SUMMARY:

Changes to the CDC Adult Immunization Schedule for 2020

Influenza

• Routine annual influenza vaccination is recommended for
  • All individuals ≥6 months who do not have contraindications
  • One influenza vaccine product is not preferred over another
• LAIV (influenza vaccine, live attenuated) is an option for adults through age 49 years with the following exceptions
  • Immunocompromising conditions, including HIV infection
  • Anatomical or functional asplenia
  • Pregnancy
  • Close contact with or are caregivers of severely immunocompromised persons in a protected environment
  • Have received influenza antiviral medications in the previous 48 hours
  • Cerebrospinal fluid leak
  • Cochlear implant

Note: “Those with a history of Guillain–Barré syndrome within 6 weeks of a previous dose of influenza vaccine generally should not be vaccinated, unless vaccination benefits outweigh risks for those at higher risk for severe complications from influenza.”

Hepatitis A

• HepA vaccination is recommended for
  • All persons with HIV ≥1 year
• Clotting factor disorders recommendation has been removed from the list
• List of other higher risk population groups “has not changed significantly” and includes the following
  • Chronic liver disease
  • Travelers in countries with high or intermediate endemic hepatitis A
  • Close, personal contact with an international adoptee in the first 60 days after arrival from a country with high or intermediate endemic hepatitis A
  • Men who have sex with men
  • Persons who use injection or noninjection drugs
  • Persons experiencing homelessness
  • Persons who work with hepatitis A virus in a laboratory or nonhuman primates infected with the virus
• Expanded definition of chronic liver disease: Now includes, but is not limited to persons with
  • Hepatitis B | Hepatitis C | Cirrhosis | Fatty liver disease | Alcoholic liver disease | Autoimmune hepatitis | ALT or AST level >2x upper limit of normal
• Pregnancy: A 2-dose series HepA (or 3-dose series HepA-HepB) is recommended for pregnant women if they are at risk for Infection or severe outcome from infection during pregnancy
• HepA vaccination is recommended for persons working in settings of exposure, including
  • Those working in health care settings for injection or noninjection drug users or group homes and nonresidential day care facilities for developmentally disabled persons)

Note: Any person who is not at risk for hepatitis A virus infection but wants protection against it may be vaccinated

Hepatitis B

• The list of populations at risk for hepatitis B infection or severe hepatitis B disease has not changed
• High risk list includes persons with
  • Hepatitis B | Hepatitis C | Cirrhosis | Fatty liver disease | Alcoholic liver disease | Autoimmune hepatitis | ALT or AST level >2x upper limit of normal
  • HIV infection
  • Sexual exposure risk such as
    • Sex partners of hepatitis B surface antigen [HBsAg]–positive person | Sexually active persons not in mutually monogamous relationships | Persons seeking evaluation or treatment of a sexually transmitted infection | Men who have sex with men
  • Current or recent injection drug use
  • Percutaneous or mucosal risk for exposure to blood such as
    • Household contacts of HBsAg-positive persons | Residents and staff of facilities for developmentally disabled persons | Health care and public safety personnel with reasonably anticipated risk for exposure to blood or blood-contaminated body fluids | Hemodialysis |Peritoneal dialysis | Home dialysis | Predialysis patients
  • Diabetes mellitus
    • < 60 years
    • ≥60 years (at the discretion of the treating clinician)
  • Incarcerated persons
  • Persons traveling in countries with high or intermediate endemic hepatitis
• Pregnancy – new ‘at risk group’
  • If at risk for infection or severe outcome from infection during pregnancy
  • Not recommended: HepB-Cpg (Heplisav-B) administration due to a lack of safety data

HPV

Catch-up HPV vaccination (not adequately vaccinated previously)

• Through age 26
  • Catch-up HPV vaccination recommended for all adults, male and female
• 27 through 45 years
  • Shared clinical decision-making is recommended

Public health benefit of HPV vaccinations for adults in this age range is minimal, yet some persons who are not adequately vaccinated might benefit. HPV vaccination does not need to be discussed with most adults older than 26 years of age, but clinicians can consider discussing HPV vaccination with persons who are most likely to benefit. HPV vaccines are not licensed for use in adults older than age 45 years.

Measles, mumps, and rubella (MMR)

• Healthcare workers: Additional language added to address and clarify indications for health care workers
  • Born ≥1957 without evidence of immunity to measles, mumps, or rubella: A 2-dose series at least 4 weeks apart and at least 1 dose of MMR “should be administered” for rubella immunity
  • Born <1957 without evidence of immunity to measles, mumps, or rubella: “Consider” a 2-dose series at least 4 weeks apart for measles or mumps immunity and at least 1 dose MMR for rubella immunity

Meningococcal B

• Persons ≥10 years with complement deficiency, complement inhibitor use, or asplenia or who are microbiologists
  • “Should receive” a MenB booster dose 1 year following completion of a MenB primary series, followed by MenB booster doses every 2–3 years thereafter, for as long as the increased risk remains
• Persons ≥10 years determined by public health officials to be at increased risk during an outbreak
  • ACIP Recommends a one-time booster dose if it has been 1 year or more since completion of a MenB primary series
  • A booster dose interval of 6 months or more may be considered by public health officials depending on the specific outbreak, vaccination strategy, and projected duration of elevated risk

Pneumococcal Vaccination

• PCV13 (pneumococcal 13-valent conjugate vaccine)
  • Offer based on shared clinical decision-making for adults ≥65 years and who have not previously received PCV13
  • Do not offer to those with an immunocompromising condition, cerebrospinal fluid leak, or cochlear implant
• PPSV23 (pneumococcal 23-valent polysaccharide vaccine
  • Recommended for all adults ≥65 years

Tetanus, Diphtheria, And Pertussis

• ACIP recommends either Td or Tdap vaccine be used for the following clinical situations where only Td vaccine is currently recommended
  • Decennial booster
  • Tetanus prophylaxis in wound management
  • Catch-up immunization schedule, including in pregnant women

Varicella

• Consider vaccination for persons with HIV without evidence of varicella immunity who have CD4 counts ≥200 cells/µL

Learn More – Primary Sources:  

Recommended Adult Immunization Schedule, United States, 2020

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