The Advisory Committee on Immunization Practices voted unanimously to recommend several changes to the general recommendations for immunizations, involving the timing and spacing of vaccines, contraindications and precautions, and vaccine administration.
First is that vaccinations should be given to hospitalized patients at the earliest opportunity, when clinical illness symptoms are improved. In addition, the general recommendations will indicate that upcoming surgery, anesthesia or hospitalization is not a contraindication for vaccination.
The suggested update also will state that although the diphtheria-tetanus-acellular pertussis (DTaP) vaccine, the 13-valent pneumococcal conjugate (PCV13; Prevnar 13, Pfizer) and haemophilus influenzae type B (Hib) vaccines are indicated to be administered intramuscularly, there is no evidence of difference in immunogenicity when the vaccines are administered subcutaneously. The statement will advise providers to address circumstances of subcutaneous administration on a case-by-case basis.
Finally, the updated general recommendations will discuss the timing of the two pneumococcal vaccines for patients indicated to receive both. The recommendation is that PCV13 be administered first when possible, followed by the 23-valent pneumococcal polysaccharide vaccine (PPSV23; Pneumovax 23, Merck) 6 to 12 months later. If PPSV23 is administered first, there should be at least a 1-year interval before PCV13 is administered.