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Ambulatory Care - Vaccination - Fast Facts | NEJM Resident 360
Many relatively new vaccinations are now recommended for adults, with specific recommendations for particular conditions. The Centers for Disease Control and Prevention (CDC) website on adult immunization provides excellent resources, including a checklist for contraindications and easy-to-read handouts for patients. (The CDC also has a free app for iOS or Android.)
The Committee made no substantial changes to its recommendations for 2022, except to address use of newly approved pneumococcal vaccines.
Pneumococcal Vaccination
Recommendations for vaccinating adults against pneumococcal disease have changed three times in the past decade, and now they are changing yet again, with the recent U.S. FDA approval of two new pneumococcal conjugate vaccines (PCVs).
The 15-valent PCV (PVC15; Vaxneuvance, Merck) and the 20-valent PCV (PVC20; Prevnar-20, Wyeth) add additional serotypes to those contained in the older 13-valent PCV (PVC13; Prevnar-13, Wyeth). All three PCVs are more immunogenic than the venerable 23-valent polysaccharide-based Pneumovax (PPSV23), although the latter covers more serotypes. Both new PCVs elicited good immunologic responses in adult volunteers; actual clinical data are not available for either one. They are not yet approved for children.
The updated recommendations apply to all older adults (age, ≥65) and to all adults who are at elevated risk for pneumococcal disease because of immunocompromise or comorbidity.
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Eligible adults who have received no pneumococcal vaccinations or have unknown vaccination histories should receive either a single dose of PCV20 with nothing further or PCV15 followed 1 year or later by a “chaser” of PPSV23. This interval can be shortened to 8 weeks for individuals at particularly high risk.
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Eligible adults who have received only PPSV23 may receive one of the new PCVs at 1 year or later after their PPSV23 vaccination; no additional PPSV23 doses are advised.
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Eligible adults who have received PCV13 alone should receive a chaser dose of PPSV23 at 1 year or later, as advised in the previous set of guidelines. No data addresses the utility of additional doses of the newer PCVs in these patients, and no further vaccinations are recommended for them at present.
The most common side effects for the new agents were injection site pain and myalgia. Serious adverse events were not reported.
Covid-19 Vaccines
ACIP recommends use of COVID-19 vaccines for everyone ages 5 and older. COVID-19 vaccine and other vaccines may be administered on the same day. Up-to-date guidance on the allocation, approval, and recommendations for Covid-19 vaccinations in the United States from the CDC and ACIP can be found here.
For more information on Covid-19, please see the NEJM Coronavirus (Covid-19) Topic Page.
2022 Recommended Immunization Schedule for Adults
2022 Recommended Immunization Schedule for Adults with Comorbidities
*Figures 1 and 2 should be read with the footnotes that contain important general information and considerations for special populations.
(Source: Recommended Immunization Schedule for Adults Aged 19 Years or Older, United States, 2022.)