Olivia Welter, PharmD
In February 2023, CDC released its immunization schedules for 2023. Both adult and childhood/adolescent schedules received updates, with changes covering recommendations for COVID-19; measles, mumps, and rubella (MMR); hepatitis B; pneumococcal vaccines; and more.
Bringing pharmacy to the table
This cycle, APhA had the opportunity to suggest recommendations, review, and provide support for the adult immunization schedule specifically.
This marks the first instance of pharmacy being an actively engaged participant in this process.
“This is a recognition of and tribute to the large impact that pharmacists have had and will continue to have in the provision of vaccine and vaccination-related activities,” said Brigid Groves, vice president of pharmacy practice at APhA.
Several pharmacy leaders affiliated with APhA served as subject matter experts for the adult vaccine schedule. APhA is listed alongside other notable health care organizations on the printable document, right next to the instructions for using the schedules.
COVID-19 vaccines: A new standard
The adult and childhood/adolescent immunization schedules show that CDC now recommends the COVID-19 vaccine series for the general population and for individuals who are moderately to severely immunocompromised. This change to the recommendations is perhaps the most anticipated since ACIP voted unanimously in October 2022 to add the COVID-19 vaccine to the new adult and childhood/adolescent immunization schedules.
Pfizer–BioNTech’s Comirnaty, Moderna’s Spikevax, and Novavax’s COVID-19 vaccines are the monovalent COVID-19 vaccines recommended within the schedules. The bivalent versions of the vaccines from Pfizer–BioNTech and Moderna have also made it onto the list of recommended immunizations to be administered as booster doses. However, Janssen’s single-dose monovalent vaccine is excluded from the recommendations.
Additionally, an FDA advisory committee voted in early 2023 to recommend “harmonizing” the primary series and booster doses of COVID-19 vaccines so that all will eventually contain the same ingredients, making vaccine selection an easier process.
Child-specific updates
Two newly licensed vaccines have made their way into the childhood immunization schedule. Priorix (GlaxoSmithKline) for MMR prevention and a 15-valent pneumococcal vaccine called Vaxneuvance (Merck) are included in the recommendations for the 2023 edition. The updated schedule also noted that the 15-valent vaccine can be used interchangeably with the 13-valent vaccine for children in both routine and catch-up pneumococcal vaccination series.
Adult-specific updates
The updated adult schedule also explores use of pneumococcal vaccines. As one of the vaccine types with the most frequently changing guidance, pneumococcal vaccines require clinicians to refer back often to CDC immunization schedules to ensure they are appropriately selecting which one to use.
In the 2023 edition of the adult schedule, the notes section reflects substantial changes regarding pneumococcal vaccines when considering prescribing the 15-valent and 20-valent version of the pneumococcal vaccine for someone who has already received other types of pneumococcal vaccines.
In addition, the schedule makes it easier for clinicians to make decisions by providing links to a guidance document and a mobile app designed specifically for pneumococcal vaccine recommendations.
Influenza recommendations for older adults are another major focus of the 2023 adult schedule. For individuals 65 years and older, the updated schedule notes that 3 versions of the vaccine are preferred: high-dose inactivated influenza vaccine, quadrivalent recombinant influenza vaccine, and quadrivalent adjuvanted inactivated influenza vaccine.
Future schedule considerations (RSV, mpox, rotavirus)
While the 2023 CDC childhood and adult immunization schedules underwent several notable changes, advisory committees are already considering new recommendations for the next edition.
A potential RSV vaccine is in the works, and both Pfizer and GSK received votes from an FDA group in favor of recommending their products for approval. If approved, the RSV vaccine may be added to future immunization schedules.
At a February 2023 ACIP meeting, a CDC immunization advisory committee voted to recommend the Jynneos vaccine for adults who are at risk for contracting mpox.
Other vaccine updates to look out for in the future include rotavirus, meningococcal, and further recommendations for COVID-19 vaccines and booster doses. ■