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October 20, 2020 07:45pm
By Jill Murphy, Assistant Editor
This yearâ€™s recommendations for the routine use of vaccines in the United States.
This year’s2017 adult and childhood immunization scheduleshave been released, with updates regarding hepatitis B virus (HBV), human papillomavirus (HPV), and meningitis B (MenB) vaccines.
Recommendations for routine vaccinations in children, adolescents, and adults in the United States are developed through a collaborative effort among the CDC and its Advisory Committee on Immunization Practices (ACIP) and the American Academy of Family Physicians (AAFP).
Updated recommendations this year include a 2-dose schedule of 9-valent HPV vaccine (HPV9; Gardasil 9) for patients aged 11 and 12 years; a 2-dose schedule of MenB for adolescents; and a clarification on recommended adult candidates for the HBV vaccine.
Additionally, the adult immunization schedule was revised to be more reader friendly, according to the AAFP.
During an ACIP meeting in October 2016, the group voted to recommend that patients aged 11 and 12 years receive 2 doses of HPV9. However, the dosing schedule can be initiated as early as 9 years and as late as ages 13 to 14 years. It’s recommended that the second dose be administered 6 to 12 months after the first dose, but the minimum interval between the first and second dose is 5 months.
The recommendation follows the granted request by the FDA to add a 2-dose schedule of HPV9 for individuals aged 9 to 14 years as an alternative to the 3-dose schedule.
According to the AAFP, patients who initiate the HPV9 vaccine at or after 15 years are recommended to take the 3-dose schedule. The second dose should be administered 1 to 2 months after the first dose, and the third dose should be administered 6 months after the initial dose.
Updates for the MenB vaccine are only applicable to the MenB-FHbp (Trumenba) product, and they clarify when 2 doses can be administered rather than the original 3-dose schedule, according to the AAFP.
“For patients at an increased risk for meningococcal disease and for use during serogroup B outbreaks, 3 doses of MenB-FHbp should be administered at ages 0, 1 to 2 months, and 6 months,” the update stated. “When given to healthy adolescents who are not at increased risk for meningococcal disease, 2 doses of MenB-FHbp should be administered at 0 and 6 months. If the second dose is given at an interval of less than 6-months, a third dose should be gen at least 6 months after the first dose.”
For the HBV vaccine, the ACIP changed its birth dose recommendation to read “within 24 hours of birth” instead of “at hospital discharge.”
The 2017 adult immunization schedule has undergone a new format that includes cleaner graphics, landscape formatting, abbreviations, and larger font in the footnotes, in order to make it easier to read.
Adults with a history of an egg allergy that manifests with symptoms besides hives, or who require epinephrine may receive age-appropriate inactived (IIV) or recombinant influenza vaccine (RIV). However, the inactivated vaccine should be supervised by a health care professional.
Adults who develop hives only after exposure to eggs should receive IIV or RIV.
The HBV vaccine is recommended for adults with chronic liver disease, including individuals with HCV and liver function enzyme levels twice the upper limit. The recommendation also includes patients with cirrhosis, fatty liver disease, autoimmune hepatitis, and alcoholic liver disease, the AAFP noted.
Lastly, the HPV recommendation for adults was not changed. Teenagers and young adults who initiate the series at age 15 to 26 years will continue to need 3 doses of the vaccine. Patients who initiated the vaccine series before the age of 15 years and who received only 1 or 2 doses less than 5 months apart, are still required to have 1 additional dose.