Adult immunization schedule recommends major changes to 3 vaccines

The Advisory Committee on Immunization Practices released its 2016 Recommended Immunization Schedule for adults with 3 major changes, related to the human papillomavirus (HPV), pneumococcal, and meningococcal (MenB) vaccines.

The 9-valent HPV vaccine (9vHPV) was added to the adult immunization schedule. This vaccine can be used for routine vaccination against HPV. It is 1 of 3 HPV vaccines (bivalent HPV vaccine [2vHPV], quadrivalent HPV vaccine [4vHPV], and 9vHPV) recommended for women and 1 of 2 HPV vaccines (4vHPV and 9vHPV) recommended for men.

The vaccine interval for 13-valent pneumococcal conjugate vaccine (PCV13) followed by 23-valent pneumococcal polysaccharide vaccine (PPSV23) has changed from “6 to 12 months” to “at least 1 year” for immunocompetent adults aged 65 and older. Adults ages 19 years or older with anatomical or functional asplenia, cerebrospinal fluid leak, or cochlear implant or who are immunocompromised should receive PPSV23 at least 8 weeks after PCV13.

The MenB vaccine series should be administered to everyone ages 10 and older at increased risk for serogroup B meningococcal disease. Those at increased risk include persons with anatomical or functional asplenia or persistent complement component deficiencies, microbiologists who are routinely exposed to isolates of Neisseria meningitidis, and people identified at increased risk because of a serogroup B meningococcal disease outbreak. The MenB vaccine series may be administered to adolescents and young adults aged 16 through 23 years (preferred age is 16 through 18 years) to provide short-term protection against most strains of serogroup B meningococcal disease.

The complete schedule, including footnote changes, is being published in Annals of Internal Medicine and on the Centers for Disease Control and Prevention website, along with 2 easy-to-reference charts showing recommended vaccines by age and by medical condition. Notable changes to the 2 figures include:

• The row for “Meningococcal” was retitled to “Meningococcal 4-valent conjugate (MenACWY) or polysaccharide (MPSV4)” to indicate that there are 2 types of serogroup A, C, W, and Y meningococcal vaccines available for adults.
• A new row for “Meningococcal B (MenB)” was added.
• Additional text was added in several indication bars to describe reasons for alternate dosing schedules for vaccines where such designations were appropriate; for example, in the “Measles, mumps, and rubella (MMR)” indication bar that states “1 or 2 doses,” the clause “depending on indication” was added.
• The text in the “Hepatitis A” indication bar was revised from “2 doses” to “2 or 3 doses depending on vaccine” to account for the hepatitis A and hepatitis B combination vaccine that is administered in a 3-dose series.