Adult Immunization in Transition: Bridging Guideline Complexity with Real-World Implementation in Global and Transplant Settings
DOI:
https://doi.org/10.69926/cva60w41Keywords:
Adult immunization, ACIP, Pakistan, transplant, antimicrobial resistance, digital health, clinical decision supportAbstract
Adult immunization is a key aspect of preventive medicine. Still, it has a very poor global uptake despite having well-founded support for its effectiveness. The adult immunization recommendation schedule created by the Advisory Committee on Immunization Practices (ACIP) offers an extensive evidence-based framework of age- and risk-based guidelines for immunizations. Nevertheless, increased complexity, expanding vaccine indications, and structural issues pose barriers to the implementation of these recommendations, especially in LMICs like Pakistan.
The current literature review presents a critical evaluation of modern approaches to adult immunization. In addition to focusing on the lack of alignment between complexity and implementation, this study specifically considers transplant recipients and immunocompromised adults whose vaccination must be tailored individually. The review further examines the relationship between immunization and antibiotic stewardship, outbreak control, and health system strengthening. Particular emphasis is placed on the practical challenges of implementing international recommendations in transplant programmes and other high-risk populations within resource-constrained healthcare systems.
In order to provide insights on how immunizations can be effectively delivered in LMICs, this literature review discusses global frameworks while paying attention to LMIC-specific barriers.
References
1. Centers for Disease Control and Prevention. Recommended adult immunization schedule for ages 19 years or older, United States, 2025. Atlanta (GA): Centers for Disease Control and Prevention; 2025.
2. Dhanireddy S. Immunizations: domestic, travel, and occupational. In: Infectious Disease Board Review. Philadelphia (PA): Elsevier; 2023.
3. World Health Organization. Immunization Agenda 2030: a global strategy to leave no one behind. Geneva: World Health Organization; 2020.
4. Advisory Committee on Immunization Practices. General best practice guidelines for immunization. Atlanta (GA): Centers for Disease Control and Prevention; 2023.
5. Plotkin SA, Orenstein WA, Offit PA, Edwards KM. Plotkin’s vaccines. 7th ed. Philadelphia (PA): Elsevier; 2018.
6. Kobayashi M, Farrar JL, Gierke R, Britton A, Childs L, Leidner AJ, et al. Use of 15-valent pneumococcal conjugate vaccine among adults: updated recommendations of the Advisory Committee on Immunization Practices—United States, 2022. MMWR Morb Mortal Wkly Rep. 2022;71(4):109–17.
7. Grohskopf LA, Blanton LH, Ferdinands JM, Chung JR, Broder KR, Talbot HK, et al. Prevention and control of seasonal influenza with vaccines: recommendations of the Advisory Committee on Immunization Practices—United States, 2023–24 influenza season. MMWR Recomm Rep. 2023;72(1):1–28.
8. Mbaeyi SA, Oliver SE, Collins JP, Branson BM, Duffy J, MacNeil JR, et al. Meningococcal vaccination: recommendations of the Advisory Committee on Immunization Practices. MMWR Recomm Rep. 2020;69(9):1–41.
9. Sutton RT, Pincock D, Baumgart DC, Sadowski DC, Fedorak RN, Kroeker KI. An overview of clinical decision support systems: benefits, risks, and strategies for success. NPJ Digit Med. 2020;3:17.
10. Topol EJ. High-performance medicine: the convergence of human and artificial intelligence. Nat Med. 2019;25(1):44–56.
11. Bates DW, Wright A. Evaluating eHealth: a systematic approach. PLoS Med. 2009;6(8):e1000146.
12. Andre FE, Booy R, Bock HL, Clemens J, Datta SK, John TJ, et al. Vaccination greatly reduces disease, disability, death and inequity worldwide. Bull World Health Organ. 2008;86(2):140–6.
13. Ozawa S, Clark S, Portnoy A, Grewal S, Brenzel L, Walker DG. Return on investment from childhood immunization in low- and middle-income countries, 2011–20. Health Aff (Millwood). 2016;35(2):199–207.
14. Kumar D, Ferreira VH, Blumberg EA, Silveira FP, Ison MG, Pruett TL, et al. Immunization in solid organ transplant recipients: current recommendations and future directions. Clin Infect Dis. 2021;72(2):e188–97.
15. Bastidas A, de la Serna J, El Idrissi M, Oostvogels L, Quittet P, López-Jiménez J, et al. Effect of recombinant zoster vaccine on incidence of herpes zoster after autologous stem cell transplantation: a randomized clinical trial. JAMA. 2019;322(2):123–33.
16. Lewnard JA, Lo NC. Scientific and ethical basis for COVID-19 vaccination strategies. Nat Med. 2021;27(2):184–6.
17. MacDonald NE. Vaccine hesitancy: definition, scope and determinants. Vaccine. 2015;33(34):4161–4.
18. Williams WW, Lu PJ, O’Halloran A, Kim DK, Grohskopf LA, Pilishvili T, et al. Surveillance of vaccination coverage among adult populations—United States, 2018. MMWR Surveill Summ. 2021;70(3):1–26.
19. Jit M, Hutubessy R, Png ME, Sundaram N, Audureau E, Edmunds WJ. The broader economic impact of vaccination: reviewing and appraising the strength of evidence. BMC Med. 2015;13:209.
20. Bloom DE, Canning D, Weston M. The value of vaccination. World Econ. 2005;6(3):15–39.
21. Gavi, the Vaccine Alliance. The economic benefits of immunization programmes. Geneva: Gavi, the Vaccine Alliance; 2023.
22. Ali M, Ahmed H, Tariq S, Khan M, Ali S, Fatima Z, et al. Barriers to adult immunization in Pakistan: a cross-sectional study. J Pak Med Assoc. 2022;72(5):987–93.
23. Sheikh NS, Sheikh AS. Vaccine hesitancy in Pakistan: a growing concern. Lancet Glob Health. 2021;9(6):e742–3.
24. Abbas KM, Kang GJ, Chen D, Werre SR, Marathe A. Demographics, social contact patterns and the impact of vaccination on infectious disease dynamics in South Asia. Vaccine. 2018;36(46):6767–74.
25. Patel MK, Goodson JL, Alexander JP Jr, Kretsinger K, Sodha SV, Steulet C, et al. Progress toward regional measles elimination—worldwide, 2000–2022. MMWR Morb Mortal Wkly Rep. 2023;72(46):1252–60.
Downloads
Published
Data Availability Statement
No new data were generated or analyzed during this study. Data sharing is not applicable to this article.
Issue
Section
License
Copyright (c) 2026 Ifra Nasir, Wajeeha Gill, Zahid Jabbar, Muhammad Rehan khan Niazi, Javeria Shah, Faisal Sultan
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
PKLI-JHS adopts the CC BY 4.0 license (Creative Commons Attribution 4.0 International License). For specifics, please refer to the full license legal code. The journal utilizes a non-exclusive licensing agreement for open access publishing, allowing authors to retain copyright and primary scholarly usage rights while granting the journal publication and distribution rights.
