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The CDC's Advisory Committee on Immunization Practices (ACIP) has updated its adult immunization schedule for 2024 to include recommendations on new vaccines for respiratory syncytial virus (RSV) and meningitis, the mpox (formerly known as monkeypox) vaccine, and the updated COVID-19 vaccines.

Key changes to this year's recommendations, published in the , include the following:

• RSV vaccines: Two RSV vaccines are now available (Abrysvo and Arexvy). In people 60 years of age or older, either RSV vaccine can be administered, but should be based on shared decision-making that considers risk factors for severe disease, risk of exposure to RSV, patient preferences, and clinical judgement. Only Abrysvo is recommended for pregnant persons at 32 weeks through 36 weeks gestation during the 2023-2024 winter season to protect both the recipient and neonates. (Alternatively, infants can be immunized with the monoclonal antibody nirsevimab [Beyfortus]).
• COVID-19 vaccine: All adults should receive at least one dose of the updated 2023-2024 formula of the COVID-19 vaccine. The number of doses needed and intervals between doses may vary depending on a patient's prior vaccination history, whether they are immunocompromised, and the vaccine product used.
• Mpox vaccine: All adults in any age group who are at increased risk of becoming infected with mpox (e.g., men who have sex with men, diagnosis of a sexually transmitted infection, multiple sex partners, etc.) should receive a two-dose series of the mpox vaccine (Jynneos).
• Meningococcal vaccine: MenACWY-D (Menactra) was removed from the schedule because the product is no longer available in the U.S. The new pentavalent meningococcal vaccine MenACWY-TT/MenB-FHbp (Penbraya) was added to the notes section. This vaccine can be used for additional MenACWY and MenB doses if both are given on the same clinic day and at least 6 months have elapsed since the most recent Penbraya dose.
• Polio vaccine: If adults are known or suspected to be unvaccinated or incompletely vaccinated for polio, they should complete a three-dose primary series. However, most adults who were born and raised in the U.S. can assume that they were vaccinated against polio during childhood. If previously vaccinated adults are at increased risk for exposure to polio, they may receive a single booster of inactivated poliovirus vaccine.
• Hepatitis B vaccine: People ages 60 years or older without known risk factors for hepatitis B may receive the hepatitis B vaccine series, and any adult over 60 who requests the vaccine should receive it, as well as those with risk factors.
• Flu vaccine: Routine annual vaccination continues to be recommended for all people ages 6 months and older who do not have contraindications. All seasonal influenza vaccines for 2023-2024 are quadrivalent. People with egg allergies can receive egg-based vaccines appropriate for their age and health status.

The updated schedule comes on the heels of a warning that many adults are not up-to-date on influenza, COVID-19, and RSV vaccination heading into the 2023-2024 winter season. As of Dec. 23, 2023 only have received an influenza vaccine. As of Dec. 2, 2023, just 17.2% of adults have received the updated COVID-19 vaccine and 15.9% have received the RSV vaccine, according to the health alert.

In an , Scott Ratzan, MD, and other members of the Council for Quality Health Communication offered scathing criticism of the CDC's complex written and visual presentation of the recommendations. "We cannot stay the present course," they commented. "The Recommended Adult Immunization Schedule article and recent CDC alert on seasonal flu, COVID-19, and RSV vaccination shortfalls are the latest warning signs that the CDC needs to upgrade its health communication capability now. Our nation's health and security depend on it."

Referring to the schedule design itself, Ratzan and colleagues commented, "The color-coded grid of indications and age groups is so crammed with asterisks and fine print that CDC was apparently obliged to produce a second chart to help the reader use the first one."

They also pointed out that the updated schedule fails to address the key issue of co-administration of influenza, RSV, and COVID-19 vaccines, a topic that is confusing for clinicians and patients alike.

Inadequate implementation of the CDC's adult vaccination recommendations is not a new problem, Ratzan and colleagues wrote, adding that "the newer challenges of misinformation and loss of trust in public health exacerbate the issue, as does the seductive concept of 'medical freedom' now promoted by vaccine skeptics."

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