New adult immunization schedule recommends changes to zoster, pneumococcal, and hep B vaccines

The Advisory Committee on Immunization Practices (ACIP) has released its 2022 Recommended Adult Immunization Schedule that includes changes to the zoster, pneumococcal, and hepatitis B vaccines. COVID-19 vaccinations are now included in the notes section of the schedule and can be co-administered with other vaccines. The authors say this year’s schedule is particularly important because many adults have fallen behind on routine vaccinations due to the COVID-19 pandemic. The complete schedule, including changes in the vaccine notes section, is being simultaneously published in Annals of Internal Medicine and in the Center for Disease Control and Prevention’s (CDC) Morbidity and Mortality Weekly Report (MMWR).

The 2022 schedule includes a new step 4 for physicians using the schedule. This step is an appendix that lists all the contraindications and precautions to each of the vaccines listed in the schedule.

• As for other changes, the zoster vaccine is now recommended for use in persons aged 19 years and older who are or will be immunodeficient or immunosuppressed because of disease or therapy.
• The pneumococcal vaccine recommendation is simplified and includes guidance on how to use the new PCV15 and PCV20 vaccines.
• The hepatitis B vaccine recommendation is more inclusive, with all adults aged 19 through 59 years recommended to receive vaccination.
• The “Special situations” section of the “Notes” section outlines the risk-based recommendations on the hepatitis B vaccine for adults aged 60 years and older

In November 2021, ACIP voted to approve the Recommended Adult Immunization Schedule for Ages 19 Years or Older, United States, 2022. The 2022 schedule is also approved by the director of the CDC and by 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, and the Society for Healthcare Epidemiology of America.

The schedule, which can be complex and challenging to implement, features revised content, and has been harmonized with the Child and Adolescent Immunization Schedule.

A series of videos by Dr. Sandra Adamson Fryhofer, MD, MACP explaining ACIP’s process, how to use the schedule, and changes to specific vaccines, including flu, are available at https://www.acponline.org/clinical-information/clinical-resources-products/adult-immunization/adult-immunization-videos.

The adult immunization schedule is published annually to consolidate and summarize updates to ACIP recommendations on vaccination of adults and to assist health care providers in implementing current ACIP recommendations. The authors note that physicians should pay careful attention to the details found in the vaccine notes section, as they clarify who needs what vaccine, when, and at what dose.