Advisory Committee On Immunization Practices Recommendations Research Articles

Annals for Educators - March 2023.

Web ExclusivesMarch 2023Annals for Educators - March 2023FREEChristine Laine, MD, MPHChristine Laine, MD, MPHSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/AWED202303210 SectionsAboutVisual AbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Clinical Practice PointsImplantable Defibrillator System Shock Function, Mortality, and Cause of Death After Magnetic Resonance ImagingData on the ability of non–MRI-conditional implantable cardioverter-defibrillators (ICDs) to terminate arrhythmias after MRI have been limited. This study examines whether non–MRI-conditional ICDs have preserved shock function of arrhythmias after an average of 2 years of follow-up after MRI.Use this article to:Review the indications for ICD placement.Invite a cardiologist to your session to teach about the different types of ICDs and how to tell whether a patient has a device that is non–MRI-conditional.Discuss how this article could be helpful in assuring patients with ICDs that it is OK for them to get an MRI if they need one.Long-Term Changes in the Size of Pituitary MicroadenomasPituitary lesions found on brain imaging that is done for other purposes are often called “incidentalomas,” and most are microadenomas with diameters less than 10 mm. Little is known about how stable these microadenomas are and how often they should be imaged. This article provides new information about the stability of pituitary microadenomas.Use this article to:Invite a radiologist to your session to review pituitary microadenomas detected on MRI.Discuss the currently recommended surveillance strategy for pituitary incidentalomas and whether the results of the study suggest that changes in the surveillance recommendations are indicated.Invite an endocrinologist to your session to review the indications for intervention of a pituitary microadenoma.Risk Model–Based Lung Cancer Screening. A Cost-Effectiveness AnalysisSelecting Candidates for Lung Cancer Screening: Implications for Effectiveness, Efficiency, Equity, and ImplementationThis study showed that risk model–based lung cancer screening approaches are more cost-effective than selecting people by using the 2021 categorical age smoking criteria from the U.S. Preventive Services Task Force (USPSTF). The accompanying editorial discusses why we cannot assume model results will be replicable in clinical practice and the need to overcome barriers to balancing tradeoffs in effectiveness, efficiency, and equity.Use this article and the editorial to:Review the current USPSTF recommendations for lung cancer screening.Discuss the potential harms associated with lung cancer screening.Invite a pulmonologist to your session to discuss the appropriate next steps if a pulmonary lesion is identified during lung cancer screening of an asymptomatic patient.Ask your learners to discuss what cost-per-QALY threshold policymakers should use to identify a “cost-effective” intervention.Planning for Mpox on a College Campus: A Model-Based Decision-Support ToolIn the current global outbreak of mpox, it is important to model how human-to-human transmission could occur in congregate settings and how to mitigate spread. This study estimated the likelihood of an mpox outbreak and the potential effect of mitigation measures in a residential college setting.Use this article to:Review the clinical presentation of mpox.Discuss the indications for vaccination to reduce the risk for mpox and the procedures for arranging vaccination at your institution.Review pharmacologic therapy for mpox and the procedures for arranging therapy at your institution.Discuss how you would counsel a patient to reduce the risk for transmission of infection to others.Symptom and Viral Rebound in Untreated SARS-CoV-2 InfectionThere have been reports of rebound of SARS-CoV-2 and symptoms after receipt of nirmatrelvir–ritonavir for treatment of COVID-19. Using prospectively obtained data from patients receiving placebo in a large COVID-19 “platform” trial, this study investigated the natural history of rebound in the absence of antiviral therapy.Use this article to:Review the indications for using nirmatrelvir–ritonavir to treat COVID-19. This article will help guide the discussion. Ask your learners whether they think this study provides convincing evidence that rebound is a feature of COVID-19 and not something associated with treatment with nirmatrelvir–ritonavir.Discuss how the findings of this study could be used to help convince patients to accept treatment if they are reluctant to take nirmatrelvir–ritonavir because they have heard stories about rebound.Vitamin D and Risk for Type 2 Diabetes in People With Prediabetes. A Systematic Review and Meta-analysis of Individual Participant Data From 3 Randomized Clinical TrialsPreventing Type 2 Diabetes With Vitamin D: Therapy Versus SupplementationThis systematic review and individual patient data meta-analysis synthesized 3 randomized controlled trials of vitamin D to prevent diabetes in persons with prediabetes. The accompanying editorial discusses the findings and emphasizes the important differences between supplementation and therapy.Use this article and the editorial to:Watch the brief video summarizing the systematic review with your learners. Review the definition of “prediabetes”.Discuss the appropriate dose of vitamin D supplementation.Review the important difference between supplementation and therapy that the editorial highlights.Ask your learners whether the findings of this review motivate them to recommend vitamin D to patients with prediabetes.Reproductive Health Policy in the United States: An American College of Physicians Policy BriefSince the U.S. Supreme Court decision in Dobbs v Jackson Women's Health Organization, some state governments have imposed stringent restrictions on abortion, whereas others have sought to protect access. In this paper, the American College of Physicians updates its previous positions to reflect this new reality and offers recommendations to promote equitable access to reproductive health care services and safeguard maternal health.Use this article to:Review the current policies on contraception and abortion in the state where your learners practice.Ask your learners whether the current policies would make them hesitant to refer a patient for abortion.Review the options for referral of a patient for abortion at your institution.Discuss the potential implications of state restrictions on reproductive health care for other health situations. This commentary, this commentary, and this commentary can help prompt discussion. Recommended Adult Immunization Schedule, United States, 2023This article provides immunization recommendations from the Advisory Committee on Immunization Practices (ACIP) for adults aged 19 years or older. The purpose of the immunization schedule is to consolidate and summarize updates to ACIP recommendations on vaccination of adults and to assist providers in implementing current ACIP recommendations.Use this article to:Invite a colleague from nursing to your session to demonstrate the proper technique for administering an intramuscular vaccine.Review the changes in the ACIP vaccine recommendations between 2022 and 2023.Ask your learners to share strategies they find helpful in discussing vaccination with patients who are hesitant to receive it. This article may help to stimulate the discussion. Public HealthFirearm Injury: An Escalating Health CrisisAn estimated 50 000 people in the United States lost their lives to guns in 2021. An infectious organism responsible for that many deaths would clearly be considered a public health threat, and that is why the American College of Physicians sees gun injury as a public health issue. Reducing the negative impact of guns on the health of the U.S. public requires multidisciplinary efforts involving government, law enforcement, gun manufacturers, and others; health care professionals also have an important role. On 11 January 2023, Annals of Internal Medicine and the American College of Physicians gathered a panel of experts to discuss what health care professionals can do to reduce the adverse effect of guns on the health of their patients.Use this article to:Watch the video of the program with your learners. Stop the video after the presentation of each clinical scenario and ask your learners how they would approach the situation.Ask your learners whether they agree that firearm injury in the United States is a public health issue.Review the policy recommendations from the American College of Physicians for reducing firearm injury. Ask your learners to discuss whether they agree that physicians have a role in reducing firearm injury. If so, what is that role?Cardiac AmyloidosisAmyloidosis is a pathologic and clinical condition resulting from the accumulation of misfolded proteins in tissues. Extracellular deposition of amyloid fibrils in the myocardium leads to cardiac amyloidosis, which is often overlooked as a cause of restrictive cardiomyopathy. Cardiac amyloidosis was previously believed to have a poor prognosis, but recent advances in diagnosis and treatment have emphasized the importance of early recognition and changed management of this important and often underrecognized clinical condition. This review provides an overview of cardiac amyloidosis and summarizes current screening, diagnosis, evaluation, and treatment options.Use this article to:Discuss the presentation of cardiac amyloidosis.Ask your learners if they have any patients with cardiac amyloidosis. How was it diagnosed?Review the complications of untreated cardiac amyloidosis.Review the available therapeutic strategies for treating cardiac amyloidosis.Test your learners' knowledge by having them complete the quiz that accompanies the article and then reviewing the correct answers.Do you like reading Annals for Educators? Receive it direct to your inbox. Sign up for the Annals for Educators alert today. Comments0 CommentsSign In to Submit A Comment Author, Article, and Disclosure InformationAffiliations: From the Editors of Annals of Internal Medicine and Education Guest Editor, Gretchen Diemer, MD, FACP, Associate Dean of Graduate Medical Education and Affiliations, Thomas Jefferson University. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Current IssueMarch 2023Volume 176, Issue 3 ePublished: 21 March 2023 Issue Published: March 2023 Copyright & PermissionsCopyright © 2023 by American College of Physicians. 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Recommended Adult Immunization Schedule, United States, 2023.

Clinical GuidelinesMarch 2023Recommended Adult Immunization Schedule, United States, 2023FREENeil Murthy, MD, MPH, MSJ, A. Patricia Wodi, MD, MPH, Sybil Cineas, MD, and Kevin A. Ault, MD, for the Advisory Committee on Immunization Practices†, Grace M. Lee, MD, MPH, Melinda Wharton, MD, MPH, Lynn Bahta, RN, MPH, CPH, Beth P. Bell, MD, MPH, Oliver Brooks, MD, Wilbur H. Chen, MD, MS, Sybil Cineas, MD, Matthew F. Daley, MD, Camille Nelson Kotton, MD, Jamie Loehr, MD, Sarah S. Long, MD, Veronica V. McNally, JD, Katherine A. Poehling, MD, MPH, Pablo J. Sánchez, MD, Nirav D. Shah, MD, JD, Helen Keipp Talbot, MD, Kevin A. Ault, Veronica McNally, John Epling, Sarah Coles, Katherine Debiec, Rhoda Sperling, Holly Fontenot, Amy Middleman, Sandra Fryhofer, Sarah McQueen, Marie-Michele Leger, Mary-Margaret Fill, Chad Rittle, William Schafner, Ken Schmader, Patsy Stinchfield, Marci Drees, Pia Pannaraj, David Kim, Jane Kim, Susan Farrall, Uzo Chukwuma, Hank Bernstein, Paul Hunter, Peter Szilagyi, Diane Peterson, Carolyn Bridges, Karen Ketner, Kathleen Harriman, Litjen Tan, Robert Hopkins, Susan Lett, A. Patricia Wodi, Neil MurthyNeil Murthy, MD, MPH, MSJCenters for Disease Control and Prevention, Atlanta, Georgia (N.M., A.P.W.)Search for more papers by this author, A. Patricia Wodi, MD, MPHCenters for Disease Control and Prevention, Atlanta, Georgia (N.M., A.P.W.)Search for more papers by this author, Sybil Cineas, MDThe Warren Alpert Medical School of Brown University, Providence, Rhode Island (S.C.)Search for more papers by this author, and Kevin A. Ault, MDUniversity of Kansas Medical Center, Kansas City, Kansas (K.A.A.).Search for more papers by this author, for the Advisory Committee on Immunization Practices†Search for more papers by this author, Author, Article, and Disclosure Informationhttps://doi.org/10.7326/M23-0041 Eligible for CME Point-of-Care SectionsAboutVisual AbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail In October 2022, the Advisory Committee on Immunization Practices (ACIP) voted to approve the Recommended Adult Immunization Schedule for Ages 19 Years or Older, United States, 2023. The 2023 adult immunization schedule, available at www.cdc.gov/vaccines/schedules/hcp/imz/adult.html, summarizes ACIP recommendations in the cover page, tables, notes, and appendix (Figure). The full ACIP recommendations for each vaccine are available at www.cdc.gov/vaccines/hcp/acip-recs/index.html. The 2023 schedule has also been approved by the director of the Centers for Disease Control and Prevention (CDC) and by the American College of Physicians (www.acponline.org), the American Academy of Family Physicians (www.aafp.org), the American College of Obstetricians and Gynecologists (www.acog.org), the American College of Nurse-Midwives (www.midwife.org), the American Academy of Physician Associates (www.aapa.org), the American Pharmacists Association (www.pharmacist.com), and the Society for Healthcare Epidemiology of America (www.shea-online.org).Figure. Recommended Adult Immunization Schedule for Ages 19 Years or Older, United States, 2023. Download figure Download PowerPoint Figure. Continued Download figure Download PowerPoint Figure. Continued Download figure Download PowerPoint Figure. Continued Download figure Download PowerPoint Figure. Continued Download figure Download PowerPoint Figure. Continued Download figure Download PowerPoint Figure. Continued Download figure Download PowerPoint Figure. Continued Download figure Download PowerPoint Figure. Continued Download figure Download PowerPoint Figure. Continued Download figure Download PowerPoint The ACIP develops recommendations on the use of each vaccine after in-depth review of vaccine-related data, such as the epidemiology and burden of the vaccine-preventable disease (VPD), vaccine efficacy and effectiveness, vaccine safety, quality of evidence, feasibility of program implementation, and economic analyses of immunization policy (1). ACIP recommendations can be complex and challenging to implement. The purpose of the immunization schedule, published annually, is to consolidate and summarize updates to ACIP recommendations on vaccination of adults and to assist providers in implementing current ACIP recommendations. The use of vaccine trade names in this article and in the schedule is for identification purposes only and does not imply endorsement by the ACIP or CDC.Changes to the 2023 Adult Immunization ScheduleCOVID-19 vaccination. A new section was added to the Notes section describing recommendations for COVID-19 vaccines approved or authorized by the U.S. Food and Drug Administration. A description of the primary series recommendations for the general population is provided, followed by a description of the primary series recommendations for persons who are moderately or severely immunocompromised. Hyperlinks referring health care providers to booster dose recommendations and to the recommendation for persons who previously received Janssen COVID-19 vaccine are also provided. Additionally, hyperlinks to the current COVID-19 vaccination schedules, use of COVID-19 preexposure prophylaxis in persons who are moderately or severely immunocompromised, as well as Emergency Use Authorization indications for COVID-19 vaccines, are provided.Haemophilus influenzae type b (Hib) vaccination. Vaccine recommendations for Hib vaccination have not changed.Hepatitis A (HepA) vaccination. Vaccine recommendations for HepA vaccination have not changed.Hepatitis B (HepB) vaccination (2). A newly licensed HepB vaccine, PreHevbrio, was added to the description of the 3-dose series. HepB vaccination continues to be universally recommended for all adults 19 through 59 years of age. Language was added stating that persons aged 60 years and older with known risk factors for hepatitis B virus infection should complete a HepB vaccine series, while persons 60 years of age and older without known risk factors for hepatitis B virus infection may complete a HepB vaccine series. The “Special situations” section provides dosing regimens for patients on dialysis.Human papillomavirus (HPV) vaccination (3). Routine recommendations for HPV vaccination have not changed.Influenza vaccination (4). Updates to the seasonal influenza vaccine recommendations reflect discussions during public meetings of ACIP held on 20 October 2021, 12 January 2022, 23 February 2022, and 22 June 2022. For the 2022–2023 influenza season, routine annual influenza vaccination is recommended for all persons aged 6 months and older who do not have contraindications. Among persons who are 65 years of age and older, any one of the quadrivalent high-dose inactivated influenza vaccine, quadrivalent recombinant influenza vaccine, or quadrivalent adjuvanted inactivated influenza vaccine is preferred compared with other influenza vaccine products. However, if none of these 3 vaccines is available, then any other age-appropriate influenza vaccine should be used. This information has been provided as a bullet in the influenza notes section, along with a hyperlink to the 2022–2023 influenza recommendations.The composition of 2022–2023 U.S. influenza vaccines includes updates to the influenza A(H3N2) and influenza B/Victoria lineage components. All seasonal influenza vaccines expected to be available for the 2022–2023 season are quadrivalent, containing hemagglutinin (HA) derived from one influenza A(H1N1)pdm09 virus, one influenza A(H3N2) virus, one influenza B/Victoria lineage virus, and one influenza B/Yamagata lineage virus. For the 2022–2023 season, U.S. egg-based influenza vaccines (i.e., vaccines other than cell culture–based inactivated influenza vaccine [ccIIV4] and recombinant influenza vaccine [RIV4]) will contain HA derived from an influenza A/Victoria/2570/2019 (H1N1)pdm09–like virus, an influenza A/Darwin/9/2021 (H3N2)–like virus, an influenza B/Austria/1359417/2021 (Victoria lineage)-like virus, and an influenza B/Phuket/3073/2013 (Yamagata lineage)–like virus. U.S. ccIIV4 and RIV4 influenza vaccines will contain an influenza A/Wisconsin/588/2019 (H1N1)pdm09–like virus, an influenza A/Darwin/6/2021 (H3N2)–like virus, an influenza B/Austria/1359417/2021 (Victoria lineage)–like virus, and an influenza B/Phuket/3073/2013 (Yamagata lineage)–like virus.Vaccination guidance for close contacts of severely immunocompromised patients who require a protected environment was added as a bullet in the notes section. In addition, the text describing guidance for persons with egg allergy who have experienced any symptom other than hives was moved from the appendix to the “Special situations” section of the Influenza notes.Measles, mumps, and rubella (MMR) vaccination (5). Routine recommendations for MMR vaccination have not changed. However, a hyperlink was provided that describes the recommendation for additional doses of MMR vaccine (including the third dose of MMR) in the context of mumps outbreak settings.Meningococcal vaccination (6). Routine recommendations for meningococcal vaccination have not changed. However, in the “Special situations” section for MenB, guidance was added stating that if the third dose of Trumenba is administered earlier than 4 months after the second dose, a fourth dose should be administered at least 4 months after the third dose.Pneumococcal vaccination (7). ACIP has new recommendations for the use of PCV15 and PCV20 in persons who previously received pneumococcal vaccines. This new guidance is presented in the revised pneumococcal notes section. Additionally, a hyperlink to the CDC app that can be used to determine a patient's pneumococcal vaccination needs has been included.Polio vaccination (8). Routine poliovirus vaccination of adults residing in the United States is not necessary. However, a new polio vaccination section was added to the Notes to address polio vaccine recommendations for adults who are at increased risk for exposure to poliovirus.Tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccination. Routine recommendations for Tdap or Td vaccination have not changed. However, minor grammatical edits were made to the “Special situations” section to help improve clarity in the language.Varicella vaccination (9). Routine recommendations for varicella vaccination have not changed.Zoster vaccination (10). The “Routine vaccination” section was revised to clarify that serologic evidence of prior varicella is not necessary for zoster vaccination and to provide guidance if serologic evidence of varicella susceptibility becomes available. The “Special situations” section was updated to provide guidance for persons with immunocompromising conditions who do not have a documented history of varicella, varicella vaccination, or herpes zoster. Additionally, minor changes were made to the immunocompromising conditions bullet to clarify that this includes persons with HIV regardless of CD4 count.Revised Content, Format, and GraphicsCover Page. The cover page of the 2023 schedule provides basic instructions on how to use the schedule to systematically identify vaccination needs of adults and lists routinely recommended vaccines and their standardized abbreviations and trade names. Major edits to the cover page include adding COVID-19 vaccines, PreHevbrio, and Priorix to the list of vaccines. Of note, ACIP has developed new abbreviations for the COVID-19 vaccine products; these abbreviations contain information on the vaccine's valency (i.e., monovalent vs. bivalent, indicated by “1v” and “2v,” respectively) and vaccine platform (mRNA vs. acellular protein subunit, or “aPS”). Additionally, the American Pharmacists Association has been added to the list of partner organizations approving the schedule. The language in the injury claims section has been modified to indicate which vaccines are covered by the National Vaccine Injury Compensation Program and which vaccines are covered by the Countermeasures Injury Compensation Program. Like in past annual immunization schedules, hyperlinks are provided where providers can download the CDC Vaccine Schedules app and access reference materials for the surveillance of VPDs, including case identification and disease outbreak response. Instructions on reporting suspected cases of reportable VPDs to local or state health departments and significant postvaccination adverse events to the Vaccine Adverse Event Reporting System are listed. Hyperlinks to other resources, such as vaccine information statements, recommended vaccines for travelers, and shared clinical decision-making guidance are also provided.Table 1. Recommended Adult Immunization Schedule by Age Group. Table 1 describes routine and catch-up vaccination recommendations for adults by age. For 2023, a COVID-19 row has been added. The row is entirely yellow indicating that COVID-19 vaccination is now routinely recommended for all adults, with a text overlay that states “2- or 3- dose primary series and booster (See Notes).” For MMR vaccination in Table 1, overlaying text has been added for adults aged 65 years and older, referring providers to the Notes section for vaccination considerations for health care personnel who are 65 years of age or older. For HepA vaccination in Table 1, the overlaying text now states “2, 3, or 4 doses depending on vaccine” to account for the possibility of an accelerated Twinrix series requiring 4 doses.Table 2. Recommended Adult Immunization Schedule by Medical Condition and Other Indications. Table 2 describes vaccination recommendations for adults based on medical conditions or other indications. For 2023, a COVID-19 row has been added to this table. The HIV and immunocompromised conditions columns have the overlaying text “See Notes,” since such patients may have different primary series requirements and may have additional considerations for preexposure prophylaxis to complement COVID-19 vaccination. Additionally, for the HepA row, the overlaying text now states “2, 3, or 4 doses depending on vaccine” to include the 4-dose accelerated Twinrix schedule that can be used for HepA vaccination.Notes. Recommended Adult Immunization Schedule. Each recommended vaccine for adults in Tables 1 and 2 is accompanied by a note, which is designed to provide additional information on routine vaccination and recommendations in special situations. The COVID-19 note is a new addition to the 2023 adult immunization schedule. Guidance on COVID-19 primary series recommendations is provided in addition to other information that providers may find helpful regarding COVID-19 vaccination. Additionally, a new polio vaccination note was added describing vaccine recommendations for adults who are at increased risk for exposure to poliovirus. New or revised language for influenza and pneumococcal vaccines has been added to their respective notes. Changes were also made to the hepatitis B vaccine, MMR vaccine, meningococcal vaccine, Tdap vaccine, and zoster vaccine notes to improve clarity in the language. All vaccines identified in Tables 1 and 2 (except PCV20 and RZV vaccines) also appear in the Recommended Child and Adolescent Immunization Schedule for Ages 18 Years or Younger, United States, 2023 (www.cdc.gov/vaccines/schedules/hcp/imz/child-adolescent.html). The notes for vaccines that appear in both the adult immunization schedule and the child and adolescent immunization schedule have been harmonized to the greatest extent possible.Appendix. Recommended Adult Immunization Schedule. The appendix lists all of the contraindications and precautions to each of the vaccines listed in the 2023 adult immunization schedule. The information presented in this appendix is adapted from the 2022–2023 influenza vaccine recommendations (4) and from ACIP General Best Practice Guidelines for Immunization (11). The header of the “Contraindications” column was changed to “Contraindicated or not recommended.” In the influenza row, information for persons with history of egg allergy was moved from the precautions column to the influenza vaccination notes section. In the HepB row, language regarding the use of Heplisav-B and PreHevbrio among pregnant persons was modified. The language now states that “Heplisav-B and PreHevbrio are not recommended due to lack of safety data in pregnant persons. Use other hepatitis B vaccines if HepB is indicated.” A footnote providing information on the pregnancy exposure registries for persons who were inadvertently vaccinated with Heplisav-B and PreHevbrio while pregnant was added. In the HPV row, language regarding the use of HPV among pregnant persons was modified. The language now states “pregnancy: HPV vaccination not recommended.”Appendix A: Members of the ACIP and the ACIP Combined Immunization Work GroupUnless otherwise indicated, the members listed were nonauthor contributors to this article.Members of the ACIPGrace M. Lee, MD, MPH (Chair), Lucile Packard Children's Hospital, Stanford University School of Medicine, Stanford, CaliforniaMelinda Wharton, MD, MPH (Executive Secretary), National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GeorgiaLynn Bahta, RN, MPH, CPH, Infectious Disease, Epidemiology, Prevention & Control Division, Minnesota Department of Health, Saint Paul, MinnesotaBeth P. Bell, MD, MPH, Department of Global Health, School of Public Health, University of Washington, Seattle, WashingtonOliver Brooks, MD, Watts HealthCare Corporation, Los Angeles, CaliforniaWilbur H. Chen, MD, MS, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MarylandSybil Cineas, MD, The Warren Alpert Medical School of Brown University, Brown Combined Residency in Internal Medicine and Pediatrics, Providence, Rhode Island*Matthew F. Daley, MD, Institute for Health Research, Kaiser Permanente Colorado, Aurora, ColoradoCamille Nelson Kotton, MD, Infectious Diseases Division, Massachusetts General Hospital, Harvard Medical School, Boston, MassachusettsJamie Loehr, MD, Cayuga Family Medicine, Ithaca, New YorkSarah S. Long, MD, Drexel University College of Medicine, Section of Infectious Diseases, St. Christopher's Hospital for Children, Philadelphia, PennsylvaniaVeronica V. McNally, JD, Franny Strong Foundation, West Bloomfield, MichiganKatherine A. Poehling, MD, MPH, Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, North CarolinaPablo J. Sánchez, MD, The Ohio State University, Nationwide Children's Hospital, Divisions of Neonatal-Perinatal Medicine and Pediatric Infectious Diseases, Center for Perinatal Research, The Research Institute at Nationwide Children's Hospital, Columbus, OhioNirav D. Shah, MD, JD, Maine Center for Disease Control and Prevention, Augusta, MaineHelen Keipp Talbot, MD, Vanderbilt University, Nashville, TennesseeACIP Combined Immunization Work GroupACIP MembersSybil Cineas (ACIP Work Group Chair)*Kevin Ault*Veronica McNallyLiaison RepresentativesJohn EplingSarah ColesKatherine DebiecRhoda SperlingHolly FontenotAmy MiddlemanSandra FryhoferSarah McQueenMarie-Michele LegerMary-Margaret FillChad RittleWilliam SchafnerKen SchmaderPatsy StinchfieldMarci DreesPia PannarajEx Officio MembersDavid KimJane KimSusan FarrallUzo ChukwumaConsultantsHank BernsteinPaul HunterPeter SzilagyiDiane PetersonCarolyn BridgesKaren KetnerKathleen HarrimanLitjen TanRobert HopkinsSusan LettCDC Co-LeadsA. Patricia Wodi*Neil Murthy** Authored the article.

Human Papillomavirus Vaccine Administration Trends Among Commercially Insured US Adults Aged 27-45 Years Before and After Advisory Committee on Immunization Practices Recommendation Change, 2007-2020

In 2019, the Advisory Committee on Immunization Practices (ACIP) recommended patient-clinician shared decision-making for human papillomavirus (HPV) vaccination in adults aged 27 to 45 years. Less is known about the HPV vaccine administration trends in this age group before and after this recommendation update. To examine the association between the ACIP recommendation update and the HPV vaccine administration among US adults aged 27 to 45 years. This large commercial claim-based retrospective cohort study used the Optum Clinformatics database for validated claims from January 1, 2007, through December 31, 2020. A total of 22 600 520 US adults aged 27 to 45 years without previous HPV vaccination claims during the study and enrollment period were included. The first-appearing HPV vaccination claim per individual was defined as a new HPV vaccine administration. Interrupted time-series analyses were conducted to assess the association between the ACIP update and the quarterly vaccine administration rate change. The annual rate trends across race and ethnicity groups and the proportions of vaccination cases by sub-age groups and valent types were also estimated. Vaccine administration trends were assessed by race and ethnicity in this age group because HPV vaccination trends were found to differ by race and ethnicity in the initially eligible population. Among 22 600 520 final study participants, the majority were men (50.9%) and non-Hispanic White (53.4%), and the mean (SD) age when first observed was 34.6 (5.8) years. In women, the ACIP update was associated with an immediate increase in vaccine administration rate (coefficient β2, 40.18 per 100 000 persons; P = .01) and an increased slope (coefficient β3, 9.62 per 100 000 persons per quarter; P = .03) over time postupdate. The ACIP update was only associated with an immediate increase in vaccine administration in men (coefficient β2, 27.54; P < .001). The annual rate trends were similar across race and ethnicity groups. Age at vaccine administration shifted over time (eg, women aged 40-45 years comprised only 4.9% of vaccinations in 2017, then 19.0% in 2019, and 22.7% in 2020). The most administered HPV vaccines in 2020 were 9 valent (women, 97.0%; men, 97.7%). In this population-based cohort study, there were statistically significant increases in HPV vaccine administration in adults aged 27 to 45 years after the ACIP recommendation update. Patient-clinician shared decision-making may have been the main associated factor for this increase. Further research is warranted to explore the decision-making process in receiving HPV vaccination and to develop effective decision aids to maximize the cancer prevention benefit in this age group.

1370. The Impact of Increased Recombinant Zoster Vaccine Use on the Burden of Herpes Zoster Among Adults Aged 50 to 59 Years

Abstract Background Recombinant zoster vaccine (RZV) was approved by the Food and Drug Administration for prevention of herpes zoster (HZ) in adults aged ≥50 years in 2017 and recommended for this population by the Advisory Committee on Immunization Practices (ACIP) in 2018. Since the ACIP recommendation, vaccination rates have been increasing but are suboptimal for adults aged 50-59 years compared to adults aged ≥50 years overall. The objective of this study was to model the change in outcomes associated with improved vaccination rates in this population. Methods A multicohort Markov model was used to compare a scenario using the real-world vaccination rate for adults in the US aged 50-59 years in 2020 to a scenario assuming a higher vaccination rate based on that of adults aged 60-64 years in 2020. Outcomes, based on a lifetime horizon, included HZ cases and complications averted, quality-adjusted life-years (QALY), and costs. Model inputs, including age-specific HZ epidemiology, RZV efficacy, real-world RZV series completion, utilities, and costs (direct and indirect), were based on published literature and US sources. The size of the population aged 50-59 years was based on 2020 US census estimates. Schematic overview of Markov model structure HZ: herpes zoster; PHN: postherpetic neuralgia Results For the 43 million adults aged 50-59 years, increasing the percentage who received at least one dose of RZV from the current estimate of 7.3% in 2020 to 14.6%, assuming 80% series completion, could avoid an additional 504,468 HZ cases. An estimated additional 42,077 post-herpetic neuralgia cases and an additional 56,247 other complication cases of HZ could be avoided. Based on the estimated cases and complications avoided, an additional 5,230 discounted QALYs would be gained. Direct costs could be reduced by an additional $638 million (M) and indirect costs by $493M. With incremental vaccination costs of approximately $1,032M, from a societal perspective, cost savings of $99M would be realized. Conclusion Increasing RZV vaccination among adults aged 50-59 years could reduce the burden associated with HZ cases, complications, and result in fewer QALY losses. From a societal perspective, cost savings could be achieved in this population in addition to improved clinical outcomes. These findings demonstrate the potential value of increasing RZV vaccination for adults in the US aged 50-59 years. Disclosures David Singer, PharmD, MS, The GSK group of companies: Employed|The GSK group of companies: Stocks/Bonds Ahmed Salem, MSc, The GSK group of companies: Employed Nikita Stempniewicz, MSc, The GSK group of companies: Employed Siyu Ma, PhD, MBBS, The GSK group of companies: Grant/Research Support Sara Poston, PharmD, The GSK group of companies: Employed|The GSK group of companies: Stocks/Bonds Desmond Curran, PhD, The GSK group of companies: Employed|The GSK group of companies: Stocks/Bonds.

118. Rapid Uptake of 2014 ACIP Pneumococcal Vaccination Recommendations among Adults Aged 65 or Higher at the Veterans Health Administration

Abstract Background Vaccination of the 13-valent pneumococcal conjugate vaccine (PCV13) for adults 65 years and older was recommended by the Advisory Committee on Immunization Practices (ACIP) in 2014 until it was withdrawn in 2019. While estimated overall vaccination coverage rates with both vaccines at ∼30% were previously reported using data from surveys or Medicare claims, it is unclear how rapidly the uptake of this ACIP recommendation occurred. We aimed to describe the uptake of the ACIP among the Veterans Health Administration (VHA) population. Methods We conducted a retrospective cohort study of patients who were at 65 years or older in October 2014 who were registered in primary care of VHA. The study period was from October 2014 to November 2019. We obtained data on the first PCV13 and 23-valent pneumococcal polysaccharide vaccine (PPSV23) vaccination and dropout from primary care follow-up due to death and termination of primary care relationship from the VHA Corporate Data Warehouse. We calculated the monthly proportion of PCV13 and PPSV23 vaccination among primary care follow-up patients in VHA. Results We enrolled 2,166,173 patients at the beginning of the study period (median age: 73 (interquartile range: 68–81)), and at the end of the study period, 30% (645,975) were dropout due to death. The numbers of patients who had at least one PCV13 and PPSV23 vaccination at the beginning of the study period were 17,718 (0.8%) and 934,836 (43.2%), respectively. Of the PCV13 used during the study period, 78.4% were administered in the first two years (Figure 1). At the end of the study period, 50.3% of the follow-up patients had been vaccinated with PCV13 and 53.3% with PPSV23 (Figure 2). 55.3% of patients received at least one dose of any vaccine, and 48.2% received both. Figure 1.Administered dose of first PCV13 and PPSV23 among the study populationFigure 2.The proportion of vaccination coverage among the study population Conclusion At the VHA, there was a very rapid uptake of 2014 ACIP pneumococcal vaccination recommendations in the first two years, followed by a steady increase. At the end of the study period, the VHA achieved comparable or higher vaccination coverage in this population with both PCV13 and PPSV23 than the previously reported Medicare population. Further studies are needed to elucidate factors contributing to this rapid uptake and improve the implementation of future vaccine recommendations. Disclosures Michihiko Goto, MD MSCI, Merck &amp; Co.: Grant/Research Support.

Measles, Mumps, Rubella Vaccine (PRIORIX): Recommendations of the Advisory Committee on Immunization Practices - United States, 2022.

Vaccination is the main means for preventing measles, mumps, and rubella virus infections and their related complications (1,2). Achieving and maintaining high 2-dose measles, mumps, and rubella vaccination coverage in the United States has led to elimination of endemic measles in 2000, rubella and congenital rubella syndrome in 2004, and a sharp decrease in mumps cases. However, measles and rubella remain endemic in many countries, leading to importations of cases and occasional local transmission within the United States (3). Reported U.S. mumps cases declined >99% from the prevaccine period (4); however, mumps is endemic worldwide, and since 2006, the number of mumps cases and mumps outbreaks has increased in the United States, with wider geographic spread since 2016 (4). Given the risk for importation of measles and rubella and the resurgence of mumps, maintaining high measles, mumps, and rubella (MMR) vaccination coverage is important. Since 1978, only one MMR vaccine, M-M-R II (Merck and Co., Inc.), has been available in the United States. On June 6, 2022, the Food and Drug Administration approved a second MMR vaccine, PRIORIX (GlaxoSmithKline Biologicals), for the prevention of measles, mumps, and rubella in persons aged ≥12 months. The three live attenuated viruses contained in PRIORIX are genetically similar or identical to the corresponding components in M-M-R II (Table) (5-7). On June 23, 2022, the Advisory Committee on Immunization Practices (ACIP) unanimously recommended PRIORIX as an option to prevent measles, mumps, and rubella according to the existing recommended schedules and for off-label uses (i.e., indications not included in the package insert)* (1,2). ACIP considered PRIORIX to be safe, immunogenic, and noninferior to M-M-R II. Both PRIORIX and M-M-R II are fully interchangeable for all indications for which MMR vaccination is recommended. This report contains ACIP recommendations specific to PRIORIX and supplements the existing ACIP recommendations for MMR use (1,2).

Risk of Inappropriately Timed Live Vaccination After Pediatric Cardiovascular Surgery.

The American Academy of Pediatrics (AAP), Advisory Committee on Immunization Practices (ACIP), and Centers for Disease Control and Prevention (CDC) recommend delaying live vaccinations up to 11 months after transfusions of certain blood products due to the risk of immunoglobulins decreasing immunization efficacy. Because vaccination schedules recommend live immunizations at 12 months, infants aged 5 to 12 months who undergo cardiac surgery requiring blood products are potentially at risk for improper vaccination. The objective of this study was to identify the risk of inappropriately timed live vaccination in pediatric patients after cardiovascular surgery. This single-center, retrospective chart review included 345 patients 5 to 12 months of age who underwent cardiovascular surgery between January 1, 2010, and December 31, 2016. Included patients received packed red blood cells (PRBCs) and/or platelets during the surgical admission and a live vaccine within the first 18 months of life. The primary endpoint was the incidence of live vaccine administration within 7 months of receiving PRBCs and/or platelets. Of the 345 included patients, 67% (n = 230) were inappropriately vaccinated after receiving platelets and/or PRBCs during cardiac surgery. Infants who undergo cardiac surgery between the ages of 5 and 12 months are at risk for inappropriate live vaccination timing. A clinically significant percentage of pediatric patients who received blood products during a cardiac surgical admission later received live vaccines at times that were inconsistent with AAP, ACIP, and CDC recommendations. Future interventions aimed at educating providers and patients may be warranted.

Hepatitis A and B vaccination in adults at risk: A survey of US healthcare providers’ attitudes and practices

ABSTRACT This study aimed to evaluate the attitudes and practices of US healthcare professionals (HCPs) regarding the Advisory Committee on Immunization Practices (ACIP) vaccination recommendations on HepA and HepB for adult patients at risk of contracting these infections or experiencing complications of hepatitis disease. This cross-sectional, web-based survey of 400 US HCPs, which included nurse practitioners and family medicine, internal medicine, infectious disease, emergency department, and gastroenterology physicians, assessed HCPs’ attitudes and practices regarding the ACIP recommendations for adult patients at risk for hepatitis disease. HCP participants were identified via a survey research panel. A recruitment quota of 400 HCPs was set, including 50 NPs, 100 FMs, 100 IMs, 50 GIs, 50 EDs, and 50 IDs. The most frequently reported reasons for not recommending either HepA or HepB vaccines were “I think the risk of HepA infection is low in this patient population” and “I am uncertain about what the guidelines say about vaccinating this population.” The most reported factors considered when determining eligibility for either vaccine were medical history and the patient’s willingness/motivation to be vaccinated. Most reported it was extremely or moderately important to prevent hepatitis disease by vaccinating adult patients at risk, and most also reported recommending a HepA vaccine or HepB vaccine to patients at risk. Although most HCPs reported recommending HepA and HepB vaccines to patients at risk, these findings contrast with the low reported vaccination rates among these populations, and improved awareness of the ACIP recommendations among HCPs is needed.

Effectiveness of COVID-19 mRNA Vaccines Against COVID-19-Associated Hospitalizations Among Immunocompromised Adults During SARS-CoV-2 Omicron Predominance - VISION Network, 10 States, December 2021-August 2022.

Persons with moderate-to-severe immunocompromising conditions might have reduced protection after COVID-19 vaccination, compared with persons without immunocompromising conditions (1-3). On August 13, 2021, the Advisory Committee on Immunization Practices (ACIP) recommended that adults with immunocompromising conditions receive an expanded primary series of 3 doses of an mRNA COVID-19 vaccine. ACIP followed with recommendations on September 23, 2021, for a fourth (booster) dose and on September 1, 2022, for a new bivalent mRNA COVID-19 vaccine booster dose, containing components of the BA.4 and BA.5 sublineages of the Omicron (B.1.1.529) variant (4). Data on vaccine effectiveness (VE) of monovalent COVID-19 vaccines among persons with immunocompromising conditions since the emergence of the Omicron variant in December 2021 are limited. In the multistate VISION Network,§ monovalent 2-, 3-, and 4-dose mRNA VE against COVID-19-related hospitalization were estimated among adults with immunocompromising conditions¶ hospitalized with COVID-19-like illness,** using a test-negative design comparing odds of previous vaccination among persons with a positive or negative molecular test result (case-patients and control-patients) for SARS-CoV-2 (the virus that causes COVID-19). During December 16, 2021-August 20, 2022, among SARS-CoV-2 test-positive case-patients, 1,815 (36.3%), 1,387 (27.7%), 1,552 (31.0%), and 251 (5.0%) received 0, 2, 3, and 4 mRNA COVID-19 vaccine doses, respectively. Among test-negative control-patients during this period, 6,928 (23.7%), 7,411 (25.4%), 12,734 (43.6%), and 2,142 (7.3%) received these respective doses. Overall, VE against COVID-19-related hospitalization among adults with immunocompromising conditions hospitalized for COVID-like illness during Omicron predominance was 36% ≥14 days after dose 2, 69% 7-89 days after dose 3, and 44% ≥90 days after dose 3. Restricting the analysis to later periods when Omicron sublineages BA.2/BA.2.12.1 and BA.4/BA.5 were predominant and 3-dose recipients were eligible to receive a fourth dose, VE was 32% ≥90 days after dose 3 and 43% ≥7 days after dose 4. Protection offered by vaccination among persons with immunocompromising conditions during Omicron predominance was moderate even after a 3-dose monovalent primary series or booster dose. Given the incomplete protection against hospitalization afforded by monovalent COVID-19 vaccines, persons with immunocompromising conditions might benefit from updated bivalent vaccine booster doses that target recently circulating Omicron sublineages, in line with ACIP recommendations. Further, additional protective recommendations for persons with immunocompromising conditions, including the use of prophylactic antibody therapy, early access to and use of antivirals, and enhanced nonpharmaceutical interventions such as well-fitting masks or respirators, should also be considered.

Cholera Vaccine: Recommendations of the Advisory Committee on Immunization Practices, 2022.

SummaryThis report summarizes all recommendations from CDC’s Advisory Committee on Immunization Practices (ACIP) for the use of lyophilized CVD 103-HgR vaccine (CVD 103-HgR) (Vaxchora, Emergent BioSolutions, Gaithersburg, MD) in the United States. The live attenuated oral cholera vaccine is derived fromVibrio cholerae O1 and is administered in a single dose. Cholera is a toxin-mediated bacterial gastrointestinal illness caused by toxigenic V. cholerae serogroup O1 or, uncommonly, O139. Up to 10% of infections manifest as severe cholera (i.e., cholera gravis), profuse watery diarrhea that can cause severe dehydration and death within hours. Fluid replacement therapy can reduce the fatality rate to <1%. Risk factors for cholera gravis include high dose exposure, blood group O, increased gastric pH (e.g., from antacid therapy), and partial gastrectomy. Cholera is rare in the United States, but cases occur among travelers to countries where cholera is endemic or epidemic and associated with unsafe water and inadequate sanitation. Travelers might be at increased risk for poor outcomes from cholera if they cannot readily access medical services or if they have a medical condition that would be worsened by dehydration, such as cardiovascular or kidney disease. This report describes previously published ACIP recommendations about use of CVD 103-HgR for adults aged 18–64 years and introduces a new recommendation for use in children and adolescents aged 2–17 years. ACIP recommends CVD 103-HgR, the only cholera vaccine licensed for use in the United States, for prevention of cholera among travelers aged 2–64 years to an area with active cholera transmission. Health care providers can use these guidelines to develop the pretravel consultation for persons traveling to areas with active cholera transmission.

Interim Recommendation of the Advisory Committee on Immunization Practices for Use of the Novavax COVID-19 Vaccine in Persons Aged ≥18 years - United States, July 2022.

The NVX-CoV2373 (Novavax) COVID-19 vaccine is a recombinant spike (rS) protein nanoparticle vaccine with Matrix-M adjuvant to protect against infection with SARS-CoV-2, the virus that causes COVID-19. On July 13, 2022, the Food and Drug Administration (FDA) issued Emergency Use Authorization (EUA) for the Novavax vaccine for primary COVID-19 immunization of unvaccinated adults aged ≥18 years, administered as 2 doses (5 μg rS and 50 μg Matrix-M adjuvant in each dose) 3 weeks apart (1). On July 19, 2022, the Advisory Committee on Immunization Practices (ACIP) issued an interim recommendation for use of the Novavax vaccine in persons aged ≥18 years for the prevention of COVID-19.* In the per-protocol† efficacy analysis, vaccine efficacy (VE) against reverse transcription-polymerase chain reaction (RT-PCR)-confirmed symptomatic COVID-19 was 89.6% (95% CI=82.4%-93.8%). The Alpha variant (B.1.1.7) of SARS-CoV-2 was the predominant circulating variant during the period of case accrual for VE assessments. Cases of myocarditis or pericarditis were reported in temporal association with vaccination, suggesting a possible causal relationship. The ACIP recommendation for the use of the Novavax COVID-19 vaccine is interim and will be updated as additional information becomes available. The adjuvanted, protein subunit-based Novavax COVID-19 vaccine provides an additional option for unvaccinated adults, increasing flexibility for the public and for vaccine providers. Vaccination is important for protection against COVID-19.

Interim Recommendations of the Advisory Committee on Immunization Practices for Use of Moderna and Pfizer-BioNTech COVID-19 Vaccines in Children Aged 6 Months-5 Years - United States, June 2022.

On June 17, 2022, the Food and Drug Administration (FDA) issued Emergency Use Authorization (EUA) amendments for the mRNA-1273 (Moderna) COVID-19 vaccine for use in children aged 6 months-5 years, administered as 2 doses (25 µg [0.25 mL] each), 4 weeks apart, and BNT162b2 (Pfizer-BioNTech) COVID-19 vaccine for use in children aged 6 months-4 years, administered as 3 doses (3 µg [0.2 mL] each), at intervals of 3 weeks between doses 1 and 2 and ≥8 weeks between doses 2 and 3. On June 18, 2022, the Advisory Committee on Immunization Practices (ACIP) issued separate interim recommendations for use of the Moderna COVID-19 vaccine in children aged 6 months-5 years and the Pfizer-BioNTech COVID-19 vaccine in children aged 6 months-4 years for the prevention of COVID-19.* Both the Moderna and Pfizer-BioNTech COVID-19 vaccines met the criteria for immunobridging, which is the comparison of neutralizing antibody levels postvaccination in young children with those in young adults in whom efficacy had been demonstrated. Descriptive efficacy analyses were also conducted for both Moderna and Pfizer-BioNTech COVID-19 vaccines during the period when the Omicron variant of SARS-CoV-2 (the virus that causes COVID-19) predominated. No specific safety concerns were identified among recipients of either vaccine. ACIP recommendations for the use of the Moderna COVID-19 vaccine and the Pfizer-BioNTech COVID-19 vaccine in children aged 6 months-5 years and 6 months-4 years, respectively, are interim and will be updated as additional information becomes available. Vaccination is important for protecting children aged 6 months-5 years against COVID-19.

Universal hepatitis B vaccination in adults aged 19–59 years: Updated recommendations of the advisory committee on immunization practices—United States, 2022

This article describes updates to the recommendations for hepatitis B vaccination in the US. Most notably, the Advisory Committee on Immunization Practices (ACIP) now recommends universal hepatitis B vaccination for all adults (without a history of hepatitis B infection) aged 19-59 years, as well as those 60 and older with known risk factors for hepatitis B such as liver disease. Thus, all transplant candidates and recipients aged 19-59 years, and all adult liver transplant candidates regardless of age, should be vaccinated for hepatitis B. Universal hepatitis B vaccination is already recommended for children. This article describes updates to the recommendations for hepatitis B vaccination in the US. Most notably, the Advisory Committee on Immunization Practices (ACIP) now recommends universal hepatitis B vaccination for all adults (without a history of hepatitis B infection) aged 19-59 years, as well as those 60 and older with known risk factors for hepatitis B such as liver disease. Thus, all transplant candidates and recipients aged 19-59 years, and all adult liver transplant candidates regardless of age, should be vaccinated for hepatitis B. Universal hepatitis B vaccination is already recommended for children. Hepatitis B (HepB) vaccines have demonstrated safety, immunogenicity, and efficacy during the past 4 decades.1Bruce MG, Bruden D, Hurlburt D, et al. Protection and antibody levels 35 years after primary series with hepatitis B vaccine and response to a booster dose. Hepatol. 2022;hep.32474. doi:10.1002/hep.32474Google Scholar,2Schillie S Vellozzi C Reingold A et al.Prevention of hepatitis B virus infection in the United States: recommendations of the Advisory Committee on Immunization Practices.MMWR Recomm Rep. 2018; 67 (doi:10.15585/mmwr.rr6701a1): 1-31Crossref PubMed Scopus (362) Google Scholar However, vaccination coverage among adults has been suboptimal, limiting further reduction in hepatitis B virus (HBV) infections in the United States. This Advisory Committee on Immunization Practices (ACIP) recommendation expands the indicated age range for universal HepB vaccination to now include adults aged 19–59 years. Removing the risk factor assessment previously recommended to determine vaccine eligibility in this adult age group2Schillie S Vellozzi C Reingold A et al.Prevention of hepatitis B virus infection in the United States: recommendations of the Advisory Committee on Immunization Practices.MMWR Recomm Rep. 2018; 67 (doi:10.15585/mmwr.rr6701a1): 1-31Crossref PubMed Scopus (362) Google Scholar could increase vaccination coverage and decrease hepatitis B cases. Hepatitis B is a vaccine-preventable, communicable disease of the liver caused by HBV. HBV is transmitted through percutaneous (i.e., puncture through the skin) or mucosal (i.e., direct contact with mucous membranes) exposure to infectious blood or body fluids. Since HepB vaccine was introduced in 1982, the number of reported hepatitis B cases has declined substantially. However, despite reductions in hepatitis B incidence during the past 4 decades, which were achieved through incremental expansion of groups for whom HepB vaccination is recommended, progress in recent years on further reducing acute hepatitis B cases has stalled.3CDC. Viral hepatitis. 2019 viral hepatitis surveillance report. US Department of Health and Human Services, CDC; 2021. https://www.cdc.gov/hepatitis/statistics/SurveillanceRpts.htmGoogle Scholar Incident hepatitis B declined from 26 654 reported cases (172 700 estimated actual cases) in 1985 to a low of 2791 reported cases (18 100 estimated actual cases) in 2014.3CDC. Viral hepatitis. 2019 viral hepatitis surveillance report. US Department of Health and Human Services, CDC; 2021. https://www.cdc.gov/hepatitis/statistics/SurveillanceRpts.htmGoogle Scholar,4Klevens RM Liu S Roberts H Jiles RB Holmberg SD. Estimating acute viral hepatitis infections from nationally reported cases.Am J Public Health. 2014; 104 (doi:10.2105/AJPH.2013.301601): 482-487Crossref PubMed Scopus (51) Google Scholar In 2019, a total of 3192 cases of acute hepatitis B were reported to CDC, corresponding to 20 700 estimated acute infections (95% CI = 11 800–50 800). The most commonly reported risk behaviors and exposures were injection drug use (35%), multiple sex partners (23%), and surgery (10%), followed by other sexual and bloodborne risk behaviors; risk behavior and exposure information were missing for 37.1% of cases. There are an estimated 880 000 (95% CI = 580 000–1 170 000) prevalent chronic HBV infections in the United States based on 2013–2018 National Health and Nutrition Examination Survey data, with a modeled estimate of 1.89 million (range = 1.49–2.40 million) that accounts for potential underrepresentation of the non-U.S.–born population.5Roberts H Ly KN Yin S Hughes E Teshale E Jiles R. Prevalence of HBV infection, vaccine-induced immunity, and susceptibility among at-risk populations: US households, 2013–2018.Hepatol. 2021; 74 (doi:10.1002/hep.31991): 2353-2365Crossref PubMed Scopus (6) Google Scholar,6Wong RJ Brosgart CL Welch S et al.An updated assessment of chronic hepatitis B prevalence among foreign-born persons living in the United States.Hepatol. 2021; 74 (doi:10.1002/hep.31782): 607-626Crossref PubMed Scopus (31) Google Scholar In 2018, the reported HepB vaccination coverage (≥3 doses) was 30.0% among adults aged ≥19 years, only a small increase over the past 4 decades.7Lu PJ Hung MC Srivastav A et al.Surveillance of vaccination coverage among adult populations—United States, 2018.MMWR Surveill Summ. 2021; 70 (doi:10.15585/mmwr.ss7003a1): 1-26Crossref PubMed Scopus (72) Google Scholar During September 2019–October 2021, the ACIP* Hepatitis Work Group† (Work Group) held monthly conference calls to review and discuss scientific evidence relevant to the use of HepB vaccines in a universal adult vaccination recommendation. The Work Group identified the following outcomes of interest for evaluation: incidence of hepatitis B, morbidity related to hepatitis B, mortality related to hepatitis B, and vaccine-related serious adverse events. Data on universal HepB vaccination outcomes and safety were summarized based on findings from a systematic review of the literature completed on September 10, 2020, and updated September 20, 2021. The Work Group assessed the certainty of evidence at the outcome level related to the U.S.-licensed HepB vaccines for all adults previously unvaccinated against HBV infection, using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. Detailed descriptions of methods and results are available in the GRADE evidence profile (https://www.cdc.gov/vaccines/acip/recs/grade/hepb-adults.html).Afterthe GRADE assessment, decisions were made using the Evidence to Recommendation (EtR) Framework (https://www.cdc.gov/vaccines/acip/recs/grade/hepb-adults-etr.html). During July 2021–February 2022, the Work Group participated in three conference calls to review the evidence for the seroprotection and safety of PreHevbrio, a three-antigen 3-dose HepB vaccine newly approved by the Food and Drug Administration (FDA) in 2021. Description of the methods and results are available for the GRADE evidence (https://www.cdc.gov/vaccines/acip/recs/grade/prehevbrio-hepb.html) and EtR Framework (https://www.cdc.gov/vaccines/acip/recs/grade/prehevbrio-hepb-etr.html). The scientific literature was searched through a systematic review using PubMed, Medline, Embase, CINAHL, and Cochrane Library databases from January 1, 2006, through September 10, 2020. Search terms included “hepatitis b vaccines,” “adult,” “routine,” and “universal.” To qualify as a candidate for inclusion in the review, a study had to discuss adult HepB vaccination. Studies were excluded if they did not address the adult population, were non-English language, discussed HepB vaccines not licensed in the United States, or if data could not be abstracted. The search identified 3226 studies, 263 of which were deemed eligible and informed this review. Rates of reported acute hepatitis B have not notably decreased for over 1 decade, with 20 700 estimated infections in 2019.3CDC. Viral hepatitis. 2019 viral hepatitis surveillance report. US Department of Health and Human Services, CDC; 2021. https://www.cdc.gov/hepatitis/statistics/SurveillanceRpts.htmGoogle Scholar,4Klevens RM Liu S Roberts H Jiles RB Holmberg SD. Estimating acute viral hepatitis infections from nationally reported cases.Am J Public Health. 2014; 104 (doi:10.2105/AJPH.2013.301601): 482-487Crossref PubMed Scopus (51) Google Scholar None of the identified studies reported hepatitis B incidence, morbidity, and mortality when comparing universal and risk-based adult HepB vaccination. The safety of single-antigen 3-dose HepB vaccines has been established.1Bruce MG, Bruden D, Hurlburt D, et al. Protection and antibody levels 35 years after primary series with hepatitis B vaccine and response to a booster dose. Hepatol. 2022;hep.32474. doi:10.1002/hep.32474Google Scholar,2Schillie S Vellozzi C Reingold A et al.Prevention of hepatitis B virus infection in the United States: recommendations of the Advisory Committee on Immunization Practices.MMWR Recomm Rep. 2018; 67 (doi:10.15585/mmwr.rr6701a1): 1-31Crossref PubMed Scopus (362) Google Scholar PreHevbrio was approved by FDA in 2021 and recommended by ACIP in 2022. Little or no difference in seroprotection or occurrence of serious adverse events or mild adverse events (GRADE evidence type 3; low certainty evidence) was found for PreHevbrio in comparison with a 3-dose, single-antigen vaccine (Engerix-B), and serious adverse events were rare for both vaccines. The 2-dose HepB vaccine (Heplisav-B) was approved by FDA in 2017 and recommended by ACIP in 2018. No difference in occurrence of serious adverse events (GRADE evidence type 1; high certainty evidence) was found for Heplisav-B compared with a 3-dose vaccine (Engerix-B), and serious adverse events were rare for both vaccines.8Schillie S Harris A Link-Gelles R Romero J Ward J Nelson N. Recommendations of the Advisory Committee on Immunization Practices for use of a hepatitis B vaccine with a novel adjuvant.MMWR Morb Mortal Wkly Rep. 2018; 67 (doi:10.15585/mmwr.mm6715a5): 455-458Crossref PubMed Scopus (106) Google Scholar,9Bruxvoort K Slezak J Qian L et al.Association between 2-dose vs 3-dose hepatitis B vaccine and acute myocardial infarction.JAMA. 2022; 327 (doi:10.1001/jama.2022.2540): 1260-1268Crossref PubMed Scopus (3) Google Scholar SummaryWhat is already known about this topic?Vaccination with hepatitis B (HepB) vaccines shows well-established safety and efficacy. However, because of risk factor−based approaches of previous vaccination recommendations, coverage among adults has been suboptimal.What is added by this report?In addition to groups for whom HepB vaccination is already recommended, the Advisory Committee on Immunization Practices recommends that all adults aged 19–59 years should receive HepB vaccines.What are the implications for public health practice?Universal adult HepB vaccination through age 59 years removes the need for risk factor screening and disclosure and could increase vaccination coverage and decrease hepatitis B cases. Vaccination with hepatitis B (HepB) vaccines shows well-established safety and efficacy. However, because of risk factor−based approaches of previous vaccination recommendations, coverage among adults has been suboptimal. In addition to groups for whom HepB vaccination is already recommended, the Advisory Committee on Immunization Practices recommends that all adults aged 19–59 years should receive HepB vaccines. Universal adult HepB vaccination through age 59 years removes the need for risk factor screening and disclosure and could increase vaccination coverage and decrease hepatitis B cases. Approximately one half of acute hepatitis B cases reported in 2019 occurred among persons aged 30–49 years (Figure 1). The number of cases of acute hepatitis B has increased among adults aged ≥40 years, particularly among those aged 40–49 years, for whom the rate of reported cases increased from 1.9 per 100 000 population in 2011 to 2.7 per 100 000 population in 2019 (Figure 1). The rate among adults aged 50–59 years increased 45.5% during the same period (from 1.1 to 1.6 per 100 000 population) and accounted for 22.2% of reported cases in 2019. Acute HBV infections among adults leads to chronic hepatitis B disease in an estimated 2%–6% of cases. HepB vaccination coverage among adults aged ≥19 years is low. In 2018, self-reported HepB vaccination coverage (≥3 doses) among adults aged ≥19 years was 30.0%.7Lu PJ Hung MC Srivastav A et al.Surveillance of vaccination coverage among adult populations—United States, 2018.MMWR Surveill Summ. 2021; 70 (doi:10.15585/mmwr.ss7003a1): 1-26Crossref PubMed Scopus (72) Google Scholar HepB vaccination coverage (≥3 doses) was 40.3% for adults aged 19–49 years and 19.1% for adults aged ≥50 years. During 2013–2018, 21.4% (95% CI = 20.2%–22.6%) of adults aged ≥25 years had vaccine-induced immunity to hepatitis B.5Roberts H Ly KN Yin S Hughes E Teshale E Jiles R. Prevalence of HBV infection, vaccine-induced immunity, and susceptibility among at-risk populations: US households, 2013–2018.Hepatol. 2021; 74 (doi:10.1002/hep.31991): 2353-2365Crossref PubMed Scopus (6) Google Scholar HepB vaccination coverage among adults with risk factors has been suboptimal. In 2018, self-reported coverage (≥3 doses) was 33.0% among adults with chronic liver disease, 38.9% among travelers to countries where HBV infections have been endemic since 1995, 33.0% among adults with diabetes aged 19–59 years, and 67.2% among health care personnel.7Lu PJ Hung MC Srivastav A et al.Surveillance of vaccination coverage among adult populations—United States, 2018.MMWR Surveill Summ. 2021; 70 (doi:10.15585/mmwr.ss7003a1): 1-26Crossref PubMed Scopus (72) Google Scholar In a national survey of 433 family medicine physicians and 420 internal medicine physicians to assess their barriers to adult HepB vaccination, 68% of physicians cited patients’ nondisclosure of risk factors as a barrier, and 44% felt there was inadequate time to routinely assess patients for risk factors.10Daley MF Hennessey KA Weinbaum CM et al.Physician practices regarding adult hepatitis B vaccination: a national survey.Am J Prev Med. 2009; 36 (doi:10.1016/j.amepre.2009.01.037): 491-496Abstract Full Text Full Text PDF PubMed Scopus (23) Google Scholar A universal recommendation for HepB vaccination could increase the number of persons who receive vaccination before the onset of chronic liver disease and other comorbidities (e.g., obesity or diabetes) that might make vaccination less effective. For example, patients with chronic liver disease are known to have decreased immune response to HepB vaccination.11Roni DA Pathapati RM Kumar AS Nihal L Sridhar K Tumkur RS. Safety and efficacy of hepatitis B vaccination in cirrhosis of liver.Adv Virol. 2013; 2013 (doi:10.1155/2013/196704): 196704Crossref PubMed Scopus (25) Google Scholar Among the 3192 case reports of acute hepatitis B received by CDC for 2019, risk behavior and exposure data were missing for 1183 (37.1%). Risk factors assessed under prior recommendations for HepB vaccination include potential criminal or stigmatizing behavior (e.g., injection-drug use, incarceration, or multiple sex partners), limiting the effectiveness of provider risk assessment.3CDC. Viral hepatitis. 2019 viral hepatitis surveillance report. US Department of Health and Human Services, CDC; 2021. https://www.cdc.gov/hepatitis/statistics/SurveillanceRpts.htmGoogle Scholar,12Taylor JEB Surey J MacLellan J Francis M Abubakar I Stagg HR. Hepatitis B vaccination uptake in hard-to-reach populations in London: a cross-sectional study.BMC Infect Dis. 2019; 19 (doi:10.1186/s12879-019-3926-2): 372Crossref PubMed Scopus (10) Google Scholar,13Mokaya J McNaughton AL Burbridge L et al.A blind spot? Confronting the stigma of hepatitis B virus (HBV) infection – A systematic review.Wellcome Open Res. 2018; 3 (doi:10.12688/wellcomeopenres.14273.1): 29Crossref PubMed Google Scholar A universal vaccination recommendation eliminates the need for risk assessment before vaccination. Racial and ethnic disparities exist among those who become infected with HBV. In 2005, acute hepatitis B incidence among non-Hispanic Black Americans was approximately twice that among several other racial and ethnic populations.3CDC. Viral hepatitis. 2019 viral hepatitis surveillance report. US Department of Health and Human Services, CDC; 2021. https://www.cdc.gov/hepatitis/statistics/SurveillanceRpts.htmGoogle Scholar In 2019, the rate of HBV infection among non-Hispanic Black adults was triple that of Asian or Pacific Islander adults and approximately twice that of Hispanic adults.3CDC. Viral hepatitis. 2019 viral hepatitis surveillance report. US Department of Health and Human Services, CDC; 2021. https://www.cdc.gov/hepatitis/statistics/SurveillanceRpts.htmGoogle Scholar Rates of hepatitis B among children and adolescents of all races and ethnicities converged to a lower rate after a universal vaccination strategy was implemented for this age group.3CDC. Viral hepatitis. 2019 viral hepatitis surveillance report. US Department of Health and Human Services, CDC; 2021. https://www.cdc.gov/hepatitis/statistics/SurveillanceRpts.htmGoogle Scholar An economic model was used to estimate the health improvements that are expected to result from universal adult HepB vaccination.14Hall EW Weng MK Harris AM et al.Assessing the cost-utility of universal hepatitis B vaccination among adults.J Infect Dis. 2022; (doi:10.1093/infdis/jiac088): jiac088Google Scholar One measure of cost-effectiveness, the incremental cost-effectiveness ratio (ICER), was calculated at $153 000 per quality-adjusted life-year (QALY) gained for all adults aged ≥19 years. A sub-analysis performed for adults aged 19–59 years yielded an ICER of $117 000 per QALY gained.§ Increased vaccination coverage resulting from the modeled vaccination intervention strategies resulted in better health outcomes; the average QALYs gained, life-years gained, number of acute HBV infections averted, and number of hepatitis B-related deaths averted all increased as vaccination coverage in the intervention strategy increased.14Hall EW Weng MK Harris AM et al.Assessing the cost-utility of universal hepatitis B vaccination among adults.J Infect Dis. 2022; (doi:10.1093/infdis/jiac088): jiac088Google Scholar Among the cohort aged ≥60 years, hepatitis B incidence is markedly lower (0.6 cases per 100 000 population in 2019); thus, the number of preventable HBV infections in that age group is lower than for those aged 19–59 years. HepB vaccination is recommended for adults aged 19–59 years and adults aged ≥60 years with risk factors for hepatitis B. Adults aged ≥60 years without known risk factors for hepatitis B may also receive HepB vaccines (Box 1). Infants and all other persons aged <19 years are already recommended to receive HepB vaccines.2Schillie S Vellozzi C Reingold A et al.Prevention of hepatitis B virus infection in the United States: recommendations of the Advisory Committee on Immunization Practices.MMWR Recomm Rep. 2018; 67 (doi:10.15585/mmwr.rr6701a1): 1-31Crossref PubMed Scopus (362) Google ScholarBOX 1Persons recommended to receive hepatitis B vaccinationAll infantsPersons aged <19 yearsAdults aged 19–59 yearsAdults aged ≥60 years with risk factors for hepatitis B:•Persons at risk for infection by sexual exposure.○Sex partners of persons testing positive for HBsAg.○Sexually active persons who are not in a long-term, mutually monogamous relationship (e.g., persons with more than one sex partner during the previous 6 months).○Persons seeking evaluation or treatment for a sexually transmitted infection.○Men who have sex with men.•Persons at risk for infection by percutaneous or mucosal exposure to blood.○Persons with current or recent injection drug use.○Household contacts of persons testing positive for HBsAg.○Residents and staff members of facilities for persons with developmental disabilities.○Health care and public safety personnel with reasonably anticipated risk for exposure to blood or blood-contaminated body fluids.○Persons on maintenance dialysis, including in-center or home hemodialysis and peritoneal dialysis, and persons who are predialysis.○Persons with diabetes at the discretion of the treating clinician.•Others○International travelers to countries with high or intermediate levels of endemic hepatitis B virus infection (HBsAg prevalence of ≥2%).○Persons with hepatitis C virus infection.○Persons with chronic liver disease (including, but not limited to, persons with cirrhosis, fatty liver disease, alcoholic liver disease, autoimmune hepatitis, and an alanine aminotransferase or aspartate aminotransferase level greater than twice the upper limit of normal).○Persons with HIV infection.○Persons who are incarcerated.Adults aged ≥60 years without known risk factors for hepatitis B may receive hepatitis B vaccines.Abbreviation: HBsAg, hepatitis B surface antigen All infants Persons aged <19 years Adults aged 19–59 years Adults aged ≥60 years with risk factors for hepatitis B: •Persons at risk for infection by sexual exposure.○Sex partners of persons testing positive for HBsAg.○Sexually active persons who are not in a long-term, mutually monogamous relationship (e.g., persons with more than one sex partner during the previous 6 months).○Persons seeking evaluation or treatment for a sexually transmitted infection.○Men who have sex with men.•Persons at risk for infection by percutaneous or mucosal exposure to blood.○Persons with current or recent injection drug use.○Household contacts of persons testing positive for HBsAg.○Residents and staff members of facilities for persons with developmental disabilities.○Health care and public safety personnel with reasonably anticipated risk for exposure to blood or blood-contaminated body fluids.○Persons on maintenance dialysis, including in-center or home hemodialysis and peritoneal dialysis, and persons who are predialysis.○Persons with diabetes at the discretion of the treating clinician.•Others○International travelers to countries with high or intermediate levels of endemic hepatitis B virus infection (HBsAg prevalence of ≥2%).○Persons with hepatitis C virus infection.○Persons with chronic liver disease (including, but not limited to, persons with cirrhosis, fatty liver disease, alcoholic liver disease, autoimmune hepatitis, and an alanine aminotransferase or aspartate aminotransferase level greater than twice the upper limit of normal).○Persons with HIV infection.○Persons who are incarcerated. Adults aged ≥60 years without known risk factors for hepatitis B may receive hepatitis B vaccines. Abbreviation: HBsAg, hepatitis B surface antigen ACIP recommends that adults aged 19–59 years and adults aged ≥60 years with risk factors for hepatitis B should receive HepB vaccines, and that adults aged ≥60 years without known risk factors for hepatitis B may receive HepB vaccines. In previous HepB vaccine recommendations, providers were advised to administer HepB vaccine to all patients who requested it. The new language for adults aged ≥60 years without known risk factors is intended to prompt all providers to offer HepB vaccination to patients in that cohort, rather than wait for a patient to request vaccination, thus shifting the responsibility of initiating the consideration of HepB vaccination from the patient to the provider. Persons who have completed a HepB vaccination series at any point or who have a history of HBV infection should not receive additional HepB vaccination, although there is no evidence that receiving additional vaccine doses is harmful.¶ However, there are cases where revaccination might be indicated as specified in the 2018 ACIP recommendation (e.g., nonresponder infants born to persons testing positive for hepatitis B surface antigen [HBsAg], health care providers, and persons on hemodialysis).2Schillie S Vellozzi C Reingold A et al.Prevention of hepatitis B virus infection in the United States: recommendations of the Advisory Committee on Immunization Practices.MMWR Recomm Rep. 2018; 67 (doi:10.15585/mmwr.rr6701a1): 1-31Crossref PubMed Scopus (362) Google Scholar Providers should only accept dated records as evidence of HepB vaccination. Vaccination of persons immune to HBV infection because of current or previous infection or HepB vaccination does not increase the risk for adverse events. However, in settings in which the patient population has a high rate of previous HBV infection,**** prevaccination testing, which may be performed concomitantly with administration of the first dose of vaccine, might reduce costs by avoiding complete vaccination of persons who are already immune. Prevaccination testing consists of testing for HBsAg, antibody to HBsAg (anti-HBs), and antibody to hepatitis B core antigen (anti-HBc). The presence of HBsAg indicates current HBV infection. The presence of anti-HBs is generally interpreted as indicating immunity, either from HepB vaccination after a complete series or after recovery from HBV infection. The presence of total anti-HBc indicates previous or ongoing infection with HBV. Detailed interpretations of serologic markers for HBV infection are available.2Schillie S Vellozzi C Reingold A et al.Prevention of hepatitis B virus infection in the United States: recommendations of the Advisory Committee on Immunization Practices.MMWR Recomm Rep. 2018; 67 (doi:10.15585/mmwr.rr6701a1): 1-31Crossref PubMed Scopus (362) Google Scholar Lack of access to serologic testing should not be a barrier to vaccination of susceptible persons, especially in populations that are difficult to reach. Testing is not a requirement for vaccination, and in settings where testing is not feasible, vaccination of persons recommended to receive the vaccine should continue.2Schillie S Vellozzi C Reingold A et al.Prevention of hepatitis B virus infection in the United States: recommendations of the Advisory Committee on Immunization Practices.MMWR Recomm Rep. 2018; 67 (doi:10.15585/mmwr.rr6701a1): 1-31Crossref PubMed Scopus (362) Google Scholar The safety and effectiveness of Heplisav-B and PreHevbrio have not been established in adults on hemodialysis (Table 1). Data are not available to assess the effects of Heplisav-B and PreHevbrio on the breastfed infant or on milk production and excretion. Data on Heplisav-B and PreHevbrio are currently insufficient to inform vaccine-associated risks in pregnancy.8Schillie S Harris A Link-Gelles R Romero J Ward J Nelson N. Recommendations of the Advisory Committee on Immunization Practices for use of a hepatitis B vaccine with a novel adjuvant.MMWR Morb Mortal Wkly Rep. 2018; 67 (doi:10.15585/mmwr.mm6715a5): 455-458Crossref PubMed Scopus (106) Google Scholar,15Food and Drug Administration. PREHEVBRIO [package insert]. US Department of Health and Human Services, Food and Drug Administration, 2021. https://www.fda.gov/media/154561/downloadexternaliconGoogle Scholar Thus, providers should vaccinate pregnant women needing HepB vaccination with Engerix-B, Recombivax HB, or Twinrix.TABLE 1Recommended doses and schedules of hepatitis B vaccine for adults aged ≥18 years and persons aged 11–19 years, by vaccine type and age groupaIf the HepB vaccination schedule is interrupted, the series does not need to be restarted. If a 3-dose series is interrupted after the first dose, the second dose should be administered as soon as possible; the second and third doses should be separated by an interval of ≥8 weeks. If only the third dose has been delayed, it should be administered as soon as possible. The final dose of a 3-dose series must be administered ≥8 weeks after the second dose and ≥ 16 weeks after the first dose; the minimum interval between the first and second doses is 4 weeks. Inadequate doses of hepatitis B vaccine or doses received after a shorter-than-recommended dosing interval should be readministered, using the correct dosage or schedule. Vaccine doses administered ≤4 days before the minimum interval or age are considered valid. Because of the unique accelerated schedule for Twinrix (https://www.fda.gov/media/119351/downloadexternalicon), the 4-day guideline does not apply to the first 3 doses of this vaccine when administered on a 0-day, 7-day, 21–30-day, and 12-month schedule. PreHevbrio (https://www.fda.gov/media/154561/downloadexternalicon) is a three-antigen HepB vaccine approved by the Food and Drug Administration in 2021 and recommended by ACIP in 2022.HepB vaccineaIf the HepB vaccination schedule is interrupted, the series does not need to be restarted. If a 3-dose series is interrupted after the first dose, the second dose should be administered as soon as possible; the second and third doses should be separated by an interval of ≥8 weeks. If only the third dose has been delayed, it should be administered as soon as possible. The final dose of a 3-dose series must be administered ≥8 weeks after the second dose and ≥ 16 weeks after the first dose; the minimum interval between the first and second doses is 4 weeks. Inadequate doses of hepatitis B vaccine or doses received after a shorter-than-recommended dosing interval should be readministered, using the correct dosage or schedule. Vaccine doses administered ≤4 days before the minimum interval or age are considered valid. Because of the unique accelerated schedule for Twinrix (https://www.fda.gov/media/119351/downloadexternalicon), the 4-day guideline does not apply to the first 3 doses of this vaccine when administered on a 0-day, 7-day, 21–30-day, and 12-month schedule. PreHevbrio (https://www.fda.gov/media/154561/downloadexternalicon) is a three-antigen HepB vaccine approved by the Food and Drug Administration in 2021 and recommended by ACIP in 2022./Age group, yearsDose (μg)Volume (ml)ScheduleRecombivax HB11–151012 doses at 0 and 4–6 mosbA 2-dose schedule of Recombivax HB adult formulation (10 μg) (https://www.fda.gov/media/74274/downloadexternalicon) is licensed for children and adolescents aged 11–15 years. When scheduled to receive the second dose, persons aged ≥16 years should be switched to a 3-dose series, with doses 2 and 3 consisting of the pediatric formulation administered on an appropriate schedule.11–1950.53 doses at 0, 1, and 6 mosbA 2-dose schedule of Recombivax HB adult formulation (10 μg) (https://www.fda.gov/media/74274/downloadexternalicon) is licensed for children and adolescents aged 11–15 years. When scheduled to receive the second dose, persons aged ≥16 years should be switched to a 3-dose series, with doses 2 and 3 consisting of the pediatric formulation administered on an appropriate schedule.≥20101Adults on hemodialysis and other immunocompromised adults aged ≥20401Engerix-B11–19100.53 doses at 0, 1, and 6 mos≥20201Adults on hemodialysis and other immunocompromised adults aged ≥204024 doses at 0, 1, 2, and 6 moscEngerix-B (https://www.fda.gov/media/119403/downloadexternalicon) for adults on hemodialysis and is administered as a series of 4 doses (2 ml each) as a single 2-mL dose or as two 1-mL doses on a 0-, 1-, 2-, and 6-month schedule. Recombivax HB for adults on dialysis is a 3-dose series.Heplisav-B≥18dThe safety and effectiveness of Heplisav-B and PreHevbrio have not been established in adults on hemodialysis. Data are not available to assess the effects of Heplisav-B and PreHevbrio on breastfed infants or on maternal milk production and excretion. Data on Heplisav-B (https://www.fda.gov/media/108745/downloadexternalicon) and PreHevbrio are currently insufficient to inform vaccine-associated risks in pregnancy. Thus, providers should vaccinate pregnant persons needing HepB vaccination with Engerix-B, Recombivax HB, or Twinrix.200.52 doses at 0 and 1 mosTwinrix (HepA-HepB combination vaccine)≥182013 doses at 0, 1, and 6 mos (standard) or 4 doses at 0 d, 7 d, 21–30 d, and 12 mos (accelerated)PreHevbrio (ACIP-recommended in 2022)≥18dThe safety and effectiveness of Heplisav-B and PreHevbrio have not been established in adults on hemodialysis. Data are not available to assess the effects of Heplisav-B and PreHevbrio on breastfed infants or on maternal milk production and excretion. Data on Heplisav-B (https://www.fda.gov/media/108745/downloadexternalicon) and PreHevbrio are currently insufficient to inform vaccine-associated risks in pregnancy. Thus, providers should vaccinate pregnant persons needing HepB vaccination with Engerix-B, Recombivax HB, or Twinrix.1013 doses at 0, 1, and 6 mosAbbreviations: ACIP, Advisory Committee on Immunization Practices; HepA, hepatitis A; HepB, hepatitis B.a If the HepB vaccination schedule is interrupted, the series does not need to be restarted. If a 3-dose series is interrupted after the first dose, the second dose should be administered as soon as possible; the second and third doses should be separated by an interval of ≥8 weeks. If only the third dose has been delayed, it should be administered as soon as possible. The final dose of a 3-dose series must be administered ≥8 weeks after the second dose and ≥ 16 weeks after the first dose; the minimum interval between the first and second doses is 4 weeks. Inadequate doses of hepatitis B vaccine or doses received after a shorter-than-recommended dosing interval should be readministered, using the correct dosage or schedule. Vaccine doses administered ≤4 days before the minimum interval or age are considered valid. Because of the unique accelerated schedule for Twinrix (https://www.fda.gov/media/119351/downloadexternalicon), the 4-day guideline does not apply to the first 3 doses of this vaccine when administered on a 0-day, 7-day, 21–30-day, and 12-month schedule. PreHevbrio (https://www.fda.gov/media/154561/downloadexternalicon) is a three-antigen HepB vaccine approved by the Food and Drug Administration in 2021 and recommended by ACIP in 2022.b A 2-dose schedule of Recombivax HB adult formulation (10 μg) (https://www.fda.gov/media/74274/downloadexternalicon) is licensed for children and adolescents aged 11–15 years. When scheduled to receive the second dose, persons aged ≥16 years should be switched to a 3-dose series, with doses 2 and 3 consisting of the pediatric formulation administered on an appropriate schedule.c Engerix-B (https://www.fda.gov/media/119403/downloadexternalicon) for adults on hemodialysis and is administered as a series of 4 doses (2 ml each) as a single 2-mL dose or as two 1-mL doses on a 0-, 1-, 2-, and 6-month schedule. Recombivax HB for adults on dialysis is a 3-dose series.d The safety and effectiveness of Heplisav-B and PreHevbrio have not been established in adults on hemodialysis. Data are not available to assess the effects of Heplisav-B and PreHevbrio on breastfed infants or on maternal milk production and excretion. Data on Heplisav-B (https://www.fda.gov/media/108745/downloadexternalicon) and PreHevbrio are currently insufficient to inform vaccine-associated risks in pregnancy. Thus, providers should vaccinate pregnant persons needing HepB vaccination with Engerix-B, Recombivax HB, or Twinrix. Open table in a new tab Abbreviations: ACIP, Advisory Committee on Immunization Practices; HepA, hepatitis A; HepB, hepatitis B. Aaron Harris; Andrew Leidner; Jessica MacNeil; Ismael Ortega-Sanchez; Sarah Schillie; Joanna Taliano; Nicola D. Thompson; Shaoman Yin; Nida Ali, Laura Cooley, Lakshmi Panagiotakopoulos, PreHevbrio evidence review. Advisory Committee on Immunization Practices (ACIP): Grace Lee, Lucile Packard Children’s Hospital, Chair; Melinda Wharton, National Center for Immunization and Respiratory Diseases, CDC, Executive Secretary; Members: Kevin Ault, University of Kansas Medical Center; Lynn Bahta, Minnesota Department of Health; Beth Bell, University of Washington; Oliver Brooks, Watts HealthCare Corporation; Wilbur Chen, University of Maryland School of Medicine; Sybil Cineas, The Warren Alpert Medical School of Brown University; Matthew Daley, Kaiser Permanente Colorado; Camille Kotton, Harvard Medical School; Sarah Long, Drexel University College of Medicine; Veronica McNally, Franny Strong Foundation; Katherine Poehling, Wake Forest School of Medicine; Pablo Sánchez, Research Institute at Nationwide Children’s Hospital; Helen Keipp Talbot, Vanderbilt University; Ex Officio Members: John Beigel, National Institutes of Health; Doran Fink, Food and Drug Administration; Mary Beth Hance, Centers for Medicare & Medicaid Services; David Kim, Office of Infectious Disease and HIV/AIDS Policy, U.S. Department of Health and Human Services; Mary Rubin, Health Resources and Services Administration; Thomas Weiser, Indian Health Service; Liaison Representatives: Phyllis Arthur, Biotechnology Industry Organization; Sandra Adamson Fryhofer, American Medical Association; Carol Baker, Infectious Diseases Society of America; Elizabeth Barnett, International Society of Travel Medicine; Thevy Chai, American College Health Association; Rebecca Coyle, American Immunization Registry Association; Marci Drees, Society for Healthcare Epidemiology of America; Stephan Foster, American Pharmacists Association; Robert Gluckman, America’s Health Insurance Plans; Jason Goldman, American College of Physicians; Stanley Grogg, American Osteopathic Association; Christine Hahn, Council of State and Territorial Epidemiologists; Carol Hayes, American College of Nurse Midwives; Molly Howell, Association of Immunization Managers; Marie-Michèle Léger, American Academy of Physician Assistants; David Kimberlin, Bonnie Maldonado, American Academy of Pediatrics; W. Paul McKinney, Association for Prevention Teaching and Research; Amy Middleman, Society for Adolescent Health and Medicine; Linda O’Neal Eckert, American College of Obstetricians and Gynecologists; Sean O’Leary, Pediatric Infectious Diseases Society; Caroline Quach, Canadian National Advisory Committee on Immunization; Charles Rittle, American Nurses Association; Corey Robertson, Pharmaceutical Research and Manufacturers of America; Pamela Rockwell, American Academy of Family Physicians; William Schaffner, National Foundation for Infectious Diseases; Kenneth Schmader, American Geriatrics Society; Nirav Shah, Association of State and Territorial Health Officials; Patricia Stinchfield, National Association of Pediatric Nurse Practitioners; Patricia Whitley-Williams, National Medical Association; Matthew Zahn, National Association of County and City Health Officials. ACIP Hepatitis Vaccines Work Group: Kevin Ault; Elizabeth Barnett; Sybil Cineas; Marci Drees; Susan Even; Darci Everett; Christine Finley; Robert Frenck; Sharon Frey; Prabhu Gounder; Kathleen Harriman; Brenna Hughes; Rajen Koshy; Susan Lett; Marian Major; Brian McMahon; Kelly Moore; David Nace; Pamela Rockwell; Jennifer Rosen; Ann Thomas; David Weber; Matthew Zahn; Jennifer Zipprich; CDC Lead: Mark K. Weng; Work Group Contributors: Erin E. Conners; Mona Doshani; Penina Haber; Megan Hofmeister; Neil Murthy; Noele P. Nelson; Lakshmi Panagiotakopoulos; Priti Patel; Philip Spradling; Carolyn Wester. All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. Kevin Ault reports grants received from the National Institutes of Health, consulting fees received from PathoVax, and leadership or fiduciary roles in American College of Obstetricians and Gynecologists, International Federation of Gynecology and Obstetrics, and Families Fighting Flu. Sharon Frey reports grants received from the National Institutes of Health and serving as chair of the HIV Vaccine Trials Network safety monitoring board. Eric W. Hall reports consulting fees from Merck for work unrelated to this manuscript. Kelly L. Moore reports that her employer receives unrestricted educational grant support from GlaxoSmithKline, Merck & Co., Inc., and a small unrestricted donation from Dynavax Technologies. No other potential conflicts of interest were disclosed. * Recommendations for routine use of vaccines in children, adolescents, and adults are developed by the ACIP. ACIP is chartered as a federal advisory committee to provide expert external advice and guidance to the CDC Director on use of vaccines and related agents for the control of vaccine-preventable diseases in the civilian U.S. population. Recommendations for routine use of vaccines in children and adolescents are harmonized to the greatest extent possible with recommendations made by the American Academy of Pediatrics, the American Academy of Family Physicians (AAFP), and the American College of Obstetricians and Gynecologists (ACOG). Recommendations for routine use of vaccines in adults are harmonized with the recommendations of AAFP, ACOG, and the American College of Physicians. ACIP recommendations approved by the CDC Director become agency guidelines on the date published in the Morbidity and Mortality Weekly Report. https://www.cdc.gov/vaccines/acip † The ACIP Hepatitis Vaccines Work Group comprises professionals from academic medicine (family medicine, internal medicine, pediatrics, obstetrics, infectious disease, occupational health, and preventive medicine specialists), federal and state public health entities, and medical societies. § https://www.cdc.gov/vaccines/acip/meetings/downloads/slides-2021-11-2-3/02-HepWG-weng-508.pdfpdficon ¶ https://www.cdc.gov/vaccines/hcp/acip-recs/general-recs/index.html ** https://cdafound.org/polaris/externalicon (Accessed November 19, 2021).

Use of a Modified Preexposure Prophylaxis Vaccination Schedule to Prevent Human Rabies: Recommendations of the Advisory Committee on Immunization Practices - United States, 2022.

Human rabies is an acute, progressive encephalomyelitis that is nearly always fatal once symptoms begin. Several measures have been implemented to prevent human rabies in the United States, including vaccination of targeted domesticated and wild animals, avoidance of behaviors that might precipitate an exposure (e.g., provoking high-risk animals), awareness of the types of animal contact that require postexposure prophylaxis (PEP), and use of proper personal protective equipment when handling animals or laboratory specimens. PEP is widely available in the United States and highly effective if administered after an exposure occurs. A small subset of persons has a higher level of risk for being exposed to rabies virus than does the general U.S. population; these persons are recommended to receive preexposure prophylaxis (PrEP), a series of human rabies vaccine doses administered before an exposure occurs, in addition to PEP after an exposure. PrEP does not eliminate the need for PEP; however, it does simplify the rabies PEP schedule (i.e., eliminates the need for rabies immunoglobulin and decreases the number of vaccine doses required for PEP). As rabies epidemiology has evolved and vaccine safety and efficacy have improved, Advisory Committee on Immunization Practices (ACIP) recommendations to prevent human rabies have changed. During September 2019-November 2021, the ACIP Rabies Work Group considered updates to the 2008 ACIP recommendations by evaluating newly published data, reviewing frequently asked questions, and identifying barriers to adherence to previous ACIP rabies vaccination recommendations. Topics were presented and discussed during six ACIP meetings. The following modifications to PrEP are summarized in this report: 1) redefined risk categories; 2) fewer vaccine doses in the primary vaccination schedule; 3) flexible options for ensuring long-term protection, or immunogenicity; 4) less frequent or no antibody titer checks for some risk groups; 5) a new minimum rabies antibody titer (0.5 international units [IUs]) per mL); and 6) clinical guidance, including for ensuring effective vaccination of certain special populations.

Annals for Educators - March 2022.

Web ExclusivesMarch 2022Annals for Educators - March 2022FREEChristine Laine, MD, MPHChristine Laine, MD, MPHSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/AWED202203150 SectionsAboutVisual AbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Clinical Practice PointsPrediction of End-Stage Kidney Disease Using Estimated Glomerular Filtration Rate With and Without Race. A Prospective Cohort StudyEliminating Racial Inequities in Kidney Health: Much More Than Revising Estimating EquationsEquations that estimate glomerular filtration rate have recently been modified to remove the adjustment for race. This study examined the predictive performance of estimated glomerular filtration rate equations with and without the variable for Black race. The accompanying editorial notes potential harms of removing race from the equations and contends that achieving racial equity in kidney health requires more than fine-tuning these equations.Use this article and the editorial to:Review the equations the clinical laboratory at your institution uses to estimate glomerular filtration rate.Based on the findings of the study reported in this article, initiate a discussion among your learners about which equation they think the laboratory should use.Discuss the potential advantages and disadvantages of removing race from equations used to estimate glomerular filtration rate.The editorialist believes that changing the equations will have a limited influence on reducing racial disparities in kidney disease outcomes. Ask your learners to identify other interventions that might be more effective at reducing disparities.Cardiometabolic Disease Burden and Steroid Excretion in Benign Adrenal Tumors. A Cross-Sectional Multicenter StudyCardiometabolic Morbidity of Mild Cortisol ExcessBenign adrenal tumors are commonly discovered on cross-sectional imaging that is done for other reasons. This study examined whether the mild autonomous cortisol secretion often found with these tumors carries risk for cardiometabolic conditions. The accompanying editorial discusses the results of the study, the clinical lessons it offers, and the issues that warrant further exploration.Use this article and the editorial to:Discuss the natural history of adrenal incidentalomas. This systematic review can help to guide the discussion. Review the recommendations for evaluation of patients with incidentally discovered adrenal tumors.Given the results of this study, what clinical actions might be reasonable to take in patients with benign adrenal tumors?Accuracy of Ultrasound Jugular Venous Pressure Height in Predicting Central Venous CongestionUse of point-of-care ultrasonography (POCUS) is growing rapidly in clinical medicine. In this prospective observational study of patients undergoing right heart catheterization for heart failure indications, the investigators examined the accuracy of POCUS in estimating jugular venous pressure and elevated central venous pressure.Use this article to:Invite a colleague with expertise in POCUS to join your session and demonstrate how to use bedside ultrasound to estimate jugular venous pressure and elevated central venous pressure.Review the availability of POCUS at your institution, and discuss clinical scenarios in which it would be appropriate and inappropriate to use it.Clinical GuidelinesRecommended Adult Immunization Schedule, United States, 2022This article provides immunization recommendations from the Advisory Committee on Immunization Practices (ACIP) for adults aged 19 years or older. The purpose of the immunization schedule is to consolidate and summarize updates to ACIP recommendations on vaccination of adults and to assist providers in implementing current ACIP recommendations.Use this article to:Start your session with the multiple-choice question provided below.Invite a colleague from nursing to your session to demonstrate the proper technique for administering an intramuscular vaccine.Review the changes in the ACIP vaccine recommendations between 2021 and 2022.Ask your learners to share strategies they find helpful in discussing vaccination with patients who are hesitant to receive it. This article may help to stimulate the discussion. Diagnostic Imaging and Medical Management of Acute Left-Sided Colonic Diverticulitis. A Systematic ReviewEvaluation and Management After Acute Left-Sided Colonic Diverticulitis. A Systematic ReviewDiagnosis and Management of Acute Left-Sided Colonic Diverticulitis: A Clinical Guideline From the American College of PhysiciansColonoscopy for Diagnostic Evaluation and Interventions to Prevent Recurrence After Acute Left-Sided Colonic Diverticulitis: A Clinical Guideline From the American College of PhysiciansThe first systematic review was conducted to support the American College of Physicians' (ACP's) new clinical practice guidelines on diagnosis and management of acute left-sided colonic diverticulitis, which include specific recommendations on the role of computed tomographic imaging, outpatient versus inpatient management for acute uncomplicated diverticulitis, and antibiotic use for acute diverticulitis. The second systematic review was conducted to support ACP's new clinical practice guidelines on patient evaluation and management after an episode of acute left-sided colonic diverticulitis, which include specific recommendations on the role of colonoscopy for diagnostic evaluation of colorectal cancer after acute left-sided colonic diverticulitis and the role of pharmacologic and elective surgical interventions to prevent recurrence after initial treatment.Use these articles to:Start your session by viewing a video summarizing key findings from one of the systematic reviews that provide the evidence base for the guideline recommendations. Review the factors that characterize trustworthy clinical guidelines. This article and this article can help guide the discussion. Review the factors that characterize complicated diverticulitis.What factors characterize patients with diverticulitis who can be managed as outpatients?Present several clinical scenarios of patients with possible diverticulitis, and ask your learners whether they would obtain imaging studies and/or prescribe antibiotics.Type 1 Diabetes MellitusType 1 diabetes mellitus is an endocrine disorder in which the beta cells of the pancreas no longer produce insulin, typically due to autoimmune destruction resulting in hyperglycemia and ketosis. Insulin replacement is vital to management. Type 1 diabetes can occur at any age. Symptoms include polyuria, polydipsia, and weight loss, and acute complications include diabetic ketoacidosis, which requires urgent management. Long-term complications include both microvascular and macrovascular disease. Patients with type 1 diabetes are at higher risk for other autoimmune diseases. The focus of management is on optimizing glucose control to reduce both acute and long-term complications.Use this article to:Review how to determine whether an adult who presents with new-onset diabetes has type 1 or type 2 diabetes.Invite an endocrinologist to join your session to review how to begin insulin therapy in a patient with newly diagnosed type 1 diabetes.Invite a diabetes nurse educator to join your session to review commonly used continuous glucose monitors and insulin pumps.Take the quiz associated with the article as a group, and review the answers.HumanitiesThe ShootingWe started to hear the rumors of an active shooter in the hospital, but no official announcement was made. We stood as a group.Use this article to:Review the procedures in place at your institution to manage an active shooter.Ask your learners to describe what they would do if they became aware that someone with a gun was threatening staff or patients on the premises of your health center.Ask your learners to share their perspectives on whether a physician should put his or her own life in danger to assist patients or colleagues in a situation such as the one described in this essay.MKSAP 19 QuestionA 26-year-old woman undergoes consultation to update her vaccinations. She is an elementary school teacher. Medical history is significant for well-controlled HIV diagnosed 6 years ago. Medications are tenofovir alafenamide, emtricitabine, and dolutegravir.The physical examination is normal.Her CD4 cell count is 520/µL and has been stable for several years. HIV viral load is undetectable.Which of the following vaccines is contraindicated in this patient?A. Human papillomavirusB. Inactivated influenzaC. Measles-mumps-rubellaD. VaricellaE. No contraindications existCorrect AnswerE. No contraindications existEducational ObjectiveIdentify appropriate vaccines for patients with HIV infection.CritiqueThis patient has no contraindications to routinely administered vaccines (Option E). Live vaccines, including varicella, varicella-zoster, measles-mumps-rubella, and influenza are not recommended for patients who are severely immunocompromised. Contraindications to live vaccines include persons with HIV with CD4 cell count ≤200/µL; pregnancy or probable pregnancy within 4 weeks; immunosuppressant therapy, including high-dose glucocorticoids; leukemia, lymphoma, or other bone marrow and lymphatic system malignancies; cellular immunodeficiency; solid organ transplant recipient; and recent hematopoietic stem cell transplantation.The live-attenuated influenza vaccine is contraindicated in patients with HIV infection regardless of CD4 cell count, but the inactivated vaccine can be given (Option B). Numerous other immunizations are recommended for all persons with HIV, including COVID-19, 13-valent pneumococcal conjugate, and 23-valent pneumococcal polysaccharide vaccines. Patients who are not already immune or infected with hepatitis B virus should receive the hepatitis B vaccine series. Tetanus-diphtheria-pertussis, hepatitis A, and human papillomavirus (HPV) vaccinations are indicated as for the general population (Option A). The Advisory Committee on Immunization Practices (ACIP) has expanded the age indications for HPV vaccination to 45 years, recommending that the decision to vaccinate between ages 26 and 45 years be determined through shared decision making with patients. The ACIP recommends that all persons with HIV infection be vaccinated for meningococcal disease with the quadrivalent meningococcal vaccine, including boosters every 5 years.For prevention of varicella-zoster, live-attenuated and recombinant vaccines are available; the inactivated recombinant vaccine is preferred and recommended for patients aged 50 years and older, even if the patient previously received the live varicella-zoster vaccine. For patients without immunity, selected live vaccines such as the measles-mumps-rubella and varicella vaccines can be given to patients with HIV infection as long as the CD4 cell count is greater than 200/µL (Option C, D).Key PointSelected live vaccines, including the varicella and measles-mumps-rubella vaccines, are safe to administer to nonimmune persons with HIV infection whose CD4 cell count has consistently been greater than 200/µL. The live influenza vaccine is contraindicated in immunocompromised patients and those with HIV regardless of CD4 cell count.BibliographyPanel on Opportunistic Infections in HIV-Infected Adults and Adolescents. Guidelines for the prevention and treatment of opportunistic infections in HIV-infected adults and adolescents: recommendations from the Centers for Disease Control and Prevention, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America. Updated 17 April 2020. Do you like reading Annals for Educators? Receive it direct to your inbox. Sign up for the Annals for Educators alert today. Comments0 CommentsSign In to Submit A Comment Author, Article, and Disclosure InformationAffiliations: From the Editors of Annals of Internal Medicine and Education Guest Editor, Gretchen Diemer, MD, FACP, Associate Dean of Graduate Medical Education and Affiliations, Thomas Jefferson University. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics March 2022Volume 175, Issue 3Page: ED3 ePublished: 15 March 2022 Issue Published: March 2022 Copyright & PermissionsCopyright © 2022 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...

Recommended Adult Immunization Schedule, United States, 2022.

Clinical GuidelinesMarch 2022Recommended Adult Immunization Schedule, United States, 2022*FREENeil Murthy, MD, MPH, MSJ, A. Patricia Wodi, MD, MPH, Henry Bernstein, DO, MHCM, and Kevin A. Ault, MD, for the Advisory Committee on Immunization Practices†Neil Murthy, MD, MPH, MSJCenters for Disease Control and Prevention, Atlanta, Georgia (N.M., A.P.W.)Search for more papers by this author, A. Patricia Wodi, MD, MPHCenters for Disease Control and Prevention, Atlanta, Georgia (N.M., A.P.W.)Search for more papers by this author, Henry Bernstein, DO, MHCMCohen Children's Medical Center, New Hyde Park, and Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York (H.B.)Search for more papers by this author, and Kevin A. Ault, MDUniversity of Kansas Medical Center, Kansas City, Kansas (K.A.A.).Search for more papers by this author, for the Advisory Committee on Immunization Practices†Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M22-0036 Eligible for CME Point-of-Care SectionsAboutVisual AbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail In November 2021, the Advisory Committee on Immunization Practices (ACIP) voted to approve the Recommended Adult Immunization Schedule for Ages 19 Years or Older, United States, 2022. The 2022 adult immunization schedule, available at www.cdc.gov/vaccines/schedules/hcp/imz/adult.html, summarizes ACIP recommendations in the cover page, tables, notes, and appendix (Figure). The appendix lists the contraindications and precautions for all routinely recommended vaccines on the adult immunization schedule (Figure). The full ACIP recommendations for each vaccine are available at www.cdc.gov/vaccines/hcp/acip-recs/index.html. The 2022 schedule has also been approved by the director of the Centers for Disease Control and Prevention (CDC) and by the American College of Physicians (www.acponline.org), the American Academy of Family Physicians (www.aafp.org), the American College of Obstetricians and Gynecologists (www.acog.org), the American College of Nurse-Midwives (www.midwife.org), the American Academy of Physician Associates (www.aapa.org), and the Society for Healthcare Epidemiology of America (www.shea-online.org).Figure. Recommended Adult Immunization Schedule for Ages 19 Years or Older, United States, 2022. Download figure Download PowerPoint Figure. Continued Download figure Download PowerPoint Figure. Continued Download figure Download PowerPoint Figure. Continued Download figure Download PowerPoint Figure. Continued Download figure Download PowerPoint Figure. Continued Download figure Download PowerPoint Figure. Continued Download figure Download PowerPoint Figure. Continued Download figure Download PowerPoint The ACIP develops recommendations on the use of each vaccine after in-depth review of vaccine-related data, such as the epidemiology and burden of the vaccine-preventable disease (VPD), vaccine efficacy and effectiveness, vaccine safety, quality of evidence, feasibility of program implementation, and economic analyses of immunization policy (1). The ACIP recommendations can be complex and challenging to implement. The purpose of the immunization schedule, published annually, is to consolidate and summarize updates to ACIP recommendations on vaccination of adults and to assist providers in implementing current ACIP recommendations. The use of vaccine trade names in this article and in the schedule is for identification purposes only and does not imply endorsement by the ACIP or CDC.Changes to the 2022 Adult Immunization ScheduleHaemophilus influenzae type b (Hib) vaccination. Routine recommendations for Hib vaccination have not changed.Hepatitis A (HepA) vaccination. Routine recommendations for HepA vaccination have not changed.Hepatitis B vaccination (2). ACIP recommends universal vaccination of all adults aged 19 through 59 years, and vaccination of adults aged 60 years and older at risk for hepatitis B virus (HBV) infection. Additionally, ACIP recommends vaccination of adults aged 60 years and older requesting protection from HBV without the need to acknowledge a specific risk factor. In the notes for hepatitis B vaccine, the 2-, 3-, and 4-dose series are described in detail under the “Routine vaccination” section, which now states that all adults aged 19 through 59 years are recommended to receive vaccination. The “Special situations” section outlines the risk-based recommendations for adults aged 60 years and older.Human papillomavirus (HPV) vaccination (3). Routine recommendations for HPV vaccination have not changed. A minor edit was made to increase clarity to now say, “No additional dose recommended when any HPV vaccine series has been completed using the recommended dosing intervals.” Additionally, minor wording changes were made in the “Special situations” section, under the immunocompromising conditions subbullet, to now read “3-dose series, even for those who initiate vaccination at age 9 through 14 years.” The wording for the pregnancy subbullet was rearranged to improve clarity.Influenza vaccination (4). Updates to the seasonal influenza vaccine recommendations reflect discussions during public meetings of ACIP held on 28 October 2020, 25 February 2021, and 24 June 2021. For the 2021–2022 influenza season, routine annual influenza vaccination is recommended for all persons aged 6 months and older who do not have contraindications. No preferential recommendation is made for one influenza vaccine product over another in persons for whom more than one licensed and recommended product based on patient age and health status is available. The composition of the 2021–2022 U.S. influenza vaccines includes updates to the influenza A(H1N1)pdm09 and influenza A(H3N2) components. All seasonal influenza vaccines expected to be available for the 2021–2022 season are quadrivalent, containing hemagglutinin (HA) derived from one influenza A(H1N1)pdm09 virus, one influenza A(H3N2) virus, one influenza B/Victoria lineage virus, and one influenza B/Yamagata lineage virus. For the 2021–2022 season, U.S. egg-based influenza vaccines (i.e., vaccines other than cell-culture–based inactivated influenza vaccine [ccIIV4] and recombinant influenza vaccine [RIV4]) will contain influenza A/Victoria/2570/2019 (H1N1)pdm09–like virus, an influenza A/Cambodia/e0826360/2020 (H3N2)–like virus, an influenza B/Washington/02/2019 (Victoria lineage)–like virus, and an influenza B/Phuket/3073/2013 (Yamagata lineage)–like virus. U.S. ccIIV4 and RIV4 influenza vaccines will contain HA derived from an influenza A/Wisconsin/588/2019 (H1N1)pdm09–like virus, an influenza A/Cambodia/e0826360/2020 (H3N2)–like virus, an influenza B/Washington/02/2019 (Victoria lineage)–like virus, and an influenza B/Phuket/3073/2013 (Yamagata lineage)–like virus.A previous severe allergic reaction to influenza vaccine is no longer a contraindication to future receipt of any influenza vaccine. Rather, individuals with a history of severe allergic reaction to an influenza vaccine may have a precaution to receive a different type of influenza vaccine. Details about contraindications and precautions to influenza vaccination can now be found in the newly added appendix section of the adult immunization schedule.Measles, mumps, and rubella (MMR) vaccination (5). Routine recommendations for MMR vaccination have not changed. However, in the “Special situations” section, CD4 percentages in addition to CD4 counts in the HIV infection bullet were added to harmonize language with the child and adolescent schedule.Meningococcal vaccination (6). Routine recommendations for meningococcal vaccination have not changed. However, a note was added at end of section that states, “MenB vaccines may be administered simultaneously with MenACWY vaccines if indicated, but at a different anatomical site, if feasible.”Pneumococcal vaccination (7). ACIP recommends routine vaccination against pneumococcal infection for all adults aged 65 years or older. For persons aged 65 years and older who have not previously received a pneumococcal conjugate vaccine or whose previous vaccination history is unknown, they should receive 1 dose of PCV15 or 1 dose of PCV20. If PCV15 is used, this should be followed by a dose of PPSV23. This guidance has now been included in the “Routine vaccination” section. Persons aged 19 through 64 years with certain underlying medical conditions or other risk factors who have not previously received a pneumococcal conjugate vaccine or whose previous vaccination history is unknown should receive 1 dose of PCV15 or 1 dose of PCV20. If PCV15 is used, this should be followed by a dose of PPSV23. This guidance is now included in the “Special situations” section. Guidance for dosing intervals between PCV15 and PPSV23 and for patients who have previously received PCV13 or PPSV23 in the past is also included. A note is added to the end listing all the underlying medical conditions or risk factors that would make those aged 19 through 64 years eligible to receive pneumococcal vaccination.Tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccination. Routine recommendations for Tdap or Td vaccination have not changed.Varicella vaccination (8). Routine recommendations for varicella vaccination have not changed. However, in the “Special situations” section, CD4 percentages in addition to CD4 counts in the HIV infection bullet were added to harmonize language with the child and adolescent schedule.Zoster vaccination (9). In the “Special situations” section under the pregnancy bullet, the language was revised to increase clarity. This bullet now states, “There is currently no ACIP recommendation for RZV use in pregnancy. Consider delaying RZV until after pregnancy.” Additionally, the immunocompromising conditions bullet was revised to reflect the new ACIP recommendations for zoster vaccination. This bullet now states “RZV is recommended for use in persons aged 19 years and older who are or will be immunodeficient or immunosuppressed because of disease or therapy.”Revised Content, Format, and GraphicsCover Page. The cover page of the 2022 schedule provides basic instructions on how to use the schedule to systematically identify vaccination needs of adults and lists routinely recommended vaccines and their standardized abbreviations and trade names. Major edits to the cover page include adding a fourth step in the “How to use the adult immunization schedule” box that directs providers to reference the appendix for all contraindications and precautions to the vaccines listed in the adult immunization schedule. Additionally, PCV15 and PCV20 have been included in the table of vaccine abbreviations and trade names and PCV13 has now been removed to reflect the new ACIP pneumococcal vaccination recommendations. Like in past annual schedules, web links are provided, where providers can download the CDC Vaccine Schedules app and access reference materials for the surveillance of VPDs, including case identification and disease outbreak response. Instructions on reporting suspected cases of reportable VPDs to local or state health departments and significant postvaccination adverse events to the Vaccine Adverse Event Reporting System are listed. Information on the Vaccine Injury Compensation Program is provided, as well as web links to other resources, such as vaccine information statements, recommended vaccines for travelers, and shared clinical decision-making guidance.Table 1. Recommended Adult Immunization Schedule by Age Group. Table 1 describes routine and catch-up vaccination recommendations for adults by age. For 2022, the zoster row of Table 1 on the adult immunization schedule was changed to purple for adults aged 19 through 49 years, indicating that recombinant zoster vaccine (RZV) is now recommended for adults in this age group who have immunocompromising conditions. The text overlay now states, “2 doses for immunocompromising conditions (see notes).” For pneumococcal vaccination in Table 1, all recommended pneumococcal vaccines (i.e., PCV15, PCV20, and PPSV23) have been collapsed to one row. Guidance for which vaccines are indicated for certain age groups is displayed by the corresponding colors and overlying text. The row is purple from 19 through 64 years and yellow for adults aged 65 years and older. The text overlay now states, “1 dose PCV15 followed by PPSV23 OR 1 dose PCV20 (see notes).” The Hepatitis B row is now yellow from 19 through 59 years of age, and purple for adults aged 60 years and older. The text overlay now states, “2, 3, or 4 doses depending on vaccine or condition.”Table 2. Recommended Adult Immunization Schedule by Medical Condition and Other Indications. Table 2 describes vaccination recommendations for adults based on medical conditions or other indications. For 2022, the header now includes CD4 percentages in addition to CD4 counts in the HIV infection columns, to harmonize the way this information is presented in the child and adolescent schedule. Additionally, the description of the color red in the legend has been reworded to “Contraindicated or not recommended.” The red boxes in the LAIV4, MMR, and VAR rows now have a text overlay of “Contraindicated” (as opposed to “Not Recommended” in the 2021 schedule) to increase clarity and to align more closely with ACIP recommendations. In the RZV row, under the Immunocompromised and HIV infection columns, the row is yellow indicating that RZV is recommended for these subgroups. Additionally, the text overlay under these columns now states, “2 doses at age ≥19 years.” The HepB row is now entirely yellow, indicating that hepatitis B vaccination is recommended for all risk-based groups in Table 2. The text overlay states, “3 doses (see notes),” in the pregnancy column, and “2, 3, or 4 doses depending on vaccine or condition,” for the remaining columns.Notes. Recommended Adult Immunization Schedule. Additional language has been added to the box containing COVID-19 vaccination recommendations. In addition to including the hyperlink to the Interim ACIP recommendations for the use of COVID-19 vaccines, the hyperlink to CDC's Interim Clinical Considerations for the use of COVID-19 vaccines is also included in this box. Each recommended vaccine for adults in Tables 1 and 2 is accompanied by a note (previously known as a footnote), which is designed to provide additional information on routine vaccination and recommendations in special situations. Each section contains concise information on vaccine indications, dosing frequencies and intervals, and other published ACIP recommendations. New or revised language for influenza, hepatitis B, pneumococcal, and zoster vaccination has been added to their respective sections in the notes. Changes were also made to the MMR vaccine, HPV vaccine, meningococcal vaccine, and varicella vaccine sections to improve clarity in the language. All vaccines identified in Tables 1 and 2 (except PCV15, PCV20, and RZV) also appear in the Recommended Child and Adolescent Immunization Schedule for Ages 18 Years or Younger, United States, 2022 (www.cdc.gov/vaccines/schedules/hcp/imz/child-adolescent.html). The notes for vaccines that appear in both the adult immunization schedule and the child and adolescent immunization schedule have been harmonized to the greatest extent possible.Appendix. Recommended Adult Immunization Schedule. The appendix lists all the contraindications and precautions to each of the vaccines listed in the 2022 adult immunization schedule. The information presented in this appendix is adapted from the 2021–2022 influenza vaccine recommendations (2) and from ACIP General Best Practice Guidelines for Immunization (10).Vaccination During the Coronavirus Disease 2019 (COVID-19) PandemicVaccination is an essential medical service for all children, adolescents, and adults; vaccines are ideally administered in the medical home. Providers should administer all due and overdue vaccines according to the routine immunization schedule during the same visit. In addition, providers should implement strategies to catch up all patients on any overdue vaccines. The CDC's interim guidance for the safe delivery of vaccines during the COVID-19 pandemic (11) includes the use of personal protective equipment and physical distancing. Routine immunization services remain critical during the COVID-19 pandemic as they prevent disease in individuals, families, and communities (11). For more information, see www.cdc.gov/vaccines/pandemic-guidance/index.html.The CDC has partnered with the National Adult and Influenza Immunization Summit, which has developed a checklist of best practices for vaccination clinics held at satellite, temporary, or off-site locations, and can be downloaded at www.izsummitpartners.org/content/uploads/2019/02/off-site-vaccination-clinic-checklist.pdf. This checklist is a step-by-step guide to help clinic coordinators/supervisors overseeing vaccination clinics held at satellite, temporary, or off-site locations follow the CDC guidelines and best practices for vaccine shipment, transport, storage, handling, preparation, administration, and documentation. This checklist can be used in any nontraditional vaccination clinic settings, such as workplaces, community centers, schools, makeshift clinics in remote areas, and medical facilities when vaccination occurs in the public areas or classrooms.Appendix ARecommendations for routine use of vaccines in children, adolescents, and adults are developed by the Advisory Committee on Immunization Practices (ACIP). ACIP is chartered as a federal advisory committee to provide expert external advice and guidance to the Director of the Centers for Disease Control and Prevention (CDC) on the use of vaccines and related agents to control vaccine-preventable diseases in the civilian population of the United States. Recommendations for routine use of vaccines in children and adolescents are harmonized to the extent possible with recommendations made by the American Academy of Pediatrics (AAP), the American Academy of Family Physicians (AAFP), and the American College of Obstetricians and Gynecologists (ACOG). Recommendations for routine use of vaccines in adults are harmonized with recommendations of AAFP, ACOG, the American College of Physicians (ACP), the American College of Nurse-Midwives (ACNM), and the American Academy of Physician Assistants (AAPA). ACIP recommendations adopted by the CDC Director become agency guidelines on the date they are published in the Morbidity and Mortality Weekly Report (MMWR). Additional information on ACIP is available at www.cdc.gov/vaccines/acip.Members of the ACIPUnless otherwise indicated, the members listed were nonauthor collaborators to this article.José R. Romero, MD, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, Arkansas (Chair); Amanda Cohn, MD, Centers for Disease Control and Prevention, Atlanta, Georgia (Executive Secretary); Robert L. Atmar, MD, Baylor College of Medicine, Houston, Texas; Kevin A. Ault, MD*, University of Kansas Medical Center, Kansas City, Kansas; Lynn Bahta, RN, MPH, CPH, Minnesota Department of Health, Saint Paul, Minnesota; Beth P. Bell, MD, MPH, University of Washington, Seattle, Washington; Henry Bernstein, DO, MHCM*, Cohen Children's Medical Center, New Hyde Park, and Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York; Sybil Cineas, MD, The Warren Alpert Medical School of Brown University, Providence, Rhode Island; Sharon E. Frey, MD, Saint Louis University Medical School, Saint Louis, Missouri; Paul Hunter, MD, City of Milwaukee Health Department, Milwaukee, Wisconsin; Grace M. Lee, MD, MPH, Lucile Packard Children's Hospital, Stanford University School of Medicine, Stanford, California; Veronica V. McNally, JD, Franny Strong Foundation, West Bloomfield, Michigan; Katherine A. Poehling, MD, MPH, Wake Forest School of Medicine, Winston-Salem, North Carolina; Pablo J. Sánchez, MD, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio; Peter Szilagyi, MD, MPH, University of California, Los Angeles, Los Angeles, California; Helen Keipp Talbot, MD, MPH, Vanderbilt University, Nashville, Tennessee. A list of current ACIP members is available at www.cdc.gov/vaccines/acip/committee/members.html.ACIP Combined Immunization Work GroupWork Group Co-Chair: Kevin A. Ault, MD*, Kansas City, Kansas.Work Group Members: Sybil Cineas, MD, Providence, Rhode Island; Sarah Coles, MD, Phoenix, Arizona; Katherine Debiec, MD, Seattle, Washington; Marci Drees, MD, Philadelphia, Pennsylvania; John Epling, MD, Roanoke, Virginia; Holly Fontenot, PhD, Boston, Massachusetts; Sandra Fryhofer, MD, Atlanta, Georgia; Molly Howell, MPH, Bismarck, North Dakota; Marie-Michelle Leger, MPH, PA-C, Alexandria, Virginia; Susan Lett, MD, MPH, Boston, Massachusetts; Veronica V. McNally, JD, West Bloomfield, Michigan; Sarah McQueen, DMS, PA-C, Charlotte, North Carolina; Amy Middleman, MD, MSEd, MPH, Oklahoma City, Oklahoma; Sean O’Leary, MD, MPH, Denver, Colorado; Chad Rittle, DNP, MPH, RN, Pittsburgh, Pennsylvania; William Schaffner, MD, Nashville, Tennessee; Ken Schmader, MD, Durham, North Carolina; Rhoda Sperling, MD, New York, New York; Patricia Stinchfield, RN, MS, Saint Paul, Minnesota; Thomas Weiser, MD, MPH, Portland, Oregon.Work Group Contributors: Anna M. Acosta, MD, Atlanta, Georgia; Tara C. Anderson, DVM, PhD, Atlanta, Georgia; Kathy Byrd, MD, MPH, Atlanta, Georgia; Margaret M. Cortese, MD, Atlanta, Georgia; Kathleen Dooling, MD, MPH, Atlanta, Georgia; Amy Parker Fiebelkorn, MSN, MPH, Atlanta, Georgia; Mark Freedman, DVM, MPH, New York, New York; Paul A. Gastañaduy, MD, Atlanta, Georgia; Lisa Grohskopf, MD, MPH, Atlanta, Georgia; Susan Hariri, PhD, Atlanta, Georgia; Aaron M. Harris, MD, Atlanta, Georgia; Fiona Havers, MD, PhD, Atlanta, Georgia; Holly Hill, PhD, MD, Atlanta, Georgia; Tara Jatlaoui, MD, MPH, Atlanta, Georgia; Suzanne Johnson-DeLeon, MPH, Atlanta, Georgia; Miwako Kobayashi, MD, MPH, Atlanta, Georgia; Ram Kopakka, MD, MPH, Atlanta, Georgia; Andrew Kroger, MD, MPH, Atlanta, Georgia; Tatiana M. Lanzieri, MD, Atlanta, Georgia; Lucy McNamara, PhD, MS, Atlanta, Georgia; Mona Marin, MD, Atlanta, Georgia; Lauri Markowitz, MD, Atlanta, Georgia; Sarah A. Mbaeyi, MD, Atlanta, Georgia; Elissa Meites, MD, MPH, Atlanta, Georgia; Noele P. Nelson, MD, PhD, Atlanta, Georgia; Sara Oliver, MD, MSPH, Atlanta, Georgia; Priti Patel, MD, MPH, Atlanta, Georgia; Tamara Pilishvili, MPH, BS, Atlanta, Georgia; Hilda Razzaghi, PhD, Atlanta, Georgia; Janell Routh, MD, Atlanta, Georgia; Sarah Schillie, MD, Atlanta, Georgia; Mark K. Weng, MD, Atlanta, Georgia; Akiko Wilson, BFA, Atlanta, Georgia; JoEllen Wolicki, BSN, Atlanta, Georgia.Work Group Consultants: Henry Bernstein, DO, MHCM*, New Hyde Park, New York; Caroline Bridges, MD, Moscow, Idaho; Kathleen Harriman, PhD, MPH, RN, Richmond, California; Robert H. Hopkins Jr., MD, Little Rock, Arkansas; Karen Ketner, DNP, Redwood City, California; David Kim, MD, MPH, Washington, DC; Jane Kim, MD, MPH, Durham, North Carolina; Diane Peterson, Saint Paul, Minnesota; Litjen Tan, PhD, Chicago, Illinois.Work Group Co-Leads: Neil Murthy, MD, MPH, MSJ*, Atlanta, Georgia; A. Patricia Wodi, MD, MPH*.* Authored the article.

Use of Recombinant Zoster Vaccine in Immunocompromised Adults Aged ≥19 Years: Recommendations of the Advisory Committee on Immunization Practices — United States, 2022

Zoster Vaccine Recombinant, Adjuvanted (Shingrix, GlaxoSmithKline [GSK]) is a 2-dose (0.5 mL each) subunit vaccine containing recombinant glycoprotein E in combination with adjuvant (AS01B) that was licensed in the United States for prevention of herpes zoster for adults aged ≥50 years by the Food and Drug Administration (FDA) and recommended for immunocompetent adults aged ≥50 years by the Advisory Committee on Immunization Practices (ACIP) in 2017* (1). On July 23, 2021, the FDA expanded the indication for recombinant zoster vaccine (RZV) to include adults aged ≥18 years who are or will be at increased risk for herpes zoster because of immunodeficiency or immunosuppression caused by known disease or therapy (2). On October 20, 2021, ACIP recommended 2 doses of RZV for the prevention of herpes zoster and related complications in adults aged ≥19 years† who are or will be immunodeficient or immunosuppressed because of disease or therapy. RZV is the first herpes zoster vaccine approved for use in immunocompromised persons. With moderate to high vaccine efficacy and an acceptable safety profile, RZV has the potential to prevent considerable herpes zoster incidence and related complications. This report updates previous ACIP recommendations for the prevention of herpes zoster (1,3).

Dengue Vaccine: Recommendations of the Advisory Committee on Immunization Practices, United States, 2021.

SummaryDengue is a vectorborne infectious disease caused by dengue viruses (DENVs), which are predominantly transmitted by Aedes aegypti and Aedes albopictus mosquitos. Dengue is caused by four closely related viruses (DENV-1–4), and a person can be infected with each serotype for a total of four infections during their lifetime. Areas where dengue is endemic in the United States and its territories and freely associated states include Puerto Rico, American Samoa, the U.S. Virgin Islands, the Federated States of Micronesia, the Republic of Marshall Islands, and the Republic of Palau. This report summarizes the recommendations of the Advisory Committee on Immunization Practices (ACIP) for use of the Dengvaxia vaccine in the United States. The vaccine is a live-attenuated, chimeric tetravalent dengue vaccine built on a yellow fever 17D backbone. Dengvaxia is safe and effective in reducing dengue-related hospitalizations and severe dengue among persons who have had dengue infection in the past. Previous natural infection is important because Dengvaxia is associated with an increased risk for severe dengue in those who experience their first natural infection (i.e., primary infection) after vaccination. Dengvaxia was licensed by the Food and Drug Administration for use among children and adolescents aged 9–16 years (referred to in this report as children). ACIP recommends vaccination with Dengvaxia for children aged 9–16 having evidence of a previous dengue infection and living in areas where dengue is endemic. Evidence of previous dengue infection, such as detection of anti-DENV immunoglobulin G with a highly specific serodiagnostic test, will be required for eligible children before vaccination.

The Advisory Committee on Immunization Practices' Interim Recommendation for Use of Pfizer-BioNTech COVID-19 Vaccine in Children Aged 5-11 Years - United States, November 2021.

The Pfizer-BioNTech COVID-19 (BNT162b2) vaccine is a lipid nanoparticle-formulated, nucleoside-modified mRNA vaccine encoding the prefusion spike glycoprotein of SARS-CoV-2, the virus that causes COVID-19. On August 23, 2021, the Food and Drug Administration (FDA) approved a Biologics License Application (BLA) for use of the Pfizer-BioNTech COVID-19 vaccine, marketed as Comirnaty (Pfizer, Inc.), in persons aged ≥16 years (1). The Pfizer-BioNTech COVID-19 vaccine is also recommended for adolescents aged 12-15 years under an Emergency Use Authorization (EUA) (1). All persons aged ≥12 years are recommended to receive 2 doses (30 μg, 0.3 mL each), administered 3 weeks apart (2,3). As of November 2, 2021, approximately 248 million doses of the Pfizer-BioNTech COVID-19 vaccine had been administered to persons aged ≥12 years in the United States.* On October 29, 2021, FDA issued an EUA amendment for a new formulation of Pfizer-BioNTech COVID-19 vaccine for use in children aged 5-11 years, administered as 2 doses (10 μg, 0.2 mL each), 3 weeks apart (Table) (1). On November 2, 2021, the Advisory Committee on Immunization Practices (ACIP) issued an interim recommendation† for use of the Pfizer-BioNTech COVID-19 vaccine in children aged 5-11 years for the prevention of COVID-19. To guide its deliberations regarding recommendations for the vaccine, ACIP used the Evidence to Recommendation (EtR) Framework§ and incorporated a Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach.¶ The ACIP recommendation for the use of the Pfizer-BioNTech COVID-19 vaccine in children aged 5-11 years under an EUA is interim and will be updated as additional information becomes available. The Pfizer-BioNTech COVID-19 vaccine has high efficacy (>90%) against COVID-19 in children aged 5-11 years, and ACIP determined benefits outweigh risks for vaccination. Vaccination is important to protect children against COVID-19 and reduce community transmission of SARS-CoV-2.

Use of Pfizer-BioNTech COVID-19 Vaccine in Persons Aged ≥16 Years: Recommendations of the Advisory Committee on Immunization Practices - United States, September 2021.

The Pfizer-BioNTech COVID-19 vaccine (BNT162b2) is a lipid nanoparticle-formulated, nucleoside mRNA vaccine encoding the prefusion spike glycoprotein of SARS-CoV-2, the virus that causes COVID-19. Vaccination with the Pfizer-BioNTech COVID-19 vaccine consists of 2 intramuscular doses (30 μg, 0.3 mL each) administered 3 weeks apart. In December 2020, the vaccine was granted Emergency Use Authorization (EUA) by the Food and Drug Administration (FDA) as well as an interim recommendation for use among persons aged ≥16 years by the Advisory Committee on Immunization Practices (ACIP) (1). In May 2021, the EUA and interim ACIP recommendations for Pfizer-BioNTech COVID-19 vaccine were extended to adolescents aged 12-15 years (2). During December 14, 2020-September 1, 2021, approximately 211 million doses of Pfizer-BioNTech COVID-19 vaccine were administered in the United States.* On August 23, 2021, FDA approved a Biologics License Application for use of the Pfizer-BioNTech COVID-19 vaccine, Comirnaty (Pfizer, Inc.), in persons aged ≥16 years (3). The ACIP COVID-19 Vaccines Work Group's conclusions regarding the evidence for the Pfizer-BioNTech COVID-19 vaccine were presented to ACIP at a public meeting on August 30, 2021. To guide its deliberations regarding the Pfizer-BioNTech COVID-19 vaccine, ACIP used the Evidence to Recommendation (EtR) Framework,† and incorporated a Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach.§ In addition to initial clinical trial data, ACIP considered new information gathered in the 8 months since issuance of the interim recommendation for Pfizer-BioNTech COVID-19 vaccine, including additional follow-up time in the clinical trial, real-world vaccine effectiveness studies, and postauthorization vaccine safety monitoring. The additional information increased certainty that benefits from prevention of asymptomatic infection, COVID-19, and associated hospitalization and death outweighs vaccine-associated risks. On August 30, 2021, ACIP issued a recommendation¶ for use of the Pfizer-BioNTech COVID-19 vaccine in persons aged ≥16 years for the prevention of COVID-19.