New ACIP adult immunization schedule changes flu, hepatitis A and B vaccination advice

Among other updates from the Advisory Committee on Immunization Practices, any licensed influenza vaccine that is appropriate for the age and health status of the patient may be used.

The Advisory Committee on Immunization Practices (ACIP) released its 2019 Recommended Immunization Schedule for adults for influenza and hepatitis A and B vaccines.

The schedule, published in Annals of Internal Medicine and on the Centers for Disease Control and Prevention web site on Feb. 5, offers revised content, format, and graphics to make it easier to follow.

In June 2018, ACIP updated recommendations on the use of live attenuated influenza vaccine (LAIV) after two influenza seasons (2016-2017 and 2017-2018) during which LAIV was not recommended in the United States. For the 2018-2019 season, any licensed influenza vaccine, including FluMist, that is appropriate for the age and health status of the patient may be used.

ACIP recommends adding homelessness as an indication for routine hepatitis A vaccination with a two-dose series of single-antigen hepatitis A vaccine or a three-dose series of combination hepatitis A and B vaccine.

Other high-risk individuals who should be routinely vaccinated against hepatitis A include patients with chronic liver disease or clotting factor disorders, travelers to countries with high or intermediate hepatitis A endemicity, those with close personal contact with an international adoptee in the first 60 days after arrival from a country with high hepatitis A endemicity, men who have sex with men, people who use injection or noninjection drugs, and those who work with hepatitis A virus in a laboratory or with nonhuman primates infected with the virus.

ACIP also now recommends use of the newly approved single-antigen recombinant hepatitis B vaccine, Heplisav-B, for prevention of hepatitis B virus infection in adults aged 18 or older (except for pregnant women) because it contains a novel adjuvant and a more rapid dosing schedule.

While the new schedule is streamlined for easier reference, physicians should pay careful attention to the details found in the footnotes, which clarify who needs what vaccine, when, and at what dose, the authors said.

“Along with routine use of the adult immunization schedule, health care providers can implement such proven strategies as incorporating vaccination assessments as part of routine patient flow and using patient reminders and recalls to improve vaccination of their adult patients,” the paper stated. “These and other activities associated with implementation of the standards for adult immunization practice can be used to develop quality improvement projects that readily meet maintenance of certification requirements.”