ACIP updates vaccine recommendations, AAFP mailing support materials

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The American Academy of Family Physicians (AAFP) is mailing members new resources to help keep patients on target with newly updated vaccine recommendations.

The full-color, laminated immunization schedule is now easier to navigate for both clinicians and patients, according to AAFP. The new immunization materials cover the changes to adult and child immunization schedule approved in February 2019 by the Centers for Disease Control and Prevention’s (CDC) Advisory Committee on Immunization Practices (ACIP).

“It’s a better education tool. It raises awareness with patients,” said Sterling N. Ransone, Jr., MD, FAAFP, a director of the AAFP and a practicing family physician in Deltaville, Va. “What we’ve been trying to do over the last few years is take vaccinations as something we do with physicals and move it into everyday visits. As we transition and make immunizations a part of our daily thought process, we’ll be able to boost vaccination rates.”

Some of the big changes to this year’s recommendations include the inclusion of the intranasal flu vaccine, changes to hepatitis vaccine recommendations, and updates on MMR vaccines.

For the flu, this year’s schedule once again includes a recommendation to offer the live attenuated influenza vaccine FluMist. The intranasal vaccine was not recommended between 2016 and 2018 due to concerns about low efficacy against the H1N1 flu strain, but changes were made to the vaccine and ACIP once again backed its use beginning with the 2018-19 flu season. There are still some restrictions on the live attenuated vaccine use, including immunocompromised and pregnant patients. 

The American Academy of Pediatrics has also suggested that the intranasal vaccine be used as a last resort in children until the changes to the vaccine in terms of H1N1 protection have been better demonstrated.

In regard to hepatitis vaccines, ACIP has added homelessness as an indication for routine hepatitis A vaccination for the first time. According to ACIP, homelessness is associated with two to three times higher odds of infection and more severe outcomes and effects of the disease. The new recommendations also include the use of a single-antigen recombinant hepatitis B vaccine with a novel adjuvant for adults. Ransone said the previous hepatitis B series consisted of three doses, with the second dose administered six months after the first, and the third and final dose a year after the second. The new series consists of only two doses spread two weeks apart, he said.

The updated schedule also removes recommendations about additional measles, mumps and rubella (MMR) doses during mumps outbreaks, referring clinicians instead to their local health departments for recommendations specific to their area.

Finally, the recommendations received a visual overhaul with the addition of a cover page with guidance on each vaccination schedule and improved readability through better color coding and larger font sizes. Ransone said the fact that the new vaccine materials are easier to read will not only help clinicians keep vaccine changes straight, but will also serve as an education tool that can help patients better understand the recommendations. 

ACIP updates vaccine tables annually, but for adults, vaccination rates have remained low. Flu vaccination rates among adults have remained steady, around 43 percent, but vaccination rates among seniors have dropped by three percentage points, and coverage is traditionally low among minority groups, as well. Pneumococcal vaccine rates had a slight bump, but overall, it can be difficult to keep adults current and informed on their vaccination needs.

Ransone said part of the problem is the increase in the number of vaccines and recommendations clinicians and patients have to keep track of. When Ransone began practicing in 2002, he said there were eight vaccines included on the schedule with six special indication categories. Now, there are 17 vaccines and 11 different antigen groups with 10 special indication categories.

“You can see that the number of vaccines we have to keep track of and when to give them has almost tripled in just the time I’ve been practicing,” Ransone said. “Vaccines are successful, they’re cost-effective, and they work. The problem we have is fake news. If we have these schedules, we can sit and talk to folks about what they have to do and why they need it, and also talk about medical misinformation.”