Adult Immunization Schedule 2020 released by ACIP
The Advisory Committee on Immunization Practices (ACIP) has released its 2020 Recommended Immunization Schedule for adults with changes to the administration of influenza, human papillomavirus (HPV), hepatitis A, hepatitis B, meningococcal B, and pneumococcal conjugate vaccines. The schedule, which can be complex and challenging to implement, features revised content, format, and graphics to make it easier to follow. The complete schedule, including changes in the vaccine notes section, is being simultaneously published in Annals of Internal Medicine and on the Centers for Disease Control and Prevention (CDC) web site.
The schedule is streamlined for ease of reference. Physicians should pay careful attention to the details found in the vaccine notes section, as they clarify who needs a what vaccine, when, and at what dose.
In addition to changes in the administration of some vaccines, the 2020 schedule includes new instructions for shared clinical decision-making for several vaccines. First, the HPV vaccine is recommended for some patients aged 27 through 45 who are not adequately vaccinated. Clinicians should consider discussing HPV vaccination with those who are most likely to benefit from it based on a detailed list of considerations. Second, the pneumococcal 13-valent conjugate vaccine (PCV13) should be discussed with adults 65 years or older who do not have an immunocompromising condition, cerebrospinal fluid leak, or cochlear implant, and who have not previously received PCV13. And third, clinicians should consider discussing the meningitis B vaccine with adolescents and young adults age 16 through 23 who are not at increased risk for meningococcal disease.
The ACIP is comprised of 15 voting members, ex officio members who represent other federal agencies, and non-voting representatives of liaison organizations, including the American College of Physicians, that bring related immunization expertise. Each year, ACIP reviews the CDC's Recommended Adult Immunization Schedule to ensure it 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.
Recommended Adult Immunization Schedule for ages 19 years or older, the United States, 2020
- Haemophilus influenzae type b vaccination
Hepatitis A vaccination-Not at risk but want protection from hepatitis A (identification of risk factor not required): 2-dose series HepA (Havrix 6–12 months apart or Vaqta 6–18 months apart [minimum interval: 6 months]) or 3-dose series HepA-HepB (Twinrix at 0, 1, 6 months [minimum intervals: 4 weeks between doses 1 and 2, 5 months between doses 2 and 3])
- Hepatitis B vaccination-Not at risk but want protection from hepatitis B (identification of risk factor not required): 2- or 3-dose series (2-dose series Heplisav-B at least 4 weeks apart [2-dose series HepB only applies when 2 doses of Heplisav-B are used at least 4 weeks apart] or 3-dose series Engerix-B or Recombivax HB at 0, 1, 6 months [minimum intervals: 4 weeks between doses 1 and 2, 8 weeks between doses 2 and 3, 16 weeks between doses 1 and 3]) or 3-dose series HepA-HepB (Twinrix at 0, 1, 6 months [minimum intervals: 4 weeks between doses 1 and 2, 5 months between doses 2 and 3])
Human papillomavirus vaccination-HPV vaccination recommended for all adults through age 26 years: 2- or 3-dose series depending on age at initial vaccination or condition:
Age 15 years or older at initial vaccination: 3-dose series at 0, 1–2, 6 months (minimum intervals: 4 weeks between doses 1 and 2/12 weeks between doses 2 and 3/5 months between doses 1 and 3; repeat dose if administered too soon)
Age 9 through 14 years at initial vaccination and received 1 dose or 2 doses less than 5 months apart: 1 dose
Age 9 through 14 years at initial vaccination and received 2 doses at least 5 months apart: HPV vaccination complete, no additional dose needed.
If completed valid vaccination series with any HPV vaccine, no additional doses needed
- Influenza vaccination-Routine vaccination
Persons age 6 months or older: 1 dose any influenza vaccine appropriate for age and health status annually
- Measles, mumps, and rubella vaccination-No evidence of immunity to measles, mumps, or rubella: 1 dose
Evidence of immunity: Born before 1957 (health care personnel, see below), documentation of receipt of MMR vaccine, laboratory, laboratory evidence of immunity or disease (diagnosis of disease without laboratory confirmation is not evidence of immunity)
- Meningococcal vaccination
- Pneumococcal vaccination-Age 65 years or older
- Tetanus, diphtheria, and pertussis vaccination-Previously did not receive Tdap at or after age 11 years: 1 dose Tdap, then Td or Tdap every 10 years
Varicella vaccination-No evidence of immunity to varicella: 2-dose series 4–8 weeks apart if previously did not receive the varicella-containing vaccine (VAR or MMRV [measles-mumps-rubella-varicella vaccine] for children); if previously received 1 dose varicella-containing vaccine, 1 dose at least 4 weeks after first dose
Evidence of immunity: U.S.-born before 1980 (except for pregnant women and health care personnel [see below]), documentation of 2 doses varicella-containing vaccine at least 4 weeks apart, diagnosis or verification of a history of varicella or herpes zoster by a health care provider, laboratory evidence of immunity or disease
- Zoster vaccination-Age 50 years or older: 2-dose series RZV (Shingrix) 2–6 months apart (minimum interval: 4 weeks; repeat dose if administered too soon) regardless of previous herpes zoster or history of ZVL (Zostavax) vaccination (administer RZV at least 2 months after ZVL)
Age 60 years or older: 2-dose series RZV 2–6 months apart (minimum interval: 4 weeks; repeat if administered too soon) or 1 dose ZVL if not previously vaccinated. RZV preferred over ZVL (if previously received ZVL, administer RZV at least 2 months after ZVL)
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