Adult Vaccines 2022: Who Needs What, and When?

This transcript has been edited for clarity.

What's new in adult immunization for 2022? Here's the latest update from the Advisory Committee on Immunization Practices (ACIP). The new schedule is available on the CDC website and published in the Annals of Internal Medicine.

We're now in year 3 of the COVID pandemic. That's why, for 2022, having a new updated schedule matters now more than ever. It's a reminder of the other vaccine-preventable diseases we need protection from. The COVID pandemic has put a damper on vaccine coverage overall. At first, we weren't supposed to give COVID vaccines with other vaccines, but that rule has been lifted. COVID vaccines can now be administered with other vaccines, so there is no reason to delay getting caught up on needed immunizations that may have been missed due to the pandemic.

Highlights of the 2022 Adult Immunization Schedule

This ACIP update summarizes who needs which vaccine and when. And as usual, some of the recommendations have changed. COVID vaccines are in the schedule. They are not on the graphics, but they're listed first in the vaccine notes section with a link to current COVID vaccine recommendations. It's likely that more COVID vaccine options will be added before the next schedule update next year. There's also a link to CDC's Interim Clinical Considerations, a live document that's updated regularly.

The 2022 schedule and its graphics are designed to colorfully and succinctly hit the high points, but more complete ACIP recommendations are only a click away. A key to these useful links can be found on the info page, along with the list of vaccines, with abbreviations and brand names. The use of trade names is for identification purposes only and does not imply endorsement by ACIP or CDC. But as a practicing physician, it's helpful to have them listed, especially if you're the one who orders vaccines for your practice.

For pneumococcal vaccines, PCV13 has been replaced by PCV15 (brand name Vaxneuvance) and PCV20 (brand name Prevnar 20), which provides protection from 20 pneumococcal subtypes.

The opening page header explains how to best use the schedule.

Step 1: Determine the patient's recommended vaccinations by age (refer to Table 1).
Step 2: Determine whether additional vaccines are needed based on medical condition and other indications (refer to Table 2).
Step 3: Check the vaccine notes to review vaccine types, frequencies, intervals, and special considerations.
Step 4 is new for 2022 and includes an appendix which reviews contraindications and precautions for each vaccine type.

Using the Schedule: 2022 Changes

We'll dive into the details, but first, some schedule construction nuts and bolts. Vaccine order is the same on both tables, but it's not in alphabetical order. Table 1 includes the full vaccine type, name and abbreviation. Table 2 has the abbreviation only. The vaccine notes are in black and white with bold blue headings. Vaccine order in the notes is alphabetical for easy reference. The notes for this year's schedule are not quite as detailed and have more links.

The graphics are color-coded, and this stays the same throughout:

Yellow means the vaccine is indicated for all who meet age requirement.
Purple means the vaccine is indicated for those with additional risk factors or another indication.
Blue means the vaccine is recommended based on shared clinical decision-making.
Orange is for precaution.
For red, the words are the same but the order is different. "Contraindicated" now comes before the phrase "not recommended." The asterisk indicates that you can vaccinate after pregnancy.
Gray means that there is no recommendation or not applicable. Gray does not mean "not recommended." If a vaccine is not recommended, it is color-coded red.

Overlays on the red bars have been adjusted to provide more precise clarification of whether a vaccine is really contraindicated or just not recommended. Other overlays have also been modified for clarity and precision.

The new schedule has updates reflecting new ACIP vaccination recommendations for zoster, pneumococcus, and hepatitis B.

New Recombinant Zoster Vaccine (RZV) Recommendation

RZV is now an option for patients aged 19-49 with immunocompromising conditions. The notes give more details as to who this includes. On Table 1, this is shown by age, with purple for those aged 19-49 and an overlay reminder to check the notes. The yellow bar starting at age 50 means everyone age 50 and older needs a two-dose RZV series.

New Hepatitis B Vaccine Recommendation

Hepatitis B vaccination is now universally recommended for all adults under 60, but a "loophole" specified in the "Notes" makes hepatitis B vaccination available to older adults who wish to receive it. There are several hepatitis B products with various application nuances. Some products have different dosing intervals. The size of the dose and the numbers of doses can vary depending on medical condition, speed of immunization needed, and pregnancy status. For example, one of the newer hepatitis B products, Heplisav, is not recommended for use in pregnant women because there are not enough safety data.

New Pneumococcal Vaccination Recommendations

The new pneumococcal vaccines introduced on the cover page foreshadow the change in pneumococcal recommendations from ACIP. The new recommendation is more streamlined with only two options to choose from: either a sequential vaccination combination of PCV15 then PPSV23, or a single dose of the higher-valent PCV20. These choices apply to adults of all ages, but only if indicated. Pneumococcal vaccination is indicated and recommended for all adults 65 and older, and also for younger adults with certain medical conditions or other risk factors (as specified in the vaccine Notes).

On Table 1, vaccination options are specified on the overlay. The bar is purple for those under age 65, with a reminder to see the notes. Pneumococcal vaccination is only recommended for those under age 65 with another risk indication or medical condition. For those 65 and older, the yellow bar means it is recommended for all in this age group.

On Table 2, the pneumococcal bar is yellow for all the medical conditions listed. There is also an overlay reminder to check the notes. You can also click on the links to view complete ACIP recommendations for more specific guidance. Also on Table 2, check out the dedicated columns for pregnant persons, healthcare personnel, and men who have sex with men.

This concludes a quick review of the changes for 2022 in ACIP's new Adult Immunization Schedule.

For Medicine Matters, I'm Dr Sandra Fryhofer.

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