ACIP Revises Recommended Adult Immunization Schedule

In October, the Advisory Committee on Immunization Practices (ACIP) approved the Recommended Immunization Schedule for Adults Aged 19 Years or Older for 2014. The changes for 2014 are as follows:

• Adults who have had a successful hematopoietic stem cell transplant are recommended to receive a three-dose series of Haemophilus influenzae type B vaccine 6 months to 12 months after transplant regardless of prior Hib vaccination. Prior Hib vaccine guidance recommended that Hib vaccination of persons infected with human immunodeficiency (HIV) be considered, but updated guidance no longer recommends Hib vaccination of previously unvaccinated adults with HIV infection because their risk for Hib infection is low.
• Information on recombinant influenza vaccines (RIVs) and the use of RIVs and inactivated influenza vaccines (IIVs) among egg-allergic patients was added to the footnote and indicates that RIVs and IIVs can be used among persons with hives-only allergy to eggs. RIVs contain no egg protein and can be used among persons aged 18 years through 49 years who have egg allergy of any severity.
• The tetanus, diphtheria and pertussis (Td/Tdap) vaccine footnote was edited to harmonize language used in the pediatric immunization schedule. 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 are still recommended to receive one dose of Tdap vaccine during each pregnancy, preferably during 27 weeks’ to 36 weeks’ gestation, regardless of the interval since the prior dose of Tdap or Td vaccine.
• Information was added to the human papillomavirus (HPV) footnote to clarify the timing between the second and third doses and to harmonize language between the pediatric and adult immunization schedules; no changes in recommendations were made.
• The HPV vaccine and the zoster vaccine footnotes were simplified, with removal of the bullet regarding healthcare personnel (HCP). Being a healthcare worker is not a specific indication for these vaccines, but they should be given to HCP and others who meet age and other indications for these vaccines.
• Because pneumococcal conjugate vaccine PCV13 is recommended to be administered before the pneumococcal polysaccharide vaccine 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 one or two doses of vaccine and to provide greater clarity regarding which patients should receive the meningococcal conjugate versus the meningococcal polysaccharide quadrivalent vaccines. The full 2014 schedule is published in the Annals of Internal Medicine. This year, the figures, footnotes and tables are not being published in Centers for Disease Control and Prevention’s (CDC’s) Morbidity and Mortality Weekly Report, but will be posted and maintained on the CDC’s website at www.cdc.gov/vaccines/schedules to facilitate updating the schedule during the year, if needed.