Updated Adult Immunisation Schedule 2008 USA

Ann Intern Med. Published online October 18, 2007.

Varicella and zoster vaccines:

• • Varicella vaccine is now extended through all age groups on the age-based schedule.
  • Varicella vaccine is extended to include HIV-infected persons with CD4⁺ T lymphocyte counts of 200 cells/µL or greater.
  • The varicella footnote has been revised to clarify that birth before 1980 in immunocompromised persons is not considered evidence of immunity.
  • Laboratory-confirmed diagnosis is required as evidence of varicella immunity in a healthcare provider diagnosis of a mild or atypical case.
  • Zoster vaccine has been added to the age-based schedule indicating that the vaccine is indicated for those aged 60 years and older.
  • Zoster vaccine is indicated for all conditions except pregnancy, immunocompromising conditions, and HIV.
• Influenza vaccine:
  • Healthcare workers can receive either TIV or LAIV.
  • The indication for influenza vaccine has been extended to include asplenia in the medical and other indications schedule.
• HPV vaccine:
  • The HPV footnote has been revised to clarify evidence of previous infection.
  • The HPV vaccine is not specifically indicated based on medical conditions.
  • Efficacy and immunogenicity of the HPV vaccine may be lower in immunocompromised persons or in those with certain medical conditions.
• Meningococcal vaccine:
  • Persons remaining at increased risk for meningococcal infection may be indicated for revaccination.
  • 1 or more doses of meningococcal vaccine may be indicated.
• Other changes:
  • HIV is considered an immunocompromising condition and the medical indication column has now been split into those with CD4⁺ T lymphocyte counts of less than 200 cells/µL and 200 cells/µL or greater.
  • The indication of "CSF leaks" has been moved from the immunocompromising condition column heading to the footnote text.
  • The hepatitis A vaccine is indicted for recipients of clotting factor concentrate.
  • Hepatitis B vaccine footnote has been revised to delete persons who receive clotting factor concentrates as a risk group and to clarify the dose schedule for special formulation indications.
  • The indication "recipients of clotting factor concentrates" has been removed from the chronic liver disease column.
  • Chronic alcoholism has been added to medical and other indications for the pneumococcal vaccine.

Changes in the 2007-2008 schedule from the previous one are as follows:

• Varicella vaccine is recommended for all adults without evidence of immunity to varicella.
  
  
• Zoster vaccine has been added to the age-based schedule and is recommended for persons 60 years of age or older.
  
  
• Because not all of the vaccines are recommended based on medical indications, the title of the medical and other indications schedule has been changed to "Vaccines That May Be Indicated for Adults Based on Medical and Other Indications."
  
  
• In the medical and other indications schedule, the immunocompromising conditions column heading has been shortened by removing the list of specific immunocompromising conditions.
  
  
• In the medical and other indications schedule, the HIV infection column has been moved next to the immunocompromising conditions column. To draw attention to vaccine indications based on CD4⁺ T lymphocyte counts, the HIV column in the medical and other indications schedule has been split into CD4⁺ T lymphocyte count less than 200 cells/µL and 200 cells/µL or greater.
  
  
• The indication "recipients of clotting factor concentrates" has been removed from the heading for the chronic liver disease column, because only 1 vaccine, the hepatitis A vaccine, has this recommendation. The indication for the hepatitis A vaccine indication remains in the footnote.
  
  
• In the medical and other indications schedule, indications for varicella vaccine have been extended to include HIV-infected persons with CD4⁺ T lymphocyte counts of 200 cells/µL or greater.
  
  
• In the medical and other indications schedule, indications for influenza vaccination of healthcare personnel now note that healthcare workers can receive either trivalent inactivated influenza vaccine (TIV) or live, attenuated influenza vaccine (LAIV).
  
  
• In the medical and other indications schedule, indications for influenza vaccine have been extended to include the asplenia risk group.
  
  
• In the medical and other indications schedule, indications for meningococcal vaccine have been revised to note that 1 or more doses of vaccine may be needed.
  
  
• Zoster vaccine has been added to the medical and other indications schedule, and it is now recommended for all indications except pregnancy, immunocompromising conditions, and HIV. Zoster vaccine is specifically contraindicated for pregnancy, immunocompromising conditions, and HIV infection with CD4⁺ T lymphocyte count less than 200 cells/µL.
  
  
• Because the footnotes now primarily summarize the indications for vaccine use, language on vaccine contraindications in pregnancy has been removed from the footnotes of human papillomavirus (HPV); measles, mumps, rubella (MMR) vaccine; and varicella vaccine. Pregnancy contraindications appear in the body of the medical and other indications schedule.
  
  
• The footnote for HPV has been revised to clarify evidence of a previous infection, to note that the HPV vaccine is not specifically indicated based on medical conditions, and to point out that the efficacy and immunogenicity may be lower in immunocompromised persons or in persons with certain medical conditions.
  
  
• The footnote for varicella has been revised to indicate that birth before 1980 in immunocompromised persons is not considered evidence of immunity and to note that an epidemiologic link to a laboratory-confirmed case is required for evidence of immunity in a healthcare provider diagnosis of a mild or atypical case.
  
  
• In the footnote for pneumococcal (polysaccharide) vaccine, chronic alcoholism has been added to make it consistent with the column heading in the medical and other indications schedule, and the list of specific immunocompromising conditions has been deleted. The "CSF [cerebrospinal fluid] leaks" indication now appears in the footnote text instead of in the immunocompromising condition column.
  
  
• The footnote for hepatitis A vaccine has been revised to clarify the dose schedule.
  
  
• The footnote for hepatitis B vaccine has been revised to clarify the dose for special formulation indications and to no longer designate as risk group persons who receive clotting factor concentrates.
  
  
• The footnote for meningococcal vaccine has been revised to clarify that persons who remain at increased risk for infection may need to be revaccinated.
  
  
• Two additional footnotes have been added: one to reflect ACIP recommendations for herpes zoster vaccination for persons age 60 years or older, and one to cite a reference for the use of vaccines in persons with immunocompromising conditions.

"General information about adult vaccinations, including recommendations on vaccination of persons with HIV and other immunosuppressive conditions is available from state and local health departments and at www.cdc.gov/vaccines/default.htm," the study authors conclude. "Vaccine information statements are available at www.cdc.gov/vaccines/pubs/vis/default.htm. Persons can view, download, and print ACIP statements for each recommended vaccine and provisional vaccine recommendations at www.cdc.gov/vaccines/pubs/acip-list.htm."