ACIP Unveils 2020 Adult Vaccine Schedule

The US Centers for Disease Control and Prevention (CDC) Advisory Committee on Immunization Practices (ACIP) has released the Recommended Adult Immunization Schedule, United States 2020 in Annals of Internal Medicine.

The new recommendations include changes in the administration of vaccines for human papillomavirus (HPV), hepatitis A, hepatitis B, influenza, meningococcal serogroup B, and pneumococcal disease.

The age range for HPV vaccination was expanded in October 2018, from 9 through 26 years to 9 through 45 years. After reviewing evidence related to adult HPV vaccination, ACIP has now updated recommendations to suggest some adults above the recommended catch-up age receive catch-up vaccination, based on shared-clinical decision making. This pertains primarily to adults aged 27 through 45.

For hepatitis A, ACIP’s updated recommendations suggest all people with HIV 1 year or older be routinely vaccinated. Other populations at high risk for hepatitis A include individuals with chronic liver disease.

The definition for chronic liver disease, relevant to hepatitis risk assessments, has been expanded to include people with cirrhosis, hepatitis B, hepatitis C, fatty liver disease, alcoholic liver disease, autoimmune hepatitis, and an alanine aminotransferase or aspartate aminotransferase level greater than twice the upper limit of normal.

Influenza vaccination recommendations for the 2019-20 flu season includes all people age 6 months or older who do not have contraindications. A live attenuated vaccine is an option for adults through 49 years of age who do not have immunocompromising conditions. People who experienced an episode of Guillain—Barre ́ syndrome within 6 weeks of a previous influenza vaccination are not recommended to receive a flu shot unless they are at high risk of complications from influenza.

Individuals at risk for meningococcal serogroup B include persons 10 years of age or older with complement inhibitor use, complement deficiency, asplenia, or who are working as a microbiologist. These individuals should receive a meningococcal B vaccine booster dose 1 year following the primary series of the vaccine. After this, they should receive a booster doses every 2 to 3 years for as long as they are considered to be at an increased risk.

Clinicians should engage in shared decision making about the meningococcal serogroup B vaccine with adolescent and young adult patients aged 16 through 23 years who are not at increased risk.

During an outbreak, people determined by health officials to be at increased risk should be administered a 1-time booster dose if it has been a year or more since completion of the meningococcal B primary series.

It is now recommended clinicians discuss the pneumococcal 13-valent conjugate vaccine with all adults 65 years or older who do not have an immunocompromising condition, cochlear implants, or cerebrospinal fluid leak, and have not received the vaccine before. Adults aged 65 years and older should receive a dose of pneumococcal 23-valent polysaccharide vaccine.

ACIP previously recommended a single dose of tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine followed by decennial booster doses of tetanus and diphtheria toxoids vaccine (Td). Tetanus, diphtheria, and pertussis vaccine recommendations have been updated to allow more flexibility in administration of either Td or Tdap.

ACIP reviews the schedule yearly. The committee is comprised of 15 voting members in addition to other non-voting officials who are experts in immunization.