Adult Immunization Schedule Updated

Shingrix and Heplisav-B vaccines now recommended for adults

older couple sitting on a park bench

Every year in the United States, thousands of adults become seriously ill and are hospitalized because of diseases that vaccines can help prevent.

The need for vaccines does not go away with age. In fact, there are specific ages in your adult life when vaccinations are recommended.

Immunization guidelines for adults are routinely updated when the US Food and Drug Administration (FDA) makes changes.

According to a JAMA article published on August 19, 2019, there have been 2 important vaccines approved by the FDA for adults, which are as follows:

Shingrix

  • Shingrix, a herpes zoster vaccine containing a specific protein subunit of the virus (recombinant glycoprotein E) with a novel adjuvant (an added substance that enhances or prolongs the immunologic response). Shingrix, a new recombinant herpes zoster vaccine approved by the FDA on October 20, 2017, is more efficacious than the older live-attenuated Zostavax (efficacy of >90% vs 51%, respectively).
  • The ACIP recommends Shingrix over Zostavax for all immunocompetent persons, for those with chronic medical conditions (eg, chronic kidney disease, diabetes, chronic lung disease), and for persons aged 50 years or older receiving low-dose immunosuppressive therapy (at 0 months and at 2-6 months), including those who previously received Zostavax (at ≥2 months after dose) or had a prior episode of shingles. 
  • A recent study showed Shingrix reduced the incidence of herpes zoster in adults who had undergone autologous hematologic stem cell transplantation. Testing for varicella-zoster antibody prior to vaccination is not recommended.

Heplisav-B

  • Heplisav-B, a single-antigen recombinant hepatitis B vaccine with a novel adjuvant. In 2017, the recombinant hepatitis B vaccine (HBV), Heplisav-B, was approved by the FDA for adults aged 18 years or older. 
  • It is a combination of HBV surface antigen (HBsAg; 20 µg) and Dynavax’s proprietary TLR9 agonist (a synthetic cytidine-phosphate-guanosine oligonucleotide, CpG 1018 adjuvant) and was designed to stimulate a directed immune response to HBsAg.
  • Heplisav-B is administered as a 2-dose series at 0 month and at 1 month. Currently, the ACIP does not endorse one hepatitis B vaccine over another; however, Heplisav-B requires only 2-doses and evidence suggests it is more immunogenic.

The vaccines you need as an adult are determined by many factors including your age, lifestyle, health condition, and which vaccines you’ve received during your life.

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The 2019 adult vaccination schedule can be found here. 

The FDA says ‘talk to your healthcare professional about which vaccines are right for you.’

The corresponding author for this JAMA article is Beverly E. Sha, MD, Rush University Medical Center, Division of Infectious Diseases, 600 S Paulina, Ste 140-143, Chicago, IL 60612 ([email protected]).