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Adult Immunization Schedule 2024

Changes to the 2024 Adult Immunization Schedule

COVID-19 vaccination (3). The COVID-19 vaccination section was updated to reflect the new COVID-19 vaccination recommendations that were approved during an ACIP public meeting held on 12 September 2023. All adults are now recommended to receive at least 1 dose of the updated (2023–2024 Formula) COVID-19 vaccine. The “Routine vaccination” section describes the vaccine recommendations for the general population, while the “Special situations” section describes the vaccine recommendations for persons who are moderately or severely immunocompromised. The number of doses needed and intervals between doses may vary based on a patient’s immunization history, their immunocompromised status, and the vaccine product used.

Haemophilus influenzae type b (Hib) vaccination. Recommendations for Hib vaccination have not changed.

Hepatitis A (HepA) vaccination (4). Minor changes were made to the “Routine vaccination” and “Special situations” sections to improve clarity in the language.

Hepatitis B (HepB) vaccination (5). Additional context was provided in the “Routine vaccination” section to describe the risk-based recommendation for persons 60 years of age and older. The text now reads, “Age 60 years or older without known risk factors for hepatitis B virus infection may receive a HepB vaccine series. Age 60 years or older with known risk factors for hepatitis B virus infection should receive a HepB vaccine series. Any adult age 60 years of age or older who requests HepB vaccination should receive a HepB vaccine series.” A note was added at the end of the “Routine vaccination” section describing the shared clinical decision-making recommendation for persons 60 years of age and older with diabetes.

Human papillomavirus (HPV) vaccination (6). Guidance on interrupted schedules was removed because that information is presented on the cover page. To add clarity, the words “of any valency” were added to the bullet “No additional dose recommended when any HPV vaccine series of any valency has been completed using the recommended dosing intervals.” Lastly, a resource was added to assist health care providers with shared clinical decision-making recommendations for HPV vaccination.

Influenza vaccination (7). For the 2023–2024 influenza season, routine annual influenza vaccination continues to be recommended for all persons aged 6 months and older who do not have contraindications.

The composition of 2023–2024 U.S. influenza vaccines includes an update to the influenza A(H1N1)pdm09 component. All seasonal influenza vaccines available for the 2023–2024 season are quadrivalent. The egg-based vaccines will contain hemagglutinin (HA) derived from an influenza A/Victoria/4897/2022 (H1N1)pdm09–like virus, an influenza A/Darwin/9/2021 (H3N2)–like virus, an influenza B/Austria/1359417/2021 (Victoria lineage)–like virus, and an influenza B/Phuket/3073/2013 (Yamagata lineage)–like virus. The cell culture–based and recombinant vaccines will contain HA derived from an influenza A/Wisconsin/67/2022 (H1N1)pdm09–like virus, an influenza A/Darwin/6/2021 (H3N2)–like virus, an influenza B/Austria/1359417/2021 (Victoria lineage)–like virus, and an influenza B/Phuket/3073/2013 (Yamagata lineage)–like virus.

Bullets referring to having an egg-based allergy were removed from the “Special situations” section, because any influenza vaccine (either egg-based or non–egg-based) indicated for the recipient’s age and health status can be used. A note explaining that any vaccine product appropriate for age and health status can be used for persons with an egg allergy was added at the end of the “Special situations” section.

Measles, mumps, and rubella (MMR) vaccination (8). Minor changes were made to the “Routine vaccination” section to improve clarity in the language.

Meningococcal vaccination (9). Menactra (MenACWY-D) was removed from the Notes section because this product is no longer distributed in the United States. A hyperlink to a resource that describes shared clinical decision making for MenB vaccination is provided. Finally, information on the use of the new pentavalent meningococcal vaccine (MenACWY-TT/MenB-FHbp, Penbraya) was provided at the end of the Meningococcal Notes section.

Mpox vaccination (10). Mpox is a new addition to the Notes section of the adult immunization schedule. Risk factors that warrant routine Jynneos (Bavarian Nordic) vaccination are listed. Bullets about the use of Jynneos among health care providers and in pregnant persons are provided at the end of the Mpox Notes section.

Pneumococcal vaccination (11). Minor edits were made throughout the “Routine vaccination” and “Special situations” sections to provide clarity on the guidance and minimum intervals between doses of pneumococcal vaccines.

Polio vaccination (12). The “Routine vaccination” section was revised and now states that adults who are known or suspected to be unvaccinated or incompletely vaccinated should complete the 3-dose inactivated poliovirus vaccine (IPV) primary series. Additionally, a statement was added stating that most adults born and raised in the United States can assume that they were vaccinated against polio as children. The “Special situations” section describes that adults who are at increased risk for exposure to poliovirus and who have completed the primary series may receive a one-time, lifetime IPV booster dose.

Respiratory syncytial virus (RSV) vaccination (13, 14). RSV is a new addition to the Notes section of the adult immunization schedule. The “Routine vaccination” section describes the use of Abrysvo (Pfizer) during 32 to 36 weeks’ gestation. A sub-bullet was added stating that either maternal RSV vaccination or infant immunization with nirsevimab (RSV monoclonal antibody) is recommended to prevent RSV lower respiratory tract infection in infants. A note was added stating that certain jurisdictions may have RSV seasonality that differs from most of the continental United States and that health care providers should follow guidance from public health authorities on timing of administration based on local RSV seasonality. The “Special situations” section describes the shared clinical decision-making recommendation for vaccination among persons 60 years of age and older; either Abrysvo (Pfizer) or Arexvy (GSK) may be used. A hyperlink to a resource that describes shared clinical decision-making recommendations for RSV vaccination is provided. Finally, a note was added describing the risk factors and medical conditions that health care providers should consider when thinking about a patient’s risk for severe RSV disease and if such patients would benefit from vaccination.

Tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccination (15). A note was added at the end of the Tdap section to clarify that a dose of Tdap received at 10 years of age may be counted as the adolescent dose routinely recommended at age 11 to 12 years.

Varicella vaccination. Routine recommendations for varicella vaccination have not changed.

Zoster vaccination. Routine recommendations for zoster vaccination have not changed.

Del Oro Hospital Days

By Amin H. Karim MD

In the 1990s, there was a small 100 bed hospital called Medical Center Del Oro Hospital situated on Greenbriar Drive, behind where the Women’s Hospital of Texas is now. it was founded in 1970s by a group of 20 or so physicians and surgeons in the Texas Medical Center who were all affiliated as Non-Baylor Non UT physicians with the major hospitals like Hermann, Methodist and St. Luke’s Episcopal Hospital. They wanted a hospital of their own free of politics as existed in the medical center hospitals with full time faculty and private physicians. (Seems they were ahead of their time). 
The hospital thrived and even added open heart surgery program when a fellow graduating from Dr. Michael E. DeBakey program at Baylor College of Medicine, Dr. Pedro Rubio went into practice and started a open heart surgery program at Del Oro. A couple of cardiologists like Dr. Mehdi Al Bassam and Matheethra Jacob later joined and did interventions in the cath lab with Dr. Rubio providing surgical backup which was mandatory in the early days of plain baloon angioplasty, some ending up with intimal dissections and needing urgent coronary bypass. Dr. DeBakey, as expected, did not like Pedro starting his own program at a neighboring hospital and potentially competing with him. But this is a free country, thank God, and there is little he could do about it. If Pedro was his resident he could have been solidly expelled from the program on the spot! Regardless, Pedro would often tell his encounters with Dr. DeBakey including one where Dr. DeBakey challenged him to car race on Fannin Street and they both did; Pedro, being smart, let the Professor win lest he was fired from the program! I did refer patients to Dr. Rubio and we got along quite well. Since I was one of the early trained fellows in Interventional Cardiology, would assist other cardiologists and teach them a thing or two of balloon angioplasty. 
I would refer some patients to Dr. Rubio but would refer the higher risk patients to Dr. Gerald Lawrie or late Dr. Jimmy Howell at the Methodist Hospital. Patients who came to me from India or Pakistan would prefer St. Luke’s Hospital, one due to Dr. Denton Cooley’s fame and second St. Luke’s offered a “package deal” for coronary bypass whereas Methodist would charge more (often much more). Hermann has it’s own international program too.

Del Oro was sold by the physician owner to HCA Hospital in the early 1980s. HCA was later acquired in the early 1990s by Columbia Hospital System. Later Columbia went bankrupt due to Federal action against them. (will write about that later). It was re-acquired by HCA. In mid 1990s it was shut down and demolished, the land being taken over by the Women’s Hospital of Texas for their expansion.
 
The photo above was at one of the Holiday parties in the 1990s with late Mr. Denzil Hamblin on the left and Pedro Rubio in the middle. Denzil was very experienced cath lab director and passed away in the early 2000s. Dr. Rubio met with a freak accident at home when he stumbled over the large box TV which a repairman had left inside his house near the front door. He broke his elbow joint and even underwent replacement but unfortunately could not longer operate. He had also pioneered laparoscopic cholecystectomy and wrote a book on it. He was honored by Royalty in Europe which he proudly displayed in his office and on his letter heads. He passed away a decade ago. 

May both rest in Peace. 

Nursing staff of the Del Oro Medical Center Hospital in 1994. Denzil, Joann and Lulu have passed away. May they rest in Peace. Joann was one of the most pleasant and kind nurse and liked by all.