ACIP Releases Updated Adult Immunization Schedule Recommendations

The Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices (ACIP) has voted to approve the updated vaccination recommendations for adults 19 years of age or older for 2018.

Changes to the schedule include new recommendations for the use of recombinant zoster vaccine (RZV) for adults over 50 years of age as well as giving an additional dose of the measles, mumps, and rubella (MMR) vaccine when in an outbreak setting, according to the new paper.

RZV, GlaxoSmithKline’s Shingrix vaccine, received approval from the US Food and Drug Administration for the treatment of adults aged 50 or over to prevent herpes zoster, or shingles, along with its complications. Updated recommendations for herpes zoster vaccines include the following:

• Adults aged 50 and older be given 2 doses of RZV, 2 to 6 months apart, regardless of past episode of herpes zoster or having had received ZVL
• Adults who have received zoster vaccine live (ZVL) previously should be given 2 doses of RZV, 2 to 6 months apart, at least 2 months after having received ZVL
• Adults aged 60 and older should be given either RZV or ZVL, although RZV is preferred

There is no recommendation on the use of RZV for pregnant women or adults with immunocompromising conditions; recommendations regarding the use of the vaccine in those with immunocomprising conditions is pending. RZV can be used in adults who are “receiving low-dose immunosuppressive therapy, are anticipating immunosuppression, or have recovered from an immunocompromising illness,” according to the paper.

As for the MMR vaccine, the updated recommendations are as follows:

• Adults who have received 2 or fewer doses of mumps-containing vaccine and are considered to be at increased risk during a mumps outbreak by a public health authority should receive 1 dose of MMR.
• Adults who do not have evidenced immunity to the disease should receive 1 dose of MMR routinely; if they are students in postsecondary educational institutions, international travelers, or are household contacts with individuals who are immunocompromised, they should receive 2 MMR doses at least 28 days apart.
• In outbreak settings, those identified to be at increased risk should receive 1 MMR dose regardless of if they received 0, 1, or 2 doses of a mumps-containing vaccine in the past.

“Although modest increases in vaccination coverage rates were observed in several groups of adult population in 2015, the overall vaccination coverage rates for adults in the United States have remained low,” authors of the paper write.

Multiple factors can result in low vaccination rates among this population. Adult patients may not be aware of the vaccines recommended for them; incomplete vaccination records can make it difficult for providers to ascertain which vaccines are needed; providers may prioritize other things over vaccinations.

To address the issue, the National Vaccine Advisory Committee has updated the standards for adult immunization practice, encouraging the “integration of vaccinations as a part of routine clinical care for adults.”

According to the paper, the standards serve as a call to action for health care providers to do the following:

1. Assess the vaccination status of adult patients at every clinical encounter
2. Strongly recommend needed vaccines to patients
3. Offer vaccines recommended to patients (providers who do not stock vaccines should refer patients to another provider or pharmacist who stocks and administers vaccines)
4. Document vaccines administered in the state or local immunization information system

For more information, or to see the 2018 recommendations in their entirety, check out the original paper.