COMMENTARY

Hot Off the Podium: ACIP Adult Vaccine Recommendation Update

Summer 2015

Sandra Adamson Fryhofer, MD

Disclosures

July 13, 2015

In This Article
Sandra Adamson Fryhofer, MD
Adjunct Associate Professor of Medicine, Emory University School of Medicine, Atlanta, Georgia

This edition of "Staying Well" summarizes selected adult immunization highlights from the June 24-25, 2015, ACIP meeting and recommendations for meningococcal B, flu, and pneumococcal vaccines. Informational updates for Tdap and herpes zoster vaccine are also included.

About ACIP

ACIP, the Advisory Committee on Immunization Practices, meets three times a year (February, June, and October) at the Centers for Disease Control and Prevention (CDC) headquarters in my hometown of Atlanta, Georgia. ACIP is charged with making immunization recommendations for vaccine-preventable diseases for the United States. Its 15 voting members are appointed by the Secretary of the Department of Health and Human Services (DHSS). Eight ex officio representatives from federal agencies also attend along with 30 nonvoting liaisons from the American Medical Association, the American College of Physicians, the American Academy of Family Physicians, the American Academy of Pediatrics, the American College of Obstetricians and Gynecologists, and other nursing, pharmacy, and health-related organizations.[1] In addition to in-person meetings, ACIP members (and liaisons) participate in work groups for specific vaccines, reviewing the most up-to-date vaccine-specific clinical and safety information. They then present their recommendations to ACIP at the meeting.[1]

In October 2010, ACIP adopted the evidence-based GRADE process (Grading of Recommendations, Assessment, Development, and Evaluation) for making new vaccination recommendations. ACIP recommendations do not become official CDC policy until they are signed by the CDC director, accepted by the DHSS Secretary and published in Morbidity and Mortality Weekly Report (MMWR). Under the Affordable Care Act, insurance companies must cover all ACIP category A and B recommendations. Coverage for vaccines without cost-sharing (when delivered by an in-network provider) is mandated 1 year after a recommendation is made. Of interest, this rule does not apply to Medicare.[2] Category A recommendations refer to those made for all persons in an age- or risk factor–based group. Category B recommendations are those that need individual clinical decision-making.[3]

New Vote: General Recommendations on Immunization Revisions for Those With Altered Immunocompetence

The "General Recommendations" document is updated and published in MMWR every 3-5 years and addresses a potpourri of vaccine topics, from timing and spacing to storage and handling. The recommended revisions for the section on patients with altered immunocompetence[4] incorporated a review of the Infectious Diseases Society of America (IDSA) Clinical Practice Guidelines for Vaccination of the Immunocompromised[5] and are an excellent resource for physicians who treat patients in this category. Specific sections discuss which vaccines to give, and when, for specific patient groups, including recipients of hematopoietic cell transplants, patients with functional or anatomic asplenia, and patients taking steroids (low dose vs high dose). The section on "other immunosuppressive drugs" includes "newer" agents, including human immune mediators (levamisole and BCG [bacillus Calmette-Guérin] bladder tumor therapy), tumor necrosis factor alpha inhibitors, and anti-B cell antibodies (eg, rituximab).[4] There is also a special section on vaccinations needed for the contacts of persons with altered immunocompetence.[4]

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