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FluMist, HBV Vax Make the 2019 Immunization Schedule

The 2019 immunization schedules brings back FluMist, adds a hepatitis B (HBV) vaccine, and establishes a new indication for hepatitis A.

New additions to this year’s vaccination schedule feature a formal re-addition of live attenuated influenza vaccine (LAIV), the addition of Heplisav-B, a recombinant vaccine against HBV, and adding homelessness as an indication for hepatitis A.

The recommended adult vaccination schedule was published in the Annals of Internal Medicine, while the recommended vaccination schedule for children and adolescents was published in Pediatrics. Both are available on the CDC website.

FluMist is Back

Re-adding FluMist may be the year’s biggest change, with the CDC’s Advisory Committee on Immunization Practices (ACIP) voting in June 2018 to include the live attenuated influenza vaccine in this year’s influenza vaccination options. The authors stated LAIV is an option for any adult age ≤49 for whom it is appropriate, which excludes immunocompromised patients, those with HIV infection, as well as pregnant patients.

LAIV may also be used in children age ≥24 months where appropriate, although the American Academy of Pediatrics weighed in on this issue in September 2018, stating that the inactivated influenza vaccine should be the “primary choice” for children age ≥6 months.

New HBV Vax

Heplisav-B is a single-antigen recombinant HBV with a novel cytosine-phosphate-guanine 1018 oligodeoxynucleotide adjuvant. It was approved by the FDA in 2017, and by the ACIP last February for adults ages ≥18. It is a two-dose vaccine and “routinely administered in 2 doses at least 4 weeks apart.” Notably, there is no data on the safety of the vaccine in pregnant women, so the authors stated that a pregnant woman with an indication for a HBV vaccine should not receive Heplisav-B.

Homelessness and Hep A

In October 2018, the ACIP approved routine vaccination of the homeless against hepatitis A with either a two-dose series of single-antigen hepatitis A vaccine or a three-dose series of combination hepatitis A and B vaccine. With this approval, the ACIP essentially added homelessness as a risk factor for hepatitis A. Current risk groups include travelers, men who have sex with men, and users of injection and non-injection illicit drugs.

Other Updates

The vaccination schedule received a face-lift with a new cover page, different color-coding schemes, and a streamlined format for easier viewing by providers, as the ACIP noted at its October meeting.

Additional changes to the vaccine schedule include:

  • A section on international travel in the hepatitis A section, with recommendations for immunizing children ages 6-11 months, and unvaccinated persons age ≥12 months
  • The word “all” was added to the HBV vaccine recommendation for medically stable infants (≥2,000 g) born to mothers who test negative for HBV, “to emphasize the recommendation for this population”
  • Language on use of MMR vaccine for a mumps outbreak and MenACWY and MenB vaccines in outbreaks of meningococcal disease has been removed, and providers should now consult local health departments for direction on vaccination during an outbreak
  • Children who “inadvertently” received a dose of Tdap or DTaP at age 7-10 years should receive the routine dose of Tdap at age 11-12 years, as part of the catch-up vaccination schedule

Kim disclosed no relevant relationships with industry. A co-author disclosed support from the CDC and the Wisconsin Department of Health Services, and a relevant relationship with Immunize Milwaukee!

The AAP Committee on Infectious Diseases members disclosed no relevant relationships with industry.