ACIP: 2023 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.

The immunization schedule has been approved by CDC, the American College of Physicians, the American Academy of Family Physicians, the American College of Obstetricians and Gynecologists, the American College of Nurse-Midwives, the American Academy of Physician Associates, the American Pharmacists Association, and the Society for Healthcare Epidemiology of America.

Major changes to the adult immunization schedule for 2023 include the following:

COVID-19 Vaccination

• Recommendations for administration of the primary series in the general population and in individuals who are moderately to severely immunocompromised has been added.
• Information on booster doses, preexposure prophylaxis, and recommendations for Janssen COVID-19 vaccine recipients have also been added.

Hepatitis B Vaccination

• PreHevbrio™ has been added to the schedule. The vaccine is administered as a 3-dose series via intramuscular injection on a 0-, 1- and 6-month schedule. It is not recommended in pregnancy due to lack of safety data.
• New addition: Persons 60 years of age and older with known risk factors for hepatitis B virus (HBV) infection should complete a HepB vaccine series, while those without known risk factors for HBV infection may complete a HepB vaccine series.

Influenza Vaccination

• Recommendations for the 2022-2023 influenza season were added.
• Language added to routine vaccination section that states quadrivalent high-dose inactivated influenza vaccine, quadrivalent recombinant influenza vaccine, or quadrivalent adjuvanted inactivated influenza vaccine is preferred for adults aged 65 years or older. If unavailable, then any other age-appropriate influenza vaccine should be used for this age group.
• Addition to Special Situations section: Live attenuated influenza vaccines should not be administered to close contacts of immunosuppressed persons who require a protected environment. 

MMR Vaccination

• Recommendations for additional MMR doses in a mumps outbreak setting have been added.

Meningococcal Vaccination

• Trumenba^®: If the third dose 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

• New recommendations for the use of PCV15 and PCV20 in persons who previously received pneumococcal vaccines.
• PneumoRecs VaxAdvisor mobile app developed to help providers determine which pneumococcal vaccines a patient needs.

Poliovirus Vaccination

• Recommendations for adults who are at increased risk of exposure to polioviruses have been added.

Zoster Vaccination

• A note has been added stating that serologic evidence of prior varicella is not necessary for zoster vaccination. If serologic evidence of varicella susceptibility becomes available, follow ACIP guidelines for varicella vaccination first.
• Immunocompromised: If there is no documented history of varicella, varicella vaccination, or herpes zoster, refer to the clinical considerations for use of recombinant zoster vaccine and the ACIP varicella vaccine recommendations for further guidance.

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.

Reference

Murthy N, Wodi AP, McNally V, et al. Advisory Committee on Immunization Practices recommended immunization schedule for adults aged 19 years or older — United States, 2023. Published online February 10, 2023. MMWR. dx.doi.org/10.15585/mmwr.mm7206a2