Advisory Committee on Immunization Practices (ACIP) recommended immunization schedule for adults aged 19 years and older--United States, 2013.

MMWR / January 28, 2013 / Vol. 62 9 Vaccines are recommended for adults on the basis of age, prior vaccinations, health conditions, lifestyle, occupation, and travel. Current levels of vaccination coverage among adults are low (1). Health-care providers should be aware of the importance of routinely assessing patients’ vaccination histories and recommending and providing routinely recommended vaccines. A strong recommendation from a health-care provider is associated with increased uptake of vaccines (2,3). Other interventions shown to increase vaccine uptake, such as implementation of reminder/recall systems and standing orders, have been summarized by the Community Guide (3). The Advisory Committee on Immunization Practices (ACIP) annually reviews and updates the adult immunization schedule, which is designed to provide vaccine providers with a summary of existing ACIP recommendations regarding the routine use of vaccines for adults (Figures 1 and 2). The adult schedule also includes a table summarizing the primary contraindications and precautions for routinely recommended vaccines (Table). In October 2012, ACIP approved the adult immunization schedule for 2013. This schedule also incorporates changes to vaccine recommendations voted on by ACIP at its October 24–25, 2012 meeting. The primary updates include adding information for the first time on the use of 13-valent pneumococcal conjugate vaccine (PCV13) and the timing of administration of PCV13 relative to the 23-valent pneumococcal polysaccharide vaccine (PPSV23) in adults (4). PCV13 is recommended for adults aged 19 years and older with immunocompromising conditions (including chronic renal failure and nephrotic syndrome), functional or anatomic asplenia, cerebrospinal fluid leaks, or cochlear implants. The schedule also clarifies which adults need 1 or 2 doses of PPSV23 before age 65 years. Other changes to the PPSV23 footnote include adding information regarding recommendations for vaccination when vaccination status is unknown. For tetanus, diphtheria, and acellular pertussis (Tdap) vaccine, recommendations have been expanded to include routine vaccination of adults aged 65 years and older and for pregnant women to receive Tdap vaccine with each pregnancy. The ideal timing of Tdap vaccination during pregnancy is during 27–36 weeks’ gestation. This recommendation was made to increase the likelihood of optimal protection for the pregnant woman and her infant during the first few months of the infant’s life, when the child is too young for vaccination but at highest risk for severe illness and death from pertussis (5,6). Manufacturers of the live, attenuated influenza vaccine (LAIV) have obtained Food and Drug Administration (FDA) approval for a quadrivalent influenza vaccine that contains one influenza A (H3N2), one influenza A (H1N1) and two influenza B vaccine virus strains, one from each lineage of circulating influenza B viruses. In approximately half of the recent influenza seasons, the trivalent influenza vaccine has included an influenza B vaccine virus from the lineage different from the predominant circulating influenza B strains (7). Inclusion of both lineages of influenza B virus is intended to increase the likelihood that the vaccine provides crossreactive antibody against a higher proportion of circulating influenza B viruses. For LAIV, beginning with the 2013–14 season, it is expected that only the quadrivalent formulation will be available and manufacture of the trivalent formulation will cease. It is possible that quadrivalent inactivated influenza vaccine formulations might be available for the 2013–14 season as well. Because a mix of quadrivalent and trivalent influenza vaccines might be available in 2013–14, the abbreviation for inactivated influenza vaccine has been changed from trivalent inactivated influenza vaccine (TIV) to inactivated influenza vaccine (IIV). The abbreviation for LAIV remains unchanged. Minor wording changes, clarifications, or simplifications have been made to footnotes for measles, mumps, rubella vaccine (MMR), human papillomavirus vaccine (HPV), zoster vaccine, and hepatitis A and hepatitis B vaccines. A correction has been made to Figure 1 for MMR vaccine: the bar that indicated the vaccine might be used in certain situations by persons born before 1957 has been removed. Persons born before 1957 are considered immune, and routine vaccination Advisory Committee on Immunization Practices (ACIP) Recommended Immunization Schedule for Adults Aged 19 Years and Older — United States, 2013