Check Out Revised Adult Immunization Schedule, Including New HPV Guidance

A new document on the AAFP Web site aims to guide clinicians' immunization practices. The revised Recommended Adult Immunization Schedule features several changes, including routinely giving some patients the human papillomavirus, or HPV, vaccine approved earlier this year.

The AAFP; CDC's Advisory Committee on Immunization Practices, or ACIP; and American College of Obstetricians and Gynecologists approved the adult immunization schedule, which extends through next September. This document, which targets adults 19 and older, contains revisions such as the following.

The Oct. 13 issue of CDC's Morbidity and Mortality Weekly Report presents and discusses the revised schedule.

The vaccine is given in a three-dose schedule, with the second and third doses administered 2 months and 6 months, respectively, after the first dose.

Routine vaccination of 11- and 12-year-old females is recommended, although the vaccination series can be started in females as young as 9 years of age. This provision allows vaccination of 9- and 10-year-olds at the discretion of the health care professional, says Jonathan Temte, M.D., Ph.D., associate professor of family medicine at the University of Wisconsin, Madison; an AAFP liaison to the ACIP; and a member of the AAFP Commission on Science.

According to the ACIP, the vaccine should be administered before potential exposure to HPV through sexual contact. However, the Recommended Adult Immunization Schedule adds, "women who are sexually active should still be vaccinated," regardless of when the series is started.

"The HPV vaccination is part of what we hope to see in the future as part of a preventive health care visit for 11- and 12-year-olds," says Temte. "The HPV vaccine, meningococcal conjugate vaccine and Tdap vaccine will serve as the platform for the early-adolescence visit, where we can discuss tobacco use, alcohol abuse, STDs, obesity, physical activity and a host of other issues."

CDC's National Immunization Program offers HPV vaccine materials for patients and health professionals, including a Q&A document that asks the bottom-line question, "How much will the HPV vaccine cost?" The answer: "The retail price of the vaccine is $120 per dose ($360 for full series)."

Temte warns, "Whenever we're talking about immunizations, if it concerns a vaccine not covered by the patient's insurer, the patient may also be stuck with the administration fee for the vaccination." However, he adds, the Vaccines for Children Program provides physicians with HPV vaccine for eligible children, and the Merck Vaccine Patient Assistance Program offers financial assistance for the vaccine for eligible adults. Merck and Co. Inc. manufactures the HPV vaccine, sold as Gardasil.

"Any females age 9 through the last day of their 18th year -- if they're eligible -- could receive the vaccine through the Vaccines for Children Program," says Temte. "Even if the patient is 18 1/2, I can start the vaccine and get all three doses in before the patient turns 19" and loses eligibility for the program.