U.S. Vaccine Guidelines for Flu, HPV Updated
CDC panel revises immunization advisory for vaccines affecting adults
Roll up your sleeves, America. A national advisory panel of the U.S. Centers for Disease Control and Prevention has released its 2017 advisory for recommended shots affecting adults.
This year's advisory revises guidance on seasonal flu shots by eliminating nasal flu vaccines and modifying flu-shot advice for people with egg allergy. It also tweaks recommendations for vaccines against human papillomavirus (HPV), hepatitis B and meningococcal disease.
Doctors use the annually updated vaccine schedule to ensure that patients receive the right vaccines for their age, medical condition and other risk factors. The entire list includes 13 vaccinations.
"All adults need immunizations to help them prevent getting and spreading serious disease that could result in poor health, missed work, medical bills, and not being able to care for family," said the report's lead author, Dr. David Kim. He is deputy associate director for adult immunizations in the CDC's Immunization Services Division.
The CDC sets the adult immunization schedule based on recommendations from the Advisory Committee on Immunization Practices (ACIP), a group of medical and public health experts whose advice reflects the latest science.
Here are the major changes you need to know about:
No more nasal flu vaccine. Unlike traditional flu shots made from dead virus, the nasal flu vaccine, marketed as FluMist, is made from a weakened form of influenza virus. Studies have found it largely ineffective.
"It's not used a ton in adult medicine," said Dr. Laura Hurley, who was not involved in setting the new guidelines. She is an assistant professor of general internal medicine at the University of Colorado School of Medicine.
Flu vaccine for people with egg allergy. The "major change" is that egg-allergic people, whether they have mild or more serious allergy, "can receive any age-appropriate" flu vaccine, said Dr. Sandra Fryhofer, a general internist in Atlanta. She is the American College of Physicians' liaison to the ACIP and served on its adult immunization work group.
Last year, people with more serious egg allergy were advised to stick with an egg-free flu vaccine, she explained.
The new guidance states that even people who develop symptoms like swelling, lightheadedness or breathing difficulties may get either type of flu shot. But they should get the shot under supervision of a health care provider who is able to recognize and manage severe allergic conditions, the committee advises.
HPV vaccine for adolescents. Young people who receive their first dose of the HPV vaccine before age 15 and the second dose at least 5 months later may be vaccinated in just two doses, instead the three as was previously recommended.
The vaccine protects against cervical cancer and a number of other tumors linked to the human papillomavirus (HPV).
On Tuesday, the American Cancer Society announced that it was supporting the new ACIP recommendation of a two-dose schedule for boys and girls who begin the vaccine regimen at ages 9 to 14.
"In the past several years, studies have shown the vaccine is even more effective than expected," explained Debbie Saslow, senior director of HPV-Related and Women's Cancers at the American Cancer Society (ACS).
"This new two-dose regimen is easier to follow, and we now know is very effective in preventing HPV, which is linked to a half dozen types of cancer," she added in an ACS news release.
Both the ACS and the CDC advisory committee still recommend three doses of the HPV vaccine for young adults who were not immunized as adolescents. The vaccine may be given to women through age 26 and men through age 21.
New advice for people who are HIV positive. Adults with HIV should receive a two-dose series of MenACWY. This combination meningococcal vaccine protects against a potentially deadly bacterial infection of the brain and spinal cord.
Hepatitis B for adults with chronic liver disease. The new vaccine schedule adds people infected with the hepatitis C virus to the list of those with chronic liver disease who could benefit from a Hep B vaccine series. Others who should receive these shots are people with: cirrhosis (scarring of the liver); fatty liver disease; alcoholic liver disease; autoimmune hepatitis; and people with elevated levels of certain liver enzymes.
"This is a lot of people," said Fryhofer. "Non-alcoholic fatty liver disease is the most common liver disorder in western industrialized countries," she added.
"If you're obese, you're more likely to have fat in your liver, which means that you would be on the list to get hepatitis B vaccination," she said.
Adult vaccination rates and barriers. U.S. adult immunization rates fall short of recommended levels, according to the ACIP.
Hurley said the flu vaccine is a particularly tough sell because it requires annual vaccination. Adults "don't prioritize vaccinations for themselves," said Hurley, noting that the flu vaccine is safe and can prevent death and complications from severe virus.
But according to the CDC's Kim, "Flu vaccine is especially important for people with chronic health conditions, pregnant women and older adults."
Also of concern, only 20 percent of adults 19 and older have had a Tdap vaccine, which protects against tetanus, diphtheria and pertussis (whooping cough), the report noted.
Fryhofer said insurance affects the likelihood of vaccination. "People who have insurance are two to five times more likely to be vaccinated, because the cost issue's a big barrier," she explained.
The new vaccine schedule appears Feb. 7 in the journal Annals of Internal Medicine.