Update on ACIP Adult Immunization Guidelines

By Carol A. Kemper, MD, FACP

Dr. Kemper is Clinical Associate Professor of Medicine, Stanford University, Division of Infectious Diseases, Santa Clara Valley Medical Center.

Dr. Kemper does research for GSK Pharmaceuticals, Abbott Laboratories, and Merck. Editor Stan Deresinski, MD, FACP, Clinical Professor of Medicine, Stanford, Associate Chief of Infectious Diseases, Santa Clara Valley Medical Center, serves on the speaker's bureau for Merck, Pfizer, Wyeth, Ortho-McNeill (J&J), Schering-Plough, and Cubist, does research for the National Institutes of Health, and is an advisory board member for Schering-Plough, Ortho-McNeil (J&J), and Cepheid. Peer reviewer Connie T. Price, MD, Assistant Professor, University of Colorado School of Medicine, reports no financial relationships relevant to this field of study.

This article originally appeared in the March 2010 issue of Infectious Disease Alert.

Sources: ACIP. Recommended Adult Immunization Schedule: United States, 2010. Ann Intern Med. 2010;152:36-39; Hopkins RH, Jr, and Vyas KS. Adult Immunization Guidelines: Challenges and Opportunities. Ann Intern Med. 2010;152:59-60.

The revised ACIP adult vaccination schedule, published January 5, 2010, includes the following changes (documented in full at www.cdc.gov/vaccines/recs/ACIP/default.htm):

HPV:

• A second HPV vaccine is now approved for use in young adults within the United States. In contrast to the earlier HPV quadrivalent vaccine, which provided protection against four strains of HPV, including two strains associated with genital warts, the newer bivalent vaccine includes only two HPV strains associated with 70% of cases of genital dysplasia and cervical cancer.

• Vaccination of young men at risk for HPV is now also recommended.

MMR:

• Two doses of MMR vaccine, administered four weeks apart, are now additionally recommended for certain groups, including health care workers, students in post-secondary educational institutions, international travelers, and adults with exposure to measles or mumps.

• All other adults born after 1957 do not require a booster dose of MMR if they have documentation of an initial primary dose.

• Heath care facilities should consider pre-emptively providing MMR for non-immune employees born before 1957.

Hepatitis A Vaccine:

• HAV is now recommended for all parents and caregivers of international adoptees.

Meningococcal Vaccine:

• A one-time booster dose of meningococcal conjugate vaccine is recommended after five years for anyone with ongoing risk factors for meningococcus, except those in campus housing.

Haemophilus Influenzae Type B (Hib) Vaccine:

• A footnote in the guidelines suggests that Hib is not "contraindicated" in adults with leukemia, sickle cell disease, HIV, or splenectomy, for those clinicians wondering what to do for patients at increased risk for encapsulated organisms.

The accompanying editorial discusses the likelihood of an increased focus on adult immunization as a quality measure. Newer electronic medical records will have embedded prompts for routine adult vaccination. Providers should anticipate that audits of electronic medical records may more readily provide feedback to clinicians regarding rates of adult vaccination, and remuneration may eventually be tied to this in some areas. I recommend posting the updated ACIP document (and the ACIP document from 2009) somewhere near your desk for quick reference, as some of the recommendations for adult vaccination are not always as straightforward as the authorities make them out to be, and questions are likely to arise.