In the Journals

ACIP updates adult immunization schedule for influenza, HPV, HBV, meningococcal vaccines

The Advisory Committee on Immunization Practices released its 2017 Recommended Immunization Schedule for adults aged 19 years and older, including new or revised recommendations for influenza, HPV, hepatitis B virus and meningococcal vaccinations.

“Some vaccination recommendations are complex and their implementation can be challenging,” David K. Kim, MD, MA, and colleagues wrote on behalf of the Advisory Committee on Immunization Practices (ACIP). “The adult immunization schedule ... is designed to help health care providers implement those recommendations.”

The updated schedule has been reviewed and approved by several professional medical organizations including the CDC, the ACP, the American Academy of Family Physicians, the American College of Obstetricians and Gynecologists and the American College of Nurse-Midwives.

Concerns about low-effectiveness of live attenuated influenza vaccine (LAIV), or nasal spray vaccine, caused the ACIP to revise their influenza vaccination recommendations. It advised that LAIV not be used during the 2016-2017 flu season. In addition, it recommended that adults with mild egg allergy receive age-appropriate inactivated influenza vaccine or recombinant influenza vaccine, while those with severe egg allergy receive their vaccine in a medical setting in which a health care provider trained in recognizing and managing severe allergic conditions is present.

ACIP noted that adults through age 26 years who received two doses of the HPV vaccine at least 5 months apart before the age of 15 years are adequately vaccinated; however, those who received only one dose or two doses less than 5 months apart before the age of 15 years are not adequately vaccinated and should receive one additional dose of HPV. In addition, adults through age 26 years who have not received any HPV vaccine should be vaccinated with a three-dose series of HPV at 0, 1-2 and 6 months.

The new schedule also recommends that adults with chronic liver disease should receive a hepatitis B virus (HBV) vaccine.

The meningococcal vaccination recommendations are similar to last year; however, ACIP made two important new changes. The committee advised that a two-dose primary series of serogroups A, C, W and Y meningococcal conjugate vaccine (MenACWY) should be administered to adults with HIV infection. Additionally, it suggested that three doses of MenB-FHbp should be administered at 0, 1-2 and 6 months to adults at an increased risk for meningococcal disease and during outbreaks of the disease; whereas, two doses of MenB-FHbp should be administered at 0 and 6 months to adults not at an increased risk for meningococcal disease.

“To improve overall adult vaccination rates, health care providers and health care systems can use a systematic approach to adult immunization and implement evidence-based strategies, such as use of standing orders, patient reminders, recall for patients with missing vaccinations, and provider reminders through electronic medical record alerts and other means,” Kim and colleagues concluded. “These proven amplifiers for adult vaccination, along with the implementation of the adult immunization practice standards, should help health care providers and health care systems reduce racial and ethnic disparities in vaccination levels for adults and reduce their risk for illness, disability, and death from vaccine preventable diseases.” – by Alaina Tedesco

Disclosure: The authors report no relevant financial disclosures.

The Advisory Committee on Immunization Practices released its 2017 Recommended Immunization Schedule for adults aged 19 years and older, including new or revised recommendations for influenza, HPV, hepatitis B virus and meningococcal vaccinations.

“Some vaccination recommendations are complex and their implementation can be challenging,” David K. Kim, MD, MA, and colleagues wrote on behalf of the Advisory Committee on Immunization Practices (ACIP). “The adult immunization schedule ... is designed to help health care providers implement those recommendations.”

The updated schedule has been reviewed and approved by several professional medical organizations including the CDC, the ACP, the American Academy of Family Physicians, the American College of Obstetricians and Gynecologists and the American College of Nurse-Midwives.

Concerns about low-effectiveness of live attenuated influenza vaccine (LAIV), or nasal spray vaccine, caused the ACIP to revise their influenza vaccination recommendations. It advised that LAIV not be used during the 2016-2017 flu season. In addition, it recommended that adults with mild egg allergy receive age-appropriate inactivated influenza vaccine or recombinant influenza vaccine, while those with severe egg allergy receive their vaccine in a medical setting in which a health care provider trained in recognizing and managing severe allergic conditions is present.

ACIP noted that adults through age 26 years who received two doses of the HPV vaccine at least 5 months apart before the age of 15 years are adequately vaccinated; however, those who received only one dose or two doses less than 5 months apart before the age of 15 years are not adequately vaccinated and should receive one additional dose of HPV. In addition, adults through age 26 years who have not received any HPV vaccine should be vaccinated with a three-dose series of HPV at 0, 1-2 and 6 months.

The new schedule also recommends that adults with chronic liver disease should receive a hepatitis B virus (HBV) vaccine.

The meningococcal vaccination recommendations are similar to last year; however, ACIP made two important new changes. The committee advised that a two-dose primary series of serogroups A, C, W and Y meningococcal conjugate vaccine (MenACWY) should be administered to adults with HIV infection. Additionally, it suggested that three doses of MenB-FHbp should be administered at 0, 1-2 and 6 months to adults at an increased risk for meningococcal disease and during outbreaks of the disease; whereas, two doses of MenB-FHbp should be administered at 0 and 6 months to adults not at an increased risk for meningococcal disease.

“To improve overall adult vaccination rates, health care providers and health care systems can use a systematic approach to adult immunization and implement evidence-based strategies, such as use of standing orders, patient reminders, recall for patients with missing vaccinations, and provider reminders through electronic medical record alerts and other means,” Kim and colleagues concluded. “These proven amplifiers for adult vaccination, along with the implementation of the adult immunization practice standards, should help health care providers and health care systems reduce racial and ethnic disparities in vaccination levels for adults and reduce their risk for illness, disability, and death from vaccine preventable diseases.” – by Alaina Tedesco

Disclosure: The authors report no relevant financial disclosures.