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Recommended Adult Immunization Schedule for 2014

Guideline Watch |
April 17, 2014

Recommended Adult Immunization Schedule for 2014

  1. Jamaluddin Moloo, MD, MPH

The CDC Advisory Committee on Immunization Practices has released its 2014 immunization schedule.

  1. Jamaluddin Moloo, MD, MPH

Sponsoring Organization: Centers for Disease Control and Prevention

Target Population: Primary care providers

Background and Objective

Recommended Adult Immunization Schedule — United States, 2014 CDC material, reprinted from Ann Intern Med 2014; 160:190 [Fig. 1].

Updated guidelines for use of vaccines routinely recommended for adults are summarized in a single schedule by vaccine and age group. A second schedule shows vaccines that might be indicated for some adults, based on medical and other indications. Extensive footnotes clarify and update previous recommendations. A summary of routinely recommended vaccinations has been provided by the CDC (see figure). These recommendations must be read with the footnotes that follow, which contain number of doses, intervals between doses, and other important information.

Key Points

  • All recommended vaccinations from the 2013 Adult Immunization Schedule (NEJM JW Gen Med Feb 14 2013) are included in the 2014 schedule.

  • Haemophilus influenzae type B (Hib) vaccine has been added to the schedule. One dose is recommended for adults who have functional or anatomic asplenia or sickle cell disease or are undergoing elective splenectomy if they have not previously received Hib vaccine. Adults who have undergone successful hematopoietic stem cell transplants should receive a three-dose series at 6 to 12 months after transplant regardless of Hib vaccination status. Hib should no longer be considered for unvaccinated HIV-positive adults because their risk for Hib infection is low.

  • Recombinant influenza vaccine (RIV) and inactivated influenza vaccine can be used in individuals with hives-only allergy to eggs. RIV contains no egg protein and can be used in 18- to 49-year-olds regardless of severity of egg allergy.

  • Pneumococcal conjugate (PCV13) vaccination is listed before pneumococcal polysaccharide (PPSV23) vaccination in the immunization schedule as a reminder that, for patients for whom both vaccines are recommended, PCV13 should be administered first.

  • Human papillomavirus (HPV) vaccination is still recommended for 19- to 26-year-old women and 19- to 21-year-old men who have not been vaccinated previously. The vaccine is given in a three-dose series. Information has been added about the timing of the second and third doses: The second dose should be given 4 to 8 weeks after the first dose; the third dose should be given 24 weeks after the first dose and 16 weeks after the second dose.

  • Adults who have not received tetanus, diphtheria, and acellular pertussis (Tdap) vaccine should receive one dose of Tdap followed by a tetanus and diphtheria toxoids (Td) booster every 10 years thereafter.

In a separate article, researchers sent surveys to >800 general internists and family physicians to assess barriers to vaccinating adults according to guidelines. Nearly all physicians reported that they assessed patients' vaccination status at annual visits, whereas only 8% of internists and 36% of family physicians reported using immunization information systems to track vaccinations. Family physicians were more likely to assess need for hepatitis A; hepatitis B; measles, mumps, and rubella; HPV; meningococcal; and varicella vaccines. The most commonly reported barriers to adult vaccination delivery were financial, including lack of adequate reimbursement for vaccine purchases, difficulty determining if a patient's insurance would reimburse for a vaccine, and lack of patient insurance coverage for vaccines. About half of physicians reported that patient refusal of vaccines and acute problems taking precedence over vaccinating were moderate-to-major barriers.

Comment

Although multiple obstacles to vaccination exist, I suspect many of us are not as familiar as we could be with recommended vaccinations, and this translates into lower rates of guideline adherence. Interactive and other tools to assist in determining needed vaccinations according to the adult immunization schedule are available on the CDC website.

  • Disclosures for Jamaluddin Moloo, MD, MPH at time of publication Grant / research support NIH

Citation(s):

Reader Comments (3)

Dorota Aleksandra Krakowska, MD Physician, Family Medicine/General Practice, Rural Medical Group, Wloclawek, Poland

Do not avoid properly diet callories suplements, also good vegetable such as garlic antbiotic and antifungal properties in adverse weather condition in infection evacuation .

Eleanor Luna MD Physician, Internal Medicine, Abu dhabi

How about for those long term care patients who are on tracheostomy wherein we can not assessed their immunization status or no records of their immunization, could we just give them the standard immunization as recommended?

SHELDON BALL Physician, Geriatrics, Anvita Health

The PubMed Unique Identifiers are:
PMID: 24658695
PMID: 24658693

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