February 24, 2022, 8:50 a.m. News Staff — On Feb. 18 the CDC’s Advisory Committee on Immunization Practices, together with the AAFP and several other medical organizations, released the 2022 adult and childhood immunization schedules.
Both schedules underwent several changes and contain updates on numerous vaccines for each patient population, with the most noticeable feature being a new step for family physicians and other health care professionals who use the schedules. Schedules are available now on AAFP.org and the CDC website.
Perhaps the biggest change is the addition of a new final step on how to use the immunization schedules, which advises health care professionals to review contraindications and precautions to vaccination. This step is presented in an appendix that lists details for each vaccine type, and is included in both the adult and childhood schedules.
“The callout for a new step to review contraindications and precautions to vaccines formalizes a process that family physicians have always followed,” said Amy Mullins, M.D., C.P.E., medical director for quality and science in the Academy’s Division of Practice Advancement. “Carefully reviewing each immunization that is needed by a patient and determining whether that immunization is appropriate is part of the routine preventive care that family physicians and their teams deliver every day.”
In addition, the cover page of each immunization schedule now features a QR code that links to the online version of the schedule.
For adults, several revisions were made to the section on pneumococcal vaccines. Prevnar 13, a pneumococcal 13-valent conjugate (PCV13) vaccine, has been removed from the list of vaccine abbreviations and trade names. The “Routine Vaccination” section, meanwhile, has been updated to state that anyone 65 years or older who has not received a pneumococcal conjugate vaccine or whose vaccination history is unknown should receive one dose of pneumococcal 15-valent conjugate vaccine (PCV15/Vaxneuvance) or pneumococcal 20-valent conjugate vaccine (PCV20/Prevnar 20). If PCV15 is used, it should be followed by a dose of pneumococcal 23-valent polysaccharide vaccine (PPSV23/Pneumovax 23) administered at least one year after the PCV15 dose.
Similarly, the “Special Situations” section has been revised to state that any adult ages 19 to 64 with certain underlying medical conditions or risk factors who have not received a pneumococcal vaccine or whose vaccination history is unknown should receive one dose of PCV15 or PCV20 vaccine, and that if PCV15 is used, it should be followed by a dose of PPSV23 vaccine at least one year later. A list of underlying medical conditions and risk factors is included at the end of the note.
For children and adolescents, the most notable change is the addition of a dengue vaccine, Dengvaxia, to the schedule. Dengvaxia is recommended for children and adolescents 9 to 16 years old who live in dengue-endemic areas and who have laboratory confirmation of previous dengue infection. It is administered in a three-dose series at zero, six and 12 months.
For children, adolescents and adults, a note has been added to the section on meningococcal serogroups A, C, W and Y vaccination. The note states that MenACWY vaccines may be administered simultaneously with meningococcal serogroup B vaccines if indicated, but that the vaccines should be administered at a different anatomic site if feasible.
The schedules also contain several population-specific revisions that family physicians should be aware of.
For Haemophilus influenzae type b, the note has been revised to include recommendations for using Vaxelis (a vaccine for diphtheria and tetanus toxoids and acellular pertussis, inactivated poliovirus, Haemophilus b conjugate and hepatitis B virus) for routine and catch-up vaccinations.
For hepatitis A, the note has been revised to clarify that the recommended age for routine vaccination is 12 to 23 months.
For hepatitis B, under “Special Situations,” the recommendation for post-vaccination serologic testing and revaccination has been clarified. Testing and revaccination is recommended for certain populations, including infants born to HBsAg-positive mothers, patients undergoing hemodialysis and other immunocompromised patients.
For HPV, under “Special Situations,” the note has been clarified to state that for individuals with immunocompromising conditions, a three-dose series is recommended, even for those who initiate vaccination at ages 9 through 14 years.
For measles, mumps and rubella vaccination and for varicella vaccination, the notes have been updated to include information on recommendations for the use of MMRV (also known as ProQuad), a combination measles, mumps, rubella and varicella vaccine.
For hepatitis B, the note has been revised to state that vaccination is universally recommended for adults ages 19 to 59 years to receive the vaccine, with regimens listed for two-, three- and four-dose series. Additionally, the “Special Situations” section has been revised to include risk-based recommendations on the use of the hepatitis B vaccine in adults 60 years and older.
For influenza vaccination, clarifying language has been added to indicate that vaccination is for adults age 19 years or older, with a link added to the 2021-2022 recommendations and a bullet point added for the 2022-2023 recommendations.
For MMR and varicella vaccinations, the “Special Situations” sections for each vaccine have been updated to include CD4 percentages in the bullet points on HIV infection to bring them in accordance with language in the child/adolescent schedule.
For zoster vaccination, a “Special Situations” section on pregnancy has been revised to state that there is no ACIP recommendation for recombinant zoster vaccine use in pregnancy, and that individuals consider delaying vaccination until after pregnancy. In addition, a bullet point on immunocompromising conditions has been revised to state that RZV is recommended for use in people 19 years and older who are or will be immunodeficient or immunosuppressed because of disease of therapy.
COVID-19 vaccination recommendations are listed at the beginning of the Notes sections for both the adult and child/adolescent schedules.
COVID-19 vaccines are recommended for use within the emergency use authorization or biologics license application for the particular vaccine. The ACIP’s recommendations for the use of COVID-19 vaccines are available online, as are the CDC’s interim clinician considerations for the use of COVID-19 vaccines.
The AAFP, which reviews all ACIP recommendations for approval through the Commission on Health of the Public and Science, approved the ACIP’s recommendations for the Pfizer-BioNTech and Moderna vaccines in December 2020, and approved the committee’s recommendations on the use of single vaccine booster doses of COVID-19 mRNA vaccines in October 2021.
“COVID-19 vaccines are proven to be the best way to prevent serious illness and possible hospitalization from COVID-19 disease,” said Mullins. “I invite all FPs to review the COVID-19 vaccination recommendations to ensure that patients receive optimal care.”