ACIP Unveils Its 2024 Grownup Immunization Suggestions

— Schedule should be extra user-friendly to enhance vaccine uptake, critics say

by
Katherine Kahn, Employees Author, MedPage At present
January 11, 2024

The CDC’s Advisory Committee on Immunization Practices (ACIP) has up to date its grownup immunization schedule for 2024 to incorporate suggestions on new vaccines for respiratory syncytial virus (RSV) and meningitis, the mpox (previously often called monkeypox) vaccine, and the up to date COVID-19 vaccines.

Key adjustments to this 12 months’s suggestions, printed within the Annals of Internal Medicine, embody the next:

• RSV vaccines: Two RSV vaccines are actually obtainable (Abrysvo and Arexvy). In folks 60 years of age or older, both RSV vaccine might be administered, however ought to be primarily based on shared decision-making that considers threat elements for extreme illness, threat of publicity to RSV, affected person preferences, and medical judgement. Solely Abrysvo is really useful for pregnant individuals at 32 weeks by way of 36 weeks gestation through the 2023-2024 winter season to guard each the recipient and neonates. (Alternatively, infants might be immunized with the monoclonal antibody nirsevimab [Beyfortus]).
• COVID-19 vaccine: All adults ought to obtain at the very least one dose of the up to date 2023-2024 formulation of the COVID-19 vaccine. The variety of doses wanted and intervals between doses might range relying on a affected person’s prior vaccination historical past, whether or not they’re immunocompromised, and the vaccine product used.
• Mpox vaccine: All adults in any age group who’re at elevated threat of changing into contaminated with mpox (e.g., males who’ve intercourse with males, analysis of a sexually transmitted an infection, a number of intercourse companions, and so on.) ought to obtain a two-dose sequence of the mpox vaccine (Jynneos).
• Meningococcal vaccine: MenACWY-D (Menactra) was faraway from the schedule as a result of the product is not obtainable within the U.S. The brand new pentavalent meningococcal vaccine MenACWY-TT/MenB-FHbp (Penbraya) was added to the notes part. This vaccine can be utilized for extra MenACWY and MenB doses if each are given on the identical clinic day and at the very least 6 months have elapsed since the latest Penbraya dose.
• Polio vaccine: If adults are recognized or suspected to be unvaccinated or incompletely vaccinated for polio, they need to full a three-dose main sequence. Nevertheless, most adults who had been born and raised within the U.S. can assume that they had been vaccinated in opposition to polio throughout childhood. If beforehand vaccinated adults are at elevated threat for publicity to polio, they might obtain a single booster of inactivated poliovirus vaccine.
• Hepatitis B vaccine: Individuals ages 60 years or older with out recognized threat elements for hepatitis B might obtain the hepatitis B vaccine sequence, and any grownup over 60 who requests the vaccine ought to obtain it, in addition to these with threat elements.
• Flu vaccine: Routine annual vaccination continues to be really useful for all folks ages 6 months and older who do not need contraindications. All seasonal influenza vaccines for 2023-2024 are quadrivalent. Individuals with egg allergy symptoms can obtain egg-based vaccines applicable for his or her age and well being standing.

The up to date schedule comes on the heels of a recent CDC health advisory alert warning that many adults are usually not up-to-date on influenza, COVID-19, and RSV vaccination heading into the 2023-2024 winter season. As of Dec. 23, 2023 solely 43.8% of adults have obtained an influenza vaccine. As of Dec. 2, 2023, simply 17.2% of adults have obtained the up to date COVID-19 vaccine and 15.9% have obtained the RSV vaccine, in line with the well being alert.

In an accompanying editorial, Scott Ratzan, MD, and different members of the Council for High quality Well being Communication supplied scathing criticism of the CDC’s advanced written and visible presentation of the suggestions. “We can’t keep the current course,” they commented. “The Really helpful Grownup Immunization Schedule article and up to date CDC alert on seasonal flu, COVID-19, and RSV vaccination shortfalls are the newest warning indicators that the CDC must improve its well being communication functionality now. Our nation’s well being and safety rely upon it.”

Referring to the schedule design itself, Ratzan and colleagues commented, “The colour-coded grid of indications and age teams is so full of asterisks and wonderful print that CDC was apparently obliged to supply a second chart to assist the reader use the primary one.”

Additionally they identified that the up to date schedule fails to deal with the important thing situation of co-administration of influenza, RSV, and COVID-19 vaccines, a subject that’s complicated for clinicians and sufferers alike.

Insufficient implementation of the CDC’s grownup vaccination suggestions just isn’t a brand new drawback, Ratzan and colleagues wrote, including that “the newer challenges of misinformation and lack of belief in public well being exacerbate the problem, as does the seductive idea of ‘medical freedom’ now promoted by vaccine skeptics.”