Changes to the adult immunization schedule include a preferential recommendation for a new recombinant zoster vaccine for older adults, and a third dose of measles mumps rubella (MMR) vaccine to adults who may be at risk of mumps during an outbreak.
The CDC Advisory Committee for Immunization Practices (ACIP) recommended changes on use of herpes zoster vaccine and use of an additional MMR dose, with additional changes in the wording of tetanus, diphtheria, and pertussis (Tdap), and other vaccine recommendations, wrote David K. Kim, MD, on behalf of the ACIP, and colleagues, in the Annals of Internal Medicine.
The authors noted that the ACIP updated the standards of adult immunization practice "to promote the integration of vaccinations as a part of routine clinical care for adults." This means healthcare providers should assess a patient's vaccination status at every clinical encounter, "strongly recommend" needed vaccines to patients, offer vaccines recommended to patients, and document vaccines administered in the state or local immunization information system.
In October, the ACIP recommended the use of recombinant zoster vaccine, Shingrix for adults ages ≥50 for prevention of herpes zoster and its complications. This was for the following three populations:
- Immunocompetent adults age ≥50 to prevent herpes zoster and related complications
- Adults age ≥50 who previously received the zoster vaccine live Zostavax
- Either recombinant zoster vaccine or zoster vaccine live for adults age ≥60, with recombinant zoster vaccine being preferred
New additions to the 2018 immunization schedule include the following recommendations for vaccine administration:
- 2 doses of recombinant zoster vaccine, 2-6 months apart to adults age ≥50, regardless of past episode of herpes zoster or receipt of zoster vaccine live
- 2 doses of recombinant zoster vaccine 2-6 months apart to adults who received zoster vaccine live, at least 2 months afterwards
The ACIP noted that there is no current recommendation on the use of recombinant zoster vaccine among pregnant women, or adults with immunocompromising conditions, such as HIV.
The ACIP also recommended a third dose of a "mumps-containing vaccine" for persons who had previously received two doses of "mumps-containing vaccine" and are "identified to public health authorities as being part of a group at risk for acquiring mumps because of an outbreak."
The new wording suggests that any adult identified by a public health authority to be at risk during an outbreak should receive one dose of MMR, regardless if they have received 0, 1 or 2 doses of mumps-containing vaccine or have unknown vaccination status.
In addition, adults without evidence of immunity to mumps (born before 1957, documented receipt of MMR, or have laboratory evidence of immunity) are "routinely recommended" to receive one dose of MMR. Exceptions would be people are students in post-secondary educational institutions, international travelers, or household contacts of immunocompromised persons, who should receive two doses of MMR at least 28 days apart, the authors said.
Other Changes
- Revised wording for the Tdap vaccine was changed to "1 dose Tdap, then Td booster every 10 years." One dose of Tdap is recommended for adults who haven't received the Tdap vaccine, except for pregnant women, who are recommended to receive the vaccine during their pregnancy at the early part of gestational weeks 27 to 36
- New wording for serogroups A, C, W and Y meningococcal vaccine (MenACWY) now reads "1 or 2 doses depending on indication, then booster every 5 years if risk remains"
- Word for human papillomavirus (HPV) vaccine wording now reads "2 or 3 doses depending on age at series initiation," to reflect the 2016 recommendation for 2 to 3 doses depending on the age when the HPV series began
- MPSV4 (4-valent meningococcal vaccine) has been removed from the schedule and is no longer available
"Vaccination records for adults are often scattered, incomplete, and difficult to keep up to date," the authors stated. "Consolidated adult vaccination records maintained in [an immunization information system] would, therefore, play an important role in providing point-of-care clinical support for healthcare providers for adults."
Disclosures
Kim disclosed no relevant relationships with industry. One co-author disclosed support from Up To Date.
Primary Source
Annals of Internal Medicine
Kim DK, et al "Recommended immunization schedule for adults aged 19 years or older, United States, 2018" Ann Intern Med 2018; DOI:10.7326/M17-3439.