The Advisory Committee on Immunization Practices has unanimously recommended updates to the adult immunization schedule for 2016, but some members expressed concern that the schedule should fall more in line with the pediatric schedule.
“Given the complexity of the schedule and this layout, it’s probably the best you can do, but I think it’s difficult to follow the columns,” said committee member Laura E. Riley, MD. “I think we’re not doing ourselves any favors in terms of increasing adults getting vaccinated because this is just too hard to follow.”
Committee Chair Nancy M. Bennett, MD, explained: “the problem is the pediatric and adult schedule don’t pair up in many ways … I think the problem with the adult schedule is that there is so much in the footnotes and not in the schedule itself that it can be difficult for providers.” She added that the goal of the panel should be to “develop an adult schedule that’s more analogous to the pediatric schedule,” which the panel also unanimously voted to recommend during their meeting.
Before the committee voted, David Kim, MD, of the Centers for Disease Control and Prevention’s (CDC) National Center for Immunization and Respiratory Diseases explained that proposed changes to the schedule include: updated ACIP policy decisions that were made since the 2015 schedule, updated word changes, and addresses two errata in the current schedule, specifically dealing with the PPSV23 (Pneumovax23, Merck) vaccine.
In the proposed schedule, wording would note that the intervals from PCV13 (Prevnar13, Pfizer) to PPSV23 be“at least one year,” which aligns the interval recommendations and brings the ACIP recommendation consistent with the current Medicare policy (Medicare covers a different, second pneumococcal vaccine one year after the first vaccine). Wording would also be changed on the part of the schedule that deals with intervals between PCV13 and PPSV23, specifically that “adults aged 19 years or older with immunocompromisng conditions” replaces the current text of “adults aged 19 through 64 years with immunocompromising conditions.” These adults should receive PPSV23 at least 8 weeks after PCV13.
In the new schedule, if adopted by the CDC, the wording that dealt with PPSV23 would read that adults aged 19 through 64 years who reside in nursing homes or long-term care facilities should be “assessed” and not routinely recommended to receive PPSV23.
Other changes include text changes in figure 2 of the adult schedule, including a single yellow bar for the influenza vaccine indicating “one dose annually,” (the type of influenza vaccine for different patients is further described in the footnote section); replacing the current “meningococcal” row with “meningococcal 4-valent conjugate or polysaccharide” adding a new row for “meningococcal B” in both figures;and the addition of the wording of “one, two or three doses,” depending on indication for PPSV23 vaccine.
Other proposed wording changes include changing the hepatitis A vaccination from “two doses to two or three doses, to account for the hepatitis A and B combination vaccine,” according to Dr Kim.
Also addressed is a recent recommendation for either the 2-dose series MenB-4C (Bexsero, Novartis) or 3-dose series MenB-FHbp (Trumenba, Pfizer) .
Additional proposed changes in footnotes would include that MenB vaccination is recommended for adults with asplenia or complement deficiencies, microbiologists who are routinely exposed to isolates of Neisseria meningitides, and those at risk in outbreak settings attributable to MenB. MenB vaccination is not routinely recommended for travelers to countries where meningococcal disease is hyperendemic or epidemic because meningococcal disease in these countries is generally not caused by serogroup B. The notes would also point out that HIV infection is not an indication for routine vaccination with MenACWY or MenB vaccine.
The schedule will also address the fact that although the 2 meningitis B vaccines are not interchangeable, the MenB-4C or MenB-FHbp vaccine may be administered concomitantly with MenACWY vaccines, but at a different anatomic site if feasible.
Dr Kim said the next steps following the ACIP’s recommendation are to obtain approval from the other clinician groups, and then submit the schedule to the CDC for clearance and subsequent publication in the Morbidity and Mortality Weekly Report in February of 2016.
1. Kim D. Adult Immunization Schedule. Presented at: Advisory Committee on Immunization Practices. Oct. 21, 2015. Atlanta.