FROM ANNALS OF INTERNAL MEDICINE
The federal Advisory Committee on Immunization Practices’ 2016 adult immunization schedule differs from the previous schedule in small but significant ways – chief among them that the nine-valent human papillomavirus vaccine (9vHPV) has been added.
“This vaccine can be used for routine vaccination against HPV as one of three HPV vaccines (bivalent HPV vaccine [2vHPV], quadrivalent HPV vaccine [4vHPV], and 9vHPV) recommended for females and one of two HPV vaccines (4vHPV and 9vHPV) recommended for males,” according to the new schedule, which is recommended and released by the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices ( Ann Intern Med. 2016 Feb 2. doi: 10.7326/M15-3005 ).
Another noteworthy change is in the amount of time recommended between receiving the 13-valent pneumococcal conjugate vaccine (PCV13) and the subsequent 23-valent pneumococcal polysaccharide vaccine (PPSV23) in adults aged 65 years and older who are deemed “immunocompetent.” That interval has been increased to “at least 1 year”; previously, it was 6-12 months.
In addition, adults aged 19 years or older should receive the PPSV23 vaccine at least 8 weeks after PCV13 only if they have “anatomical or functional asplenia, cerebrospinal fluid leak, or cochlear implant,” or if they are deemed immunocompromised.
The schedule for meningococcal serogroup B (MenB) has also been changed slightly. It is now recommended for all individuals aged 10 years or older who are considered to be “at increased risk for [MenB],” which ACIP outlines as persons with “anatomical or functional asplenia or persistent complement component deficiencies, microbiologists who are routinely exposed to isolates of Neisseria meningitidis, and persons identified at increased risk because of a serogroup B meningococcal disease outbreak.”
The recommendations note that the MenB series of vaccines can be given to any adolescents and young adults between the ages of 16 and 23 years to provide protection against the disease on a short-term basis, with a recommended age range of 16-18 years as optimal for vaccination.
Other changes are more minor, consisting of alterations to the vaccine schedule’s figures and accompanying text.
The row pertaining to “Meningococcal” vaccinations has been changed to “Meningococcal 4-valent conjugate (MenACWY) or polysaccharide (MPSV4),” in order to clarify that “there are two types of serogroup A, C, W, and Y meningococcal vaccines available for adults.” Furthermore, MenB has been given its own row on the immunization schedule.
The text regarding hepatitis A has been amended from “2 doses” to “2 to 3 doses depending on vaccine” because of differences between the hepatitis A and B vaccine series. The other changes are to texts detailing alternate dosing schedules for common vaccines, such as “Measles, mumps, and rubella,” to show that those recommendations can be changed “depending on indication.”
The 2016 adult immunization schedule was reviewed and approved by the American College of Physicians, the American Academy of Family Physicians, the American College of Obstetricians and Gynecologists, and the American College of Nurse-Midwives.
