Dr. Sandra Fryhofer: Hello, I'm Dr. Sandra Fryhofer. Welcome to Medicine Matters. The topic is key changes in the 2012 adult immunization schedule, which was published in Annals of Internal Medicine.[1,2]
Here is why it matters.
Vaccinations are vital to our nation's heath. The Advisory Committee on Immunization Practices (ACIP) has now adopted an evidence-based process for reviewing data and economic impact.
For specific recommendation changes, let's start with the human papillomavirus (HPV) vaccine, which is no longer just for girls. The new HPV recommendation: routine vaccination for males aged 11 through 21 years. (Routine vaccination for females is recommended for those aged 11 through 26 years). Female vaccination rates are now low, which makes male vaccination more cost-effective. Routine HPV vaccination in men who have sex with men is recommended through age 26 years; it is cost-effective, regardless of coverage rates in females.
Hepatitis B vaccination is now recommended routinely for adults with diabetes who are younger than age 60 years. Those with diabetes age 23 through 59 years have more than twice the risk for contracting hepatitis B compared with people without diabetes. Those with diabetes who are age 60 years or older may be vaccinated at physician discretion.
Tdap and Pertussis Protection
Recommendations for adult tetanus, diphtheria, and pertussis (Tdap) vaccination concern pertussis protection and, specifically, cocooning infants and young children by vaccinating family and household contacts, including those over age 65 years. The new change is when to vaccinate pregnant mothers, which should be during pregnancy, after 20 weeks' gestation. Timing the vaccination this way will allow the mother's antibodies to pass on to the fetus.
In the latest recommendations, egg allergy is no longer a contraindication to the influenza vaccination, although egg-allergic patients must get the inactivated shot because that is what has been studied. In addition, the new intradermal influenza vaccine, with its microinjector apparatus and ultrafine needle, is an option for adults aged 18 through 64 years. Finally, everyone over 6 months old should be vaccinated for flu, and this includes healthcare workers.
Another heads-up: the American College of Physicians has just released the fourth edition of the Guide to Adult Immunization, and there is even a mobile app in the works. So please, keep vaccinating.