Major changes regarding the use of the human papillomavirus vaccine in males, the hepatitis B vaccine in adults with diabetes, the tetanus-diphtheria-acellular pertussis vaccine in pregnant women, and the influenza in egg-allergic individuals are among the highlights in the 2012 Adult Immunization Schedule from the Advisory Committee on Immunization Practices. The recommendations were published online Jan. 31 in Annals of Internal Medicine.

The new routine recommendation for use of the 4-valent HPV vaccine (Gardasil) in males starts at age 11 years, as with females, but extends routine vaccination to males only through age 21 years vs. 26 years for females. Men who have sex with men and immunocompromised and HIV-positive males "should" be vaccinated through age 26 years, according to the recommendations.

Hepatitis B vaccination is now routinely recommended for unvaccinated adults with diabetes through age 59 years. This age cutoff was chosen on the basis of disease risk and cost-effectiveness. There is also a softer recommendation that hepatitis B vaccine "may" be administered to older diabetes patients at physician discretion.

The tetanus, diphtheria, and acellular pertussis (Tdap) booster is now recommended during pregnancy, preferably after 20 weeks of gestation, so that protective maternal antibodies then pass to the fetus. Previous guidance had advised Tdap immediately postpartum. The Tdap booster is still recommended for family, household contacts, and health care personnel who come into contact with newborns.

Egg allergy is no longer a contraindication to influenza vaccination, although egg-allergic patients can receive only the inactivated flu vaccine. No skin tests are needed before vaccinating, and the entire vaccine dose can be given at one time. Patients should be observed for 30 minutes after receiving the vaccine.

Also, a new intradermal flu formulation (Fluzone Intradermal) is now an option for adults aged 18-64 years.

Click here for the Recommended Adult Immunization Schedule- United States- 2012.

The immunization recommendations were approved by the ACIP, a part of the Centers for Disease Control and Prevention; the American College of Physicians; the American Academy of Family Physicians; the American College of Obstetricians and Gynecologists; and the American College of Nurse-Midwives.