ACIP 2017 Immunization Schedule: The Key Points

I'm Dr Sandra Fryhofer. The topic for this edition of Medicine Matters is changes in adult immunization for 2017, the latest update from the Advisory Committee on Immunization Practices (ACIP).

Each year, ACIP summarizes the immunizations that adults age 19 years or older need. The new adult schedule is available on the US Centers for Disease Control and Prevention (CDC) website and is also published in the Annals of Internal Medicine.^[1]

The format is relatively short, and colorful. Two color-coded graphics are used, with corresponding footnotes for each vaccine. There is also a table with contraindications and precautions for each vaccine.

The new graphic design features blocks instead or bars. It may look more streamlined, but be sure to read the footnotes carefully and completely. They contain important and specific detailed instructions about who needs what, and when, and even how. The new graphics categorize vaccine information by age group and according to medical conditions. We will now review changes for this year.

Influenza Vaccination

Everyone 6 months of age or older needs flu vaccination every year, but the how has changed.

ACIP says that for the 2016-2017 season, the quadrivalent, live attenuated nasal-spray influenza vaccine (LAIV4) should not be used because studies have shown that it just didn't seem to work. Researches are still trying to figure out exactly why, but there are still plenty of vaccine choices for adults:

Trivalent and quadrivalent versions of the inactivated influenza vaccine (IIV);
The almost egg-free cell-cultured inactivated influenza vaccine (ccIIV); and
Recombinant influenza vaccine (RIV), which is totally egg free.

Adults age 65 or older have two additional choices:

High-dose inactivated influenza vaccine (Fluzone® High-Dose); and
Newer adjuvant formulation of trivalent inactivated influenza vaccine (FLUAD™).

There's still good news for anyone allergic to eggs. Adults with hives-only egg allergy can be given any age-appropriate IIV or RIV. The amount of egg protein in even the IIV vaccines, which are grown in eggs, is minuscule.

The same goes for adults with more serious egg allergy symptoms, including angioedema, respiratory distress, lightheadedness, recurrent vomiting, or a reaction requiring epinephrine. They also can receive any age-appropriate IIV or RIV, but with an important stipulation: It must be given under the supervision of a healthcare provider who is able to recognize and manage severe allergic conditions.

The schedule says that pregnant women should only receive the inactivated version, IIV.

HPV Vaccination

Here's what's new: Only two doses of human papillomavirus (HPV) vaccine are needed for those who start the series before age 15. The doses should be given at least 6 months apart. The three-dose requirement still applies for anyone who starts the HPV vaccine series at 15 years or older.

Hepatitis B Vaccination

The new schedule clarifies the types of liver disease that call for hepatitis B vaccination. Take a look at the full list. It now includes fatty liver disease and anyone with an alanine aminotransferase (ALT) or aspartate aminotransferase (AST) level greater than twice normal.

Meningococcal Vaccination

Adults with HIV infection now should receive two doses of meningococcal conjugate vaccine (MenACWY). However, routine meningococcal B vaccination for those with HIV is currently not recommended.

For meningococcal B protection, ACIP gives no preference as to which of the two vaccines to use, but there is some clarification about the number of doses needed for Men B-FHbp vaccine (Trumenba®). During a meningococcal B outbreak, three doses are needed. For routine vaccination of healthy adolescents and young adults, two doses will suffice. No changes were made to the two-dose schedule for MenB-4c vaccine (Bexsero®).

Pneumococcal Vaccination

Pay close attention to the pneumococcal vaccination section in the footnotes. It's complicated. Remember that there are now two pneumococcal vaccines for adults: the 23-valent pneumococcal polysaccharide vaccine (PPSV23) and the 13-valent pneumococcal conjugate vaccine (PCV 13). They should not be given at the same time. Depending on age and medical condition, some patients need one and some patients need both. Some patients need PPSV23 revaccination. Who needs what and when is all in the footnotes.

My advice is to keep a hard copy of the new adult immunization schedule in your exam rooms or have it readily available on your mobile device.

Conclusion

I have briefly reviewed the changes for this year's adult immunization schedule, but please take some time to read the footnotes carefully. The schedule is a lot to remember. My advice is to keep a hard copy of the new adult immunization schedule in your exam rooms or have it readily available on your mobile device. Be sure to share it with your staff. It's your best way to make sure your patients get the vaccinations they need.

Happy vaccinating!

For Medicine Matters, I'm Dr Sandra Fryhofer.

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