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Clinical Guidelines |

Advisory Committee on Immunization Practices Recommended Immunization Schedule for Adults Aged 19 Years or Older: United States, 2015*Recommended Adult Immunization Schedule: United States, 2015 FREE

David K. Kim, MD; Carolyn B. Bridges, MD; Kathleen H. Harriman, PhD, MPH, RN, on behalf of the Advisory Committee on Immunization Practices
[+] Article, Author, and Disclosure Information

* The 2015 ACIP adult immunization schedule appeared in Annals of Internal Medicine and on the Centers for Disease Control and Prevention Web site at www.cdc.gov/vaccines. A summary of changes in the 2015 adult immunization schedule is published concurrently in the Morbidity and Mortality Weekly Report. Readers who wish to cite the 2015 adult immunization schedule should use the following citation: Kim DK, Bridges CB, Harriman HK; Advisory Committee on Immunization Practices. Advisory Committee on Immunization Practices recommended immunization schedule for adults aged 19 years or older: United States, 2015. Ann Intern Med. 2015:162:214-23. doi:10.7326/M14-5147

† The 2015 adult immunization schedule was prepared by the Advisory Committee on Immunization Practices (ACIP); ACIP Adult Immunization Work Group; David K. Kim, MD (Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia), Carolyn B. Bridges, MD (Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia), and Kathleen H. Harriman, PhD, MPH, RN (California Department of Public Health, Richmond, California). Drs. Kim, Bridges, and Harriman authored this work. For a list of contributor members of the ACIP and the ACIP Adult Immunization Work Group, see the Appendix.


From the Centers for Disease Control and Prevention, Atlanta, Georgia.

Disclosures: To assure the integrity of the ACIP, the U.S. Department of Health and Human Services has taken steps to ensure that there is technical adherence to ethics statutes and regulations regarding financial conflicts of interest. Concerns regarding the potential for the appearance of a conflict are addressed, or avoided altogether, through pre- and post-appointment considerations. Individuals with particular vaccine-related interests will not be considered for appointment to the committee. Potential nominees are screened for conflicts of interest and, if any are found, they are asked to divest or forgo certain vaccine-related activities. In addition, at the beginning of each ACIP meeting, each member is asked to declare his or her conflicts. Members with conflicts are not permitted to vote if the conflict involves the vaccine or biological being voted on. Details can be found at www.cdc.gov/vaccines/acip/committee/structure-role.html. Drs. Kim, Bridges, and Harriman authored this work. Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?ms Num=M14-2755.

Corresponding Author: David K. Kim, MD, Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mailstop A-19, Atlanta, GA 30333; e-mail, dkim@cdc.gov.

Current Author Addresses: Dr. Kim: Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mailstop A-19, Atlanta, GA 30333.

Dr. Bridges: Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mailstop A-19, Atlanta, GA 30333.

Dr. Harriman: California Department of Public Health, 850 Marina Bay Parkway, Building P, Second Floor, Richmond, CA 94804.

Author Contributions: Conception and design: D.K. Kim, C.B. Bridges.

Drafting of the article: D.K. Kim.

Critical revision of the article for important intellectual content: D.K. Kim, C.B. Bridges, K.H. Harriman.

Final approval of the article: D.K. Kim, C.B. Bridges, K.H. Harriman.

Administrative, technical, or logistic support: D.K. Kim, C.B. Bridges.

Collection and assembly of data: D.K. Kim.


Ann Intern Med. 2015;162(3):214-223. doi:10.7326/M14-2755
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In October 2014, the Advisory Committee on Immunization Practices (ACIP) approved the Recommended Adult Immunization Schedule, United States, 2015. This schedule provides a summary of ACIP recommendations for the use of vaccines routinely recommended for adults in 2 figures (Figures 1 and 2), footnotes for each vaccine, and a table that describes primary contraindications and precautions for commonly used vaccines for adults (Table 1). Changes in the 2015 adult immunization schedule from the 2014 schedule include the September 2014 recommendation for routine administration of the 13-valent pneumococcal conjugate vaccine (PCV13) in series with the 23-valent pneumococcal polysaccharide vaccine (PPSV23) for all adults aged 65 years or older (1), the August 2014 revision on contraindications and precautions for the live attenuated influenza vaccine (LAIV) (2), and the October 2014 approval by the U.S. Food and Drug Administration (FDA) to expand the approved age for use of recombinant influenza vaccine (RIV) (3). The 2015 adult immunization schedule was also reviewed and approved by the American College of Physicians, American Academy of Family Physicians, American College of Obstetricians and Gynecologists, and American College of Nurse-Midwives.

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Figure 1.

Recommended adult immunization schedule, by vaccine and age group, for adults aged 19 years or older: United States, 2015.

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Figure 2.

Vaccines that might be indicated for adults aged 19 years or older, based on medical and other indications: United States, 2015.

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Footnotes.

Footnotes to the recommended adult immunization schedule for adults aged 19 years or older: United States, 2015.

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Table Jump PlaceholderTable 1. Contraindications and Precautions for Commonly Used Vaccines in Adults*†‡ 

The 2015 adult immunization schedule contains the following changes from 2014:

Figure 1, the recommended adult immunization schedule by vaccine and age group, has been revised to designate PCV13 for adults aged 65 years or older as “recommended” (from the previous “recommended if some other risk is present”). Figure 2, showing vaccines that might be indicated for adults on the basis of medical and other indications, is unchanged.

• The footnotes for pneumococcal vaccination have been revised to provide algorithmic, patient-based guidance for the health care provider to arrive at appropriate vaccination decisions for individual patients.

• The footnote for influenza vaccination has been updated to indicate that adults aged 18 years or older (changed from adults aged 18 through 49 years) can receive RIV. A list of updated available influenza vaccines can be found at www.cdc.gov/flu/protect/vaccine/vaccines.htm.

Table 1, showing contraindications and precautions to commonly used vaccines in adults, has been revised to update the section on LAIV to reflect the changes in the ACIP recommendations for the 2014–2015 influenza season. These changes include moving “influenza antiviral use within the last 48 hours” from the precautions column to the contraindications column, and moving asthma and chronic lung diseases; cardiovascular, renal, and hepatic diseases; and diabetes and other conditions from the contraindications column to the precautions column. Immune suppression, egg allergy, and pregnancy remain contraindications for LAIV.

Details on these updates and information on other vaccines recommended for adults can be found in the Recommended Adult Immunization Schedule, United States, 2015 at www.cdc.gov/vaccines/schedules. The full ACIP recommendations for each vaccine are not included in the schedule owing to space limitations but can be found at www.cdc.gov/vaccines/hcp/acip-recs/index.html.

In the United States, despite extensive and targeted recommendations for use of PCV13 and PPSV23 for age and risk groups, Streptococcus pneumoniae (pneumococcus) infection continues to be a major cause of morbidity, including bacteremia, meningitis, and pneumonia. Approximately 40 000 cases of invasive pneumococcal disease (IPD) occur annually, 13 500 of which occur among adults aged 65 years or older (4; Centers for Disease Control and Prevention. Active Bacterial Core Surveillance: Emerging Infections Program Network. Unpublished data, 2013). Although the incidence of IPD caused by serotypes unique to PCV13 among adults aged 65 years or older in 2013 had declined by approximately 50% compared with 2010 owing to indirect effects of the pediatric pneumococcal vaccination program, approximately 20% to 25% of IPD cases (4; Centers for Disease Control and Prevention. Active Bacterial Core Surveillance: Emerging Infections Program Network. Unpublished data, 2013) and 10% of community-acquired pneumonia cases (5) are caused by PCV13 serotypes and are potentially preventable with the use of PCV13. PCV13 has shown 45.6% efficacy against vaccine-type pneumococcal pneumonia, 45.0% efficacy against vaccine-type nonbacteremic pneumococcal pneumonia, and 75.0% efficacy against vaccine-type IPD (5). In addition, 2 randomized, multicenter immunogenicity studies conducted in the United States and Europe among older adults showed that PCV13 induced an immune response similar to that of PPSV23 (6).

The ACIP has recommended PPSV23 for adults with certain high-risk conditions and for all adults aged 65 years or older since 1997. In 2010, the ACIP added smoking and asthma as indications for PPSV23 among adults (7). Adults aged 19 through 64 years with certain high-risk conditions, including cochlear implant, cerebrospinal fluid leak, diabetes, and chronic heart or lung disease, are recommended to receive 1 dose of PPSV23 at the time of diagnosis. A second dose of PPSV23 is then recommended at age 65 years if at least 5 years have passed since the first dose.

In 2012, the ACIP recommended a routine use of PCV13 for adults aged 19 years or older with immunocompromising conditions, anatomical or functional asplenia, cochlear implant, or cerebrospinal fluid leak (8). These adults are then recommended to receive a dose of PPSV23 at least 8 weeks later, followed by a second dose of PPSV23 at least 5 years after the first PPSV23 dose. A third dose of PPSV23 is recommended for them at age 65 years or older if the second dose was received at age younger than 65 years and at least 5 years have passed since the second dose. Definitions of immunocompromising conditions, anatomical or functional asplenia, and chronic health conditions are as follows:

• Immunocompromising conditions that are indications for PCV13 and PPSV23 are congenital or acquired immunodeficiency (including B- or T-lymphocyte deficiency, complement deficiencies, and phagocytic disorders excluding chronic granulomatous disease), HIV infection, chronic renal failure, nephrotic syndrome, leukemia, lymphoma, Hodgkin disease, generalized malignancy, multiple myeloma, solid-organ transplant, and iatrogenic immunosuppression (including long-term systemic corticosteroids and radiation therapy). If indicated, administer pneumococcal vaccines at least 2 weeks before immunosuppressive therapy, and as soon as possible to adults who are newly diagnosed with asymptomatic or symptomatic HIV infection.

• Anatomical or functional asplenia conditions that are indications for PCV13 and PPSV23 are sickle cell disease and other hemoglobinopathies, congenital or acquired asplenia, splenic dysfunction, and splenectomy. If indicated, administer pneumococcal vaccines at least 2 weeks before an elective splenectomy.

• Chronic health conditions that are indications for PPSV23 for adults aged 19 through 64 years are chronic heart disease (including congestive heart failure and cardiomyopathies, excluding hypertension), chronic lung disease (including chronic obstructive lung disease, emphysema, and asthma), chronic liver disease (including cirrhosis), alcoholism, and diabetes mellitus.

In August 2014, the ACIP recommended a routine use of PCV13 in series with PPSV23 for all adults aged 65 years or older (1). Adults aged 65 years or older who were not previously vaccinated with PCV13 are recommended to receive PCV13, followed by PPSV23 6 to 12 months later.

Vaccinating adults with PCV13 and PPSV23 can be challenging because of complexities in the timing of the 2 vaccines, frequency, and intervals between doses depending on a patient's age, health conditions, vaccination history, and other factors. Figure 3 contains a schematic schedule that describes when PCV13 and PPSV23 should be administered for adults. Table 2 contains a summary of the recommended pneumococcal vaccination schedule as determined by the patient's age, health conditions, vaccination history, and other factors. In administering pneumococcal vaccines to adult patients, health care providers should be aware of the following:

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Figure 3.

Recommended pneumococcal vaccination schedule and intervals, by age, health condition, and other risks.

The dashed line represents the interval between the two PPSV23 doses. PCV13 = 13-valent pneumococcal conjugate vaccine; PPSV23 = 23-valent pneumococcal polysaccharide vaccine.

* Chronic health conditions are defined as chronic heart disease (including congestive heart failure and cardiomyopathies, excluding hypertension), chronic lung disease (including chronic obstructive lung disease, emphysema, and asthma), chronic liver disease (including cirrhosis), alcoholism, or diabetes mellitus.

† Immunocompromising conditions are defined as congenital or acquired immunodeficiency (including B- or T-lymphocyte deficiency, complement deficiencies, and phagocytic disorders excluding chronic granulomatous disease), HIV infection, chronic renal failure, nephrotic syndrome, leukemia, lymphoma, Hodgkin disease, generalized malignancy, multiple myeloma, solid organ transplant, and iatrogenic immunosuppression (including long-term systemic corticosteroids and radiation therapy).

‡ Anatomical or functional asplenia is defined as sickle cell disease and other hemoglobinopathies, congenital or acquired asplenia, splenic dysfunction, and splenectomy.

§ Administer PPSV23 as soon as possible if the 6- to 12-month time window has passed.

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Table Jump PlaceholderTable 2. Pneumococcal Vaccination Recommendations, by Patient Age, Health Condition, Pneumococcal Vaccination History, and Other Risks 

• One dose of PCV13 is indicated for all adults; the timing of PCV13 is dependent on their age and health conditions.

• The maximum number of doses of PPSV23 that an adult should receive is:

—Three, if he or she has an immunocompromising condition or anatomical or functional asplenia: 2 doses at age 19 through 64 years, and 1 dose at age 65 years or older.

—Two, if he or she has chronic health conditions, is a smoker or a resident of a long-term care or nursing home facility, or has cerebrospinal fluid leak or cochlear transplant: 1 dose at age 19 through 64 years and 1 dose at age 65 years or older.

—One, if he or she has none of the indicated health condition or risk: at age 65 years or older.

• No additional doses of PPSV23 are indicated for adults who were vaccinated with PPSV23 at or after age 65 years.

• When both PCV13 and PPSV23 are indicated, PCV13 should be administered first; PCV13 and PPSV23 should not be administered during the same visit.

• For adults whose pneumococcal vaccination history is incomplete or unknown, both PCV13 and PPSV23 should be administered when indicated (but not during the same visit).

• Note that PPSV23 should be administered 6 to 12 months after PCV13 for adults aged 65 years or older; but for adults aged 19 through 64 years with immunocompromising conditions, anatomical or functional asplenia, or cerebrospinal fluid leak or cochlear implant, PPSV23 should be administered at least 8 weeks after PCV13.

In 2013, pneumococcal vaccination coverage rates for adults aged 65 years or older and for adults aged 19 through 64 years at high risk were 59.7% and 21.2%, respectively, similar to 2012 (9). These pneumococcal vaccination coverage rates remain well below the Healthy People 2020 target levels of 90% for adults aged 65 years or older and 60% for adults aged 18 through 64 years who are at high risk. At the intersection of these low pneumococcal vaccination coverage rates and the availability of safe and effective pneumococcal vaccines, health care providers have an opportunity to make a significant impact in reducing the morbidity of pneumococcal disease among adults by ensuring that their patients are up to date on their pneumococcal vaccinations.

Vaccination coverage rates for other vaccines for adults are also low; for example, only 24% of adults aged 60 years or older have received the herpes zoster vaccine, and 26% of adults aged 19 through 59 years who have diabetes have received the hepatitis B vaccine (9). In addition to pneumococcal vaccines, health care providers should ensure that their adult patients are aware of and receive recommendations for other vaccines they need. A recommendation by a patient's health care provider for needed vaccines is a strong predictor of the patient receiving recommended vaccines (10). Health care providers should implement the adult immunization practice standards (11) and routinely assess their patients' immunization status, strongly recommend the vaccines patients need, administer the vaccines or refer patients to a vaccinating provider, and document vaccinations administered in state immunization information systems (commonly known as “vaccine registries”) to increase vaccination rates among adults and reduce illness, hospitalizations, and deaths from vaccine-preventable diseases.

Appendices

Appendix
About the ACIP

Recommendations 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 use of vaccines and related agents for the control of 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 greatest 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, and the American College of Physicians (ACP). ACIP recommendations adopted by the CDC Director become agency guidelines on the date published in the Morbidity and Mortality Weekly Report (MMWR). Additional information on ACIP is available at www.cdc.gov/vaccines/acip.

Members of the ACIP

Jonathan Temte, MD, PhD (Chair), University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; Larry K. Pickering, MD (Executive Secretary), Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, Atlanta, Georgia; Nancy Bennett, MD, MS, University of Rochester School of Medicine and Dentistry, Rochester, New York; Edward Belongia, MD, Marshfield Clinic Research Foundation, Marshfield, Wisconsin; Joseph A. Bocchini Jr., MD, Louisiana State University Health Sciences Center, Shreveport, Louisiana; Douglas Campos-Outcalt, MD, MPA, University of Arizona College of Medicine–Phoenix, Phoenix, Arizona; Kathleen H. Harriman, PhD, MPH, RN, California Department of Public Health, Richmond, California; Lee H. Harrison, MD, University of Pittsburgh, Pittsburgh, Pennsylvania; Ruth A. Karron, MD, Center for Immunization Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Allison Kempe, MD, University of Colorado School of Medicine, The Children's Hospital of Denver, Denver, Colorado; Cynthia Pellegrini, March of Dimes, Washington, District of Columbia; Arthur L. Reingold, MD, University of California School of Public Health, Berkeley, California; Laura E. Riley, MD, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts; José R. Romero, MD, University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Arkansas Children's Hospital Research Institute, Little Rock, Arkansas; Lorry Rubin, MD, Steven and Alexandra Cohen Children's Medical Center of New York, North Shore–Long Island Jewish Health System, New Hyde Park, New York; Marietta Vázquez, MD, Yale University School of Medicine, New Haven, Connecticut. A list of current ACIP members is available at www.cdc.gov/vaccines/acip/committee/members.html.

ACIP Adult Immunization Work Group

Work Group Chair: Kathleen H. Harriman, PhD, MPH, RN, Richmond, California.

Work Group Members: John Epling, MD, MSEd, Syracuse, New York; Sandra Fryhofer, MD, Atlanta, Georgia; Jane Kim, MD, Durham, North Carolina; Laura Pinkston Koenigs, MD, Springfield, Massachusetts; Marie-Michele Leger, MPH, PA-C, Alexandria, Virginia; Susan M. Lett, MD, Boston, Massachusetts; Robert Palinkas, MD, Urbana, Illinois; Gregory Poland, MD, Rochester, Minnesota; Joni Reynolds, MPH, Denver, Colorado; Laura E. Riley, MD, Boston, Massachusetts; William Schaffner, MD, Nashville, Tennessee; Kenneth Schmader, MD, Durham, North Carolina; Rhoda Sperling, MD, New York, New York.

Work Group Contributors: Carolyn B. Bridges, MD, Atlanta, Georgia; Elizabeth Briere, MD, MPH, Atlanta, Georgia; Amy Fiebelkorn, MSN, MPH, Atlanta, Georgia; Lisa Grohskopf, MD, MPH, Atlanta, Georgia; Craig Hales, MD, MPH, Atlanta, Georgia; Rafael Harpaz, MD, MPH, Atlanta, Georgia; Charles LeBaron, MD, Atlanta, Georgia; Jennifer L. Liang, DVM, MPVM, Atlanta, Georgia; Jessica MacNeil, MPH, Atlanta, Georgia; Lauri Markowitz, MD, Atlanta, Georgia; Matthew Moore, MD, Atlanta, Georgia; Tamara Pilishvili, MPH, Atlanta, Georgia; Sarah Schillie, MD, Atlanta, Georgia; Raymond A. Strikas, MD, MPH, Atlanta, Georgia; Walter W. Williams, MD, MPH, Atlanta, Georgia.

Work Group Consultants: Tamera Coyne-Beasley, MD, MPH, Chapel Hill, North Carolina; Molly Howell, MPH, Bismarck, North Dakota; Linda Kinsinger, MD, MPH, Durham, North Carolina; Diane Peterson, St. Paul, Minnesota; Litjen Tan, PhD, Chicago, Illinois.

Work Group Secretariat: David K. Kim, MD, Atlanta, Georgia.

References

Tomcsyk S, Bennett NM, Stoecker C, Gierke R, Moore MR, Whitney CG, et al. Use of 13-valent pneumococcal conjugate vaccine and 23-valent pneumococcal polysaccharide vaccine among adults aged ≥65 years: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR.. 2014; 63:822-5.
PubMed
 
Grohskopf LA, Olsen SJ, Sokolow LZ, Bresee JS, Cox NJ, Broder KR, et al, Centers for Disease Control and Prevention. Prevention and control of seasonal influenza with vaccines: recommendations of the Advisory Committee on Immunization Practices (ACIP)—United States, 2014-15 influenza season. MMWR. 2014; 63:691-7.
PubMed
 
U.S. Food and Drug Administration.  October 29, 2014 approval letter—Flublok. Silver Spring, MD: U.S. Food and Drug Administration; 2014. Accessed at www.fda.gov/BiologicsBloodVaccines/Vaccines/ApprovedProducts/ucm421396.htm on 10 December 2014.
 
Centers for Disease Control and Prevention.  Active Bacterial Core Surveillance (ABCs) report, Emerging Infections Program Network: Streptococcus pneumoniae, 2010. Accessed at www.cdc.gov/abcs/reports-findings/survreports/spneu10.pdf on 10 December 2014.
 
Bonten M, Bolkenbaas M, Huijts S, Webber C, Gault S, Gruber W, et al. Community Acquired Pneumonia Immunization Trial in Adults (CAPiTA) [abstract]. Pneumonia. 2014; 3:95 Abstract 0541.
 
U.S. Food and Drug Administration. Vaccines and Related Biological Products Advisory Committee (VRBPAC) adult indication briefing document: Prevnar 13. Silver Spring, MD: U.S. Food and Drug Administration; 2011.
 
Centers for Disease Control and Prevention (CDC); Advisory Committee on Immunization Practices. Updated recommendations for prevention of invasive pneumococcal disease among adults using the 23-valent pneumococcal polysaccharide vaccine (PPSV23). MMWR. 2010; 59:1102-6.
PubMed
 
Centers for Disease Control and Prevention (CDC). Use of 13-valent pneumococcal conjugate vaccine and 23-valent pneumococcal polysaccharide vaccine for adults with immunocompromising conditions: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR. 2012; 61:816-9.
PubMed
 
Williams WW, Lu PF, O'Halloran A, Bridges CB, Kim DK, Pilishvili T, et al. Noninfluenza vaccination coverage among adults—United States, 2013. MMWR. 2015.
 
Miller BL, Kretsinger K, Euler GL, Lu PJ, Ahmed F. Barriers to early uptake of tetanus, diphtheria and acellular pertussis vaccine (Tdap) among adults—United States, 2005-2007. Vaccine. 2011; 29:3850-6.
PubMed
CrossRef
 
Update on the National Vaccine Advisory Committee Standards for Adult Immunization Practice. 10 September 2013. Accessed at www.hhs.gov/nvpo/nvac/reports/nvacstandards.pdf on 10 December 2014.
 

Figures

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Figure 1.

Recommended adult immunization schedule, by vaccine and age group, for adults aged 19 years or older: United States, 2015.

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Figure 2.

Vaccines that might be indicated for adults aged 19 years or older, based on medical and other indications: United States, 2015.

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Grahic Jump Location
Footnotes.

Footnotes to the recommended adult immunization schedule for adults aged 19 years or older: United States, 2015.

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Figure 3.

Recommended pneumococcal vaccination schedule and intervals, by age, health condition, and other risks.

The dashed line represents the interval between the two PPSV23 doses. PCV13 = 13-valent pneumococcal conjugate vaccine; PPSV23 = 23-valent pneumococcal polysaccharide vaccine.

* Chronic health conditions are defined as chronic heart disease (including congestive heart failure and cardiomyopathies, excluding hypertension), chronic lung disease (including chronic obstructive lung disease, emphysema, and asthma), chronic liver disease (including cirrhosis), alcoholism, or diabetes mellitus.

† Immunocompromising conditions are defined as congenital or acquired immunodeficiency (including B- or T-lymphocyte deficiency, complement deficiencies, and phagocytic disorders excluding chronic granulomatous disease), HIV infection, chronic renal failure, nephrotic syndrome, leukemia, lymphoma, Hodgkin disease, generalized malignancy, multiple myeloma, solid organ transplant, and iatrogenic immunosuppression (including long-term systemic corticosteroids and radiation therapy).

‡ Anatomical or functional asplenia is defined as sickle cell disease and other hemoglobinopathies, congenital or acquired asplenia, splenic dysfunction, and splenectomy.

§ Administer PPSV23 as soon as possible if the 6- to 12-month time window has passed.

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Tables

Table Jump PlaceholderTable 1. Contraindications and Precautions for Commonly Used Vaccines in Adults*†‡ 
Table Jump PlaceholderTable 2. Pneumococcal Vaccination Recommendations, by Patient Age, Health Condition, Pneumococcal Vaccination History, and Other Risks 

References

Tomcsyk S, Bennett NM, Stoecker C, Gierke R, Moore MR, Whitney CG, et al. Use of 13-valent pneumococcal conjugate vaccine and 23-valent pneumococcal polysaccharide vaccine among adults aged ≥65 years: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR.. 2014; 63:822-5.
PubMed
 
Grohskopf LA, Olsen SJ, Sokolow LZ, Bresee JS, Cox NJ, Broder KR, et al, Centers for Disease Control and Prevention. Prevention and control of seasonal influenza with vaccines: recommendations of the Advisory Committee on Immunization Practices (ACIP)—United States, 2014-15 influenza season. MMWR. 2014; 63:691-7.
PubMed
 
U.S. Food and Drug Administration.  October 29, 2014 approval letter—Flublok. Silver Spring, MD: U.S. Food and Drug Administration; 2014. Accessed at www.fda.gov/BiologicsBloodVaccines/Vaccines/ApprovedProducts/ucm421396.htm on 10 December 2014.
 
Centers for Disease Control and Prevention.  Active Bacterial Core Surveillance (ABCs) report, Emerging Infections Program Network: Streptococcus pneumoniae, 2010. Accessed at www.cdc.gov/abcs/reports-findings/survreports/spneu10.pdf on 10 December 2014.
 
Bonten M, Bolkenbaas M, Huijts S, Webber C, Gault S, Gruber W, et al. Community Acquired Pneumonia Immunization Trial in Adults (CAPiTA) [abstract]. Pneumonia. 2014; 3:95 Abstract 0541.
 
U.S. Food and Drug Administration. Vaccines and Related Biological Products Advisory Committee (VRBPAC) adult indication briefing document: Prevnar 13. Silver Spring, MD: U.S. Food and Drug Administration; 2011.
 
Centers for Disease Control and Prevention (CDC); Advisory Committee on Immunization Practices. Updated recommendations for prevention of invasive pneumococcal disease among adults using the 23-valent pneumococcal polysaccharide vaccine (PPSV23). MMWR. 2010; 59:1102-6.
PubMed
 
Centers for Disease Control and Prevention (CDC). Use of 13-valent pneumococcal conjugate vaccine and 23-valent pneumococcal polysaccharide vaccine for adults with immunocompromising conditions: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR. 2012; 61:816-9.
PubMed
 
Williams WW, Lu PF, O'Halloran A, Bridges CB, Kim DK, Pilishvili T, et al. Noninfluenza vaccination coverage among adults—United States, 2013. MMWR. 2015.
 
Miller BL, Kretsinger K, Euler GL, Lu PJ, Ahmed F. Barriers to early uptake of tetanus, diphtheria and acellular pertussis vaccine (Tdap) among adults—United States, 2005-2007. Vaccine. 2011; 29:3850-6.
PubMed
CrossRef
 
Update on the National Vaccine Advisory Committee Standards for Adult Immunization Practice. 10 September 2013. Accessed at www.hhs.gov/nvpo/nvac/reports/nvacstandards.pdf on 10 December 2014.
 

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