Adult Immunizations — 2017 Changes
March 1, 2017 4 minutes read
By Stan Deresinski, MD, FACP, FIDSA
Clinical Professor of Medicine, Stanford University
Dr. Deresinski reports no financial relationships relevant to this field of study.
SYNOPSIS: Significant changes in recommendations for adult immunization for 2017 have been made or influenza, meningococcal infection, human papillomavirus, and hepatitis B.
SOURCE: Kim DK, Riley LE, Harriman KH, et al. Advisory Committee on Immunization Practices Recommended Immunization Schedule for Adults Aged 19 Years or Older — United States, 2017. MMWR Morb Mortal Wkly Rep 2017;66:136-138.
The Advisory Committee on Immunization Practices (ACIP) has published updated recommendations for immunization of adults. The following is a list of some of the significant changes between the 2016 and 2017 recommendations.
Influenza Vaccine
- Live attenuated influenza vaccine (LAIV). Because of evidence of limited protective efficacy against influenza A(H1N1) pdm09 during the 2013-2014 and 2015-2016 U.S. influenza seasons, LAIV should not be used for the 2016-2017 season.
- Egg allergy.
- Adults who have a history of allergy to eggs but whose only manifestation was the occurrence of hives should receive either inactivated influenza vaccine (IIV) or recombinant vaccine (RV).
- Adults with a history of egg allergy who have had manifestations other than simply hives (e.g., angioedema, respiratory distress, lightheadedness, or recurrent emesis, or who required epinephrine or another emergency medical intervention) may receive age-appropriate IIV or RV, which should be administered in a medical setting with supervision by a healthcare provider with competence in the recognition and management of severe allergic reactions.
Human Papillomavirus Vaccine (HPV)
- Previously unvaccinated (0 doses) adult females and adult males (through 26 years and 21 years of age, respectively) should receive three doses of HPV at 0, 1-2, and 6 months.
- Previously unvaccinated (0 doses) adult males ages 22 through 26 years may receive three doses of HPV at 0, 1-2, and 6 months.
- Adult females through age 26 years and adult males through age 21 years (as well as males ages 22 through 26 years who may receive HPV vaccine) who initiated the HPV vaccination series before age 15 years and received two doses at least five months apart are considered adequately vaccinated and do not need an additional dose of HPV vaccine.
- Adult females through age 26 years and adult males through age 21 years (and males ages 22 through 26 years who may receive HPV vaccine) who initiated the HPV vaccination series before age 15 years and received only one dose, or two doses less than five months apart, are not considered adequately vaccinated and should receive one additional dose of HPV vaccine.
Meningococcal Vaccine
- Adults with anatomical or functional asplenia or persistent complement component deficiencies [this includes receipt of eculizumab] should receive:
- A two-dose primary series of serogroups A, C, W, and Y meningococcal conjugate vaccine (MenACWY), with doses administered at least two months apart, and should be revaccinated every five years AND
- Serogroup B meningococcal vaccine (MenB) with either MenB-4C (two doses administered at least one month apart) or MenB-FHbp (three doses administered at 0, 1-2, and 6 months).
- HIV-infected adults should receive:
- If previously unvaccinated, a two-dose primary MenACWY vaccination series, with doses administered at least two months apart, and should be revaccinated every five years.
- If previously received one dose of MenACWY, a second dose at least two months after the first dose.
- Note: MenB is not routinely recommended for adults with HIV infection, because meningococcal disease in this population is caused primarily by serogroups C, W, and Y.
- Microbiologists potentially routinely exposed to isolates of Neisseria meningitidis should receive one dose of MenACWY and should be revaccinated every five years if the risk for infection remains, as well as either MenB-4C (two doses administered at least one month apart) or MenB-FHbp (three doses administered at 0, 1-2, and 6 months).
- Adults at risk because of a meningococcal disease outbreak should receive one dose of MenACWY if the outbreak is attributable to serogroup A, C, W, or Y; or, if the outbreak is attributable to serogroup B, either MenB-4C (two doses administered at least one month apart) or MenB-FHbp (three doses administered at 0, 1-2, and 6 months).
- Young adults at risk ages 16 through 23 years (preferred age range is 16 through 18 years) who are healthy and not at increased risk for serogroup B meningococcal disease may receive either MenB-4C (two doses administered at least one month apart) or MenB-FHbp (three doses administered at 0, 1-2, and 6 months) for short-term protection against most strains of serogroup B meningococcal disease.
Hepatitis B Vaccine
- Adults with chronic liver disease, including, but not limited to, hepatitis C virus infection, cirrhosis, fatty liver disease, alcoholic liver disease, autoimmune hepatitis, and an alanine aminotransferase (ALT) or aspartate aminotransferase (AST) level greater than twice the upper limit of normal should receive a HepB series.
Significant changes in recommendations for adult immunization for 2017 have been made or influenza, meningococcal infection, human papillomavirus, and hepatitis B.
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