Recommended Adult Immunization Schedule --- United States, 2010

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Recommended Adult Immunization Schedule --- United States, 2010

Weekly

January 15, 2010 / 59(01);1-4

The Advisory Committee on Immunization Practices (ACIP) annually reviews the

recommended Adult Immunization Schedule to ensure that the schedule reflects

current recommendations for the licensed vaccines. In October 2009, ACIP

approved the Adult Immunization Schedule for 2010, which includes several

changes. A bivalent human papillomavirus vaccine (HPV2) was licensed for use in

females in October 2009. ACIP recommends vaccination of females with either HPV2

or the quadrivalent human papillomavirus vaccine (HPV4). HPV4 was licensed for

use in males in October 2009, and ACIP issued a permissive recommendation for

use in males. Introductory sentences were added to the footnotes for measles,

mumps, rubella, influenza, pneumococcal, hepatitis A, hepatitis B, and

meningococcal vaccines. Clarifications were made to the footnotes for measles,

mumps, rubella, influenza, hepatitis A, meningococcal, and Haemophilus influenza

type b vaccines, and schedule information was added to the hepatitis B vaccine

footnote.

Additional information is available as follows: schedule (in English and

Spanish) at http://www.cdc.gov/vaccines/recs/schedules/adult-schedule.htm; adult

vaccination at http://www.cdc.gov/vaccines/default.htm; ACIP statements for

specific vaccines at http://www.cdc.gov/vaccine/pubs/acip-list.htm; and

reporting adverse events at http://www.vaers.hhs.gov or by telephone,

800-822-7967.

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•The hepatitis A footnote (#9) has language added to indicate that unvaccinated

persons who anticipate close contact with an international adoptee should

consider vaccination.

•The hepatitis B footnote (#10) has language added to include schedule

information for the 3-dose hepatitis B vaccine

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9.Hepatitis A vaccination

Vaccinate persons with any of the following indications and any person seeking

protection from hepatitis A virus (HAV) infection.

Behavioral: Men who have sex with men and persons who use injection drugs.

Occupational: Persons working with HAV-infected primates or with HAV in a

research laboratory setting.

Medical: Persons with chronic liver disease and persons who receive clotting

factor concentrates.

Other: Persons traveling to or working in countries that have high or

intermediate endemicity of hepatitis A (a list of countries is available at

http://wwwn.cdc.gov/travel/contentdiseases.aspx).

Unvaccinated persons who anticipate close personal contact (e.g., household

contact or regular babysitting) with an international adoptee from a country of

high or intermediate endemicity during the first 60 days after arrival of the

adoptee in the United States should consider vaccination. The first dose of the

2-dose hepatitis A vaccine series should be administered as soon as adoption is

planned, ideally>2 weeks before the arrival of the adoptee.

Single-antigen vaccine formulations should be administered in a 2-dose schedule

at either 0 and 6--12 months (Havrix), or 0 and 6--18 months (Vaqta). If the

combined hepatitis A and hepatitis B vaccine (Twinrix) is used, administer 3

doses at 0, 1, and 6 months; alternatively, a 4-dose schedule, administered on

days 0, 7, and 21--30 followed by a booster dose at month 12 may be used.

10.Hepatitis B vaccination

Vaccinate persons with any of the following indications and any person seeking

protection from hepatitis B virus (HBV) infection.

Behavioral: 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 disease (STD); current or recent injection-drug users; and men who

have sex with men.

Occupational: Health-care personnel and public-safety workers who are exposed to

blood or other potentially infectious body fluids.

Medical: Persons with end-stage renal disease, including patients receiving

hemodialysis; persons with HIV infection; and persons with chronic liver

disease.

Other: Household contacts and sex partners of persons with chronic HBV

infection; clients and staff members of institutions for persons with

developmental disabilities; and international travelers to countries with high

or intermediate prevalence of chronic HBV infection (a list of countries is

available at http://wwwn.cdc.gov/travel/contentdiseases.aspx).

Hepatitis B vaccination is recommended for all adults in the following settings:

STD treatment facilities; HIV testing and treatment facilities; facilities

providing drug-abuse treatment and prevention services; health-care settings

targeting services to injection-drug users or men who have sex with men;

correctional facilities; end-stage renal disease programs and facilities for

chronic hemodialysis patients; and institutions and nonresidential day-care

facilities for persons with developmental disabilities.

Administer or complete a 3-dose series of hepatitis B vaccine to those persons

not previously vaccinated. The second dose should be administered 1 month after

the first dose; the third dose should be administered at least 2 months after

the second dose (and at least 4 months after the first dose). If the combined

hepatitis A and hepatitis B vaccine (Twinrix) is used, administer 3 doses at 0,

1, and 6 months; alternatively, a 4-dose schedule, administered on days 0, 7,

and 21--30 followed by a booster dose at month 12 may be used.

Adult patients receiving hemodialysis or with other immunocompromising

conditions should receive 1 dose of 40 µg/mL (Recombivax HB) administered on a

3-dose schedule or 2 doses of 20 µg/mL (Engerix- administered simultaneously

on a 4-dose schedule at 0, 1, 2, and 6 months.