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ACIP approves updates to 2016 adult immunization schedule
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The CDC’s Advisory Committee on Immunization Practices voted unanimously today to approve various updates to the 2016 adult immunization schedule.
“This schedule represents current ACIP policy, and also updates approved policy updates from ACIP meetings,” Kathleen Harriman, PhD, chair of the ACIP Work Group, said during the meeting. “The adult immunization working group meets monthly, and has ongoing consultation with vaccine subject matter experts. Updates in adult immunization schedule are approved by the American College of Physicians, the American Academy of Family Physicians, the American College of Obstetrics and Gynecology, and the American College of Nurse Midwives.”
David K. Kim
David K. Kim, MD, from the CDC’s Immunization Services Division, National Center for Immunization and Respiratory Diseases, presented the proposed changes to the adult immunization schedule, which reflected recent policy updates in HPV, pneumococcal and meningococcal vaccinations.
Along with language clarifications, HPV vaccination recommendation updates included the use of Gardasil 9 (9-valent HPV vaccine, Merck) alongside other HPV vaccination options. A three-dose series of the 2-valent, 4-valent or 9-valent HPV vaccine now is recommended for females aged 19 to 26 years, while a three-dose series of 4-valent and 9-valent HPV vaccine is recommended for males aged 19 to 21 years. In addition, men who have sex with men and immunocompromised men aged 26 years or younger are recommended to receive a three-dose series of the 4-valent or 9-valent HPV vaccine.
Pneumococcal vaccination recommendations for immunocompetent adults aged 65 years or older were updated to extend the interval between Prevnar 13 (13-valent pneumococcal conjugate vaccine, PCV13; Pfizer) and Pneumovax 23 (23-valent pneumococcal polysaccharide vaccine, PPSV23; Merck) to at least 1 year. Errata in the 2015 adult immunization schedule involving vaccine recommendations for immunocompromised adults and those who smoke cigarettes or reside in long-term care facilities also were corrected.
Recommendations for serogroup B meningococcal vaccine proposed by the committee in June were added to the 2016 schedule and listed in figures separately from Menveo (MenACWY-C RM, Novartis) and Menommune (MenACYW135, Sanofi Pasteur). A two-dose series of Bexsero (4CMenB, Novartis) or three-dose Trumenba (MenB-FHbp, Pfizer) was recommended for adults with asplenia or complement diseases as well as those at risk for meningitis B infection, but not for travelers entering countries where the disease is endemic. A Category B recommendation was made for young adults aged 16 to 23 years to receive MenB vaccination for short-term protection; however, Kim said further issues to maximize protection still need to be solved for this age group. Other notes and clarifications regarding MenB vaccination were included in the recommendation footnotes.
Kim also demonstrated changes to schedule figures regarding these updates, which primarily comprised indications for influenza and meningococcal vaccines. Comments on the proposal were largely focused on improving clarity within the 2016 immunization schedule’s footnotes, which were taken into account, and the final adult immunization schedule was passed in a 15-0 vote by the committee. – by Dave Muoio
Perspective
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Sandra Adamson Fryhofer, MD
At its October meeting, ACIP, the Advisory Committee on Immunization Practices, maintained its tradition of summarizing changes planned for its annual adult immunization schedule update.
This year’s changes include updates for intervals between pneumococcal vaccinations, as well as clearing up confusion surrounding vaccination intervals for high-risk groups, specifically immunocompromised patients and immunocompetent patients with CSF leaks and cochlear implants. Unless Medicare makes a policy change, these high-risk groups fall in the Medicare immunization dollar coverage gap.
Changes in meningococcal vaccination strategies will incorporate ACIP’s new Meningococcal B vaccination Category A recommendation for use in anyone aged 10 years and older at increased risk (complement deficiencies and asplenia) and also for those exposed during an outbreak. This is an off-label use for older adults since both new meningococcal B vaccinations are licensed only for those aged 10 to 25 years. It will also include the Category B (for individual clinical decision making) Meningococcal B recommendation for those aged 16 to 23 years. Parents of kids going off to college need to be aware of this option.
ACIP’s HPV vaccination recommendation now includes 9-valent HPV vaccine as a choice for the three-dose series for age- (and condition-) appropriate males and females. The introduction of the 9-valent HPV vaccine expands potential cancer protection (4% for males; 14% for females), but ACIP falls short of recommending additional 9-valent HPV vaccination for those who have already received a three-dose HPV vaccine series. The final graphic and footnotes changes will be unveiled in early 2016. Look for its publication in Annals of Internal Medicine, on the CDC website, and in CDC’s MMWR. Meanwhile, happy vaccinating!
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