New 2023 Immunization Schedules Now Available

Changes Cover COVID-19, MMR, Hepatitis B, Pneumococcal Vaccines

Feb. 13, 2023, Michael Devitt — The AAFP joined the CDC and several other medical organizations on Feb. 10 to release the new 2023 adult and childhood/adolescent immunization schedules. Members can find the schedules on AAFP.org and access patient-friendly versions on the CDC website.

While the addition of COVID-19 vaccines to the schedules is likely to draw significant attention, there are plenty of other important revisions that family physicians and others who administer vaccines should be aware of. These include changes and updates for several childhood and adult vaccines that offer protection against a variety of infectious diseases.

“CDC continues to improve ease and readability of vaccine schedules through harmonization of the child/adolescent and adult immunization schedules with format, color coding and verbiage,” said Pamela Rockwell, D.O., of Ann Arbor, Mich., the AAFP’s liaison to the CDC’s Advisory Committee on Immunization Practices.

“New vaccines for prevention of pneumococcal disease, measles, mumps and rubella, hepatitis and COVID-19 have been added, with an appendix for easy reference to precautions and contraindications to vaccines and a QR code for quick online access to information,” Rockwell continued. “COVID-19 vaccines added to the child/adolescent and adult schedules as routine vaccine recommendations include clear notes and resources available to access for those with special situations.”

Highlights and Updates

Vaccines that offer protection against COVID-19 feature prominently on both schedules.

For adults, rows for COVID-19 vaccines have been added to the recommended immunization schedules based on age and medical condition, while for children and adolescents, rows have been added based on age and medical indication.

In both schedules, the COVID-19 vaccine row is yellow, indicating that vaccination is now routinely recommended for all individuals, except where indicated. In addition, sections on COVID-19 vaccines have been added to the Notes area of each immunization to include:

primary series recommendations for the general population and those who are moderately or severely immunocompromised;
links to booster dose recommendations and recommendations for those who previously received the Janssen/Johnson & Johnson vaccine;
links to current COVID-19 vaccination schedules and to information about COVID-19 pre-exposure prophylaxis in immunocompromised people; and
the latest emergency use authorization indications.

In addition, the cover page of each immunization schedule contains the abbreviations and trade names for all currently approved monovalent and bivalent COVID-19 vaccines.

Details for Children and Adolescents

For influenza vaccination, the Notes section now includes new guidance on vaccinating individuals who are close contacts of severely immunocompromised patients who require a protected environment. For adults over age 65, a preferential recommendation is made to give a high-dose flu vaccine.

For measles, mumps and rubella vaccination, a newly licensed vaccine with the trade name Priorix has been added to the table of vaccine abbreviations and trade names. Routine MMR vaccination consists of a two-dose series, with the first dose administered at age 12 to 15 months and the second dose at age 4 to 6 years.

For pneumococcal vaccination, a new 15-valent pneumococcal conjugate vaccine with the trade name Vaxneuvance has been added to the cover page, all tables, and the Notes section. All children should receive four doses of pneumococcal conjugate vaccine (either PCV13 or PCV15) at 2, 4, 6 and 12 to 15 months.

For both routine and catch-up vaccinations, the Notes section states that PCV15 can be used interchangeably with 13-valent pneumococcal conjugate vaccine in children who are healthy or have underlying conditions. No additional PCV15 vaccine is indicated for children who have already completed their age-appropriate complete PCV13 series.

Finally, the appendix received several clarifying edits, with changes on the rows for dengue vaccine, egg-based influenza vaccines, hepatitis B vaccines, human papillomavirus vaccine, MMR vaccines and varicella vaccine.

Details for Adults

For hepatitis B vaccination, a three-dose vaccine with the trade name PreHevbrio has been added to the table of vaccine abbreviations and trade names; PreHevbrio is not recommended during pregnancy due to a lack of safety data. In addition, clarifying language has been inserted into the Notes section stating that people age 60 or older with known risk factors for hepatitis B infection should complete a hepatitis B vaccine series, while those 60 and older without known risk factors may complete a vaccine series.

For influenza vaccination, new language has been added to the Notes section stating that for people 65 years and older who are undergoing routine vaccination, any one of the following is preferred:

high-dose inactivated influenza vaccine,
quadrivalent recombinant influenza vaccine or
quadrivalent adjuvanted inactivated influenza vaccine.

If none of these vaccines is available, then any other age-appropriate influenza vaccine should be used.

Also for influenza vaccination, additional guidance has been provided for close contacts of severely immunocompromised patients who require a protected environment.

For pneumococcal vaccination, the Notes section has undergone substantial changes on the use of PCV15 and PCV20 vaccines in people who previously received other pneumococcal vaccines. The Notes section also contains links to CDC’s Pneumococcal Vaccine Timing for Adults guidance document and the agency’s PneumoRecs VaxAdvisor mobile app to assist clinicians in determining which pneumococcal vaccines a person needs and when.

For polio vaccination, a new section in the Notes section addresses polio vaccine recommendations for adults at increased risk of exposure to poliovirus.

More Vaccine Updates

The draft agenda for the ACIP’s Feb. 22-24 meeting includes votes on vaccines for Mpox and rotavirus, and discussion about the status of vaccines for several other infectious diseases.

Late last month, the FDA’s Vaccines and Related Biological Products Advisory Committee voted unanimously to recommend “harmonizing” the vaccine strain composition of the COVID-19 vaccine primary series and booster doses so all COVID-19 vaccines contain the same ingredients.

VRBPAC did not, however, vote on an FDA proposal that called for annual COVID-19 shots, similar to the current immunization strategy for influenza. The AAFP is monitoring the FDA’s actions and will issue its own statement once official recommendations have been published.

Finally, the CDC in late January updated the list of errata and updates for the General Best Practice Guidelines for Immunization. These updates include adding:

PCV15 and PCV20 vaccines to tables on the dose and route of administration for selected vaccines, and vaccine storage temperature recommendations;
PCV15 and PCV20 vaccines, with an explanatory footnote, to a table on the recommended and minimum ages and intervals between vaccine doses; and
clarifying language on guidance involving the re-administration of recombinant zoster vaccine to people who received hematopoietic stem cell transplants.