The 2019 U.S. Adult Immunization Schedule: What ACIP Changed

In October 2018, the Advisory Committee on Immunization Practices (ACIP) voted to approve the Recommended Immunization Schedule for Adults Aged 19 Years or Older, United States, 2019. It was also approved by the CDC director, the American College of Physicians, the American Academy of Family Physicians, the American College of Obstetricians and Gynecologists and the American College of Nurse-Midwives. The schedule is published every year to gather ACIP's recommendations for adults in two tables and notes; recommendations can also change between editions. The current schedule is at cdc.gov/vaccines/schedules.

ACIP bases each recommendation on in-depth review of disease burden, vaccine efficacy and effectiveness, safety, quality of evidence, feasibility and economics.

New recommendations in 2019

Influenza. After two seasons (2016–17 and 2017–18) when it was not recommended, the nasal-spray live attenuated influenza vaccine (LAIV, FluMist Quadrivalent) returned as an option for 2018–19 — for adults 49 or younger, except those who:

• have immunocompromising conditions, including HIV;
• have anatomic or functional asplenia;
• are pregnant;
• are close contacts or caregivers of severely immunocompromised people in a protected environment;
• took influenza antivirals in the past 48 hours;
• have a cerebrospinal fluid leak or cochlear implant.

Adults who had Guillain-Barré syndrome within 6 weeks of a flu vaccine generally should not receive it.

Hepatitis B. In February 2018, ACIP recommended Heplisav-B, a new recombinant vaccine with a novel adjuvant, approved by the Food and Drug Administration in November 2017, for adults 18 and older:

• 2 doses, at least 4 weeks apart; a valid 2-dose series needs both doses to be Heplisav-B, though it can stand in within a 3-dose series of another vaccine;
• use the same manufacturer's vaccine to finish a series when feasible — but don't delay if the earlier vaccine is unknown or unavailable;
• not for pregnant women, for lack of safety data.

Hepatitis A. In October 2018, ACIP added homelessness as an indication for routine vaccination — 2 doses of hepatitis A vaccine (Havrix, Vaqta) or 3 doses of the combined hepatitis A and B vaccine (Twinrix). Also recommended for:

• people with chronic liver disease or clotting factor disorders;
• travelers to countries with high or intermediate hepatitis A;
• close contacts of an international adoptee in the first 60 days after arrival from a high-prevalence country;
• men who have sex with men;
• people who use injection or non-injection drugs;
• people who work with the virus in a laboratory or with infected nonhuman primates;
• and anyone who wants protection.

A clearer schedule

Usability testing — in-depth interviews with 48 clinicians and staff familiar with the schedule, and an online survey of 251 internal and family medicine physicians — shaped a redesign:

• a simpler cover, with how to use the schedule, the routine vaccines, their abbreviations and trade names, and links to the CDC Vaccine Schedules App, disease reporting, the Vaccine Adverse Event Reporting System, the Vaccine Injury Compensation Program, Vaccine Information Statements and travel vaccines;
• former Figures 1 and 2 became Table 1 (by age) and Table 2 (by medical condition), with LAIV listed separately;
• notes replace footnotes, listed alphabetically, and match the child and adolescent schedule;
• the contraindications table was removed — providers rarely used it — with that information online.

New colors in Table 2:

The live attenuated zoster vaccine (Zostavax) is contraindicated in pregnancy.

Sources

Based on Kim DK, Hunter P, "Advisory Committee on Immunization Practices Recommended Immunization Schedule for Adults Aged 19 Years or Older — United States, 2019," MMWR Morbidity and Mortality Weekly Report, volume 68, Centers for Disease Control and Prevention; a work of the United States government in the public domain. The schedule is revised every year; see CDC for the current one.