CDC: 2017 Vaccine Schedule Targets Immune-Compromised Adults

Diana Swift

October 21, 2016

A simpler yet more informative adult vaccination schedule has been approved for 2017. Meeting this week in Atlanta, the Centers for Disease Control and Prevention's (CDC's) Advisory Panel on Immunization Practices (ACIP) voted on changes to reflect updated recommendations and to make the document's graphics simpler and its wording both simpler and more consistent. The schedule will also contain fuller information on adults with immune-compromising medical conditions.

The ACIP also approved changes to the 2017 schedule for children and adolescents.

The CDC's immunization schedules are updated annually and approved by several partners, including the American College of Physicians, the American College of Family Physicians, and the American College of Obstetrics and Gynecology.

Changes in the 2017 six-panel schedule were outlined by David Kim, MD, the CDC's deputy associate director for adult immunizations. These included the following:

In the first graphic, the age groups 27 to 49 and 50 to 59 years are combined into one block for ages 27 to 59 years. "The last of those adults 'born before 1957,' a phrase used to indicate immunity to MMR [measles, mumps, rubella] will graduate into the 60-to-64 age bracket in 2017," Dr Kim noted.

Colored blocks have replaced bars, and important information, such as reference to the National Vaccine Injury Compensation Program, has been moved to the cover page.

In the second graphic outlining medical conditions pertinent to vaccination, the column for MSM (men who have sex with men) has been relocated to alert healthcare providers to look at high-risk populations.

And the relevant footnote information has been updated in line with ACIP's June 2016 recommendation for the routine vaccination of all HIV-infected adults with two-dose primary ACWY meningococcal series with revaccination every 5 years. Signaling this, the bar color has been changed to yellow from purple, which indicates routine vaccination only in the presence of another risk factor. Vaccination for meningococcal serogroup B disease is not specifically recommended for HIV-infected patients because all adults at risk for this infection are advised to receive two-dose MenB-C (Bexsero, GlaxoSmithKline) or three-dose MenB-FHbp (Trumenba, Pfizer).

The revision also contains a fuller explanation of vaccination precautions and contraindications, with consolidation of those applicable to all vaccinations and a separate listing for special cases. The updated precautions address inactivated influenza vaccine and egg allergies and include ACIP's recommendation against using live activated influenza vaccine for the 2016–2017 season.

More details have been added to the recommendation on varicella and zoster vaccinations for at-risk populations, such as healthcare workers and patients with HIV and other immunocompromising conditions.

Changes to the section on human papillomavirus vaccination reflected those in the children's schedule. No changes were made regarding routine immunization, but details were added on vaccinating adults with immunocompromising conditions and the MSM population.

Adults with hepatitis C have joined the list of those who should receive hepatitis B vaccine, while immunocompromising conditions have been stricken as an indication for hepatitis B vaccination.

Once CDC-cleared and finalized, the schedule will be published in early 2017 in Annals of Internal Medicine and the CDC's Morbidity and Mortality Weekly Report. "With help from our partners we will work to widely disseminate the schedule and help promote adult immunization," Dr Kim said. The CDC will launch an evaluation project in November based on in-depth interviews with healthcare providers in an effort to further improve the schedule's usability.

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