This year's Adult Immunization Schedule includes the 2008 recommendation to use the pneumococcal polysaccharide vaccine in cigarette smokers and patients with asthma.
No new vaccines have been added to the schedule, but there are several changes to the chart's format, as well as updated footnotes for certain vaccines, said Dr. Gina Mootrey of the CDC's Immunization Services Administration, and her associates.
The schedule, published in January, was approved by the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices (ACIP) and endorsed by the American Academy of Family Physicians, the American College of Physicians, and the American College of Obstetricians and Gynecologists (MMWR 2009;57:Q1-Q4).
ACIP voted to recommend pneumococcal polysaccharide vaccine to adults with asthma in June 2008, based on data suggesting that adults with asthma were at more than double the risk (adjusted odds ratio 2.4) for invasive pneumococcal disease. The ACIP decision on smokers was made in October 2008, based on data that smoking is the strongest independent risk factor for pneumococcal disease in nonelderly immunocompetent adults, with an adjusted odds ratio of 4.1.
In an editorial, Dr. Gregory A. Poland and Dr. William Schaffner noted that most asthmatic adults who develop invasive pneumococcal disease already have another condition for which the vaccine is indicated, but they don't receive it (Ann. Intern. Med. 2009;150:53–6).
“Making asthma an indication for pneumococcal vaccination will resolve previous ambiguity, be consistent with the influenza vaccine recommendations, and challenge us to identify and vaccinate these patients,” said Dr. Poland of the Mayo Clinic, Rochester, Minn., and Dr. Schaffner of Vanderbilt University, Nashville, Tenn.
It is now recommended that all children from 5 years through 18 years of age (in addition to children aged 6 months to 5 years, per the previous recommendation), receive the influenza vaccine, as well as individuals who live with or care for people at increased risk for influenza-related complications, including all health care workers. As the target population for influenza vaccination continues to rise, it will become necessary to extend the “vaccination season” into December and January, “and even beyond,” Dr. Poland and Dr. Schaffner said.
Additional changes to the childhood schedule involve dosing schedule provisions to accommodate the availability of a second oral rotavirus vaccine licensed by the FDA. The first dose of either vaccine should be administered at 6 weeks through 14 weeks 6 days of age. Immunization should not be initiated for infants 15 weeks 0 days of age or older. The final dose should be administered by 8 months 0 days of age.
Other changes and clarifications in the footnotes of the 2009 adult schedule include:
▸ A note was added to say that health care personnel are not at increased risk for human papillomavirus through occupational exposure, and that they should receive the vaccine consistent with age-based recommendations.
▸ A second dose of varicella vaccine should be given to adults who previously received only one dose.
▸ Information was added about an alternative four-dose schedule for the combined hepatitis A/B vaccine.
▸ The 5-year revaccination interval for the meningococcal vaccine was clarified.
Last fall, the American College of Physicians and the Infectious Diseases Society of America issued a joint statement on the importance of adult immunization, which was subsequently endorsed by 17 other medical societies. The statement advises that all physicians conduct an immunization review with their adult patients, that they provide recommended immunizations or refer patients to someone who will, and that all physicians and their staffs should be vaccinated according to the CDC, with particular attention to annual influenza immunization.
“We hope that publication of the annual Adult Immunization Schedule in this issue will prompt clinicians to redouble their efforts to improve their practices' immunization rates. Doing so will prevent needless morbidity, mortality, and expense,” Dr. Poland and Dr. Schaffner concluded. Both doctors disclosed financial ties to several vaccine manufacturers.
ACIP members follow strict conflict of interest guidelines.
The Adult Immunization Schedule is available at www.cdc.gov/vaccines/recs/schedules/adult-schedule.htm