Updated ACIP Recommendations for Adults Include Universal Recommendation for Adults Aged 19 to 59 Years

Any patients aged 60 years or older who does not meet risk-based recommendations can still receive hepatitis B vaccination.

The latest updated adult immunization guidelines from the Advisory Committee on Immunization Practices (ACIP) include universal hepatitis B virus (HBV) vaccination for adults between 19 and 59 years of age, as well as vaccination for adults 60 years of age or older if they have an additional risk factor or other indication.1

According to a press release from the CDC, the recommendation specifies that 2, 3, or 4 HBV vaccine dosages could be used, depending on the vaccine or condition of the patient. Three doses are recommended for pregnant patients, whereas the recommendations say “2, 3, or 4 doses” for patients with other risk factors.

Furthermore, language has been added to the “routine vaccination” recommendations stating that any patients aged 60 years or older who does not meet risk-based recommendations can still receive HBV vaccination.1

“Age 60 is the cutoff for the universal recommendation,” said Sandra Adamson Fryhofer, MD, MACP, in a video from the American College of Physicians (ACP) reviewing the updated ACIP recommendations. “But the hep B notes are clear. Anyone [aged] 60 or older who does not meet risk-based recommendations may still receive it.”2

A new appendix has been added listing the contraindications and precautions for each vaccine. According to the notes for HBV vaccination, the 2-dose Heplisav series contains a new adjuvant and should not be used for pregnant individuals due to a lack of safety data. Furthermore, 4 doses of the HBV double strength vaccines (Engerix B) are recommended for adults receiving hemodialysis.2

In addition to changes for HBV vaccination, the new ACIP recommendations for adults include vaccine-specific changes in the 2022 immunization schedule for influenza, pneumococcal, recombinant zoster, and COVID-19 vaccinations.1

For adults between 19 and 49 years of age, recombinant zoster vaccination is now recommended for individuals who have immunocompromising conditions. The text overlay now states that 2 doses are recommended for this patient population, according to a press release from the CDC.1

“To review, the live virus shingles vaccine, Zostavax, is no longer available,” Fryhofer said in the ACP video. “That’s why only 1 zoster vaccine—RZV, or recombinant zoster vaccine (brand name Shingrix)—is listed on the schedule.”2

Recommendations for pneumococcal vaccines have also changed, with a recommendation for adults aged 19 to 64 years only if they have an additional risk factor or another indication. For adults aged 65 years or older, the recommendations state that pneumococcal vaccination is universally recommended if they have never received a previous vaccine or if their vaccination history is unknown.1

According to the press release, the text overlay states that 1 dose of a 15-valent vaccine should be followed by 1 dose of a 23-valent vaccine, or a single dose of a 20-valent vaccine is sufficient. Notably, the 13-valent vaccine is not included in the recommendations.1


1. Advisory Committee on Immunization Practices Recommended Immunization Schedule for Adults Aged 19 Years or Older—United States, 2022. CDC Morbidity and Mortality Weekly Report; February 18, 2022. Accessed February 22, 2022. https://www.cdc.gov/mmwr/volumes/71/wr/mm7107a1.htm?s_cid=mm7107a1_w

2. American College of Physicians. Adult Immunization Videos; Accessed February 22, 2022. https://www.acponline.org/clinical-information/clinical-resources-products/adult-immunization/adult-immunization-videos