The Advisory Committee on Immunization Practices (ACIP) made a few changes its 2019 recommended adult immunization schedule, including some new guidance for using live-attenuated vaccines.
But, perhaps more notably, ACIP brought some bigger changes to how they're presenting that information to providers.
The 2019 Adult Immunization Schedule, published on the CDC site and in the Annals of Internal Medicine, was redesigned to make the information easier to scan at a glance or find quickly and easily.
Among the changes? Footnotes that once directed physicians toward detailed information on each vaccine have been replaced with a simple list of vaccines in alphabetical order. A table includes common trade names to make it easier for physicians to identify vaccines.
Most noticeably, the tables convey recommended dosages, contraindications and other precautionary information in a clear, concise manner.
“This is the biggest makeover that the schedules ever had,” said Sandra Fryhofer, M.D., a member of the Adult Immunization Work Group.
“A lot of work went into trying to make this more user-friendly and make it a document that can really help clinicians take care of their patients, and I think, particularly, this new form is a good resource for patients who wonder if they’re getting the immunizations they need,” she adds.
ACIP used an in-depth evaluation of the 2017 schedule to inform the changes. Interviews suggested that most doctors were far more familiar with the schedule’s first figure, which shows recommended immunizations by age group, than the second, which outlines recommendations based on medical condition and other indications.
According to Fryhofer, the updated format of the pregnancy column, in particular, marks an important step toward guiding a rightly cautious patient group toward appropriate decisions about immunizations.
While ACIP recommends pregnant women delay or avoid several common vaccines, it can be dangerous to avoid them all.
“Only just over half of pregnant women receive Tdap. You know, that keeps babies from dying and CDC has been recommending that vaccination for pregnant women since 2012,” Dr. Fryhofer said.
Changes to this year’s recommendations
ACIP made three changes to its recommendations regarding vaccines currently on the schedule:
The group now includes homelessness as an indication for the hepatitis A vaccine, in part due to a 2018 outbreak in San Diego. Poor hygienic conditions and overcrowding make homeless individuals more susceptible to infection and one dose of the single-antigen vaccine is highly effective. Therefore, targeting the group for vaccination makes a lot of sense from a public health standpoint, according to Dr. Fryhofer.
- ACIP added a change in its recommendation for hepatitis B vaccinations due to the availability of a new single-antigen recombinant vaccine marketed as Heplisav-B. Patients can get the vaccine in two doses as little as a month apart, making it a quicker route to immunity. Since the drug is still new, Fryhofer said that pregnant women need to use older vaccines for now. Post-marketing studies will also be necessary to track potential concerns about cardiovascular events.
- Following a reformulation of its components, live attenuated influenza vaccines are back on the schedule this year. Physicians should note that they have their own row in the tables, which make it clear that the live vaccines are contraindicated in pregnant women and should be used with caution for several other disease states. For otherwise healthy non-pregnant individuals between 19 and 49 years of age who hate needles, ACIP recommends the live vaccine as a viable alternative.