The recommendations were released Tuesday by the Advisory Committee for Immunization Practices, with proposed changes on several vaccinations. ACIP is a panel of experts that continually reviews the latest evidence on vaccine effectiveness and safety; it meets three times a year and makes recommendations to the U.S. Centers for Disease Control and Prevention, which usually adopts ACIP’s advice as policy.
The panel regularly makes changes to the recommended schedule, usually once a year.
Among the most notable of the new suggestions was the one on mumps. The current schedule calls for two doses of the MMR (measles, mumps, rubella) vaccine, at around 1 year old and 4 to 6 years old.
Mumps outbreaks have occurred in several places around the nation over the past couple of years, however. Close to 3,000 people fell ill in Arkansas during 2016-17; Texas experienced a smaller outbreak that nonetheless sickened more than 200 people. The new adult recommendations call for “the use of an additional dose of measles, mumps, and rubella vaccine (MMR) in a mumps outbreak setting,” the CDC reported in its Morbidity and Mortality Weekly Report.
A similar recommendation was made for children who are exposed to mumps.
Other recommendations made for the childhood schedule of vaccines included:
- A formal recommendation against using the nasal flu mist, a live attenuated vaccination against flu that was the favored vaccine for children until studies showed that it no longer appeared effective. As a matter of practice, the nasal flu mist was not offered during the last flu season or this one.
- Using the hepatitis B vaccine within 24 hours of birth for newborns weight more than 2000 grams (4.4 pounds) born to mothers who test negative for hepatitis B.
- Providing the flu vaccine to most children 6 months or older, which confirms longstanding recommendations.
Additional recommendations for adults include two doses of the newly approved recombinant zoster vaccine for adults 50 years and older, two to six months apart, in order to prevent shingles. That recommendation includes adults in that age group who already received the live vaccine for shingles, which was found to be far less effective than the new vaccine. The recommendation was for adults with health immune systems; ACIP has not developed a recommendation for people with compromised immune systems.
The new recombinant vaccine “is an excellent new vaccine providing excellent protection," David Kim, MD, the CDC's deputy director for adult immunization, told Medscape Medical News in its report on the new recommendations. "It has long duration and does not wane, and because of its longer protection we incorporated the recommendation for those age 50 and older instead of just the age 60 and older group."
Other medical experts including Sandra Adamson Fryhofer the American College of Physicians’ liaison to ACIP, noted that patiients receiving the new vaccine should be warned of the higher likelihood of side effects including muscle aches and fatigue, though these are generally minor and far less disabling and uncomfortable than getting shingles. That warning will make it clear to patients that despite the discomfort, they must go to the doctor for their second dose.
"So we have to tell our patients,” Fryhofer told Medscape, “that if they react to the first dose, they won't necessarily have a reaction to the second dose, and they do need that second dose."
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