Expert panel updates recommendations for adult immunizations

The Advisory Committee on Immunization Practices (ACIP) just announced its recommended changes to the schedule of immunizations for US adults. 

“The adult immunization schedule is updated every year, and provides a guide for healthcare professionals to make sure adults ages 19 years or older get all the vaccines they need when they need them,” Mark Freedman, DVM, MPH, of the ACIP Adult Immunization Work Group, told MDLinx.com.

Dr. Freedman, who works at the CDC and is a Commander for the US Public Health Service, explained that the new 2020 recommendations make several changes from the 2019 schedule. These changes include updates to vaccines for hepatitis A, HPV, influenza, meningococcal and pneumococcal diseases, as well as tetanus, diphtheria, and pertussis.

By their own admission, “ACIP recommendations can be complex and challenging to implement,” Dr. Freedman and ACIP coauthors wrote in their newly published clinical guidelines in the Annals of Internal Medicine. 

So, to make it easier for clinicians, here’s a quick list of the ACIP’s recommended changes to the adult immunization schedule for 2020: 

Hepatitis A

New this year, the ACIP recommends all persons aged 1 year or older with HIV to be routinely vaccinated against hepatitis A. The advisory committee made no significant changes to its recommendations for other populations at risk for hepatitis A infection or severe hepatitis A disease, except that people with clotting factor disorders have been removed from the list of those at risk for hepatitis A. 

HPV

Also new this year, the ACIP advises “catch-up” HPV vaccination for all adults through age 26 years who aren’t adequately vaccinated. 

In addition, the ACIP recommends “shared clinical decision-making” for adults aged 27 to 45 years who aren’t adequately vaccinated. “Public health benefit of HPV vaccinations for adults in this age range is minimal, yet some persons who are not adequately vaccinated might benefit,” the advisory committee wrote. 

The ACIP reminds clinicians that HPV vaccines are not licensed for use in adults older than age 45 years.

Influenza

The ACIP continues to recommend routine, annual influenza vaccines for everyone age 6 months and older who does not have contraindications. No one flu vaccine product is recommended over another. 

Live attenuated influenza vaccine is an option for adults under age 50 years, except for those who: 

• Have immunocompromising conditions, including HIV infection

• Have anatomical or functional asplenia

• Are pregnant

• Have close contact with severely immunocompromised persons in a protected environment

• Have received influenza antiviral medications in the previous 48 hours

• Have a cerebrospinal fluid leak or a cochlear implant

“CDC recommends that all US healthcare workers get vaccinated annually against influenza,” Dr. Freedman noted.

Meningococcal disease

The ACIP now recommends that individuals age 10 years or older with complement deficiency, complement inhibitor use, or asplenia—as well as all microbiologists—receive a serogroup B meningococcal (MenB) booster 1 year after completing a MenB primary series. This regimen should be followed by MenB boosters every 2 to 3 years for as long as the increased risk remains.

For individuals age 10 years or older who are determined by public health officials to be at increased risk during an outbreak, the ACIP recommends a one-time booster if it’s been 1 year or more since the individual completed a MenB primary series.

“In addition, a booster dose interval of 6 months or more may be considered by public health officials depending on the specific outbreak, vaccination strategy, and projected duration of elevated risk,” Dr. Freedman and coauthors advised. 

Pneumococcal disease

The advisory committee recommends shared clinical decision-making for use of PCV13 (pneumococcal 13-valent conjugate vaccine) in adults aged 65 years or older who don’t have an immunocompromising condition, cerebrospinal fluid leak, or cochlear implant and who have not previously received PCV13. 

“All adults 65 years or older should receive a dose of PPSV23 (pneumococcal 23-valent polysaccharide vaccine),” Dr. Freedman and coauthors wrote. 

Tetanus, diphtheria, and pertussis 

The ACIP recommends either tetanus/diphtheria (Td) vaccine or tetanus/diphtheria/pertussis (Tdap) vaccine be used in situations where only Td vaccine is currently recommended for the decennial booster, tetanus prophylaxis in wound management, and in the catch-up immunization schedule, including in pregnant women.

The 2020 adult immunization schedule is available at www.cdc.gov/vaccines/schedules/hcp/imz/adult.html. The full ACIP recommendations for each vaccine are available at www.cdc.gov/vaccines/hcp/acip-recs/index.html.