Practice Alert

ACIP immunization update

Author and Disclosure Information

Males ages 11 to 12 years should routinely receive quadrivalent vaccine against human papillomavirus; patients through age 59 years who have diabetes should receive HBV vaccine routinely.



In February, the Centers for Disease Control and Prevention (CDC) published the 2012 immunization schedules for infants and children, adolescents, and adults.1,2 The schedules, which are available at, are updated annually and incorporate additions and changes recommended by the Advisory Committee on Immunization Practices (ACIP) over the past year. While there were no major advances in new vaccines in 2011, there were a number of new indications for existing ones.

Human papillomavirus vaccine for males
Quadrivalent vaccine against human papillomavirus is now recommended for routine use for males ages 11 to 12 years to prevent genital warts and anal intraepithelial neoplasia.3,4 Catch-up vaccination is also recommended for males ages 13 to 21 who have not received it. In addition, routine use is recommended for males ages 22 to 26 years who have sex with men or are HIV positive or immuno-compromised.

Tetanus toxoid, reduced strength diphtheria toxoid, and acellular pertussis (Tdap)
Indications for the routine use of Tdap were expanded to include children ages 7 to 10 years, pregnant women, and adults age 65 and older who have contact with infants.5,6 Children ages 7 to 10 years who have not had the full series of DTaP should receive Td/Tdap according to the catch-up schedule,1 with one of the doses being Tdap. Adults older than 65 who have never received Tdap and who have close contact with infants should receive one dose. No minimum interval is required between receipt of the Td and Tdap vaccines. Other older adults who ask for Tdap vaccination should receive it. Use of Tdap in those ages 7 to 10 years or 65 and older is off label.5

Pregnant women who have not received Tdap should receive 1 dose after week 20 of pregnancy, although receiving it earlier is not contraindicated if tetanus toxoid is needed for tetanus prevention following a wound.6

Hepatitis B virus (HBV) vaccine
Added to the list of high-risk adults who should receive HBV vaccine routinely are those ages 19 through 59 years with diabetes.7 Vaccinate as soon as possible after the diabetes diagnosis is confirmed. The decision as to whether to vaccinate patients ≥60 years with diabetes should be based on the likelihood that they will become infected. Considerations include the risks associated with an increased need for help with blood-glucose monitoring in long-term care facilities, the likelihood that the patient will experience chronic sequelae if infected, and the likelihood that the patient will mount a proper immune response to the vaccine.7 (The more frail patients are, the less likely they are to achieve adequate immunity.7)

Meningococcal conjugate vaccine, quadrivalent (MCV4)
An MCV4 vaccine (Menactra) has now been licensed for use in children as young as 9 months.8 At this time, however, neither Menactra nor its competitor, Menveo (licensed for use in those 2 years and older), is recommended for routine administration until the age of 11 to 12 years. Infants and children ages 9 through 23 months with complement deficiencies, or who will be traveling to countries with endemic high levels of meningococcus, should be vaccinated with 2 doses of Menactra 3 months apart, and with a booster dose after 3 years if risk persists. The recommendations regarding the use of MCV4 in those ≤2 years with high-risk conditions are listed in TABLE 1.

Coverage for adult immunizations is suboptimal

In February 2012, the CDC announced results of the 2010 National Health Interview Survey. Increases in immunization coverage occurred only with Tdap vaccination for individuals 19 to 64 years of age (from 6.6% to 8.2%), herpes zoster vaccination among those ≥60 years (from 10% to 14.4%), and ≥1 dose of HPV vaccination for women 19 to 26 years (from 17.1% to 20.7%). Rates of immunization were unchanged for other vaccines. The CDC said a substantial improvement in coverage is needed to reduce vaccine-preventable diseases among adults.

Source: CDC. Adult vaccination coverage—United States, 2010. MMWR Morb Mortal Wkly Rep. 2012;61:66-72.

Another change regarding the use of MCV4 is a recommended booster dose for those age 16 and older who were first vaccinated at age 11 or 12 years.9 For those vaccinated at ages 13 to 15, a booster should be received at ages 16 to 18. No booster is needed if the first MCV4 dose is received at or after age 16. Recommendations for MCV4 use and booster doses for those 2 years and older are listed in TABLE 2.

Recommended Menactra schedule for young children at high risk for invasive meningococcal disease

Risk groupPrimary vaccination seriesBooster dose, if child remains at increased risk
Children ages 9-23 months at high risk for invasive meningococcal disease,* except those with functional or anatomic asplenia2 doses, 3 months apart
Catch-up dose at earliest opportunity if dose 2 is not given on schedule
Initial booster 3 years after completing primary series
At 5-year intervals after initial booster
Children with functional or anatomic asplenia at high risk for invasive meningococcal disease2 doses, 2 months apart, starting at age 2 years and ≥4 weeks after completing the PCV13 vaccine series
PCV, pneumococcal conjugate vaccine.
*Children who have persistent complement component deficiencies (eg, C5–C9, properdin, factor H, or factor D); those traveling to (or residents of) countries where meningococcal disease is hyperendemic or epidemic; or those who are in a defined risk group during a community or institutional meningococcal outbreak.


Next Article: