The CDC has announced changes to the 2021 immunization schedules for adults aged 19 years and older.

The updates affect recommendations for vaccines to prevent influenza, hepatitis A (HepA), hepatitis B (HepB), human papillomavirus (HPV), pneumococcal infections, meningococcal serogroups A, C, W, and Y (MenACWY) infections, meningococcal B (MenB) infections, and herpes zoster.

The CDC’s Advisory Committee on Immunization Practices (ACIP) also recommends the use of COVID-19 vaccines within the scope of the Emergency Use Authorization or Biologics License Application for the particular vaccine.

Here are some of the key changes:

• HepA—Text has been added for the accelerated Twinrix schedule: “HepA-HepB combination vaccine or Twinrix may be administered on an accelerated schedule of 3 doses at 0, 7, and 21–30 days, followed by a booster dose at 12 months.”
• HepB —The recommendation has been changed to indicate that HebB vaccination for adults aged 60 years or older with diabetes is recommended, using shared clinical decision-making.
• HPV—The section now states, “HPV vaccination recommended for all persons through age 26 years.” Under routine vaccination, the text was reformatted to match the Child/Adolescent schedule and now reads “Age 15 years or older at initial vaccination: 3-dose series at 0, 1–2 months, 6 months (minimum intervals: dose 1 to dose 2: 4 weeks / dose 2 to dose 3: 12 weeks / dose 1 to dose 3: 5 months; repeat dose if administered too soon.” It adds that no additional doses of HPV are recommended after completing a series at the recommended dosing intervals using any HPV vaccine. Other changes involve shared clinical decision-making.
• Influenza—Guidance was changed on allergy monitoring, i.e., “If using an influenza vaccine other than RIV4 or ccIIV4, administer in medical setting under supervision of health care provider who can recognize and manage severe allergic reactions.” It also clarifies when a severe allergic reaction is a contraindication to future receipt of the vaccine and points out that the specific LAIV4 version should not be used if influenza antiviral medications oseltamivir or zanamivir were received “within the previous 48 hours, peramivir within the previous 5 days, or baloxavir within the previous 17 days.”
• Meningococcal vaccination—MenQuadfi (MenACWY-TT) vaccine was added to all relevant sections because it is now licensed. For both MenA and MenB, text updates recommendations about boosters in special situations and in outbreak setting (e.g., in community or organizational settings and among men who have sex with men).  
• Pneumococcal vaccination—The advice has been updated for routine vaccination in those aged 65 years and older. Under the Shared clinical decision-making section, bullets have been reordered as follows:
       o PCV13 and PPSV23 should not be administered during the same visit.
       o If both PCV13 and PPSV23 are to be administered, PCV13 should be administered first.
       o PCV13 and PPSV23 should be administered at least 1 year apart.
• Tdap—Wound management information has been updated for patients with three or more doses of tetanus toxoid-containing vaccine, “For clean and minor wounds, administer Tdap or Td if more than 10 years since last dose of tetanus toxoid-containing vaccine; for all other wounds, administer Tdap or Td if more than 5 years since last dose of tetanus toxoid-containing vaccine. Tdap is preferred for persons who have not previously received Tdap or whose Tdap history is unknown. If a tetanus toxoid-containing vaccine is indicated for a pregnant woman, use Tdap.”
• Zoster vaccination—References have been removed to previous receipt of (zoster vaccine live or Zostavax (ZVL)) dose when considering vaccination of persons aged 50 years or older with recombinant zoster vaccines or Shingrix (RZV). In addition, the bullet about ZVL for persons aged 60 years or older was deleted because ZVL is no longer available in the U.S. market.

The content contained in this article is for informational purposes only. The content is not intended to be a substitute for professional advice. Reliance on any information provided in this article is solely at your own risk.

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