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ACIP updates adult immunization schedule for influenza, HAV, HBV

The Advisory Committee on Immunization Practices released its 2019 immunization schedule for adults aged 19 years and older, including new or revised recommendations for influenza, hepatitis A virus and hepatitis B virus vaccinations.

“ACIP recommendations can be complex and challenging to implement,” David K. Kim, MD, MA, from the CDC, and colleagues wrote on behalf of ACIP. “The purpose of the annually published adult immunization schedule is to consolidate and summarize updates to ACIP recommendations on vaccination of adults and assist adult care providers in implementing current ACIP recommendations.”

The recommendations are developed based on a thorough review of vaccine-related data. The updated schedule has been reviewed and approved by several professional medical organizations including the CDC, American College of Physicians, American Academy of Family Physicians, American College of Obstetricians and Gynecologists and American College of Nurse-Midwives.

Influenza

After recommending against the use of the live-attenuated influenza vaccine during the 2016 to 2017 and 2017 to 2018 influenza seasons, the ACIP determined that for the 2018 to 2019 season, any licensed influenza vaccine, such as FluMist (AstraZeneca), may be used in accordance with the age and health status of the patient.

HAV

The ACIP added homelessness as an indication and risk factor for HAV. Individuals who are homeless should receive routine vaccination with a two-dose series of single-antigen HAV vaccine or a three-dose series combining the HAV and HBV vaccine, according to the ACIP.

Routine vaccination for HAV should be given to other high-risk individuals, including:

• those with chronic liver disease or clotting factor disorders;
• those traveling to countries with high or intermediate HAV endemicity;
• those who have had personal contact with an international adoptee from a country with high HAV endemicity in the first 60 days of their arrival;
• men who have sex with men;
• those who use drugs via injection or noninjection; and
• those who work with HAV in a laboratory or nonhuman primates infected with the virus.

Individuals who want protection against HAV but are not necessarily at risk for it may be vaccinated.

HBV

The newly approved single-antigen recombinant HBV vaccine (Heplisav-B, Dynavax) should be used to prevent HBV infection in adults aged 18 or older, according to the ACIP. Pregnant women should not receive the vaccine due to lack of safety data in this population.

Heplisav-B should be administered in two doses at least 4 weeks apart and may be used as a substitute in a three-dose series with another HBV vaccine, according to the ACIP.

“Along with routine use of the adult immunization schedule, health care providers can implement such proven strategies as incorporating vaccination assessments as part of routine patient flow and using patient reminders and recalls to improve vaccination of their adult patients,” Kim wrote.

“By consistently using the Recommended Adult Immunization Schedule, United States, 2019, and implementing the standards for adult immunization practice, health care providers can reduce the burden of illnesses, hospitalizations, and mortality associated with vaccine-preventable diseases among their adult patients,” he added. – by Alaina Tedesco

Disclosures: Kim reports no relevant financial disclosures. Please see paper for all other authors’ relevant financial disclosures.