ACIP: 2020 Adult Immunization Schedule Updates

The Centers for Disease Control and Prevention’s (CDC) Advisory Committee on Immunization Practices (ACIP) has released an updated version of the adult immunization schedule for ages 19 years and older in the United States. 

Changes to the adults immunization schedule for 2020 include the following:

Hepatitis A vaccination

• Recommendation added for vaccination in settings of exposure (ie, healthcare settings for drug users or group homes; nonresidential day care facilities for developmentally disabled individuals).
• Removal of clotting factor disorders as an indication for vaccination. 

Hepatitis B vaccination 

• Pregnancy, if at risk for infection or severe outcome from infection during pregnancy, has been added as a population at risk. 
• Heplisav-B administration is not recommended during pregnancy due to a lack of safety data.

Human papillomavirus (HPV) vaccination 

• Recommendation added for HPV vaccination for all adults through age 26 years who are not adequately vaccinated. 
• Recommendation added for shared clinical decision-making regarding HPV vaccination in adults aged 27 to 45 years who are not adequately vaccinated.

Influenza vaccination

• Bulleted list added of when live attenuated influenza vaccine should not be used:
  • History of severe allergic reaction to any vaccine component (excluding egg) or to a previous dose of any influenza vaccine
  • Immunocompromised due to any cause (including medications and HIV infection)
  • Anatomic or functional asplenia
  • Cochlear implant
  • Cerebrospinal fluid-oropharyngeal communication
  • Close contacts or caregivers of severely immunosuppressed persons who require a protected environment
  • Pregnancy
  • Received influenza antiviral medications within the previous 48 hours

Measles, mumps, and rubella (MMR) vaccination

• Revised recommendations for healthcare personnel:
  • Born in 1957 or later with no evidence of immunity to measles, mumps, or rubella: 2-dose series at least 4 weeks apart for measles or mumps or at least 1 dose MMR for rubella
  • Born before 1957 with no evidence of immunity to measles, mumps, or rubella: Consider 2-dose series at least 4 weeks apart for measles or mumps or 1 dose for rubella

Meningococcal vaccination 

• Recommendation added for MenB vaccination based on shared clinical decision-making in patients aged 16 to 23 years (age 16 to 18 years preferred) not at increased risk for meningococcal disease, with a 2-dose series MenB-4C at least 1 month apart, or 2-dose series MenB-FHbp at 0, 6 months (if dose 2 was administered less than 6 months after dose 1, administer dose 3 at least 4 months after dose 2).  
• Under Special Situations, for patients with anatomical or functional asplenia (including sickle cell disease), persistent complement component deficiency, complement inhibitor (eg, eculizumab, ravulizumab) use, or microbiologists routinely exposed to Neisseria meningitidis, a recommendation was added to administer a booster dose of MenB 1 year after the primary series and revaccinate every 2-3 years if the risk remains.

Pneumococcal vaccination

• The 13-valent pneumococcal conjugate vaccine (PCV13) is no longer recommended for routine use in adults aged ≥65 years. 
• ACIP recommends shared clinical decision-making with regard to PCV13 use in patients aged ≥65 years who do not have an immunocompromising condition, cerebrospinal fluid leak, or cochlear implant and who have not previously received PCV13.

Tetanus, diphtheria, and pertussis vaccination 

• The use of either tetanus and diphtheria toxoid (Td) or tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine is recommended for decennial booster, tetanus prophylaxis for wound management, and for catch-up immunization in individuals who have received at least 1 Tdap dose. Previously, only Td vaccine had been recommended for repeat use.

Varicella vaccination 

• An addition to Special Situations: vaccination may be considered for persons with HIV without evidence of varicella immunity who have CD4 counts ≥200 cells/µL. 

For additional guidance on the use of each vaccine appearing in the schedule, including precautions and contraindications, clinicians can view the respective ACIP vaccine recommendations at CDC.gov.