ACIP Publishes 2023 Adult Immunization Schedule with important changes to COVID-19 and pneumococcal vaccines

Abstract: http://annals.org/aim/article/doi/10.7326/M23-0041       

URL goes live when the embargo lifts

The Advisory Committee on Immunization Practices (ACIP) has released its 2023 Recommended Adult Immunization Schedule containing important updates to the routine vaccination schedule. The COVID-19 vaccine has been added as a row in the tables and has been added in the notes section. Additionally, pneumococcal vaccine recommendations for adults who have previously received PCV13 and PPSV23 have been included.  While routine poliovirus vaccination of adults residing in the United States is not necessary, the 2023 schedule now includes a new poliovirus vaccination section that describes the use of inactivated poliovirus vaccine (IPV) in adults with increased risk of exposure to polioviruses. These and other changes are detailed in the full schedule, which is simultaneously published in Annals of Internal Medicine and in the Center for Disease Control and Prevention’s (CDC) Morbidity and Mortality Weekly Report (MMWR).

For the first time in history, the COVID-19 vaccine is featured in the tables and in the notes section of the schedule.  Special links added to the schedule will aid decision-making around COVID-19 boosters, which many may find they still need.

It is important to note that for COVID-19, mRNA and protein-based vaccines are included but viral vector vaccines are not listed on the cover page table of available vaccines. For those who are moderately or severely immunocompromised, the schedule includes links to COVID pre-exposure prophylaxis (PrEP) with monoclonal antibodies. While the initial vaccine series and boosters are recommended, this does not mean they are federally mandated. COVID-19 vaccine mandates are decided by individual jurisdictions.

The new schedule includes new options for pneumococcal vaccination which incorporate the higher valent PCV20 vaccine now available, should patients meet certain criteria as explained in the notes. The schedule also has a link to a new pneumococcal vaccination app to aid in making pneumococcal vaccination recommendations for patients.

In another historical change, the ACIP adult schedule has included current polio vaccine recommendations for adults. Adults who have completed a 3-dose polio vaccination series but are at increased risk for infection may receive one lifetime IPV booster. Those who are at increased risk of exposure to poliovirus without documentation of a completed polio vaccination series should talk to their doctor about how many doses they should receive to complete a 3-dose series.

The ACIP schedule is presented in four sections, making it simple for vaccine administrators to use. The schedule can be used to determine recommended vaccines by age; to assess the need for additional recommended vaccines by medical condition or other indication; to review vaccine types, frequencies, intervals, and considerations for special situations; and to review contraindications and precautions by vaccine types.

In October 2022, ACIP voted to approve the Recommended Adult Immunization Schedule for Ages 19 Years or Older, United States, 2023. The 2023 schedule is 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 America. For the first time this year, the American Pharmacists Association also approved the schedule. According to the committee, the pandemic helped to solidify pharmacists as important partners in vaccine administration.

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. 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.

 

Media notes: For an embargoed PDF please contact Angela Collom at [email protected]. To speak with CDC’s corresponding author, please email [email protected]. To speak with ACIP liaison, Dr. Sandra Fryhofer, please contact her directly at [email protected].