Updated 2019 immunization recommendations include both scientific changes and a few design changes to the content and appearance of the schedule.

 

Changes to the 2019 adult immunization schedule:

• The intranasal live attenuated influenza vaccine (LAIV, FluMist) is back. It was previously removed for lack of efficacy but has been re-added as an acceptable vaccination option. It should not be given to immunocompromised people, pregnant women, or anyone in close contact with severely immunocompromised people. Adults with diabetes or substantial heart, liver, and renal disease should receive another preparation.
• A new recombinant hepatitis B vaccine (Heplisav-B, Dynavax) can be dosed only twice, due to its novel adjuvant, rather than the typical 3-dose schedule for older preparations.
• Homelessness has been added to other clinical indications for routine hepatitis A vaccination. This change was made in response to recent outbreaks of hepatitis A in homeless populations.
• A section has been added for guidance on vaccinating people with a history of egg allergies and when not to give LAIV.

 

Changes to the 2019 child and adolescent immunization schedule:

• The intranasal live attenuated influenza vaccine (LAIV, FluMist) is back. It was previously removed for lack of efficacy but has been re-added as an acceptable vaccination option. It should be reserved for children who refuse to get the shot and not be given to immunocompromised people or anyone in close contact with severely immunocompromised people.
• Homelessness has been added to other clinical indications for routine hepatitis A vaccination. This change was made in response to recent outbreaks of hepatitis A in homeless populations.
• A section has been added for guidance on vaccinating people with a history of egg allergies and when not to give LAIV.