CDC, AAFP Release 2017 Immunization Schedules

Updates Include New HPV, MenB and HepB Vaccine Recommendations

February 06, 2017 04:04 pm Chris Crawford

The CDC and its Advisory Committee on Immunization Practices (ACIP), together with the AAFP and other medical professional organizations, have released the 2017 adult and childhood immunization schedules.

[Youth getting vaccinated by gloved medical professional]

Changes this year include updated recommendations for a two-dose schedule of nine-valent HPV vaccine (HPV9; Gardasil 9) for patients ages 11-12, a two-dose schedule of meningitis B vaccine (MenB) for adolescents, a clarification regarding recommended adult candidates for hepatitis B (HepB) vaccine and revisions designed to make the adult schedule easier to navigate.

Release of the annual immunization schedules comes amid concerns that the Trump administration has proposed appointing a group to study the safety and effectiveness of vaccines.

In response, AAFP President John Meigs, M.D., of Centreville, Ala., said in a statement: "A new federal commission on immunizations is not necessary and would divert much-needed dollars from other, more pressing health care issues. To suggest the need for such an organization promotes unnecessary, ongoing and disproven skepticism about vaccines and public safety."

Story highlights
  • The CDC and its Advisory Committee on Immunization Practices, together with the AAFP and other medical professional organizations, have released the 2017 adult and childhood immunization schedules.
  • Changes this year include updated recommendations for a two-dose schedule of nine-valent HPV vaccine for patients ages 11-12, a two-dose schedule of meningitis B vaccine for adolescents and a clarification regarding recommended adult candidates for hepatitis B vaccine.
  • The 2017 adult immunization schedule has been revised to be more reader-friendly.

Meigs said plainly that vaccines are safe, effective and save lives, further explaining that allegations of a link between vaccines and autism have been thoroughly debunked.

"The science is clear, and family physicians stand ready to help everyone -- from the incoming administration to the general public -- understand how safe and important vaccines are," he stated.

Childhood and Catch-up Schedule Highlights

During the ACIP's Oct. 19-20 meeting, the group voted to recommend that patients ages 11-12 receive two doses of HPV9; however, this dosing schedule can begin as early as age 9 and as late as ages 13-14. Although it is recommended that the second dose of the two-dose schedule be administered six to 12 months after the first dose, the minimum interval between the first and second doses is five months.

This recommendation follows the FDA's approval(www.fda.gov) of a request this past October to add a two-dose schedule of HPV9 for adolescents ages 9-14 as an alternative to the previously licensed three-dose schedule.

For patients initiating HPV9 vaccination at or after age 15, the recommended immunization schedule is three doses. The second dose should be administered one to two months after the first dose, and the third dose should be administered six months after the first dose.  

AAFP liaison to the ACIP Margot Savoy, M.D., M.P.H., told AAFP News a study published Jan. 23 in Cancer(onlinelibrary.wiley.com) revealed that after correcting national statistics for the prevalence of hysterectomy, mortality rates for cervical cancer were found to have been underestimated, particularly among black women.

"That's all the more reason why we need to vaccinate kids before they are exposed to HPV so that they don't have to have that conversation down the line," she said.

Majority of Americans Support MMR Vaccination

According to a Pew Research Center survey report(assets.pewresearch.org) released Feb. 2, more than 80 percent of Americans support requiring children who attend public schools to be vaccinated for measles, mumps and rubella (MMR). More than 70 percent of Americans see substantial preventive health benefits from the MMR vaccine, and 66 percent think there is a low risk of side effects from the vaccine. Overall, 88 percent of those surveyed said they think the benefits of MMR vaccination outweigh the risks.

However, several groups expressed concern about the safety of the MMR vaccine, according to a summary of the 104-page report(www.pewinternet.org), including parents of young children. Slightly more than half of parents with children ages 4 years and younger said the risk of side effects from the MMR vaccine is low, with 43 percent saying they think the risk is medium or high.

"In addition to parents of young children, this analysis finds that adults under age 30, blacks and people with lower knowledge about science topics see a higher risk of side effects or lower preventive health benefits from this vaccine," said Pew's Associate Director of Research Cary Funk in a news release(www.sciencedaily.com). "Public health benefits from vaccines hinge on very high levels of immunization in the population, so it's important to understand which groups hold reservations about the MMR vaccine."  

The ACIP's updates for the MenB vaccine apply only to the MenB-FHbp (Trumenba) product and clarify when two doses may be administered rather than the original three-dose schedule.

The approved final language reads: "For patients at increased risk for meningococcal disease and for use during serogroup B outbreaks, three doses of MenB-FHbp should be administered at ages 0, 1-2 months and 6 months. When given to healthy adolescents who are not at increased risk for meningococcal disease, two doses of MenB-FHbp should be administered at 0 and 6 months. If the second dose is given at an interval of less than 6 months, a third dose should be given at least 6 months after the first dose."

Regarding the HepB vaccine, the ACIP changed its birth dose recommendation to read "within 24 hours of birth" instead of the previous "at hospital discharge."

The full recommendation reads: "For all medically stable infants weighing greater than or equal to 2,000 grams at birth and born to HBsAg (hepatitis B surface antigen)-negative mothers, the first dose should be administered within 24 hours of birth. Only single-antigen HepB vaccine should be used for the birth dose."

And finally, as an update on the influenza vaccine, Savoy noted that even though live attenuated influenza vaccine (LAIV; FluMist) was taken off the market this flu season in the United States, the ACIP still hasn't announced a plan for its use during the 2017-2018 season. The group is, however, scheduled to discuss the vaccine at its Feb. 22-23 meeting(www.cdc.gov).

Adult Schedule Highlights

The 2017 adult immunization schedule has been revised to be easier to read, with a new format that includes landscape formatting, cleaner graphics, use of abbreviations and a larger font in the footnotes.

Savoy said adult patients with a history of egg allergy that manifests with symptoms other than hives -- such as those who experience angioedema, respiratory distress, lightheadedness or recurrent emesis, or who require epinephrine or another emergency medical intervention -- may receive age-appropriate inactivated (IIV) or recombinant influenza vaccine (RIV). But, she added, administration of the inactivated vaccine should be supervised by a health care professional who can recognize and manage severe allergic conditions.

Adults with egg allergy who experience only hives after exposure to egg should receive IIV or RIV.

The ACIP recommends the HepB vaccine for adults with chronic liver disease, including those with hepatitis C infection and liver function enzyme levels twice the upper limit. This recommendation also includes patients with cirrhosis, fatty liver disease, alcoholic liver disease and autoimmune hepatitis.

"This recommendation broadens and better specifies which adults should receive hepatitis B vaccine," Savoy said.

Finally, she noted, the HPV recommendation for adults didn't actually change. Teens and young adults who start the series at ages 15-26 will continue to need three doses of HPV vaccine.

"If you are an adult and you're just now getting your HPV vaccine series, you should be getting the full three-dose series, as before," said Savoy.

Furthermore, patients in this age range who initiated the series before age 15 and who have received only one or two doses less than five months apart still require one additional dose for adequate immunization.

"It doesn't matter which vaccine you started with, you can complete the series with the nine-valent HPV vaccine," Savoy said.

Related AAFP News Coverage
ACIP Recommends Two-dose Regimen for HPV Vaccine
Group Offers Additional Recommendations for Hep B, MenB-FHbp, Tdap Vaccines
(10/26/2016)

ACIP Recommends MenACWY-D for HIV-infected Patients, Cholera Vaccine
(6/29/2016)

ACIP: Don't Use LAIV During 2016-17 Flu Season
(6/23/2016)