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CDC Updates Adult Immunization Schedule


 

Revised recommendations for human papillomavirus vaccination—including a permissive recommendation for young men—are part of the newly issued 2010 adult immunization schedule from the Advisory Committee on Immunization Practices at the Centers for Disease Control and Prevention.

The schedule, approved by the American College of Obstetricians and Gynecologists, includes these changes:

▸ For human papillomavirus (HPV), a bivalent vaccine (HPV2) has been licensed for use in females. Therefore, either the bivalent or quadrivalent (HPV4) vaccination can be used for women between 19 and 26 years. In addition, HPV4 may be given to males aged 9-25 years “to reduce their likelihood of acquiring genital warts,” according to the revised schedule.

▸ For influenza vaccination, the term “seasonal” has been added to distinguish between seasonal and pandemic influenza vaccines.

▸ For measles, mumps, rubella (MMR) vaccination, most adults born after 1957 do not require repeat vaccination if they have documentation of having received at least one dose of the vaccine. Women without documentation of rubella vaccination should receive a dose of the MMR vaccine.

Health care workers, college students, international travelers, and individuals who have been exposed to measles or mumps in an outbreak setting should receive two doses of MMR. When a second MMR dose is indicated, it should be administered 4 weeks after the first dose.

During an outbreak, MMR vaccination is recommended for unvaccinated health care workers born before 1957 who do not have evidence of immunity or disease.

▸ For hepatitis A, vaccination is recommended for unvaccinated individuals who anticipate close personal contact with an international adoptee from a country with intermediate or high endemicity to hepatitis A. The first dose should be given at least 2 weeks before the arrival of the adoptee.

▸ For the three-dose hepatitis B vaccine, the second dose should be administered 1 month after the first dose, and the third dose should be administered at least 2 months after the second. If using the combined hepatitis A and B vaccine, three doses should be administered at 0, 1, and 6 months. Alternatively, a four-dose schedule, administered on days 0, 7, 21, and 30, followed by a 12-month booster, may be used.

▸ For meningococcal vaccination, the conjugate vaccine (MCV4) is preferred for adults aged 55 years or younger, while the polysaccharide vaccine (MPSV4) is recommended for adults older than 55 years. Revaccination with MCV4 after 5 years is recommended for individuals who continue to be at risk for infection, such as adults with anatomic or functional asplenia. However, it is not recommended for individuals whose only risk factor is continued on-campus residence.

▸ For Haemophilus influenzae type B (Hib) vaccination, there is no recommendation for individuals older than age 5 years. One dose of the vaccine may be given to certain high-risk unvaccinated patients (Ann. Intern. Med. 2010;152:36-9).

“Deaths from vaccine-preventable illnesses still occur in the United States,” noted Dr. Robert H. Hopkins Jr. and Dr. Keyur S. Vyas of the University of Arkansas, Little Rock, in an accompanying editorial.

Clinicians' “challenge is to change this perception and to make immunizations integral to each encounter for physicians who care for adults in primary and specialty care settings,” they added.

In addition, the importance of immunization should be imparted to students and residents early in their training, as an essential component of the comprehensive care of adults in ambulatory and inpatient settings, they said (Ann. Intern. Med. 2010;152:59-60).

The complete 2010 Adult Immunization Schedule will be available at www.cdc.gov/vaccines/recs/schedules/adult-schedule.htm

Disclosures: Members of ACIP disclosed relationships with MedImmune, Sanofi Pasteur, Novartis, and Wyeth. According to the report, members with conflicts are not permitted to vote if the conflict involves the vaccine or agent being considered. Dr. Hopkins and Dr. Vyas reported no potential conflicts of interest.

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