2009 Adult Immunization Schedule Debuts

Asthma, Smoking Are Newly Added Indications for Pneumococcal Vaccine

By David Mitchell
1/12/2009

Smokers and people with asthma should be vaccinated against pneumococcal disease, according to the 2009 adult immunization schedule (2-page PDF; About PDFs) released Jan. 9. The new schedule was developed by the AAFP in conjunction with the American College of Physicians, the American College of Obstetricians and Gynecologists, and the CDC's Advisory Committee on Immunization Practices, or ACIP.

The 2009 adult immunization schedule was released Jan. 9 by the AAFP in conjunction with the American College of Physicians, the American College of Obstetricians and Gynecologists, and the CDC's Advisory Committee on Immunization Practices.

AAFP already had adopted provisional recommendations from ACIP that added smoking and asthma as indications for administration of the 23-valent pneumococcal polysaccharide vaccine in adults ages 19-64.

"Asthma and use of cigarettes are both independent risk factors for invasive pneumococcal disease," said Jonathan Temte, M.D., Ph.D., an associate professor in the department of family medicine at the University of Wisconsin, Madison, and a member of the ACIP. "Accordingly, use of the pneumococcal vaccine can offer protection for these individuals."

Temte said that when a vaccination recommendation is made based on an underlying health condition or a risk behavior, rather than strictly on age parameters, physicians often are less likely to adhere to the recommendation.

"The challenge," he said, "is to adapt clinical practice to the specific patient and provide the best care that is possible. With ACIP's recommendation for pneumococcal vaccine for smokers also comes the recommendation that patients be counseled to quit smoking."

This year's adult immunization schedule includes several other changes, as well:

the recommendation for human papillomavirus vaccine clarifies that health care workers are not at increased risk because of any potential occupational exposure, but they should be vaccinated consistent with age-based recommendations;
the varicella vaccine recommendation clarifies that adults who previously received only one dose of vaccine should receive a second dose; and
the meningococcal vaccine recommendation clarifies that people who previously received meningococcal polysaccharide vaccine may be revaccinated after five years with quadrivalent polysaccharide vaccine if they remain at increased risk for meningococcal disease.

There is no new recommendation for influenza vaccine during pregnancy, but Temte said physicians need to do a better job of vaccinating pregnant women against the flu. He said that less than 15 percent of pregnant women receive influenza vaccine and emphasized that the strongest predictor of vaccination is the recommendation of a woman's physician.

"There is a misconception that influenza vaccine may be dangerous during the first trimester," Temte said. "It is not. The vaccine is recommended for all women who are pregnant or due to deliver during the influenza season. Trimester does not matter."

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