Immunization of Adults – Updates

Immunization of Adults Updates

By Stan Deresinski, MD, FACP, FIDSA

Clinical Professor of Medicine, Stanford University, Editor of Infectious Disease Alert

SOURCE: Bridges CB, Coyne-Beasley T; Immunization Services Division, National Center for Immunization and Respiratory Diseases, CDC. Advisory committee on immunization practices recommended immunization schedule for adults aged 19 years or older - United States, 2014. MMWR 2014; 63:110-2.

SYNOPSIS: Recommendations for immunization of adults have been updated.

Updated standards for immunization of adults were approved by the National Vaccine Advisory Committee (NVAC) in September 2013.^1-3 Some of the changes made are as follows.

• Haemophilus influenzae type B (Hib) vaccine is now recommended for selected adults at increased risk of Hib infection who have not previously received the vaccine. Regardless of previous receipt, adult hematopoietic stem cell transplant recipients should receive 3 doses of Hib vaccine 6-12 months after vaccination. In contrast to previous guidance, it is no longer recommended that HIV-infected individuals be vaccinated against Hib as a result of recognition of their low risk of infection with this organism.
• Recombinant influenza vaccine contains no egg protein and can be administered to individuals 18 through 49 years of age with egg allergy of any severity. Either recombinant or inactivated influenza vaccine (which does contain egg protein) can be given to individual whose only allergic manifestation after egg protein exposure is urticaria.
• A single dose of Tdap vaccine is recommended for previously unvaccinated persons aged 11 years or older, and a Td booster should be administered every 10 years thereafter. Pregnant women continue to be recommended to receive 1 dose of Tdap vaccine during each pregnancy, preferably during 2736 weeks' gestation, regardless of the interval since prior dose of Tdap or Td vaccine.
• Because the 13-valent conjugated pneumococcal vaccine (PCV13) is recommended to be administered before PPSV23 among persons for whom both vaccines are recommended, the PCV13 footnote now precedes the PPSV23 footnote and includes wording to remind providers of the appropriate order of these vaccines when both are indicated.
• The meningococcal vaccine footnote was edited to clarify which persons need either 1 or 2 doses of vaccine and to provide greater clarity regarding which patients should receive the meningococcal conjugate versus the meningococcal polysaccharide quadrivalent vaccines.
• No changes or minor clarifications were made to the MMR, hepatitis A, or hepatitis B vaccine footnotes; no changes in recommendations were made.

Vaccination levels of adults in the United States are disappointingly low. The NVAC recommends that providers assess vaccination needs for their patients at each visit, recommend needed vaccines, and then, ideally, offer the vaccine or, if the provider does not stock the needed vaccines, refer the patient to a provider who does vaccinate. Vaccination providers should also ensure that patients and their referring health-care providers have documentation of the vaccination.

References

1. http://www.cdc.gov/vaccines/schedules
2. Advisory Committee on Immunization Practices Recommended Immunization Schedule for Adults Aged 19 Years or Older: United States, 2014. Ann Intern Med 2014;160:1907.
3. ACIP Adult Immunization Work Group, Bridges CB, et al. Centers for Disease Control and Prevention (CDC). Advisory Committee on Immunization Practices (ACIP) recommended immunization schedule for adults aged 19 years and older--United States, 2013. MMWR 2013 Feb 1;62 Suppl 1:9-19. PubMed PMID: 23364303.