Adult Immunization Schedule Updated, Released for 2009
The Adult Immunization Schedule is available at www.cdc.gov/vaccines/recs/schedules/adult-schedule.htmwww.cdc.gov/vaccines/pubs/acip-list.comwww.vaers.hhs.gov
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 College of Physicians, the American Academy of Family Physicians, and the American College of Obstetricians and Gynecologists (MMWR 2009;57:Q1–4).
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 (INTERNAL MEDICINE NEWS, July 15, 2008, p. 1). 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 (INTERNAL MEDICINE NEWS, Nov. 15, 2008, p. 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, as previously recommended), 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.
Other changes and clarifications in the footnotes of the 2009 schedule include the following:
▸ 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.
Dr. Poland and Dr. Schaffner both disclosed financial ties to several vaccine manufacturers. Members of ACIP who disclosed relationships with vaccine manufacturers were not allowed to vote on issues pertaining to those companies' products.
