In light of Immunization Awareness Month, the American College of Physicians (ACP) has issued a press statement to remind adults of the importance of staying up to date on all recommended vaccinations.1 This follows the annual update on adult immunization schedules from the United States Centers for Disease Control and Prevention’s (CDC) Advisory Committee on Immunization Practices (ACIP) earlier this year.2
Further, the ACIP has made additional recommendations since the guidelines update. In June 2019, the ACIP voted to raise the upper age for catch-up vaccination against HPV in men up to age 26 years, which mimics the recommendation for women, and also recommended that patients aged 27 to 45 years who previously were considered aged out of the vaccine range discuss receiving the vaccine with their doctors.
ACIP also voted to recommend that the 13-valent pneumococcal conjugate vaccine be administered on the basis of clinician judgment in adults aged >65 years who are immunocompetent and have not previously received PCV13. These recommendations must be reviewed and approved by the CDC director before amendments are made to the guidelines for vaccination schedules.1
Compared with 2018 guidelines, the updated guidelines made amended recommendations for the influenza vaccine, the hepatitis B vaccine, and the hepatitis A vaccine, as follows:2
- Any licensed influenza vaccine that is appropriate for the age and health status of the patient may be used, compared with last year’s recommendation for the use of live-attenuated influenza vaccine. The updated guidelines note that the live-attenuated vaccine is an option for adults age ≤49 years, except for adults who are immunocompromised (including individuals with HIV infection, and individuals with anatomical or functional asplenia or who have close contact with individuals who are severely immunocompromised in a protected environment; individuals who are pregnant or have close contact with individuals who are severely immunocompromised in a protected environment; individuals who have received influenza antiviral medications in the previous 48 hours, or have cerebrospinal fluid leak or a cochlear implant.
- Heplisav-B, a new single-antigen recombinant hepatitis B vaccine with a novel cytosine-phosphate-guanine 1018 oligodeoxynucleotide adjuvant, has been approved for routine administration in 2 doses given at least 4 weeks apart for the prophylaxis of hepatitis B infection. It can be used as a substitute in a 3-dose series with a different hepatitis B vaccine, but a valid series requires 2 doses of Heplisav-B with at least 4 weeks between doses. This vaccine is not recommended for administration to pregnant women, as there are no safety data yet in this population.
- In addition to the 2018 guideline’s inclusion of homelessness as an indication for receipt of hepatitis A vaccination, other populations now recommended to receive the vaccine are individuals with chronic liver disease or clotting factor disorders, travelers in countries with high or intermediate endemic hepatitis A, individuals with close personal contact with an international adoptee within the first 60 days after arrival from a country with high or intermediate endemic hepatitis A, men who have sex with men, individuals who are injection or non-injection drug users, and individuals who work with hepatitis A virus in a laboratory. In addition, any person who is not at risk for hepatitis A virus infection but wants protection against it may be vaccinated.
Since 2014, the ACIP has updated the guidelines for immunization schedules annually in an effort to engage clinicians in staying abreast of the changes and adjustments, and allow for appropriate counseling and care of adult patients. This is particularly important in the current climate surrounding vaccine hesitancy. In fact, although “modest increases in vaccination coverage rates were observed in several sectors of the adult population in 2016, the overall rates for adults in the United States have remained low.”2
- American College of Physicians reminds adults: Vaccines are not just for children [news release]. Philadelphia, PA: American College of Physicians; July 30, 2019. http://www.dssimon.com/MM/ACP-immunizations. Accessed August 6, 2019.
- Kim D, Hunter P. Recommended adult immunization schedule, United States, 2019. Ann Int Med. 2019;170(3):182-192.