Mark Freedman, DVM, MPH; Andrew Kroger, MD, MPH; Paul Hunter, MD; Kevin A. Ault, MD; for the Advisory Committee on Immunization Practices †
Disclosures: To ensure the integrity of the ACIP, the U.S. Department of Health and Human Services has taken steps to ensure 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 preappointment and postappointment 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, 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. Dr. Freedman and Dr. Kroger have nothing to disclose. Dr. Hunter reports travel expenses to ACIP meetings paid by the Centers for Disease Control and Prevention; grants from the Wisconsin Department of Health Services for speaking to clinicians in Milwaukee about adult vaccinations; and board membership in Immunize Milwaukee! (www.immunizationcoalitions.org/network-members/?coal=immunize-milwaukee_oid457), an ad hoc, nonincorporated, unfunded community coalition seeking to increase vaccination rates in metro Milwaukee. Dr. Ault reports travel expenses to the ACIP meetings paid by the Centers for Disease Control and Prevention and the American College of Obstetricians and
Gynecologists (ACOG). Dr. Ault is also on committees for ACOG and the National Cancer Institute and has travel expenses paid by those organizations. Dr. Ault was a member of a data safety and monitoring committee for an immunization trial and received consultant fees and travel expenses from ACI Clinical for this activity. Dr. Ault is also a volunteer medical advisor for “Families Fighting Flu” (www.familiesfightingflu.org) and receives no compensation from that nonprofit organization. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M20-0046.
Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that her spouse has stock options/holdings with Targeted Diagnostics and Therapeutics. Darren B. Taichman, MD, PhD, Executive Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Christina C. Wee, MD, MPH, Deputy Editor, reports employment with Beth Israel Deaconess Medical Center. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Yu-Xiao Yang, MD, MSCE, Deputy Editor, reports that he has no financial relationships or interest to disclose.
Corresponding Author: Mark Freedman, DVM, MPH, Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mailstop H24-6, Atlanta, GA 30329-4027; e-mail, email@example.com.
Current Author Addresses: Dr. Freedman: Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mailstop H24-6, Atlanta, GA 30329-4027.
Dr. Hunter: City of Milwaukee Health Department, 1100 Delaplaine Court, Madison, WI 53715.
Dr. Kroger: Centers for Disease Control and Prevention, 1600 Clifton Road, MS H24-6, Atlanta, GA 30329.
Dr. Ault: University of Kansas Medical Center, Department of Obstetrics and Gynecology, 3901 Rainbow Boulevard, Mailstop 2028, Kansas City, KS 66160.
Author Contributions: Conception and design: M.S. Freedman.
Analysis and interpretation of the data: K. Ault, P.H. Hunter.
Drafting of the article: M.S. Freedman.
Critical revision for important intellectual content: K. Ault, P.H. Hunter, A. Kroger.
Final approval of the article: K. Ault, M.S. Freedman, P.H. Hunter, A. Kroger.
Administrative, technical, or logistic support: A. Kroger.
Collection and assembly of data: K. Ault, M.S. Freedman, A. Kroger.
Recommended Adult Immunization Schedule for Ages 19 Years or Older, United States, 2020.
HPV is a very common sexually transmitted infection. Most HPV infections are transient and asymptomatic and cause no clinical problems.
Although new HPV infections are most commonly acquired in adolescence and young adulthood, some adults are at risk for new HPV infections. At any age, having a new sex partner is a risk factor for acquiring a new HPV infection.
Persons who are in a long-term, mutually monogamous sexual partnership are not likely to acquire a new HPV infection.
Most sexually active adults have been exposed to some HPV types, although not necessarily all of the HPV types targeted by vaccination.
No clinical antibody test can determine whether a person is already immune or still susceptible to any given HPV type.
HPV vaccine efficacy is high among persons who have not been exposed to vaccine-type HPV before vaccination.
Vaccine effectiveness might be low among persons with risk factors for HPV infection or disease (e.g., adults with multiple lifetime sex partners and likely previous infection with vaccine-type HPV), as well as among persons with certain immunocompromising conditions.
HPV vaccines are prophylactic (i.e., they prevent new HPV infections). They do not prevent progression of HPV infection to disease, decrease time to clearance of HPV infection, or treat HPV-related disease.
PCV13 is a safe and potentially effective vaccine for older adults.
The following adults age 65 years and older are potentially at increased risk for exposure to PCV13 serotypes and might attain higher than average benefit from PCV13 vaccination. Clinicians and practices caring for many patients in these groups may consider regularly offering PCV13 to their patients age 65 years and older who have not previously received PCV13:
—Persons residing in nursing homes or other long-term care facilities.
—Persons residing in settings with low pediatric PCV13 uptake.
—Persons traveling to settings with no pediatric PCV13 program.
Incidence of PCV13-type invasive pneumococcal disease and pneumonia increases with increasing age and is higher among persons with chronic heart, lung, or liver disease, diabetes, or alcoholism, and those who smoke cigarettes or who have more than one chronic medical condition. Although indirect effects from pediatric PCV13 use were documented for these groups of adults and were comparable to those observed among healthy adults, the residual PCV13-type disease burden remains higher in these groups. Clinicians and practices caring for patients with these medical conditions may consider offering PCV13 to such patients who are age 65 years and older and who have not previously received PCV13.
Freedman M, Kroger A, Hunter P, et al, for the Advisory Committee on Immunization Practices. Recommended Adult Immunization Schedule, United States, 2020*. Ann Intern Med. 2020;:. [Epub ahead of print 4 February 2020]. doi: https://doi.org/10.7326/M20-0046
Download citation file:
Published: Ann Intern Med. 2020.
Guidelines, Infectious Disease, Prevention/Screening, Vaccines/Immunization.
Results provided by:
Copyright © 2020 American College of Physicians. All Rights Reserved.
Print ISSN: 0003-4819 | Online ISSN: 1539-3704
Conditions of Use