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Recommended Adult Immunization Schedule, United States, 2021

2021; American College of Physicians; Volume: 174; Issue: 3 Linguagem: Inglês

10.7326/m20-8080

1539-3704

Mark S. Freedman, Henry H. Bernstein, Kevin A. Ault,

Hepatitis B Virus Studies

Clinical GuidelinesMarch 2021Recommended Adult Immunization Schedule, United States, 2021FREEMark S. Freedman, DVM, MPH, Henry Bernstein, DO, MHCM, and Kevin A. Ault, MD, Advisory Committee on Immunization Practices†Mark S. Freedman, DVM, MPHCenters for Disease Control and Prevention, Atlanta, Georgia (M.S.F.), Henry Bernstein, DO, MHCMCohen Children's Medical Center, New Hyde Park, and Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York (H.B.), and Kevin A. Ault, MDand University of Kansas Medical Center, Kansas City, Kansas (K.A.A.)., Advisory Committee on Immunization Practices†Author, Article, and Disclosure Informationhttps://doi.org/10.7326/M20-8080 Eligible for CME Point-of-Care SectionsAboutVisual AbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail In October 2020, the Advisory Committee on Immunization Practices (ACIP) voted to approve the Recommended Adult Immunization Schedule for Ages 19 Years or Older, United States, 2021. Following Emergency Use Authorization of Pfizer-BioNTech COVID-19 vaccine by the U.S. Food and Drug Administration, ACIP issued an interim recommendation at its 12 December 2020 emergency meeting for use of Pfizer-BioNTech COVID-19 vaccine in persons aged 16 years or older (1). In addition, ACIP approved an amendment to include COVID-19 vaccine recommendations in the child and adolescent and adult immunization schedules. Following Emergency Use Authorization of Moderna COVID-19 vaccine by the U.S. Food and Drug Administration, ACIP issued an interim recommendation at its 19 December 2020 emergency meeting for use of Moderna COVID-19 vaccine in persons aged 18 years or older (2). The 2021 adult immunization schedule, available at www.cdc.gov/vaccines/schedules/hcp/imz/adult.html, summarizes ACIP recommendations in 2 tables and accompanying notes (Figure). The full ACIP recommendations for each vaccine are available at www.cdc.gov/vaccines/hcp/acip-recs/index.html. The 2021 schedule has also been approved by the director of the Centers for Disease Control and Prevention (CDC) and by the American College of Physicians (www.acponline.org), the American Academy of Family Physicians (www.aafp.org), the American College of Obstetricians and Gynecologists (www.acog.org), the American College of Nurse-Midwives (www.midwife.org), and the American Academy of Physician Assistants (www.aapa.org).Figure. Recommended Adult Immunization Schedule for Ages 19 Years or Older, United States, 2021. Download figure Download PowerPoint Table 1 Recommended Adult Immunization Schedule by Age Group, United States, 2021Table 2 Recommended Adult Immunization Schedule by Medical Condition and Other Indications, United States, 2021Notes Recommended Adult Immunization Schedule for Ages 19 Years or Older, United States, 2021 Download figure Download PowerPoint Notes Recommended Adult Immunization Schedule, United States, 2021 Download figure Download PowerPoint Notes Recommended Adult Immunization Schedule, United States, 2021 Download figure Download PowerPoint The ACIP develops recommendations on the use of each vaccine after in-depth review of vaccine-related data, such as the epidemiology and burden of the vaccine-preventable disease (VPD), vaccine efficacy and effectiveness, vaccine safety, quality of evidence, feasibility of program implementation, and economic analyses of immunization policy (3). ACIP recommendations can be complex and challenging to implement. The purpose of the immunization schedule, published annually, is to consolidate and summarize updates to ACIP recommendations on vaccination of adults and to assist providers in implementing current ACIP recommendations. The use of vaccine trade names in this article and in the schedule is for identification purposes only and does not imply endorsement by the ACIP or CDC.Changes to the 2021 Adult Immunization ScheduleInfluenza vaccination (4). Updates to the seasonal influenza vaccine recommendations reflect discussions during public meetings of ACIP held on 23 October 2019, 26 February 2020, and 24 June 2020. For the 2020–2021 flu season, routine annual influenza vaccination is recommended for all persons aged 6 months and older who do not have contraindications. No preferential recommendation is made for one influenza vaccine product over another in persons for whom more than one licensed, recommended, and for which appropriate product based on patient age and health status are available. The composition of the 2020–2021 U.S. influenza vaccines includes updates to the influenza A(H1N1)pdm09, influenza A(H3N2), and influenza B/Victoria lineage components. These updated components are included in both trivalent and quadrivalent vaccines. Quadrivalent vaccines will include an additional influenza B virus component from the B/Yamagata lineage, which is unchanged from that included in quadrivalent influenza vaccines used during the 2019–2020 season. For the 2020–2021 season, U.S. egg-based influenza vaccines (i.e., vaccines other than cell-culture based inactivated influenza vaccine [ccIIV4] and recombinant influenza vaccine [RIV4]) will contain hemagglutinin (HA) derived from an influenza A/Guangdong-Maonan/SWL1536/2019 (H1N1) pdm09–like virus, an influenza A/Hong Kong/2671/2019 (H3N2)–like virus, an influenza B/Washington/02/2019 (Victoria lineage)–like virus, and (for quadrivalent egg-based vaccines) an influenza B/Phuket/3073/2013 (Yamagata lineage)–like virus. U.S. ccIIV4 and RIV4 influenza vaccines will contain HA derived from an influenza A/Hawaii/70/2019 (H1N1)pdm09–like virus, an influenza A/Hong Kong/45/2019 (H3N2)–like virus, an influenza B/Washington/02/2019 (Victoria lineage)–like virus, and an influenza B/Phuket/3073/2013 (Yamagata lineage)–like virus.Live attenuated influenza vaccine (LAIV4) is an option for adults through age 49 years, except for those who have immunocompromising conditions, including HIV infection; have anatomical or functional asplenia; are pregnant; have close contact with or are caregivers of severely immunocompromised persons who require a protected environment; have cranial CSF/oropharyngeal communications or cochlear implants; or have received influenza antiviral medications recently (see below). Per the LAIV4 package insert, antiviral agents might reduce the effectiveness of LAIV4 if given within the interval from 48 hours before to 14 days after vaccination. However, the newer influenza antivirals peramivir and baloxavir have longer half-lives than oseltamivir and zanamivir (approximately 20 hours for peramivir and 79 hours for baloxavir). LAIV4 should not be used if a person received either oseltamivir or zanamivir within the previous 48 hours, peramivir within the previous 5 days, or baloxavir within the previous 17 days.In persons with a history of an egg allergy more severe than hives, if using an influenza vaccine other than RIV4 (Flublok Quadrivalent) or ccIIV4 (Flucelvax Quadrivalent), administer the vaccine in a medical setting under the supervision of a health care provider who can recognize and manage severe allergic reactions. However, providers should note that severe allergic reactions to any vaccine can occur even in the absence of a history of previous allergic reaction. Therefore, all vaccination providers should be familiar with the office emergency plan and certified in cardiopulmonary resuscitation. A previous severe allergic reaction to influenza vaccine is a contraindication to future receipt of any influenza vaccine. Adults with a history of Guillain–Barré syndrome within 6 weeks of a previous dose of influenza vaccine generally should not be vaccinated, unless vaccination benefits outweigh risks for those at higher risk for severe complications from influenza.Tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccination (5). In October 2019, ACIP recommended allowing either tetanus and diphtheria toxoids (Td) vaccine or tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine (Tdap) to be used for the decennial Td booster, for tetanus prophylaxis against wound management, and for additional required doses in the catch-up immunization schedule if a person has received at least 1 Tdap dose. In the notes for Tdap, the language for wound management was updated and states, "Persons with 3 or more doses of tetanus toxoid-containing vaccine: For clean and minor wounds, administer Tdap or Td if more than 10 years since last dose of tetanus toxoid-containing vaccine; for all other wounds, administer Tdap or Td if more than 5 years since last dose of tetanus toxoid-containing vaccine. Tdap is preferred for persons who have not previously received Tdap or whose Tdap history is unknown. If a tetanus toxoid-containing vaccine is indicated for a pregnant woman, use Tdap. For detailed information, see www.cdc.gov/mmwr/volumes/69/wr/mm6903a5.htm."Hepatitis A (HepA) vaccination (6). ACIP recommends HepA vaccination for adults at risk for hepatitis A virus (HAV) infection or severe disease resulting from HAV infection and for adults requesting protection against HAV without the need to acknowledge a risk factor. In the notes for hepatitis A vaccine, under travel in countries with high or intermediate endemic hepatitis A, language was added for the accelerated Twinrix schedule ("HepA-HepB combination vaccine or Twinrix may be administered on an accelerated schedule of 3 doses at 0, 7, and 21 to 30 days, followed by a booster dose at 12 months").Hepatitis B (HepB) vaccination (7). ACIP recommends vaccination of adults at risk for hepatitis B virus (HBV) infection, including universal vaccination of adults in settings in which a high proportion have risk factors for HBV infection and vaccination of adults requesting protection from HBV without the need to acknowledge a specific risk factor. In the notes for hepatitis B vaccine, under Special Situations, language was added stating that hepatitis B vaccination for persons with diabetes aged 60 years or older is recommended by shared clinical decision-making.Human papillomavirus (HPV) vaccination (8). Routine vaccination is recommended at 11 to 12 years and can be started at age 9 years. Catch-up HPV vaccination is recommended for all persons through age 26 years. For adults aged 27 through 45 years, the public health benefit of HPV vaccination in this age range is minimal; shared clinical decision-making regarding HPV vaccination is recommended because some persons in this age group who are not adequately vaccinated might benefit from vaccination. In the notes for HPV vaccine, minor wording changes were made to clarify the text. Under routine vaccination, the first bullet now states, "Age 15 years or older at initial vaccination: 3-dose series at 0, 1–2, 6 months (minimum intervals: dose 1 to dose 2: 4 weeks / dose 2 to dose 3: 12 weeks / dose 1 to dose 3: 5 months; repeat dose if administered too soon)," to match the language in the child and adolescent schedule. A bullet was added stating that no additional doses of HPV are recommended after completing a series at the recommended dosing intervals using any HPV vaccine. Under Shared Clinical Decision-Making, the bullet text was modified and now states, "Some adults aged 27–45 years: based on shared clinical decision-making, 2- or 3-dose series as above." Under Special Situations, 2 bullets were added. The first states, "Age ranges recommended above for routine and catch-up vaccination or shared clinical decision-making also apply in special situations." The second states, "Immunocompromising conditions, including HIV infection: 3-dose series as above, regardless of age at initial vaccination."Measles, mumps, and rubella (MMR) vaccination (9). Routine recommendations for MMR vaccination have not changed.Meningococcal A, C, W, Y vaccination (10). ACIP recommends routine vaccination with a quadrivalent meningococcal conjugate vaccine (MenACWY) for persons at increased risk for meningococcal disease caused by serogroups A, C, W, or Y, including persons who have persistent complement component deficiencies; persons receiving a complement inhibitor (e.g., eculizumab [Soliris] or ravulizumab [Ultomiris]); persons who have anatomical or functional asplenia; persons with HIV infection; microbiologists routinely exposed to isolates of Neisseria meningitidis; persons identified to be at increased risk because of a meningococcal disease outbreak caused by serogroups A, C, W, or Y; persons who travel to or live in areas in which meningococcal disease is hyperendemic or epidemic; unvaccinated or incompletely vaccinated first-year college students living in residence halls; and military recruits. ACIP recommends MenACWY booster doses for previously vaccinated persons who become or remain at increased risk. On the schedule cover page, MenACWY-TT (MenQuadfi) was added to the list of approved MenACWY vaccines. MenACWY-TT was first licensed in the United States in 2020 for the prevention of meningococcal disease caused by serogroups A, C, W, and Y in persons aged 2 years or older (11). In the notes for MenACWY, a bullet regarding booster doses was added: "For MenACWY booster dose recommendations for groups listed under 'Special situations' and in an outbreak setting (e.g., in community or organizational settings, and among men who have sex with men) and additional meningococcal vaccination information, see www.cdc.gov/mmwr/volumes/69/rr/rr6909a1.htm."Meningococcal B vaccination (10). ACIP recommends routine use of serogroup B meningococcal (MenB) vaccine in persons aged 10 years or older who are at increased risk for serogroup B meningococcal disease, including persons who have persistent complement component deficiencies; persons receiving a complement inhibitor; persons who have anatomical or functional asplenia; microbiologists who are routinely exposed to isolates of N meningitidis; and persons identified to be at increased risk because of a meningococcal disease outbreak caused by serogroup B. ACIP recommends MenB booster doses for previously vaccinated persons who become or remain at increased risk. In addition, ACIP recommends a MenB series for adolescents and young adults aged 16 to 23 years by shared clinical decision-making to provide short-term protection against disease caused by most strains of serogroup B meningococcal disease. In the notes for MenB vaccine, a bullet regarding booster doses was added: "For MenB booster dose recommendations for groups listed under 'Special situations' and in an outbreak setting (e.g., in community or organizational settings, and among men who have sex with men) and additional meningococcal vaccination information, see www.cdc.gov/mmwr/volumes/69/rr/rr6909a1.htm."Pneumococcal vaccination (12). ACIP recommends a routine single dose of PPSV23 (pneumococcal 23-valent polysaccharide vaccine) for adults aged 65 years or older. For persons aged 65 years or older who do not have an immunocompromising condition, cerebrospinal fluid leak, or cochlear implant and who have not previously received PCV13, PCV13 vaccination is recommended by shared clinical decision-making if previously not administered. If a decision to administer PCV13 is made, PCV13 should be administered first, followed by PPSV23 at least 1 year later. In the notes for PCV13, an updated link for routine vaccination recommendations in persons aged 65 years or older was added. Under Shared Clinical Decision-Making, the bullets were reordered as follows:• PCV13 and PPSV23 should not be administered during the same visit• If both PCV13 and PPSV23 are to be administered, PCV13 should be administered first• PCV13 and PPSV23 should be administered at least 1 year apartVaricella vaccination (13). Routine recommendations for varicella vaccination have not changed.Zoster vaccination (14). Routine recommendations for zoster vaccination have not changed. Zoster vaccine live (ZVL, or Zostavax) was no longer sold in the United States starting on 1 July 2020. All remaining Zostavax in stock expired by 18 November 2020 and should no longer be used. All references to Zostavax have been removed from the 2021 adult immunization schedule. Therefore, the reference to recombinant zoster vaccine (RZV, or Shingrix) being preferred was also removed.Revised Content, Format, and GraphicsThe cover page of the 2021 schedule provides basic instructions on how to use the schedule to systematically identify vaccination needs of adults and lists routinely recommended vaccines and their standardized abbreviations and trade names. Web links are provided, where providers can download the CDC Vaccine Schedules app and access reference materials for the surveillance of vaccine-preventable diseases, including case identification and disease outbreak response. Instructions on reporting suspected cases of reportable VPDs to local or state health departments and significant postvaccination adverse events to the Vaccine Adverse Event Reporting System are listed. Information on the Vaccine Injury Compensation Program is provided, as well as web links to other resources, such as vaccine information statements, recommended vaccines for travelers, and shared clinical decision-making guidance.Table 1. Recommended Adult Immunization Schedule by Age Group. Table 1 describes routine and catch-up vaccination recommendations for adults by age. For 2021, the Tdap row of Table 1 on the adult immunization schedule has been split in half. The upper half is purple to indicate vaccination is recommended for adults with an additional risk factor or another indication (i.e., each pregnancy and wound management); the lower half is yellow, indicating vaccination is recommended for adults who meet the age requirement, lack documentation of vaccination, or lack evidence of past infection. In addition, a text overlay was added to the purple half of the row that states, "1-dose Tdap with each pregnancy; 1-dose Td/Tdap for wound management (see notes)" for clarification. In the MMR row, the yellow color was extended through 50 to 64 years to reflect the age of persons born in 1957 or later. In the varicella vaccine (VAR) row, the line between the yellow color and the purple color has been shifted to the left to reflect the age of persons born in 1980 or later. In the zoster row, Zostavax (ZVL) was deleted since it is no longer available and the text "RZV is preferred" was deleted. In the PCV13 row, in the column for age 65 years and older, the text overlay in the blue box was changed from "≥65 years" to "1 dose."Table 2. Recommended Adult Immunization Schedule by Medical Condition and Other Indications. Table 2 describes vaccination recommendations for adults based on medical conditions or other indications. For 2021, in the hepatitis B row, the text overlay has been modified to state "2, 3, or 4 doses depending on vaccine or condition." In the diabetes column, the box has been split in half. The upper half is yellow and has the text overlay "<60 years" to indicate hepatitis B vaccine is routinely recommended for adults with diabetes younger than 60 years. The lower half is blue and has the text overlay "≥60 years" to indicate shared clinical decision-making should be used for vaccinating person with diabetes who are aged 60 years or older with hepatitis B vaccine. In the HPV row, pregnancy column, the pink color for "Delay under after Pregnancy" has been replaced with red for "Not Recommended." Although this recommendation has not changed, the color was changed to simplify the schedule because the vaccine is not recommended during pregnancy and should be delayed until after pregnancy. In addition, an asterisk was added after "Not Recommended" to indicate HPV vaccine should be administered after pregnancy. The text overlay spanning the columns "asplenia, complement deficiencies" through "men who have sex with men" has been modified and now states "2 or 3 doses through age 26 years depending on age at initial vaccination or condition." In the MMR row, pregnancy column, an asterisk was added after "Not Recommended" to indicate MMR vaccine should be administered after pregnancy. A line was added between the pregnancy column and the immunocompromised column to separate them. In the VAR row, pregnancy column, an asterisk was added after "Not Recommended" to indicate VAR should be administered after pregnancy. A line was added between the pregnancy column and the immunocompromised column to separate them. In the column for "HIV infection with a CD4 count ≥200 cells/mm3," the color is now blue, indicating vaccination is recommended based on shared clinical decision-making to reflect this vaccine may be considered for this group. In the Zoster row, Zostavax (ZVL) has been removed since it is no longer available on the market. In the pregnancy column, the pink color for "Delay under after Pregnancy" has been replaced with gray as there is no recommendation for RZV during pregnancy.Notes. Recommended Adult Immunization Schedule. An Additional Information section has been added to include language for COVID-19 vaccination recommendations. Each recommended vaccine for adults in Tables 1 and 2 is accompanied by a note (previously known as a footnote), which is designed to provide additional information on routine vaccination and recommendations in special situations. Each section contains concise information on vaccine indications, dosing frequencies and intervals, and other published ACIP recommendations. New or revised language for influenza, hepatitis A, hepatitis B, HPV, pneumococcal, meningococcal ACWY, meningococcal B, Tdap, and zoster vaccination has been added to their respective sections in the notes. All vaccines identified in Tables 1 and 2 (except zoster vaccine) also appear in the Recommended Child and Adolescent Immunization Schedule for Ages 18 Years or Younger, United States, 2021 (www.cdc.gov/vaccines/schedules/hcp/imz/child-adolescent.html). The notes for vaccines that appear in both the adult immunization schedule and the child and adolescent immunization schedule have been harmonized to the greatest extent possible.Vaccination During the Coronavirus Disease 2019 (COVID-19) PandemicVaccination is an essential medical service for all children, adolescents, and adults; vaccines are ideally administered in the medical home. Providers should administer all due or overdue vaccines according to the routine immunization schedule during the same visit. In addition, providers should implement strategies to catch up all patients on any overdue vaccines. Providers should prioritize newborns, infants, and children up to age 24 months, then young children and adolescents, and lastly adults. CDC's interim guidance for the safe delivery of vaccines during the COVID-19 pandemic (15) includes the use of personal protective equipment (PPE) and physical distancing. Routine immunization services remain critical during the COVID-19 pandemic as they prevent disease in individuals, families, and the community (For more information, see https://www.cdc.gov/vaccines/pandemic-guidance/index.html). The CDC has partnered with the National Adult and Influenza Immunization Summit, which has developed a checklist of best practices for vaccination clinics held at satellite, temporary, or off-site locations and can be downloaded at www.izsummitpartners.org/content/uploads/2019/02/off-site-vaccination-clinic-checklist.pdf. This checklist is a step-by-step guide to help clinic coordinators or supervisors overseeing vaccination clinics held at satellite, temporary, or off-site locations follow CDC guidelines and best practices for vaccine shipment, transport, storage, handling, preparation, administration, and documentation. This checklist should be used in any nontraditional vaccination clinic settings, such as workplaces, community centers, schools, makeshift clinics in remote areas, and medical facilities when vaccination occurs in the public areas or classrooms.AppendixRecommendations for routine use of vaccines in children, adolescents, and adults are developed by the Advisory Committee on Immunization Practices (ACIP). ACIP is chartered as a federal advisory committee to provide expert external advice and guidance to the Director of the Centers for Disease Control and Prevention (CDC) on the use of vaccines and related agents to control vaccine-preventable diseases in the civilian population of the United States. Recommendations for routine use of vaccines in children and adolescents are harmonized to the extent possible with recommendations made by the American Academy of Pediatrics (AAP), the American Academy of Family Physicians (AAFP), and the American College of Obstetricians and Gynecologists (ACOG). Recommendations for routine use of vaccines in adults are harmonized with recommendations of AAFP, ACOG, the American College of Physicians (ACP), the American College of Nurse-Midwives (ACNM), and the American Academy of Physician Assistants (AAPA). ACIP recommendations adopted by the CDC Director become agency guidelines on the date they are published in the Morbidity and Mortality Weekly Report (MMWR). Additional information on ACIP is available at www.cdc.gov/vaccines/acip.Members of the ACIPUnless otherwise indicated, the members listed were nonauthor contributors to this article.José R. Romero, MD, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, Arkansas (Chair); Amanda Cohn, MD, Centers for Disease Control and Prevention, Atlanta, Georgia (Executive Secretary); Robert L. Atmar, MD, Baylor College of Medicine, Houston, Texas; Kevin A. Ault, MD*, University of Kansas Medical Center, Kansas City, Kansas; Lynn Bahta, RN, MPH, CPH, Minnesota Department of Health, Saint Paul, Minnesota; Beth P. Bell, MD, MPH, University of Washington, Seattle, Washington; Henry Bernstein, DO, MHCM*, Cohen Children's Medical Center, New Hyde Park, and Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York; Sharon E. Frey, MD, Saint Louis University Medical School, Saint Louis, Missouri; Paul Hunter, MD, City of Milwaukee Health Department, Milwaukee, Wisconsin; Grace M. Lee, MD, MPH, Lucile Packard Children's Hospital, Stanford University School of Medicine, Stanford, California; Veronica V. McNally, JD, Franny Strong Foundation, West Bloomfield, Michigan; Katherine A. Poehling, MD, MPH, Wake Forest School of Medicine, Winston-Salem, North Carolina; Pablo J. Sánchez, MD, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio; Peter Szilagyi, MD, MPH, University of California, Los Angeles, Los Angeles, California; Helen Keipp Talbot, MD, MPH, Vanderbilt University, Nashville, Tennessee. A list of current ACIP members is available at www.cdc.gov/vaccines/acip/committee/members.html.ACIP Combined Immunization Work GroupWork Group Co-Chairs: Kevin A. Ault, MD*, Kansas City, Kansas; Henry Bernstein, DO, MHCM*, New Hyde Park, New York.Work Group Members: Sarah Coles, MD, Phoenix, Arizona; Katherine Debiec, MD, Seattle, Washington; Marci Drees, MD, Philadelphia, Pennsylvania; John Epling, MD, Roanoke, Virginia; Holly Fontenot, PhD, Boston, Massachusetts; Sandra Fryhofer, MD, Atlanta, Georgia; Molly Howell, MPH, Bismarck, North Dakota; Marie-Michelle Leger, MPH, PA-C, Alexandria, Virginia; Susan Lett, MD, MPH, Boston, Massachusetts; Sarah McQueen, DMs, PA-C, Charlotte, North Carolina; Amy Middleman, MD, MSEd, MPH, Oklahoma City, Oklahoma; Sean O'Leary, MD, MPH, Denver, Colorado; Chad Rittle, DNP, MPH, RN, Pittsburgh, Pennsylvania; William Schaffner, MD, Nashville, Tennessee; Ken Schmader, MD, Durham, North Carolina; Rhoda Sperling, MD, New York, New York; Patricia Stinchfield, RN, MS, Saint Paul, Minnesota; Thomas Weiser, MD, MPH, Portland, Oregon.Work Group Contributors: Kathy Byrd, MD, MPH, Atlanta, Georgia; Kathleen Dooling, MD, MPH, Atlanta, Georgia; Amy Parker Fiebelkorn, MSN, MPH, Atlanta, Georgia; Lisa Grohskopf, MD, MPH, Atlanta, Georgia; Susan Hariri, PhD, Atlanta, Georgia; Fiona Havers, MD, PhD, Atlanta, Georgia; Holly Hill, PhD, MD, Atlanta, Georgia; Tara Jatlaoui, MD, MPH, Atlanta, Georgia; Suzanne Johnson-DeLeon, MPH, Atlanta, Georgia; Miwako Kobayashi, MD, MPH, Atlanta, Georgia; Ram Kopakka, MD, MPH, Atlanta, Georgia; Andrew Kroger, MD, MPH, Atlanta, Georgia; Lucy McNamara, PhD, MS, Atlanta, Georgia; Jessica MacNeil, Atlanta, Georgia; Lauri Markowitz, MD, Atlanta, Georgia; Elissa Meites, MD, MPH, Atlanta, Georgia; Tina Objio, RN, Atlanta, Georgia; Sara Oliver, MD, MSPH, Atlanta, Georgia; Priti Patel, MD, MPH, Atlanta, Georgia; Tamara Pilishvili, MPH, BS, Atlanta, Georgia; Ginger Redmon, MA, BA, Atlanta, Georgia; Candice Robinson, MD, MPH, Atlanta, Georgia; Sarah Schillie, MD, Atlanta, Georgia; Cindy Weinbaum, MD, MPH, Atlanta, Georgia; Walter W. Williams, MD, MPH, Atlanta, Georgia; Akiko Wilson, BFA, Atlanta, Georgia; JoEllen Wolicki, BSN, Atlanta, Georgia.Work Group Consultants: Caroline Bridges, MD, Moscow, Idaho; Kathleen Harriman, PhD, MPH, RN, Richmond, California; Robert H. Hopkins Jr., MD, Little Rock, Arkansas; Karen Ketner, DNP, Redwood City, California; David Kim, MD, MPH, Washington, DC; Jane Kim, MD, MPH, Durham, North Carolina; Maria C. Lanzi, ANP, MPH, Philadelphia, Pennsylvania; Diane Peterson, Saint Paul, Minnesota; Litjen Tan, PhD, Chicago, Illinois.Work Group Co-Leads: Mark Freedman, DVM, MPH*, Atlanta, Georgia; A. Patricia Wodi, MD, MPH.* Authored the article.References1. Oliver SE, Gargano JW, Marin M, et al. The Advisory Committee on Immunization Practices' interim recommendation for use of Pfizer-BioNTech COVID-19 vaccine - United States, December 2020. MMWR Morb Mortal Wkly Rep. 2020;69:1922-1924. [PMID: 33332292] doi:10.15585/mmwr.mm6950e2 Google Scholar2. Oliver SE, Gargano JW, Marin M, et al. 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Google Scholar Comments0 CommentsSign In to Submit A Comment Author, Article, and Disclosure InformationAffiliations: Centers for Disease Control and Prevention, Atlanta, Georgia (M.S.F.)Cohen Children's Medical Center, New Hyde Park, and Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York (H.B.)and University of Kansas Medical Center, Kansas City, Kansas (K.A.A.).Disclosures: To ensure the integrity of the ACIP, the U.S. Department of Health and Human Services has taken steps to ensure there is technical adherence to ethics statutes and regulations regarding financial conflicts of interest. Concerns regarding the potential for the appearance of a conflict are addressed or avoided altogether through preappointment and postappointment considerations. Individuals with particular vaccine-related interests will not be considered for appointment to the committee. Potential nominees are screened for conflicts of interest and, if any are found, are asked to divest or forgo certain vaccine-related activities. In addition, at the beginning of each ACIP meeting, each member is asked to declare his or her conflicts. Members with conflicts are not permitted to vote if the conflict involves the vaccine or biological being voted on. Details can be found at www.cdc.gov/vaccines/acip/committee/structure-role.html. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M20-8080.Corresponding Author: Mark S. Freedman, DVM, MPH, Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mailstop H24-6, Atlanta, GA 30329-4027; e-mail, [email protected]gov.Correction: This article was corrected on 16 March 2021 to fix two URLs in the text.Current Author Addresses: Dr. Freedman: Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mailstop H24-6, Atlanta, GA 30329-4027.Dr. Bernstein: Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 410 Lakeville Road, Suite 311, New Hyde Park, NY 11042.Dr. Ault: University of Kansas Medical Center, Department of Obstetrics and Gynecology, 3901 Rainbow Boulevard, Mailstop 2028, Kansas City, KS 66160.Author Contributions: Conception and design: K. Ault, H. Bernstein, M.S. Freedman.Analysis and interpretation of the data: K. Ault, H. Bernstein, M.S. Freedman.Drafting of the article: M.S. Freedman.Critical revision for important intellectual content: K. Ault, H. Bernstein, M.S. Freedman.Final approval of the article: K. Ault, H. Bernstein, M.S. Freedman.Collection and assembly of data: K. Ault, H. Bernstein, M.S. Freedman.This article was published at Annals.org on 11 February 2021.* The 2021 adult immunization schedule appeared in Annals of Internal Medicine and on the Centers for Disease Control and Prevention website at www.cdc.gov/vaccines/schedules. An announcement summarizing changes to the 2021 adult immunization schedule is published concurrently in the Morbidity and Mortality Weekly Report. Readers can cite the 2021 adult immunization schedule as follows: Freedman MS, Bernstein H, Ault KA; Advisory Committee on Immunization Practices. Recommended adult immunization schedule, United States, 2021. Ann Intern Med. 11 February 2021. [Epub ahead of print]. doi:10.7326/M20-8080† The 2021 adult immunization schedule was prepared by the Advisory Committee on Immunization Practices (ACIP); the ACIP Combined Immunization Schedule Work Group; Mark S. Freedman, DVM, MPH (Centers for Disease Control and Prevention, Atlanta, Georgia); Henry Bernstein, DO, MHCM (Cohen Children's Medical Center, New Hyde Park, and Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York); and Kevin A. Ault, MD (University of Kansas Medical Center, Kansas City, Kansas). For a list of members of the ACIP and the ACIP Combined Immunization Schedule Work Group, see the Appendix. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited by2022 American College of Rheumatology Guideline for Vaccinations in Patients With Rheumatic and Musculoskeletal Diseases2022 American College of Rheumatology Guideline for Vaccinations in Patients With Rheumatic and Musculoskeletal DiseasesPneumococcal Disease in High-Risk Adults in Lebanon: Expert OpinionInfluenza Vaccines in Maintenance Hemodialysis Patients: Does Seroresponse Vary With Different Vaccine Formulations?Safety of Immunizations for the Adult Patient With Inflammatory Bowel Disease—A Systematic Review and Meta-analysisHealth Care Maintenance in Patients with Crohn's DiseaseCumulative incidence of and risk factors for herpes zoster among patients with diabetes mellitus: Results from a 10-year nested case-control studyThe Awareness and Attitude of Physicians to Older Adult Routine Vaccination SchemeHealth Maintenance for Adult Patients with Inflammatory Bowel Disease March 2021Volume 174, Issue 3Page: 374-384KeywordsAdolescentsCOVID-19ChildrenHepatitis AHospital medicineHuman papillomavirusMeningococcal diseasePregnancyTetanusVaccines ePublished: 11 February 2021 Issue Published: March 2021 PDF downloadLoading ...