The CDC and its Advisory Committee on Immunization Practices (ACIP), together with the AAFP and other medical professional organizations, have released the 2016 adult and childhood immunization schedules. Changes this year include updated recommendations for timing of pneumococcal vaccination in older adults and for serogroup B meningococcal vaccination in children and adolescents.
AAFP liaison to the ACIP Margot Savoy, M.D., M.P.H., told AAFP News that the release of the schedules offers physicians a valuable way to start conversations with patients about the importance of vaccination.
Savoy summarized the adult schedule changes in a Practice Guidelines article(76 KB PDF) American Family Physician (AFP) published online Feb. 2.
In February 2015, the ACIP recommended Merck Inc.'s nine-valent HPV vaccine (HPV9; Gardasil 9) as one of three options that can be used to vaccinate males and females ages 9-26. The vaccine protects against HPV types 6, 11, 16, 18, 31, 33, 45, 52 and 58.
- The CDC's Advisory Committee on Immunization Practices (ACIP), the AAFP and others have released the 2016 adult and childhood immunization schedules.
- Changes include updated recommendations for the timing of pneumococcal vaccination in older adults and for serogroup B meningococcal vaccination in children and adolescents.
- AAFP liaison to the ACIP Margot Savoy, M.D., M.P.H., summarized changes to the respective schedules in separate articles for American Family Physician.
And although HPV vaccination is routinely recommended at age 11 or 12, it can be given as early as age 9 and is included in catch-up schedules for women through age 26 and men through age 21. For men at high risk for HPV, such as those who have sex with other men, are immunocompromised or infected with HIV, HPV vaccine may be given through age 26. There is no recommendation to revaccinate patients who have already completed the series.
The ACIP recommends patients at increased risk for meningococcal disease routinely receive quadrivalent meningococcal conjugate vaccine (MenACWY-D; Menactra) to protect against serogroups A, C, W and Y.
For patients age 10 or older who are at increased risk for serogroup B meningococcal (MenB) disease, the ACIP recommends either a two-dose series of MenB-4c vaccine (Bexsero) or a three-dose series of MenB-FHbp vaccine (Trumenba). This recommendation includes adults with asplenia or complement deficiencies and those who work in outbreak areas. HIV infection is not an indication for vaccination with MenACWY-D or MenB vaccine.
ACIP members voted during their June meeting to issue a Category B recommendation(www.cdc.gov) saying that patients ages 16-23 may be vaccinated for short-term protection against most strains of meningococcus B.
There is no contraindication to giving quadrivalent meningococcal conjugate vaccine and MenB vaccine on the same day as long as different injection sites are used.
For protection against pneumococcal disease, the ACIP recommends that a dose of 13-valent pneumococcal conjugate vaccine (PCV13; Prevnar) be followed by a dose of pneumococcal polysaccharide vaccine (PPSV23; Pneumovax) in patients 65 and older who have not previously received pneumococcal vaccine and in patients 2 and older who are at high risk for the disease because of medical conditions.
Also during the June meeting, the ACIP increased its recommended administration interval between PCV13 and PPSV23 -- previously six to 12 months -- to at least one year for immunocompetent adults 65 and older, which aligns with CMS' coverage policy. Recommended intervals were not changed for other age or risk groups.
Childhood and Catch-up Schedules
As noted in the adult schedule, the ACIP recommended HPV9 as one of three options that can be used for vaccinating adolescents. Noting that HPV vaccination is routinely recommended at ages 11-12, the updated schedule also highlights the ACIP's recommendation to vaccinate patients beginning at age 9 for any child with a history of sexual assault. There is no recommendation to revaccinate patients who have already completed the full series.
For MenB vaccination, the ACIP recommends either a two-dose series of MenB-4c or a three-dose series of MenB-FHbp for patients ages 10 or older who are at increased risk of MenB disease. There is no preference for which MenB vaccine should be used, but the two products are not interchangeable once the series is started.
The ACIP clarified the footnotes for the childhood schedule's section on diphtheria, tetanus and acellular pertussis (DTaP) vaccine, including that the fourth DTaP dose usually administered at age 15 months may be given as early as age 12 months if six months or more has passed since the third dose. If the fourth dose of DTaP was administered at least four months but less than six months after the third dose, it does not need to be repeated.
Other footnote clarifications include administering one dose of inactivated poliovirus vaccine at age 4 at least four weeks after the final oral poliovirus vaccine dose was administered for children who previously received only the oral vaccine before age 4. Also, the meningococcal footnote defined persistent complement deficiency to include those with inherited or chronic deficiencies in C3, C5-9, properidin, or factor D or H and patients taking eculizumab (Soliris).
Related AAFP News Coverage
ACIP to Reconfigure Pediatric Immunization Schedule
Meningococcal B Vaccine, Standing Orders for Adult Vaccines Also Discussed