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  • Immunization Practices for Influenza and Other Viruses: Updated ACIP Recommendations for Adults

    October brings with it a seasonal influx of individuals seeking influenza vaccination, and it offers an opportunity for healthcare providers to review and address updated vaccination guidance with patients. Earlier this year, the Advisory Committee on Immunization Practices (ACIP) completed its update for the Recommended Adult Immunization Schedule for Adults Aged 19 Years or Older, with major changes affecting influenza, human papillomavirus, hepatitis B, and meningococcal vaccines.

    The CDC recommends that people get an influenza vaccine by the end of October, if possible; however, the vaccination should continue to be offered throughout the influenza season, even into January or later. It takes approximately two weeks after vaccination for influenza antibodies to develop. Due to the low effectiveness of the quadrivalent live attenuated influenza vaccine (LAIV4) in the U.S. during the 2013-14 and 2015-16 seasons, the ACIP made a temporary recommendation that LAIV4 (FluMist) should not be used in the 2016-17 season; it later extended this advisement for the 2017-18 season. Recommendations for individuals with egg allergy have been modified and now indicate that those with a history of egg allergy who have experienced only hives after egg exposure can receive any age-appropriate inactivated influenza vaccine or recombinant influenza vaccine, excluding LAIV4. Additionally, pregnant women are also able to receive any licensed, recommended, age-appropriate influenza vaccine.

    Vaccine viruses included in the 2017-18 U.S. trivalent influenza vaccines will be an A/Michigan/45/2015 (H1N1)pdm09-like virus, an A/Hong Kong/4801/2014 (H3N2)-like virus, and a B/Brisbane/60/2008-like virus (Victoria lineage). Quadrivalent influenza vaccines will contain these three viruses and an additional influenza B vaccine virus, a B/Phuket/3073/2013-like virus (Yamagata lineage). Influenza vaccines have been updated to better match circulating viruses (the influenza A (H1N1) component was updated). Two new quadrivalent influenza vaccines have been licensed: one inactivated influenza vaccine ("Afluria Quadrivalent" IIV) and one recombinant influenza vaccine ("Flublok Quadrivalent" RIV). There is no preference for one vaccine over another among the recommended, approved injectable influenza vaccines.

    Regarding the human papillomavirus vaccine (HPV), the ACIP has advised that healthy adolescents who start their HPV series before 15 years of age are recommended to receive two doses of HPV. However, adults and adolescents who started their HPV series after age 15 are still recommended to receive three doses. Updated recommendations for adults who did not complete the HPV series as adolescents include women through age 26 years and men through age 21 years (and men aged 22-26 years who may receive HPV) who initiated the HPV series before age 15 years and received only one dose, or two doses less than five months apart, should receive one additional dose of HPV.

    In addition, the panel updated the chronic liver disease conditions for which a hepatitis B vaccine series is recommended, including, but not limited to, hepatitis C virus infection, cirrhosis, fatty liver disease, alcoholic liver disease, autoimmune hepatitis, and an alanine aminotransferase or aspartate aminotransferase level greater than twice the upper limit of normal.

    There were two significant updates to the meningococcal vaccination series. First, for adults with HIV infection who have not been previously vaccinated, the panel recommended a two-dose primary MenACWY vaccination series, with doses administered at least two months apart, and revaccination every five years. HIV-infected adults who previously received one dose of MenACWY are recommended to receive a second dose at least two months after the first dose. Also, the ACIP updated the dosing guidelines for one of the serogroup B meningococcal vaccines (MenB), the MenB-FHbp, summarized in the following:

    • Adults who are at increased risk for meningococcal disease where the outbreak is attributable to serogroup B are recommended either MenB-4C (2 doses administered at least one month apart) or MenB-FHbp (three doses administered at 0, 1-2, and 6 months)
    • Young adults (16-23 years) who are healthy and not at increased risk for serogroup B meningococcal disease may receive either a two-dose series of MenB-4C at least one month apart or a two-dose series of MenB-FHbp at 0 and 6 months (MenB-FHbp was previously recommended as a three-dose series at 0, 2, and 6 months)

    The ACIP provided these revised recommendations based on previous years' findings to optimize vaccinations. Furthermore, to tackle the lack of familiarity with the adult immunization schedule by physicians, the graphics and the footnotes of the immunization schedule were streamlined with standardized acronyms and reorganization by vaccine-specific information. With the simplification and updates to the Recommended Adult Immunization Schedule, the ACIP seeks to improve adult vaccination and decrease the risk of illness, disability, and death from vaccine-preventable diseases.

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    Sources:

    Centers for Disease Control and Prevention. (2017). Recommended Immunization Schedules for Adults. Retrieved from https://www.cdc.gov/vaccines/schedules/hcp/adult.html

    Grohskopf LA, Sokolow LZ, Broder KR, et al. Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices-United States, 2017-18 Influenza Season. MMWR Recomm Rep 2017;66(No. RR-2):1-20. DOI: http://dx.doi.org/10.15585/mmwr.rr6602a1

    Kim DK, Riley LE, Harriman KH, et al. Recommended Immunization Schedule for Adults Aged 19 Years or Older, United States, 2017. Ann Intern Med. 2017;166(3):209-219. http://annals.org/aim/article/2601209/recommended-immunization-schedule-adults-aged-19-years-older-united-states