Adult immunization schedule released for 2017

The Advisory Committee on Immunization Practices (ACIP) has released its 2017 Recommended Immunization Schedule for adults, with changes to influenza, human papillomavirus (HPV), hepatitis B, and meningococcal vaccinations.

For the influenza vaccine, the ACIP recommends that live attenuated influenza vaccine (LAIV) not be used in the 2016-2017 influenza season due to its low effectiveness against influenza A(H1N1)pdm09 during the 2013-2014 and 2015-2016 influenza seasons. The ACIP also recommends that patients with a history of egg allergy who react to egg exposure only with hives should receive age-appropriate inactivated influenza vaccine or recombinant influenza vaccine. For adults with a history of egg allergy and symptoms other than hives (e.g., respiratory distress or need for epinephrine or other emergency intervention), age-appropriate inactivated influenza vaccine or recombinant influenza vaccine may be administered but should be given in a medical setting and should be supervised by a clinician who can recognize and manage severe allergic conditions.

For the HPV vaccine, the ACIP made updates to recommendations for adults who did not complete the series as adolescents, as follows:

• Women ages 26 and younger and men ages 21 and younger who have not received any dose of HPV vaccines should receive a three-dose series at zero, one to two, and six months. Men ages 22 through 26 can receive a three-dose series at zero, one to two, and six months.
• Women ages 26 and younger and men ages 21 and younger (and men ages 22 through 26 who may receive HPV) who started the HPV series before age 15 years and got two doses at least five months apart are considered to be adequately vaccinated and do not need an additional HPV vaccine dose.
• Women ages 26 and younger and adult men ages 21 and younger (and men ages 22 through 26 who may receive HPV) who started the HPV series before age 15 years and got only one dose or two doses less than five months apart are not considered adequately vaccinated and should receive an additional dose of HPV vaccine.

The ACIP also updated the chronic liver conditions for which the hepatitis B vaccine is indicated, 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 more than twice the upper limit of normal.

For meningococcal vaccination, the ACIP recommended that adults with HIV infection receive a two-dose primary series of serogroups A, C, W, and Y meningococcal conjugate vaccine. The committee also provided updated guidance on dosing for one of the serogroup B meningococcal vaccines, MenB-Fhbp.

Vaccine recommendations in the 2017 scheduled are summarized in two figures, detailed footnotes, and a table of contraindications and precautions. The schedule also includes a cover page with information on select general principles, additional CDC resources, instructions for reporting vaccine-related adverse events, and a list of ACIP-approved acronyms. It was published by Annals of Internal Medicine on Feb. 7.