ACIP’s 2022 Updates: Recommended Adult Immunization Schedule Includes Contraindications, Precautions

The Centers for Disease Control and Prevention’s (CDC) Advisory Committee on Immunization Practices (ACIP) has updated the immunization schedule for adults aged 19 and over. A key change is a routine hepatitis B vaccine is now recommended for adults aged 19 to 59 years and over aged 60 years if they have an additional risk factor or other indication.

The announcement, published in the CDC’s Morbidity and Mortality Weekly Report, included either updates or clarification to the recommendations for the following vaccines: Hepatitis B vaccine, recombinant zoster vaccine (RZV), and the pneumococcal vaccine. Other vaccinations covered by the announcement were human papillomavirus (HPV), influenza, meningococcal vaccination, measles, mumps, and rubella, varicella, and COVID-19.

“The 2022 adult immunization schedule summarizes ACIP recommendations, including several changes to the cover page, tables, and notes from the 2021 immunization schedule.” Panel authors said in the supplementary article. “In addition, the 2022 adult immunization schedule provides an appendix that lists the contraindications to and precautions for all routinely recommended vaccines in the schedule.”

For the hepatitis B vaccine, now all adults aged 19 to 59 are recommended to receive a 2-, 3-, or 4-dose regimen. Adults aged 60 and older are eligible for the vaccination with an additional risk factor or other indication. Even without meeting the risk-based recommendations, anyone in that age group may receive the hepatitis B vaccine.

WIth the update, RZV vaccination is recommended for adults aged 19 and older who are or will be immunodeficient or immunosuppressed due to disease or therapy. The authors mention that no ACIP recommendation is given for RZV use during pregnancy and recommend postponing the vaccine until after pregnancy.

Pneumococcal vaccination is recommended for adults aged 65 and older who have not previously received a pneumococcal conjugate vaccine or whose previous vaccination history is unknown to receive 1 dose of PCV15 (15-valent pneumococcal vaccine) or 1 dose of PCV20 (20 valent pneumococcal vaccine). For individuals aged 19 to 64 with certain underly medical conditions or other risk factors who have not previously received a pneumococcal conjugate vaccine or whose previous vaccination history is unknown, the recommended vaccine is 1 dose of PCV15 or 1 dose of PCV20. Further, all ages from 19 years and older may receive a dose of dose of the PCV15 or PCV20. Patients who receive PCV15 should also receive a dose of the pneumococcal polysaccharide vaccine (PPSV23).

“ACIP’s recommendations for the use of each vaccine are developed after in-depth reviews of vaccine-related data, including the epidemiology and societal impacts of the vaccine-preventable disease, vaccine efficacy and effectiveness, vaccine safety, quality of evidence, feasibility of program implementation, and economic analyses of immunization policy,” the Advisory Committee reported in the announcement.

Alll due and overdue vaccines should be administered according to the routine immunization schedule. They may be given during the same visit. The authors also recommend implementing a scheduling strategy to get the patient caught up on any overdue vaccines.

The immunization schedule is recommended by ACIP and approved by the CDC, the American College of Physicians, the American Academy of Family Physicians, the American College of Obstetricians and Gynecologists, the American College of Nurse-Midwives, the American Academy of Physician Associates, and the Society for Healthcare Epidemiology of America.

Further APIC vaccine recommendations and guidance, including precautions and contraindications, are available on the CDC website. The ACIP recommendations for the use of COVID-19 vaccines and the Interim Clinical Considerations for the use of the COVID-19 vaccines are included in the report.