Revised recommendations for human papillomavirus vaccination—including a permissive recommendation for young men—and for measles, mumps, rubella immunization are part of the newly issued 2010 immunization schedule from the Advisory Committee on Immunization Practices at the Centers for Disease Control and Prevention.
The new schedule also includes updated indications and schedule information for hepatitis A and B vaccination, as well as clarifications about meningococcal and Haemophilus influenzae type B vaccination.
The 2010 Recommended Adult Immunization Schedule earned ACIP approval in October 2009 and reflects current recommendations for the licensed vaccines, according to the schedule's accompanying report (Ann. Intern. Med. 2010;152:36–9). The schedule is approved by the American Academy of Family Physicians, the American College of Obstetricians and Gynecologists, and the American College of Physicians.
The revised schedule includes the following changes:
▸ For human papillomavirus (HPV), a bivalent vaccine (HPV2) has been licensed for use in females. Therefore, either the bivalent or quadrivalent (HPV4) vaccination can be used for women between 19 and 26 years. In addition, HPV4 may be given to males aged 9 through 25 years “to reduce their likelihood of acquiring genital warts,” according to the revised schedule.
▸ For influenza vaccination, the term “seasonal” has been added to distinguish between seasonal and pandemic influenza vaccines.
▸ For measles, mumps, rubella (MMR) vaccination, most adults born after 1957 do not require repeat vaccination if they have documentation of having received at least one dose of the vaccine. Women without documentation of rubella vaccination should receive a dose of the MMR vaccine. Health care workers, college students, international travelers, and individuals who have been exposed to measles or mumps in an outbreak setting should receive two doses of MMR.
▸ For hepatitis A, vaccination is recommended for unvaccinated individuals who anticipate close personal contact with an international adoptee from a country with intermediate or high endemicity to hepatitis A. The first dose should be administered at least 2 weeks before the adoptee arrives.
▸ For the three-dose hepatitis B vaccine, the second dose should be administered 1 month after the first dose, and the third dose should be administered at least 2 months after the second. If using the combined hepatitis A and B vaccine, three doses should be administered at 0, 1, and 6 months.
▸ For meningococcal vaccination, the conjugate vaccine (MCV4) is preferred for adults age 55 years or younger, while the polysaccharide vaccine (MPSV4) is recommended for adults older than 55 years. Revaccination with MCV4 after 5 years is recommended for individuals who continue to be at risk for infection, such as adults with anatomic or functional asplenia.
▸ For Haemophilus influenzae type B (Hib) vaccination, there is no recommendation for individuals older than age 5 years. One dose of the vaccine is not contraindicated in certain high-risk patients who have not received the vaccine previously, including those patients with sickle cell disease, leukemia, HIV infection, or splenectomy.
Although vaccines are among the most effective strategies for preventing individual illness and protecting public health, “deaths from vaccine-preventable illnesses still occur in the United States,” noted Dr. Robert H. Hopkins Jr. and Dr. Keyur S. Vyas of the University of Arkansas for Medical Sciences, Little Rock, in an accompanying editorial (Ann. Intern. Med. 2010;152:59–60).
Clinicians must overcome patients' perception of vaccines as necessary only for children and travelers, added Dr. Hopkins and Dr. Vyas. “Our challenge is to change this perception and to make immunizations integral to each encounter for physicians who care for adults in primary and specialty care settings.”
The complete 2010 Adult Immunization Schedule will be available in English and Spanish at www.cdc.gov/vaccines/recs/schedules/adult-schedule.htm
Members of ACIP disclosed relationships with Med-Immune, Sanofi Pasteur, Novartis, and Wyeth. According to the report, members with conflicts are not permitted to vote if the conflict involves the vaccine or agent being considered.
Dr. Hopkins and Dr. Vyas reported no potential conflicts of interest.
The term “seasonal” has been added to distinguish between seasonal and pandemic influenza vaccines.
Source Joyce Frieden/Elsevier Global Medical News