The Advisory Committee on Immunization Practices (ACIP) from the Centers of Disease Control and Prevention (CDC) has issued its recommended immunization schedule for adults aged ≥19 years in the US. Changes in the 2018 adult immunization schedule from the previous year’s schedule include new ACIP recommendations on the use of recombinant zoster vaccine (RZV) to prevent shingles in adults aged ≥50 years and the use of an additional dose of measles, mumps, and rubella vaccine (MMR) in a mumps outbreak setting. The update includes the following recommendations:
- Administer 2 doses of RZV 2-6 months apart to adults aged ≥50 years regardless of past episode of herpes zoster or receipt of zoster vaccine live (ZVL).
- Administer 2 doses of RZV 2-6 months apart to adults who previously received ZVL at least 2 months after ZVL.
- For adults aged ≥60 years, administer either RZV or ZVL (RZV is preferred).
- Administer 1 dose of MMR to adults who previously received ≤2 doses of mumps virus–containing vaccine and are identified by a public health authority to be at increased risk during a mumps outbreak.
The full updated 2018 ACIP immunization schedule can be found at https://www.cdc.gov/mmwr/volumes/67/wr/mm6705e3.htm?s_cid=mm6705e3_e.
Kim DK, Riley LE, Hunter P. Recommended immunization schedule for adults aged 19 years or older, United States, 2018. Ann Intern Med. 2018;168:210–220. doi:10.7326/M17-3439.
The change in recommendation to preferential use of RZV (Shingrix) is a large and exciting one. It is large because the recommendation begins at age 50, an age where we are not currently used to recommending vaccination, so it will take a concerted effort to integrate this into practice. It is also large because it has the potential to benefit many people given the much better efficacy of RZV in preventing shingles than the previous vaccine. Vaccination in adults is an important area to emphasize, as vaccination coverage rates for adults in the US are lower than they should be. For those eligible for vaccination, current rates of vaccination are: influenza (45%); Tdap (23%); zoster (31%). —Neil Skolnik, MD
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