ACIP Recommends Universal HBV Vaccination for Adults Under 60, Expands Recommendations for Vaccines Against Orthopoxviruses and Ebola

Lucy Hicks

November 04, 2021

The Advisory Committee on Immunization Practices (ACIP) of the US Centers for Disease Control and Prevention has unanimously voted to recommend universal hepatitis B (HBV) immunization in all unvaccinated adults aged 59 or younger. The group also voted to expand recommendations for vaccinating people at risk for occupational exposure to Ebola and to recommend Jynneos, a smallpox and monkeypox vaccine, for at-risk populations.

The recommendations were approved November 3.

Previously, ACIP recommended HBV vaccination for unvaccinated adults at increased risk for infection due to sexual exposure, percutaneous or mucosal exposure to blood, hepatitis C infection, chronic liver disease, end-stage renal disease, HIV infection, and travel to areas with high to intermediate levels of HBV infection. But experts agreed a new strategy was needed, as previously falling rates of HBV have plateaued. "The past decade has illustrated that risk-based screening has got us as far as it can take us," said Mark Weng, MD, a lieutenant commander in the US Public Health Service and lead of the ACIP Hepatitis Vaccine Working Group, during the meeting.

There are 1.9 million people living with chronic HBV in the United States, with over 20,000 new acute infections every year. Rates are highest among those in their 40s and 50s, Weng noted.

The group debated whether to apply the universal recommendation to all ages, but in a close vote (8 yes, 7 no), ACIP included an age cut-off of 59. The majority argued that adults 60 and older are at lower risk for infection and vaccination efforts targeting younger adults would be more effective. Those 60 and older would continue to follow the risk-based guidelines, but anyone, regardless of age, can receive the vaccine if they wish to be protected, the group added.

The CDC director as well as several professional societies need to approve the recommendation before it becomes public policy.

ACIP also voted to recommend the following:

  • Adding updated recommendations to the 2022 immunization schedules for children, adolescents, and adults, including dengue vaccination for children 9-16 in endemic areas and routine pneumococcal vaccination in adults over 65 and those aged 19-64 with certain chronic conditions.

  • The use of Jynneos, a smallpox and monkeypox vaccine, as an alternative to ACAM2000 for those at risk for occupational exposure.

  • Pre-exposure vaccination of healthcare personnel involved in the transport and treatment of suspected Ebola patients at special treatment centers, or lab and support staff working with or handling specimens that may contain the Ebola virus.

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