Public Health

Flu shot, mpox, COVID and RSV vaccines: New ACIP and CDC adult immunization schedule 2024


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Breaking down the new schedule of adult vaccines from the CDC and the recommendations for the COVID, RSV, mpox vaccines and more. AMA ACIP liaison and AMA’s immediate past board chair, Sandra Fryhofer, MD, joins to discuss what has changed and what physicians and patients need to know. AMA Chief Experience Officer Todd Unger hosts.


  • Sandra Fryhofer, MD, physician; immediate past chair, AMA Board of Trustees and AMA liaison to ACIP

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Unger: Hello and welcome to the AMA Update video and podcast. Today's topic, adult immunizations. ACIP, or the CDC's Advisory Committee on Immunization Practices, just released a new adult schedule for 2024. And here to talk about what's new this year is the AMA's own in-house vaccine expert, our AMA ACIP liaison and AMA's immediate past AMA board chair Dr. Sandra Fryhofer. I'm Todd Unger, AMA's chief experience officer in Chicago. Dr. Fryhofer, happy new year. And thanks so much for joining us.

Dr. Fryhofer: Well, happy new year to you, Todd. And thanks for having me back.

Unger: Dr. Fryhofer, you're not only our AMA liaison to the ACIP. You're also a member of the ACIP workgroup for the adult schedule. And why don't we just get into that by starting with what kinds of new recommendations are we talking about for 2024?

Dr. Fryhofer: Well, Todd. It's a new year, which means new ACIP immunization schedules. There's a schedule for children and adolescents. There's a separate schedule for adults. And I'm an internal medicine physician. So the adult schedule is the one I use the most.

And as you said, I'm a member of ACIP's immunization schedule workgroup. We meet regularly throughout the year. But the workgroup does not make any new vaccine recommendations. We just put together all current ACIP recommendations in one easy to use reference.

Unger: And that's a big help. Because things have certainly gotten more complicated over the past few years. What do you think the biggest change is in the schedule for the year?

Dr. Fryhofer: Well, the biggest change for 2024 is the new schedule became available in 2023. This is the first time that's happened. There was a soft launch in November 2023, when the new schedule was posted on the CDC website. And it included ACIP recommendations approved by the CDC director through October 2023.

The major 2024 launch was this month in January, when the adult schedule was published in the Annals of Internal Medicine, which is the flagship journal for the American College of Physicians. And ACP, the American College of Physicians, has also posted several new segments in their 2024 adult immunization video series. And there's a video about the new schedule, as well as vaccine-specific videos for COVID, RSV and other vaccines for respiratory diseases.

Unger: Well, thank you so much for that heads up. ACP, of course, being an important federation partner and member. And we'll add a link to those videos in the description of this particular video. Dr. Fryhofer, so what prompted the change for releasing the schedule earlier this year, which makes, of course, a lot of sense?

Dr. Fryhofer: Vaccination coverage by insurance companies is tied to ACIP immunization schedules. And there have been reports of insurance companies not reimbursing for administered vaccines because the vaccines weren't formally incorporated into the schedules. ACA, the Affordable Care Act, requires ACA-compliant insurance coverage plans to cover any ACIP recommended vaccines without cost sharing no later than one year after the CDC director signs off on the recommendation.

And now for 2024 and for the very first time ever, the schedule is a live document. Meaning, it will be updated in real time. New for 2024 is a new section called the addendum, which will list any additional ACIP recommendations made since October 2023 and adopted by the CDC director.

Now, understand ACIP meets several times a year. This new addendum means any new ACIP recommendations can now become part of the current schedule in real time. This new addendum essentially starts the time clock for insurance coverage.

It closes a loophole which should make ACA-compliant insurance plans cover ACIP-recommended vaccinations sooner. And this is a win-win for patients and the physicians who care for them.

Unger: Absolutely. Really smart moves on behalf of patients, as you point out. Dr. Fryhofer, we talked at the beginning of this why this, again, is so important. More vaccines to think about. And let's talk a little bit about 2024. What vaccines have been added?

Dr. Fryhofer: Well, the newest vaccine additions to the schedule include RSV vaccines, the mpox vaccine, and a new MenACWY, menB combo vaccine, and of course, the new 2023-2024 formulation of the COVID vaccine. Both mRNA and protein-based adjuvanted versions are included.

Both tables on the schedule now have two new rows, a new row for RSV vaccines and another new row for mpox vaccines. COVID vaccines were already on the tables. They were added to the tables last year.

Unger: So just because we haven't heard that term before, the tables, can you just give us a little clarification around how the schedule is actually organized?

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Dr. Fryhofer: The schedule begins with a cover page, which lists this year's vaccines in alphabetical order along with their pedigree, their abbreviations, and for identification purposes only, their trade names. It also has links to helpful resources, including vaccine information statements, as well as complete ACIP recommendations for each vaccine.

There's a link to VAERS, CDC's Vaccine Adverse Event Reporting System, if you need to report a clinically significant adverse event. There's also a link to download CDC's vaccine app. The cover page even has a QR code, which allows for quick and easy access to the schedule online.

There are two very colorful color-coded tables. Table one looks at vaccinations by age. Table two looks at vaccinations by medical conditions or other indications. And as I already explained, each table has new rows for RSV and mpox vaccines. Vaccine order is the same on both tables. However, their color-code legends have been adjusted and refined.

Unger: What does that mean? How has that changed?

Dr. Fryhofer: Well, it's a little bit confusing this year. In that, the color-code legends are not the same for table one and table two. This is new and can be a little confusing. So take a close look at that.

There's also a new color that's been introduced, the color brown. And it's only on table two. And this highlights groups and conditions that require recurrent revaccination. And this includes giving Tdap in each and every pregnancy at 27 to 36 weeks. It includes revaccination with MenACWY every five years for people living with HIV and revaccination of those with asplenia and/or complement deficiency with both MenACWY every five years and menB revaccination every two to three years. Also, stem cell transplant recipients need three doses of HIB. So all those are indicated in brown.

There's also color code blue for shared clinical decision making for RSV vaccines for those 60 and older. Meaning, you have to talk to your patient. And you and your patient have to discuss and decide what to do.

Next is step four, the notes, which, in my opinion, are the schedule's best-kept secret. They're a treasure trove of great information. They're short but sweet and very concise.

Unger: Are they kind of the cliff notes version, so to speak, of the full ACIP recommendations?

Dr. Fryhofer: Exactly. They are so concise that you might need more details. And the schedule has links to the full ACIP vaccine-specific recommendations. The notes are in alphabetical order. COVID vaccines are listed first.

And each year, the notes are updated and edited for clarity and reveal who needs what and when. And they also include special vaccine-specific sections for special circumstances. The tables and the notes are designed to work nicely together. And they do.

Step four is an appendix of vaccine-specific contraindications and precautions. And we've already talked about step five, the new addendum, which will keep the schedule's vaccine recommendations up to date in real time all year long.

Unger: Excellent. Well, let's circle back a little bit to talk about the notes. Can you share some more details about the new vaccine additions, especially about COVID vaccines?

Dr. Fryhofer: Sure. For COVID vaccines for adults, and this includes those age five and older, a single dose of the updated vaccine is all you need to be up to date, regardless of previous vaccination status and even if you've never had any previous COVID vaccinations. And this is because everyone age five and older is thought to have at least some immunity to COVID from vaccines, from previous infection or both.

Our recommendations for the updated 2023-2024 COVID vaccines are specified, including details for those with immunocompromising conditions. As for timing, the new vaccine can be given at least two months after your last COVID vaccine dose for both the mRNA and protein-based adjuvanted versions. And for those with immunocompromising conditions, these people may receive additional doses if recommended by their physician.

Unger: All right, so that's great perspective on the COVID side. What about the RSV vaccines?

Dr. Fryhofer: And this is all in the notes. There are two RSV vaccines. They're identified by tradename for clarity. Arexvy contains an adjuvant. Abrysvo does not. And the note explains, only Abrysvo, that's the vaccine without the adjuvant, can be given to pregnant people only at 32 to 36 weeks and only to those whose baby would be born during RSV season. And that's why the notes say give it to pregnant women September through January.

For adults 60 and older, ACIP recommends a dose of either vaccine under shared clinical decision making. Meaning, you and your patient have to discuss and decide. The notes also link to additional guidance for making that decision.

Unger: All right, so COVID, RSV. You also mentioned mpox upfront, that it's now on the schedule. Dr. Fryhofer, who needs that vaccine? And what do the notes say?

Dr. Fryhofer: Well, the notes specify two doses of mpox vaccine given 28 days apart is recommended for anyone at risk. The mpox vaccine notes include a list of risk factors. For pregnant people, there is no ACIP recommendation. But pregnant persons with a risk factor may receive it. Men who have sex with men are on the list of mpox risk factors. And health care personnel without sexual risk factors should not receive it, except in rare circumstances.

Unger: All right, that has been excellent perspective. A lot of new information. Great improvements in terms of communicating that schedule. Dr. Fryhofer, before we conclude, any final thoughts?

Dr. Fryhofer: Well, Todd, I hope the timing of the launch of this new 2024 adult immunization schedule will be a reminder to everyone to make sure you're up to date on needed vaccinations. Here in Georgia, where I live, the level of respiratory illness activity is off the chart high. The CDC map shows the Southeast is mostly purple, indicating very high levels of respiratory illness.

And Georgia is not alone. CDC says the amount of respiratory illness causing people to seek health care is elevating and increasing across most areas of the country. We're also seeing increases in emergency department visits for COVID, flu and for RSV. And yes, you can have all three of them at the same time.

And for the first time ever, we have vaccines for all three of these respiratory illnesses. And unfortunately, national vaccination coverage for COVID, flu and RSV vaccines remain low. Vaccines can help protect us from the most serious health effects of fall and winter viruses.

This new adult schedule is a great resource for figuring out which vaccines your patients need and when. The challenge now is making it happen, getting those needed vaccines into arms.

Unger: Dr. Fryhofer, thank you so much for all this additional information. Thank you for your work and to the ACIP workgroup committee for such an important advance in terms of communication. We know how important that is to that objective, which is getting those vaccines into arms.

That wraps up today's episode. Again, Dr. Fryhofer, it's always great to have you. And we'll look forward to talking with you again as new information emerges. We'll be back soon with another episode. In the meantime, you can find all our videos and podcasts at Thanks for joining us today. And please take care.

Disclaimer: The viewpoints expressed in this video are those of the participants and/or do not necessarily reflect the views and policies of the AMA.

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