ACIP adult vaccine schedule updated for 2014

The Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices (ACIP) just announced its recommended 2014 adult immunization schedule.

The full schedule was published in the Feb. 4 Annals of Internal Medicine and on the CDC's website. The ACIP includes ACP and 16 other medical societies. The recommendations are intended to guide physicians and other clinicians about the appropriate vaccines for their adult patients.

The recommendations, which were approved in October 2013, include changes for several vaccines:

• Influenza. Recommendations on the recombinant influenza (RIV) and inactivated influenza (IIV) vaccines now indicate that RIV or IIV can be used among persons with hives-only allergy to eggs and RIV can be used in persons age 18 to 49 with egg allergy of any severity.
• Haemophilus influenza type b (Hib). The recommendations were updated to note that vaccination of patients with HIV is no longer recommended because their risk of Hib is low. Adults who have had a successful hematopoietic stem-cell transplant should receive a 3-dose series of Hib vaccine 6 to 12 months after the transplant regardless of prior Hib vaccination status.
• Health care workers. Notes about health care personnel were removed from the HPV and zoster recommendations. Being a health care worker is not a specific indication for either vaccine. The vaccines should be given to those who meet the age and other indications.
• Human papillomavirus (HPV). Information was added to clarify the timing between the second and third doses. The second dose should be administered 4 to 8 weeks (minimum interval of 4 weeks) after the first dose; the third dose should be administered 24 weeks after the first dose and 16 weeks after the second dose (minimum interval of 12 weeks).
• Pneumonia. The recommendation was updated to remind clinicians that pneumococcal conjugate vaccine (PCV13) should be administered before the pneumococcal polysaccharide vaccine (PPSV23) in persons for whom both vaccines are recommended.
• Meningitis. The meningococcal vaccine recommendation was edited to clarify which persons need 1 or 2 doses of vaccine and which should receive meningococcal conjugate (MenACWY-D) versus the meningococcal polysaccharide (MenACWY-CRM). MenACWY-D is preferred for those age 55 years or younger as well as for adults age 56 years or older who were vaccinated previously with MenACWY-D or for whom multiple doses are anticipated. Two doses (of MenACWY-D) are recommended at least 2 months apart to adults with functional asplenia or persistent complement component deficiencies. (HIV infection is not an indication for routine vaccination with MenACWY-D.) A single dose of vaccine is recommended for military recruits, persons at risk during an outbreak attributable to a vaccine serogroup, and travelers to countries in which disease is hyperendemic or epidemic. MenACWY-CRM is preferred for adults age 56 years or older who have not received MenACWY-D previously and who require a single dose only.
• Tetanus, diphtheria, acellular pertussis (Tdap) and tetanus, diphtheria (Td). Tdap and Td vaccine recommendations were edited to harmonize with the language used in the pediatric immunization schedule. A single dose of Tdap vaccine is recommended for previously unvaccinated persons age 11 years or older, and Td booster should be administered every 10 years thereafter.

A study in the same issue of Annals reported U.S. primary care physicians' perspectives on adult vaccines. The survey of general internists and family physicians found that most don't assess vaccination status at every visit and that the biggest barriers to vaccination are financial. Vaccination rates could be improved by more communication between physicians and alternate vaccinators, more use of electronic tools, and removal of policy-related barriers, the authors concluded.