The Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC) has issued its 2018 Recommended Immunization Schedule for Adults Aged 19 or Older, and was recently published in Annals of Internal Medicine.
Key changes in the updated schedule pertain to the new herpes zoster vaccine, as well as to the measles, mumps, and rubella (MMR) vaccine. Following the US Food and Drug Administration’s October 2017 approval of recombinant zoster vaccine to prevent shingles in adults age 50 years and older, the ACIP now recommends RZV as follows:
- Give two doses of RZV 2 to 6 months apart to adults age 50 years and older with competent immune systems regardless of a history of herpes zoster or receipt of the zoster vaccine live.
- Give two doses of RZV 2 to 6 months apart to previous recipients of ZVL at least 2 months after ZVL.
- For persons age 60 years and older, administer RZV or ZVL, with RZV the preferred option.
“The new zoster vaccination recommendations is a reminder for health care providers, including pharmacists, to routinely discuss vaccinations with their adult patients (similar to reviewing medication lists; vaccines, as do medicines, help prevent disease, reduce the severity of disease, and prevent complications from disease) and educating them that there are vaccines specifically recommended for adults,” says Richard Benson of the CDC. “Improving low vaccination coverage rates for adults is possible with increased awareness by adult patients and health care providers’ advocacy.”
Additional vaccines on the schedule include those for hepatitis A and B, varicella, influenza, and human papillomavirus, among others. ACIP offers recommendations for each based on age, medical comorbidities, and contraindications, with considerations for specialized populations. The goal is to make adult immunization routine practice by encouraging clinicians to evaluate vaccination standing of adult patients at each clinical visit; recommend and provide those vaccines as needed; and document vaccine administration in local or state information systems, which can aid in clinical decisionmaking both at the point of care and on a broader level.
In another new recommendation, the 2018 ACIP guideline endorses administering an additional dose of MMR during a mumps outbreak to at-risk adults previously vaccinated with two (or fewer) doses of a mumps-containing vaccine.
“The ACIP has been monitoring developments in RZV and evaluating its use and potential impact in the United States since 2015,” says Benson. “The recommended use of additional dose of MMR in mumps outbreaks settings has been under discussion since an increase in the number of mumps outbreaks and outbreak-associated cases has been observed in the United States since 2015.”
The study authors also note that more needs to be done to encourage vaccine uptake in adults. Despite modest increases in vaccination coverage rates observed in some adult groups in 2015, overall vaccination coverage rates for US adults remain low. Except for a steady rise in zoster vaccination among persons age 60 years and older, no sustained increases in vaccination coverage have occurred in the past few years.
