CME/CE Released: 02/03/2011; Valid for credit through 02/03/2012
February 3, 2011 — In October 2010, the Advisory Committee on Immunization Practices (ACIP) approved the Adult Immunization Schedule for 2011, which includes several changes.
The 2011 schedule, which reflects current recommendations for the licensed vaccines, is published in the February 1 issue of the Annals of Internal Medicine. The 2011 schedule was also approved by the American Academy of Family Physicians, American College of Obstetricians and Gynecologists, and the American College of Physicians.
“The notation for seasonal influenza vaccine in the figure and footnotes was changed to reflect the expanded recommendation for annual influenza vaccination for everyone 6 months of age or older, which was approved by ACIP in February 2010,” write Abigail Shefer, MD, Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, and colleagues. “In October 2010, ACIP issued a permissive recommendation for use of the tetanus, diphtheria, pertussis (Tdap) vaccine in adults aged 65 years or older; approved the recommendation that Tdap can be administered regardless of how much time has elapsed since the last tetanus and diphtheria (Td)–containing vaccine; and approved a recommendation for a 2-dose series of meningococcal vaccine in adults with certain high-risk medical conditions. The vaccines listed in the Figure have been reordered to keep all universally recommended vaccines together (for example, influenza, Td/Tdap, varicella, human papillomavirus [HPV], and zoster).”
Other changes include clarifications to the footnotes for the measles, mumps, rubella; HPV; and Haemophilus influenza type B (Hib) vaccines and for revaccination with pneumococcal polysaccharide (PPSV). A vaccine series does not need to be restarted, regardless of the time elapsed between doses.
Specific Updated Changes
Specific changes in the schedule for 2011 include the following:
- All persons at least 6 months old, including all adults, should be vaccinated against seasonal influenza. Adults at least 65 years old may receive the high-dose influenza vaccine (Fluzone; sanofi-pasteur, Swiftwater, Pennsylvania), licensed in 2010 for use in this age group, as an option.
- Persons at least 65 years old in close contact with an infant younger than 12 months should receive Tdap vaccine, and all persons at least 65 years old may receive Tdap vaccine. Tdap should be administered regardless of time elapsed since receiving the last Td-containing vaccine.
- Either quadrivalent human papillomavirus (HPV4) vaccine or bivalent (HPV2) vaccine is recommended for girls and women.
- For revaccination with PPSV, 1-time revaccination after 5 years applies only to persons 19 through 64 years old with indicated chronic conditions, namely chronic renal failure or the nephrotic syndrome, functional or anatomic asplenia, or immunocompromising conditions.
- For adults with anatomic or functional asplenia or persistent complement component deficiencies and adults with HIV infection who are vaccinated with meningococcal conjugate vaccine (MCV4), a 2-dose series of meningococcal vaccine is recommended, with the 2 doses given 2 months apart. For those with other indications, a single dose of meningococcal vaccine is still recommended. Information in the new schedule clarifies that MCV4 is a quadrivalent vaccine.
- Information regarding the Hib vaccine clarifies which high-risk persons may receive 1 dose of Hib vaccine, namely persons who have sickle cell disease, leukemia, or HIV infection, or those who have had a splenectomy, if they have not previously received Hib vaccine.