of the Guide to Adult Immunization, and there is even a mobile app in the works. So please, keep vaccinating.

For Medicine Matters, I'm Dr. Sandra Fryhofer.

[ CLOSE WINDOW ]

References

1. Advisory Committee on Immunization Practices. Recommended Adult Immunization Schedule: United States, 2012. Ann Intern Med. 2012;156:211-217.
2. Fryhofer SA. Adult immunization 2012: politics, process, and progress. Ann Intern Med. 2012;156:243-245