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In today’s AMA Update, vaccines for adults: what you need to know about CDC’s recently released adult immunization schedule for 2023 with Sandra Fryhofer, MD, AMA’s liaison to the Advisory Committee on Immunization Practices (ACIP) and member of ACIP’s COVID-19 Vaccine Workgroup. Also discussing routine vaccines for kids, vaccine-preventable diseases like polio—plus CDC's Morbidity and Mortality Weekly Report (MMWR) and the Annals of Internal Medicine (ACP Journals). AMA Chief Experience Officer Todd Unger hosts.
- Sandra Fryhofer, MD, chair, AMA Board of Trustees
Unger: Hello, and welcome to the AMA Update video and podcast. Today, we're discussing a new tool to help with adult vaccination. ACIP, the CDC's Advisory Committee on Immunization Practices, has just released its new adult immunization schedule for 2023.
Here to talk about this new tool is the AMA's Board Chair, Dr. Sandra Fryhofer, who's also the AMA's liaison to the CDC's Advisory Committee on Immunization Practices. She's also a member of ACIP's vaccine workgroup for the adult immunization schedule. I'm Todd Unger, AMA's chief experience officer in Chicago. Dr. Fryhofer, welcome back.
Dr. Fryhofer: Todd, thanks for having me.
Unger: So let's start by talking about, what exactly is the adult immunization schedule and why is it so important? We usually think about routine vaccinations for kids and not adults. Tell us more.
Dr. Fryhofer: Well, vaccines are not just for kids, adults need them too. And each year, CDC's Advisory Committee on Immunization Practices collates vaccination recommendations for adults in one easy-to-access reference. It includes ACIP's most up-to-date recommendations, which is really convenient and really helpful for practicing clinicians.
For many years now, the new schedule has been published in both the Annals of Internal Medicine and in CDC's MMWR. Access to this content is free, so patients have easy access to it too. And it's a fabulous reference for helping make sure your patients are up to date on vaccine-preventable diseases.
There's also a separate schedule for children and adolescents. The adult schedule starts at age 19. So physicians who have younger patients also need to check the child and adolescent schedule too.
Unger: Dr. Fryhofer, tell us a little bit about how the particular schedule you're talking about is organized.
Dr. Fryhofer: Well, there are two colorful graphics with recommended vaccines that are organized by age and also organized by medical condition and other indications. The vaccine notes section has more specifics about dosing and special situations for each vaccine. There's also an appendix with vaccine-specific contraindications and precautions.
The new schedule also has new updated hot links that are quite useful. And since they're on the schedule, they're all in one place. For example, if you need more detailed information about a specific vaccine, there's an easy link to the more complete ACIP recommendation. If you need to report any sort of adverse reaction, there's a link to do that too.
The cover page of the graphics has a list of vaccines for adults along with their trade names, not to promote them, but to help clinicians differentiate different vaccine products that may have special nuances for particular patients.
Unger: Dr. Fryhofer, so if there is or when there is a new schedule each year, are you starting from scratch? Or are you updating last year's version? Obviously, we have a big change coming with COVID. How does that work?
Dr. Fryhofer: Well, there's a dedicated ACIP workgroup that looks at the adult immunization schedule. And I've been a member of that workgroup for several years. We meet regularly, we have special graphic designers, who help us create graphics that are understandable, meaningful and pleasing to look at.
We take a fresh look each year at last year's schedule and make necessary updates and tweaks. Also, as new vaccines are developed and vetted by ACIP, they can be added to the schedule if recommended by ACIP. The adults schedule does not create new recommendations for specific vaccines, it simply summarizes the most up-to-date ACIP recommendations all in one place.
Unger: What are the biggest changes for this year's schedule?
Dr. Fryhofer: Well, COVID vaccines are front and center and that's really no big surprise. They've been given official abbreviations on the cover page and brand names are also included for the FDA-approved COVID vaccine versions.
COVID vaccines are also at the top of the list on both of the schedule's graphics. They also happen to be listed first in the vaccine notes sections, which is coincidental and only because the notes are alphabetically ordered by vaccine name, and COVID vaccines begin with a C.
Current polio vaccination recommendations for adults are also included in the notes section, and this is also new. And as you know, polio was thought to be eradicated but with the recent case of paralytic polio in New York, ACIP has reconvened its polio vaccine workgroup and I'm also a member of that.
Workgroup discussions are confidential, and we often discuss proprietary information. However, recommendations from the workgroup are presented to ACIP at public ACIP meetings that are regularly scheduled to take place three times a year. But with COVID, we've had to add many, many emergency ACIP meetings to address timely COVID vaccine developments and vaccine recommendation changes.
Unger: Well, besides COVID, are there any new changes for other vaccines that had already been on the schedule?
Dr. Fryhofer: Yes. For example, this year's schedule includes the new shared clinical decision-making option for giving a dose of PCV20—that's the newer, higher-valent pneumococcal conjugate vaccine—to those 65 and older who are at least five years out from the previously recommended sequential PCV13, then PPSV23 combination. Yes, I know, that's a lot of numbers, letters, and acronyms.
The pneumococcal vaccination schedule for adults is very complicated, and more help is here. This year's adult schedule has a link to a new pneumococcal vaccination app to help determine which patients, what patients need which pneumococcal vaccine, and when. The vaccine notes section also includes ACIP's new flu vaccine preferential recommendation for older adults, those 65 and older.
Now, you and I talked about this new recommendation on an earlier AMA Update when the recommendation first came out. For those 65 and older, a high-dose, adjuvanted or recombinant flu vaccine is preferred. There are also two newer hepatitis B products, Heplisav, which contains a neoadjuvant, and the new triple-antigen hep B vaccine, PreHevbrio. Both are listed on the cover page and are also discussed in the notes.
Unger: Now, Dr. Fryhofer, we've talked a lot about COVID vaccines but what's the impact of some of these other vaccine-preventable diseases? You mentioned polio, for instance, in the U.S.
Dr. Fryhofer: Well, for flu since 2010, flu-related deaths have ranged from 12,000 to 56,000, depending on the severity of the flu season and the type of flu circulating. About 320,000 people get pneumococcal pneumonia every year, leading to over 150,000 hospitalizations and 5,000 deaths, mostly in older patients.
Hepatitis B is vaccine preventable. About 880,000 people develop chronic hepatitis B each year and this can lead to liver damage, cirrhosis, liver cancer and even death. HPV, the human papillomavirus, causes over 27,000 cancers in women and men each year. About 4,000 women die each year from cervical cancer, which is caused by the HPV virus. We now have a vaccine that can prevent HPV virus infection. But it works best if given before exposure to the virus.
And then there's shingles, which can cause much suffering and greatly diminished quality of life. Each year in the United States, 1 million people get shingles. Some people have severe pain that continues long after their rash clears up and can persist for years. The Shingrix vaccine can help prevent that.
Unger: Absolutely. Any final thoughts, Dr. Fryhofer, before we close?
Dr. Fryhofer: Well, I want to encourage everyone to check out ACIP's new adult immunization schedule published in the Annals of Internal Medicine and in CDC's MMWR. It's a handy dandy resource for making sure your patients are up to date on all recommended vaccinations. And you can download it for free.
Unger: I don't know. Is handy dandy official ACIP language, Dr. Fryhofer?
Dr. Fryhofer: If they can get people vaccinated, it most certainly is.
Unger: Well, thanks so much for being here. It's really valuable to be able to have these conversations firsthand with you. And I'm sure the physicians out there really appreciate it. That's it for today's episode.
We'll be back soon with another AMA Update. And you can find all our videos and podcasts at ama-assn.org/podcasts. Thanks for joining us today. Please take care.
Disclaimer: The viewpoints expressed in this podcast are those of the participants and/or do not necessarily reflect the views and policies of the AMA.