Vaccine recommendations updated for pneumococcus, Tdap and flu

The Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices (ACIP) issued a new adult immunization schedule that adds the pneumococcal conjugate vaccine, updates Tdap regimens for the elderly and pregnant women, and eliminates the egg-allergy exception for influenza vaccines.

Because current vaccination rates are low, ACIP also urges clinicians to regularly assess patient vaccination histories and implement intervention strategies to increase adherence, the recommendations state.

The recommendations were published online Jan. 29 by Annals of Internal Medicine.

For the first time, the 13-valent pneumococcal conjugate vaccine (PCV13) was added to the adult schedule. PCV13 should be used with the 23-valent pneumococcal polysaccharide vaccine (PPSV23) for immunocompromised adults, or those with diseases such as HIV, cancer, advanced kidney disease, functional or anatomic asplenia, cerebrospinal fluid leaks or cochlear implants. The schedule also clarifies which adults would need one or two doses of PPSV23 before the age of 65.

Recommendations for the Tdap vaccine have expanded to include routine vaccination of adults age 65 or older and vaccination of pregnant women with each pregnancy. The ideal timing of Tdap vaccination during pregnancy is in the third trimester, between 27 and 36 weeks' gestation. This recommendation was made to safeguard the pregnant woman and her baby, as protective maternal antibodies will pass to the fetus. Infants are too young for the vaccination but are at the highest risk for severe illness or death from pertussis, the recommendations noted.

All patients age six months and over should continue to be vaccinated against influenza. Mild egg allergy is no longer a contraindication, but patients with an egg allergy should get the inactivated flu shot because that is what has been studied. The FDA has approved a quadrivalent influenza vaccine that contains influenza A (H3N2), influenza A (H1N1), and two influenza B vaccine virus strains, one from each lineage of circulating influenza B viruses. This is meant to increase the likelihood that the vaccine provides cross-reactive antibody against a higher proportion of circulating influenza B viruses.

Beginning with the 2013-2014 season, it is expected that only the quadrivalent formulation will be available. Because a mix of quadrivalent and trivalent influenza vaccines may be available in 2013-2014, the abbreviation for inactivated influenza vaccine has been changed from TIV (trivalent inactivated influenza vaccine) to IIV (inactivated influenza vaccine). The abbreviation for live-attenuated influenza vaccine (LAIV) remains unchanged.

ACP and 16 other medical societies comprise ACIP, which annually reviews the vaccination schedule to ensure that it reflects current clinical recommendations for licensed vaccines.