2012 adult immunization schedule broadens recommendations for HPV and hepatitis B vaccinations

The CDC's Advisory Committee on Immunization Practices (ACIP) now recommends routine HPV vaccination for males aged 11 to 12 years and catch-up vaccination for males aged 13 to 21. These are just two of the changes to the 2012 Recommended Adult Immunization Schedule being published February 1 in Annals of Internal Medicine (www.annals.org), the flagship journal of the American College of Physicians (ACP).

In addition to the changes in the HPV vaccine, the ACIP now recommends vaccination against Hepatitis B for adults younger than age 60 who have diabetes, as soon as possible after diabetes is diagnosed. Hepatitis B vaccinations should also be given to adults with diabetes aged 60 years or older based on a patient's need for assisted blood glucose monitoring, likelihood of acquiring hepatitis B, and likelihood of immune response to vaccination.

The ACIP is comprised of the 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. In October 2010, the ACIP adopted an evidence-based process that considers quality of evidence, benefits and harms, values and preferences of affected populations, and economic impact. Voting to expand routine HPV vaccination to males and hepatitis B vaccinations to young adult diabetics was the first exercise of this approach.

Changes were also made to when mothers should receive the tetanus, diphtheria, and acellular pertussis (Tdap) booster that is designed to protect infants from pertusiss. According to the 2012 schedule, women should receive the vaccine during pregnancy, preferably after 20 weeks of gestation. Protective maternal antibodies will pass to the fetus.

Adult patients should continue to be vaccinated against influenza. Egg allergy is no longer a contraindication, but patients with an egg allergy should get the inactivated flu shot because that is what has been studied.

A footnote was added to the schedule directing readers to links for the full ACIP vaccine recommendations. Specific vaccine recommendations for travelers also were added. In another new addition, the schedule now includes a table summarizing precautions and contraindications for vaccines.

The full 2012 Recommended Adult Immunization Schedule can be viewed at www.annals.org.

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