New ACIP Adult Immunization Schedule recommends major changes to flu, HPV, and meningococcal vaccines

The Advisory Committee on Immunization Practices (ACIP) released its 2017 Recommended Immunization Schedule for adults with major changes to the influenza, human papillomavirus (HPV), and meningococcal (MenB) vaccines. This year's schedule includes a colorful cover page with references, resources, approved acronyms, and instructions for specific patient populations. The schedule is published in Annals of Internal Medicine.

In a major change, ACIP says patients should not use the live attenuated influenza vaccine (LAIV), or nasal spray vaccine, because of concerns about low effectiveness. Adults with a mild egg allergy should receive age-appropriate inactivated influenza vaccine (IIV) or recombinant influenza vaccine (RIV). Those with more severe egg allergy should have their vaccine administered in a medical setting supervised by a health care provider who is able to recognize and manage severe allergic conditions.

For the HPV vaccine, some patients are considered adequately vaccinated with two doses. For patients who did not receive HPV vaccination before age 15, three doses are still required and may be given to females up to age 26 and males up to age 21. Recommendations for MenB vaccination are similar to last year, but indications for high-risk patient populations have changed. Finally, the new schedule also includes recommendations for chronic liver conditions that warrant vaccination for HBV.

While the new schedule is clean and streamlined, physicians should pay careful attention to the details found in the footnotes. The footnotes clarify who needs what vaccine, when, and at what dose.

The complete schedule, including footnote changes, is being simultaneously published in Annals of Internal Medicine and on the Centers for Disease Control and Prevention (CDC) web site. The CDC's ACIP is comprised of the American College of Physicians (ACP) and 16 other medical societies representing various medical practice areas. Each year, the ACIP reviews the CDC's Recommended Adult Immunization Schedule to ensure the schedule reflects current clinical recommendations for licensed vaccines. The recommendations are intended to guide physicians and other clinicians about the appropriate vaccines for their adult patients.