The Center for Disease Control and Prevention’s Advisory Committee on Immunization Practices (ACIP) announced its recommended 2013 adult immunization schedule that includes important updates to the pneumococcal, Tdap (tetanus, diphtheria, and acellular pertussis), and influenza vaccines. Because current vaccination rates are low, ACIP also urges health care providers to regularly assess patient vaccination histories and implement intervention strategies to increase adherence. This recommendation will be published in Annals of Internal Medicine, the flagship journal of the American College of Physicians (ACP).
For the first time, information on the use of 13-valent pneumococcal conjugate vaccine (PCV13) was added to the schedule. PCV13 should be used with the 23-valent pneumococcal polysaccharide vaccine (PPSV23) for immunocompromised adults, or those with diseases such as HIV, cancer, or advanced kidney disease. The schedule includes information on timing the administration of the vaccines and 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 aged 65 or older and for pregnant women to receive Tdap vaccine 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.
All patients aged 6 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 U.S. Food and Drug Administration has approved a quadrivalent influenza vaccine that contains two influenza A and two influenza B virus strains to increase the likelihood that the vaccine provides cross-reactive antibody against a higher proportion of circulating influenza B viruses.
The ACIP is comprised of ACP and 16 other medical societies representing various medical practice areas. Each year, the ACIP reviews the CDC’s Recommended Adult Immunization Schedule to ensure the schedule reflects current clinical recommendations for licensed vaccines. The recommendations are intended to guide physicians and other clinicians about the appropriate vaccines for their adult patients. In October 2010, the ACIP adopted an evidence-based process that considers quality of evidence, benefits and harms, values and preferences of affected populations, and economic impact.
The full 2013 Recommended Adult Immunization Schedule, including information about other recommended vaccines and changes to the footnotes, can be viewed at http://www.annals.org.
American College of Physicians