USA Adult Immunization Schedule for 2011 Released

From Medscape Medical News

Laurie Barclay, MD

January 31, 2011 — In October 2010, the Advisory Committee on Immunization Practices (ACIP) approved the Adult Immunization Schedule for 2011, which includes several changes.
An adult woman receives a vaccine at her primary care provider's office.

The 2011 schedule, which reflects current recommendations for the licensed vaccines, is published in the February 1 issue of the Annals of Internal Medicine. The 2011 schedule was also approved by the American Academy of Family Physicians, American College of Obstetricians and Gynecologists, and the American College of Physicians.

"The notation for seasonal influenza vaccine in the figure and footnotes was changed to reflect the expanded recommendation for annual influenza vaccination for everyone 6 months of age or older, which was approved by ACIP in February 2010," write Abigail Shefer, MD, Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, and colleagues.
"In October 2010, ACIP issued a permissive recommendation for use of the tetanus, diphtheria, pertussis (Tdap) vaccine in adults aged 65 years or older; approved the recommendation that Tdap can be administered regardless of how much time has elapsed since the last tetanus and diphtheria (Td)–containing vaccine;
and approved a recommendation for a 2-dose series of meningococcal vaccine in adults with certain high-risk medical conditions. The vaccines listed in the Figure have been reordered to keep all universally recommended vaccines together (for example, influenza, Td/Tdap, varicella, human papillomavirus [HPV], and zoster)."

Other changes include clarifications to the footnotes for the measles, mumps, rubella; HPV; and Haemophilus influenza type B (Hib) vaccines and for revaccination with pneumococcal polysaccharide (PPSV). A vaccine series does not need to be restarted, regardless of the time elapsed between doses.

Specific Updated Changes

Specific changes in the schedule for 2011 include the following:

* All persons at least 6 months old, including all adults, should be vaccinated against seasonal influenza. Adults at least 65 years old may receive the high-dose influenza vaccine (Fluzone; sanofi-pasteur, Swiftwater, Pennsylvania), licensed in 2010 for use in this age group, as an option.
* Persons at least 65 years old in close contact with an infant younger than 12 months should receive Tdap vaccine, and all persons at least 65 years old may receive Tdap vaccine. Tdap should be administered regardless of time elapsed since receiving the last Td-containing vaccine.
* Either quadrivalent human papillomavirus (HPV4) vaccine or bivalent (HPV2) vaccine is recommended for girls and women.
* For revaccination with PPSV, 1-time revaccination after 5 years applies only to persons 19 through 64 years old with indicated chronic conditions, namely chronic renal failure or the nephrotic syndrome, functional or anatomic asplenia, or immunocompromising conditions.
* For adults with anatomic or functional asplenia or persistent complement component deficiencies and adults with HIV infection who are vaccinated with meningococcal conjugate vaccine (MCV4), a 2-dose series of meningococcal vaccine is recommended, with the 2 doses given 2 months apart.
For those with other indications, a single dose of meningococcal vaccine is still recommended.
Information in the new schedule clarifies that MCV4 is a quadrivalent vaccine.
* Information regarding the Hib vaccine clarifies which high-risk persons may receive 1 dose of Hib vaccine, namely persons who have sickle cell disease, leukemia, or HIV infection, or those who have had a splenectomy, if they have not previously received Hib vaccine.

Additional Schedule Highlights

Additional highlights of the Adult Immunization Schedule include the following:

* Adults younger than 65 years whose previous Td status is unknown should receive 1 dose of Tdap. Tdap should be administered immediately to postpartum women, close contacts of infants younger than 12 months, and healthcare workers.
* Girls 11 to 12 years old should receive HPV4 or HPV2. Catch-up vaccination in girls may be given until age 26 years. Boys and men 9 to 26 years old may be given HPV4 to lower their risk of acquiring genital warts.
* All persons at least 60 years old should receive a single dose of vaccine against herpes zoster, regardless of whether personal history is positive for herpes zoster.
* Recommendations for varicella vaccination are unchanged. Two vaccine doses at least 4 weeks apart should be given to all adults born during or after 1980 who have no evidence of immunity to varicella.
Healthcare workers should not be considered to have immunity against varicella simply because of their age.
Pregnant women should be evaluated for evidence of varicella immunity, and those lacking such evidence should receive the first dose of varicella vaccine on completion or termination of pregnancy and before discharge from the healthcare facility.
The second dose should be given 4 to 8 weeks after the first dose.
* Hepatitis A vaccination should be given to anyone seeking protection from hepatitis A virus (HAV) infection, men who have sex with men, users of injection drugs, persons working with HAV-infected primates or with HAV in a research laboratory setting, persons with chronic liver disease and persons who receive clotting factor concentrates, and persons traveling to or working in countries with high or intermediate endemicity of hepatitis A.
* Hepatitis B vaccination should be given to anyone seeking protection from hepatitis B virus (HBV) infection, persons with more than 1 sex partner during the previous 6 months, persons seeking evaluation or treatment of a sexually transmitted disease, current or recent injection-drug users, men who have sex with men, healthcare personnel and public safety workers exposed to blood or other potentially infectious body fluids, persons with end-stage renal disease, persons with HIV infection, persons with chronic liver disease, household contacts and sex partners of persons with chronic HBV infection, clients and staff members of institutions for persons with developmental disabilities, and international travelers to countries with a high or intermediate prevalence of chronic HBV infection.

Ann Intern Med. 2011:154:168-173. Full text