ACIP Shared Clinical Decision-Making Recommendations

Introduction

These frequently asked questions (FAQs) address the Advisory Committee on Immunization Practices’ (ACIP) shared clinical decision-making recommendations and guidance and implementation considerations.

Frequently Asked Questions

What are ACIP’s current shared clinical decision-making recommendations?

ACIP has five recommendations for vaccination based on shared clinical decision-making and these are shown in the adult and child/adolescent the immunization schedules.

• Meningococcal B (MenB) vaccination for adolescents and young adults aged 16–23 years
• Hepatitis B (HepB) vaccination for adults aged 60 years and older with diabetes mellitus
• Human papillomavirus (HPV) vaccination for adults aged 27–45 years
• Pneumococcal conjugate vaccination (PCV20 or PCV21) for adults aged 65 years and older who have completed the recommended vaccine series with both PCV13 (at any age) and PPSV23 (which was administered at age ≥65 years)
• Additional doses of COVID-19 vaccination for people who are moderately or severely immunocompromised

How do shared clinical decision-making recommendations differ from routine, catch-up, and risk-based immunization recommendations?

Unlike routine, catch-up, and risk-based recommendations, shared clinical decision-making vaccinations are not recommended for everyone in a particular age group or everyone in an identifiable risk group. Rather, shared clinical decision-making recommendations are individually based and informed by a decision process between the health care provider and the patient or parent/guardian.

The key distinction between routine, catch-up, and risk-based recommendations and shared clinical decision-making recommendations is the default decision to vaccinate. For routine, catch-up, and risk-based recommendations, the default decision should be to vaccinate the patient based on age group or other indication, unless contraindicated. For shared clinical decision-making recommendations, there is no default—the decision about whether or not to vaccinate may be informed by the best available evidence of who may benefit from vaccination; the individual’s characteristics, values, and preferences; the health care provider’s clinical discretion; and the characteristics of the vaccine being considered. There is not a prescribed set of considerations or decision points in the decision-making process.

When does ACIP make shared clinical decision-making recommendations?

Generally, ACIP makes shared clinical decision-making recommendations when individuals may benefit from vaccination, but broad vaccination of people in that group is unlikely to have population-level impacts.

For example, in June 2019, ACIP recommended shared clinical decision-making for HPV vaccination of adults aged 27–45 years. HPV acquisition generally occurs soon after first sexual activity. Vaccine effectiveness is lower in older age groups because of prior infections and lower risk of exposure (for example, among persons who are in a long-term, mutually monogamous sexual partnership). ACIP recommended shared clinical decision-making rather than catch-up vaccination because most adults in this age group would have no or minimal benefits from vaccination. However, some individuals who are not already immune to HPV through vaccination or natural infection (e.g., a previously unvaccinated person who has never had sex) and who might be at risk for acquiring a new HPV infection in the future (e.g., plans to have sex with a new partner in the future) might benefit from vaccination.

Who is considered a health care provider with regard to shared clinical decision-making recommendations?

In this context, CDC defines a health care provider as anyone who provides or administers vaccines: primary care physicians, specialists, physician assistants, nurse practitioners, registered nurses, and pharmacists.

Which patients should providers discuss shared clinical decision-making recommendations with?

It’s up to the provider. Some health care providers may choose to discuss immunizations recommended for shared clinical decision-making with all or most of their patients who could receive it, while some providers may be more selective when discussing these immunizations with their patients. Health care providers should also be receptive to patient-initiated conversations about these immunizations.

What resources are available for providers who want to implement these recommendations?

ACIP and CDC provide resources to help providers implement these recommendations.

ACIP recommendations

Health care providers can find information on ACIP’s recommendations on the ACIP Vaccine Recommendations and Guidelines page.

For every ACIP recommendation, CDC publishes a policy note in the Morbidity and Mortality Weekly Report (MMWR), which provides background and considerations on each recommendation.

CDC resources for shared clinical decision-making

CDC will also develop vaccine-specific guidance to help clinicians understand and apply shared clinical decision-making recommendations.

Meningococcal B Vaccination

Hepatitis B Vaccination

HPV Vaccination for Adults Aged 27-45 Years

Pneumococcal Vaccination for Adults 65 Years or Older

Are shared clinical decision-making recommendations covered by private insurers?

Under the Affordable Care Act and its implementing regulations, ACIP recommendations that have been adopted by CDC “with respect to the individual involved” and are “listed on the Immunization Schedules of the Centers for Disease Control and Prevention” generally are required to be covered by group health plans and health insurance issuers offering group or individual health insurance coverage without imposing any cost-sharing requirements (such as a copayment, coinsurance, or deductible).A This coverage requirement includes shared clinical decision-making recommendations when they have been adopted by CDC and are listed on the immunization schedules.