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ACIP approves meningococcal booster for persons at increased risk
according to the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices.
The committee voted unanimously in favor of a booster dose of MenB vaccine 1 year after completion of the primary series, with additional boosters every 2-3 years “for as long as risk remains” for high-risk persons, including microbiologists and persons with complement deficiency, complement inhibitor use, or asplenia.
The committee also voted unanimously in favor of a one-time MenB booster for individuals aged 10 years and older who are at least a year beyond completion of a MenB primary series and deemed at increased risk by public health officials in an outbreak situation.
In addition, “a booster dose interval of 6 months or more may be considered by public health officials depending on the specific outbreak, vaccine strategy, and projected duration of elevated risk” according to the language, which was included in the unanimously approved statement “Meningococcal Vaccination: Recommendations of The Advisory Committee on Immunization Practices.”
The updated statement on meningococcal vaccination was developed in 2019 “to consolidate all existing ACIP recommendations for MenACWY and MenB vaccines in a single document,” said Sarah Mbaeyi, MD, of the CDC’s National Center for Immunization and Respiratory Diseases, who presented immunogenicity data and the proposed recommendations.
The statement includes the recommendation of a MenB primary series for individuals aged 16-23 years based on shared clinical decision making. Kelly Moore, MD, of Vanderbilt University, Nashville, Tenn., noted the importance of ongoing data collection, and said clinicians must make clear to patients that, “if they want protection, they need the booster.”
Approximately 7% of serogroup B cases in the United States are related to disease outbreaks, mainly among college students, Dr. Mbaeyi said. All 13 universities that experienced outbreaks between 2013 and 2019 have implemented a MenB primary series, and one university has implemented an off-label booster program.
The work group concluded that a MenB booster dose is necessary to sustain protection against serogroup B disease in persons at increased risk during an outbreak, and that the potential benefits outweighed the harms given the seriousness of meningococcal disease.
Paul Hunter, MD, of the City of Milwaukee Health Department, noted that “the booster recommendation gives more flexibility” in an outbreak response.
The committee also voted unanimously to approve the Vaccines for Children resolution for the meningococcal vaccine that updates language to align with the new recommendations.
The ACIP members had no financial conflicts to disclose.
according to the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices.
The committee voted unanimously in favor of a booster dose of MenB vaccine 1 year after completion of the primary series, with additional boosters every 2-3 years “for as long as risk remains” for high-risk persons, including microbiologists and persons with complement deficiency, complement inhibitor use, or asplenia.
The committee also voted unanimously in favor of a one-time MenB booster for individuals aged 10 years and older who are at least a year beyond completion of a MenB primary series and deemed at increased risk by public health officials in an outbreak situation.
In addition, “a booster dose interval of 6 months or more may be considered by public health officials depending on the specific outbreak, vaccine strategy, and projected duration of elevated risk” according to the language, which was included in the unanimously approved statement “Meningococcal Vaccination: Recommendations of The Advisory Committee on Immunization Practices.”
The updated statement on meningococcal vaccination was developed in 2019 “to consolidate all existing ACIP recommendations for MenACWY and MenB vaccines in a single document,” said Sarah Mbaeyi, MD, of the CDC’s National Center for Immunization and Respiratory Diseases, who presented immunogenicity data and the proposed recommendations.
The statement includes the recommendation of a MenB primary series for individuals aged 16-23 years based on shared clinical decision making. Kelly Moore, MD, of Vanderbilt University, Nashville, Tenn., noted the importance of ongoing data collection, and said clinicians must make clear to patients that, “if they want protection, they need the booster.”
Approximately 7% of serogroup B cases in the United States are related to disease outbreaks, mainly among college students, Dr. Mbaeyi said. All 13 universities that experienced outbreaks between 2013 and 2019 have implemented a MenB primary series, and one university has implemented an off-label booster program.
The work group concluded that a MenB booster dose is necessary to sustain protection against serogroup B disease in persons at increased risk during an outbreak, and that the potential benefits outweighed the harms given the seriousness of meningococcal disease.
Paul Hunter, MD, of the City of Milwaukee Health Department, noted that “the booster recommendation gives more flexibility” in an outbreak response.
The committee also voted unanimously to approve the Vaccines for Children resolution for the meningococcal vaccine that updates language to align with the new recommendations.
The ACIP members had no financial conflicts to disclose.
according to the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices.
The committee voted unanimously in favor of a booster dose of MenB vaccine 1 year after completion of the primary series, with additional boosters every 2-3 years “for as long as risk remains” for high-risk persons, including microbiologists and persons with complement deficiency, complement inhibitor use, or asplenia.
The committee also voted unanimously in favor of a one-time MenB booster for individuals aged 10 years and older who are at least a year beyond completion of a MenB primary series and deemed at increased risk by public health officials in an outbreak situation.
In addition, “a booster dose interval of 6 months or more may be considered by public health officials depending on the specific outbreak, vaccine strategy, and projected duration of elevated risk” according to the language, which was included in the unanimously approved statement “Meningococcal Vaccination: Recommendations of The Advisory Committee on Immunization Practices.”
The updated statement on meningococcal vaccination was developed in 2019 “to consolidate all existing ACIP recommendations for MenACWY and MenB vaccines in a single document,” said Sarah Mbaeyi, MD, of the CDC’s National Center for Immunization and Respiratory Diseases, who presented immunogenicity data and the proposed recommendations.
The statement includes the recommendation of a MenB primary series for individuals aged 16-23 years based on shared clinical decision making. Kelly Moore, MD, of Vanderbilt University, Nashville, Tenn., noted the importance of ongoing data collection, and said clinicians must make clear to patients that, “if they want protection, they need the booster.”
Approximately 7% of serogroup B cases in the United States are related to disease outbreaks, mainly among college students, Dr. Mbaeyi said. All 13 universities that experienced outbreaks between 2013 and 2019 have implemented a MenB primary series, and one university has implemented an off-label booster program.
The work group concluded that a MenB booster dose is necessary to sustain protection against serogroup B disease in persons at increased risk during an outbreak, and that the potential benefits outweighed the harms given the seriousness of meningococcal disease.
Paul Hunter, MD, of the City of Milwaukee Health Department, noted that “the booster recommendation gives more flexibility” in an outbreak response.
The committee also voted unanimously to approve the Vaccines for Children resolution for the meningococcal vaccine that updates language to align with the new recommendations.
The ACIP members had no financial conflicts to disclose.
REPORTING FROM AN ACIP MEETING
ACIP approves flu vaccine recommendations for 2019-2020 season
All individuals aged 6 months and older should receive the influenza vaccine by the end of October next season, according to the Centers for Disease Control and Prevention’s Committee on Immunization Practices. The committee voted unanimously to accept minor updates to the ACIP flu recommendations for the 2019-2020 season, but no major changes were made from recent years.
The past flu season was moderate overall, but notable for two waves of viral infections of similar magnitude, one with H1N1 and another with H3N2, said Lynette Brewer of the CDC’s National Center for Immunization and Respiratory Diseases, who presented data on last year’s flu activity.
Last year’s vaccine likely prevented between 40,000 and 90,000 hospitalizations, but mostly reduced the burden of H1N1 disease and provided no real protection against H3N2, she said.
The recommended H3N2 component for next season is A/Kansas/14/2017–like virus, which is genetically similar to the H3N2 that circulated last year.
Lisa Grohskopf, MD, of the CDC’s influenza division, presented the minor adjustments that included the changes in vaccine composition for next year, some licensure changes, and a new table summarizing dose volumes. Also, language was changed to advise vaccination for all eligible individuals by the end of October, and individuals who need two doses should have the first one as soon as it becomes available, in July or August if possible. The updated language also clarified that 8 year olds who need two doses should receive the second dose, even if they turn 9 between the two doses.
Additional guidance updates approved by the committee included harmonizing language on groups that should be the focus of vaccination in the event of limited supply to be more consistent with the 2011 ACIP Recommendations for the Immunization of Health Care Personnel.
The committee also voted unanimously to accept the proposed influenza vaccine in the Vaccines for Children program; there were no changes in recommended dosing intervals, dosages, contraindications, or precautions, according to Frank Whitlach of the National Center for Immunization and Respiratory Diseases, who presented the Vaccines for Children information.
The ACIP members had no financial conflicts to disclose.
All individuals aged 6 months and older should receive the influenza vaccine by the end of October next season, according to the Centers for Disease Control and Prevention’s Committee on Immunization Practices. The committee voted unanimously to accept minor updates to the ACIP flu recommendations for the 2019-2020 season, but no major changes were made from recent years.
The past flu season was moderate overall, but notable for two waves of viral infections of similar magnitude, one with H1N1 and another with H3N2, said Lynette Brewer of the CDC’s National Center for Immunization and Respiratory Diseases, who presented data on last year’s flu activity.
Last year’s vaccine likely prevented between 40,000 and 90,000 hospitalizations, but mostly reduced the burden of H1N1 disease and provided no real protection against H3N2, she said.
The recommended H3N2 component for next season is A/Kansas/14/2017–like virus, which is genetically similar to the H3N2 that circulated last year.
Lisa Grohskopf, MD, of the CDC’s influenza division, presented the minor adjustments that included the changes in vaccine composition for next year, some licensure changes, and a new table summarizing dose volumes. Also, language was changed to advise vaccination for all eligible individuals by the end of October, and individuals who need two doses should have the first one as soon as it becomes available, in July or August if possible. The updated language also clarified that 8 year olds who need two doses should receive the second dose, even if they turn 9 between the two doses.
Additional guidance updates approved by the committee included harmonizing language on groups that should be the focus of vaccination in the event of limited supply to be more consistent with the 2011 ACIP Recommendations for the Immunization of Health Care Personnel.
The committee also voted unanimously to accept the proposed influenza vaccine in the Vaccines for Children program; there were no changes in recommended dosing intervals, dosages, contraindications, or precautions, according to Frank Whitlach of the National Center for Immunization and Respiratory Diseases, who presented the Vaccines for Children information.
The ACIP members had no financial conflicts to disclose.
All individuals aged 6 months and older should receive the influenza vaccine by the end of October next season, according to the Centers for Disease Control and Prevention’s Committee on Immunization Practices. The committee voted unanimously to accept minor updates to the ACIP flu recommendations for the 2019-2020 season, but no major changes were made from recent years.
The past flu season was moderate overall, but notable for two waves of viral infections of similar magnitude, one with H1N1 and another with H3N2, said Lynette Brewer of the CDC’s National Center for Immunization and Respiratory Diseases, who presented data on last year’s flu activity.
Last year’s vaccine likely prevented between 40,000 and 90,000 hospitalizations, but mostly reduced the burden of H1N1 disease and provided no real protection against H3N2, she said.
The recommended H3N2 component for next season is A/Kansas/14/2017–like virus, which is genetically similar to the H3N2 that circulated last year.
Lisa Grohskopf, MD, of the CDC’s influenza division, presented the minor adjustments that included the changes in vaccine composition for next year, some licensure changes, and a new table summarizing dose volumes. Also, language was changed to advise vaccination for all eligible individuals by the end of October, and individuals who need two doses should have the first one as soon as it becomes available, in July or August if possible. The updated language also clarified that 8 year olds who need two doses should receive the second dose, even if they turn 9 between the two doses.
Additional guidance updates approved by the committee included harmonizing language on groups that should be the focus of vaccination in the event of limited supply to be more consistent with the 2011 ACIP Recommendations for the Immunization of Health Care Personnel.
The committee also voted unanimously to accept the proposed influenza vaccine in the Vaccines for Children program; there were no changes in recommended dosing intervals, dosages, contraindications, or precautions, according to Frank Whitlach of the National Center for Immunization and Respiratory Diseases, who presented the Vaccines for Children information.
The ACIP members had no financial conflicts to disclose.
REPORTING FROM AN ACIP MEETING
ACIP endorses catch-up hepatitis A vaccinations
The Centers for Disease Control and Prevention’s Committee on Immunization Practices voted unanimously in support of three recommendations for the use of hepatitis A vaccines.
The committee recommended catch-up vaccination at any age for all children aged 2-18 years who had not previously received hepatitis A vaccination, recommended that all persons with HIV aged 1 year and older should be vaccinated with the hepatitis A vaccine, and approved updating the language in the full hepatitis A vaccine statement, “Prevention of Hepatitis A Virus Infection in The United States: Recommendations of The Advisory Committee on Immunization Practices.”
Catch-up vaccination will expand coverage to adolescents who might have missed it, and data show that the vaccine effectiveness is high, and the rates of adverse events are low in the child and adolescent population, said Noele Nelson, MD, of the CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, who presented the recommendations to the committee. “Recent outbreaks are occurring primarily among adults,” and many cases are among persons who use drugs or are homeless, she added.
Several committee members noted that the specific recommendations for catch-up in children and teens and for vaccination of HIV patients offer more opportunities for protection than risk-based recommendations. Catching up with vaccinating adolescents is “more effective than tracking down high-risk adults later in life,” noted Grace Lee, MD, of Lucile Packard Children’s Hospital at Stanford, Calif.
The committee also recommended that all persons with HIV aged 1 year and older should be vaccinated with the hepatitis A vaccine. Data on persons with HIV show that approximately 60% have at least one risk factor for hepatitis A, such as men who have sex with men or individuals engaged in intravenous drug use, said Dr. Nelson. Data also show that individuals with HIV are at increased risk for complications if they get hepatitis A.
The committee’s approval of the full hepatitis A vaccine statement included one notable change – the removal of clotting factor disorders as a high-risk group. The risk has decreased over time based on improvements such as better screening of source plasma, and this group is now at no greater risk than the general population, according to work group chair Kelly Moore, MD, of Vanderbilt University, Nashville, Tenn.
The ACIP members had no financial conflicts to disclose.
The Centers for Disease Control and Prevention’s Committee on Immunization Practices voted unanimously in support of three recommendations for the use of hepatitis A vaccines.
The committee recommended catch-up vaccination at any age for all children aged 2-18 years who had not previously received hepatitis A vaccination, recommended that all persons with HIV aged 1 year and older should be vaccinated with the hepatitis A vaccine, and approved updating the language in the full hepatitis A vaccine statement, “Prevention of Hepatitis A Virus Infection in The United States: Recommendations of The Advisory Committee on Immunization Practices.”
Catch-up vaccination will expand coverage to adolescents who might have missed it, and data show that the vaccine effectiveness is high, and the rates of adverse events are low in the child and adolescent population, said Noele Nelson, MD, of the CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, who presented the recommendations to the committee. “Recent outbreaks are occurring primarily among adults,” and many cases are among persons who use drugs or are homeless, she added.
Several committee members noted that the specific recommendations for catch-up in children and teens and for vaccination of HIV patients offer more opportunities for protection than risk-based recommendations. Catching up with vaccinating adolescents is “more effective than tracking down high-risk adults later in life,” noted Grace Lee, MD, of Lucile Packard Children’s Hospital at Stanford, Calif.
The committee also recommended that all persons with HIV aged 1 year and older should be vaccinated with the hepatitis A vaccine. Data on persons with HIV show that approximately 60% have at least one risk factor for hepatitis A, such as men who have sex with men or individuals engaged in intravenous drug use, said Dr. Nelson. Data also show that individuals with HIV are at increased risk for complications if they get hepatitis A.
The committee’s approval of the full hepatitis A vaccine statement included one notable change – the removal of clotting factor disorders as a high-risk group. The risk has decreased over time based on improvements such as better screening of source plasma, and this group is now at no greater risk than the general population, according to work group chair Kelly Moore, MD, of Vanderbilt University, Nashville, Tenn.
The ACIP members had no financial conflicts to disclose.
The Centers for Disease Control and Prevention’s Committee on Immunization Practices voted unanimously in support of three recommendations for the use of hepatitis A vaccines.
The committee recommended catch-up vaccination at any age for all children aged 2-18 years who had not previously received hepatitis A vaccination, recommended that all persons with HIV aged 1 year and older should be vaccinated with the hepatitis A vaccine, and approved updating the language in the full hepatitis A vaccine statement, “Prevention of Hepatitis A Virus Infection in The United States: Recommendations of The Advisory Committee on Immunization Practices.”
Catch-up vaccination will expand coverage to adolescents who might have missed it, and data show that the vaccine effectiveness is high, and the rates of adverse events are low in the child and adolescent population, said Noele Nelson, MD, of the CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, who presented the recommendations to the committee. “Recent outbreaks are occurring primarily among adults,” and many cases are among persons who use drugs or are homeless, she added.
Several committee members noted that the specific recommendations for catch-up in children and teens and for vaccination of HIV patients offer more opportunities for protection than risk-based recommendations. Catching up with vaccinating adolescents is “more effective than tracking down high-risk adults later in life,” noted Grace Lee, MD, of Lucile Packard Children’s Hospital at Stanford, Calif.
The committee also recommended that all persons with HIV aged 1 year and older should be vaccinated with the hepatitis A vaccine. Data on persons with HIV show that approximately 60% have at least one risk factor for hepatitis A, such as men who have sex with men or individuals engaged in intravenous drug use, said Dr. Nelson. Data also show that individuals with HIV are at increased risk for complications if they get hepatitis A.
The committee’s approval of the full hepatitis A vaccine statement included one notable change – the removal of clotting factor disorders as a high-risk group. The risk has decreased over time based on improvements such as better screening of source plasma, and this group is now at no greater risk than the general population, according to work group chair Kelly Moore, MD, of Vanderbilt University, Nashville, Tenn.
The ACIP members had no financial conflicts to disclose.
REPORTING FROM AN ACIP MEETING
ACIP adds hexavalent vaccine to VFC program
The pediatric hexavalent vaccine (DTaP-[inactivated poliovirus] IPV-[hepatitis B] HepB-[Haemophilis influenzae type b] Hib) should be included as an option in the Vaccines for Children (VFC) program for the infant series at ages 2, 4, and 6 months, according to unanimous votes at a meeting of the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices.
The addition of the vaccine to the VFC program required no motions on the part of the committee, but involved separate votes on each component of the vaccine.
Combination vaccination has been associated with increased coverage and more likely completion of the full infant vaccine series, said Sara Oliver, MD, of the CDC’s National Center for Immunization and Respiratory Diseases.
The new vaccine is being developed jointly by Sanofi and Merck, and has been approved by the Food and Drug Administration for use in children through age 4 years.
Dr. Oliver presented evidence that the safety profile of the combination vaccine is consistent with that of the component vaccines. In addition, “use of combination vaccines can reduce the number of injections patient receive and alleviate concern associated with the number of injections,” she said. However, “considerations should include provider assessment, patient preference, and the potential for adverse events.”
although it will not be available until 2021 in order to ensure sufficient supply, Dr. Oliver noted.
The combination vaccination work group considered whether the new vaccine should be preferentially recommended for American Indian and Alaskan Native populations, but they concluded that post–dose one immunogenicity data are needed before such a preferential recommendation can be made.
The ACIP members had no financial conflicts to disclose.
The pediatric hexavalent vaccine (DTaP-[inactivated poliovirus] IPV-[hepatitis B] HepB-[Haemophilis influenzae type b] Hib) should be included as an option in the Vaccines for Children (VFC) program for the infant series at ages 2, 4, and 6 months, according to unanimous votes at a meeting of the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices.
The addition of the vaccine to the VFC program required no motions on the part of the committee, but involved separate votes on each component of the vaccine.
Combination vaccination has been associated with increased coverage and more likely completion of the full infant vaccine series, said Sara Oliver, MD, of the CDC’s National Center for Immunization and Respiratory Diseases.
The new vaccine is being developed jointly by Sanofi and Merck, and has been approved by the Food and Drug Administration for use in children through age 4 years.
Dr. Oliver presented evidence that the safety profile of the combination vaccine is consistent with that of the component vaccines. In addition, “use of combination vaccines can reduce the number of injections patient receive and alleviate concern associated with the number of injections,” she said. However, “considerations should include provider assessment, patient preference, and the potential for adverse events.”
although it will not be available until 2021 in order to ensure sufficient supply, Dr. Oliver noted.
The combination vaccination work group considered whether the new vaccine should be preferentially recommended for American Indian and Alaskan Native populations, but they concluded that post–dose one immunogenicity data are needed before such a preferential recommendation can be made.
The ACIP members had no financial conflicts to disclose.
The pediatric hexavalent vaccine (DTaP-[inactivated poliovirus] IPV-[hepatitis B] HepB-[Haemophilis influenzae type b] Hib) should be included as an option in the Vaccines for Children (VFC) program for the infant series at ages 2, 4, and 6 months, according to unanimous votes at a meeting of the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices.
The addition of the vaccine to the VFC program required no motions on the part of the committee, but involved separate votes on each component of the vaccine.
Combination vaccination has been associated with increased coverage and more likely completion of the full infant vaccine series, said Sara Oliver, MD, of the CDC’s National Center for Immunization and Respiratory Diseases.
The new vaccine is being developed jointly by Sanofi and Merck, and has been approved by the Food and Drug Administration for use in children through age 4 years.
Dr. Oliver presented evidence that the safety profile of the combination vaccine is consistent with that of the component vaccines. In addition, “use of combination vaccines can reduce the number of injections patient receive and alleviate concern associated with the number of injections,” she said. However, “considerations should include provider assessment, patient preference, and the potential for adverse events.”
although it will not be available until 2021 in order to ensure sufficient supply, Dr. Oliver noted.
The combination vaccination work group considered whether the new vaccine should be preferentially recommended for American Indian and Alaskan Native populations, but they concluded that post–dose one immunogenicity data are needed before such a preferential recommendation can be made.
The ACIP members had no financial conflicts to disclose.
REPORTING FROM AN ACIP MEETING
ACIP favors shared decision on pneumococcal vaccine for older adults
Pneumococcal vaccination with the 13-valent pneumococcal conjugate vaccine (PCV13) based on shared clinical decision making is recommended for immunocompetent adults aged 65 years and older who have not previously received PCV13, and all adults aged 65 years and older should continue to receive the pneumococcal polysaccharide vaccine (PPSV23), according to a vote at a meeting of the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices.
The motion passed with an 11-1 vote after members voted down two other options to either discontinue or continue the current recommendation of PCV13 for all immunocompetent adults aged 65 years and older. The current recommendation for PCV13 for adults aged 65 years and older has been in place since 2014.
The pneumococcal work group assessed indirect effects of the pediatric PCV vaccination on older adults prior to 2014 and since 2014, and what additional benefits might be expected if routine vaccination of older adults continued.
“Indirect effects have been observed in all age groups” said Almea Matanock, MD, of the CDC’s National Center for Immunization and Respiratory Diseases. Although there were no safety concerns, the public health impact of continued vaccination of adults was minimal.
Although PCV13 resulted in a 75% reduction in vaccine-type invasive pneumococcal disease and a 45% reduction in vaccine-type nonbacteremic pneumonia in 2014, the annual number needed to vaccinate to prevent a single case of outpatient pneumonia was 2,600, said Dr. Matanock.
Dr. Matanock presented key issues from the Evidence to Recommendations Framework for and against the recommendation for PCV13 in older adults. Work group comments in favor of continuing the recommendation for PCV13 in older adults included effective disease prevention and the potential negative impact on the importance of adult vaccines if the vaccine was no longer recommended. However, some work group members and committee members expressed concern about resource allocation and steering vaccines away from younger age groups in whom they have been more consistently effective.
Paul Hunter, MD, of the City of Milwaukee Health Department, voted against the shared clinical decision making, and instead favored discontinuing the recommendation for PCV13 for older adults. “I think clinicians need a clear message,” he said, adding that “the public health bang for the buck is with the kids.”
“I think there was a recognition that the population level benefit is minimal,” said work group chair Grace Lee, MD.
Although the work group recognized some benefit for older adults, the burden of disease for PCV-specific disease is low, compared with all-cause pneumonia, said Dr. Lee of Lucile Packard Children’s Hospital at Stanford, Calif. However, the recommendation for shared clinical decision making allows for potential insurance coverage of the vaccine for adults who decide after discussion with their health care provider that they would benefit.
“We are still unpacking this construct” of shared clinical decision making, which in this case applies to adults without immunocompromising conditions, and is more of a provider assessment than a risk assessment, she said.
The ACIP members had no financial conflicts to disclose.
Pneumococcal vaccination with the 13-valent pneumococcal conjugate vaccine (PCV13) based on shared clinical decision making is recommended for immunocompetent adults aged 65 years and older who have not previously received PCV13, and all adults aged 65 years and older should continue to receive the pneumococcal polysaccharide vaccine (PPSV23), according to a vote at a meeting of the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices.
The motion passed with an 11-1 vote after members voted down two other options to either discontinue or continue the current recommendation of PCV13 for all immunocompetent adults aged 65 years and older. The current recommendation for PCV13 for adults aged 65 years and older has been in place since 2014.
The pneumococcal work group assessed indirect effects of the pediatric PCV vaccination on older adults prior to 2014 and since 2014, and what additional benefits might be expected if routine vaccination of older adults continued.
“Indirect effects have been observed in all age groups” said Almea Matanock, MD, of the CDC’s National Center for Immunization and Respiratory Diseases. Although there were no safety concerns, the public health impact of continued vaccination of adults was minimal.
Although PCV13 resulted in a 75% reduction in vaccine-type invasive pneumococcal disease and a 45% reduction in vaccine-type nonbacteremic pneumonia in 2014, the annual number needed to vaccinate to prevent a single case of outpatient pneumonia was 2,600, said Dr. Matanock.
Dr. Matanock presented key issues from the Evidence to Recommendations Framework for and against the recommendation for PCV13 in older adults. Work group comments in favor of continuing the recommendation for PCV13 in older adults included effective disease prevention and the potential negative impact on the importance of adult vaccines if the vaccine was no longer recommended. However, some work group members and committee members expressed concern about resource allocation and steering vaccines away from younger age groups in whom they have been more consistently effective.
Paul Hunter, MD, of the City of Milwaukee Health Department, voted against the shared clinical decision making, and instead favored discontinuing the recommendation for PCV13 for older adults. “I think clinicians need a clear message,” he said, adding that “the public health bang for the buck is with the kids.”
“I think there was a recognition that the population level benefit is minimal,” said work group chair Grace Lee, MD.
Although the work group recognized some benefit for older adults, the burden of disease for PCV-specific disease is low, compared with all-cause pneumonia, said Dr. Lee of Lucile Packard Children’s Hospital at Stanford, Calif. However, the recommendation for shared clinical decision making allows for potential insurance coverage of the vaccine for adults who decide after discussion with their health care provider that they would benefit.
“We are still unpacking this construct” of shared clinical decision making, which in this case applies to adults without immunocompromising conditions, and is more of a provider assessment than a risk assessment, she said.
The ACIP members had no financial conflicts to disclose.
Pneumococcal vaccination with the 13-valent pneumococcal conjugate vaccine (PCV13) based on shared clinical decision making is recommended for immunocompetent adults aged 65 years and older who have not previously received PCV13, and all adults aged 65 years and older should continue to receive the pneumococcal polysaccharide vaccine (PPSV23), according to a vote at a meeting of the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices.
The motion passed with an 11-1 vote after members voted down two other options to either discontinue or continue the current recommendation of PCV13 for all immunocompetent adults aged 65 years and older. The current recommendation for PCV13 for adults aged 65 years and older has been in place since 2014.
The pneumococcal work group assessed indirect effects of the pediatric PCV vaccination on older adults prior to 2014 and since 2014, and what additional benefits might be expected if routine vaccination of older adults continued.
“Indirect effects have been observed in all age groups” said Almea Matanock, MD, of the CDC’s National Center for Immunization and Respiratory Diseases. Although there were no safety concerns, the public health impact of continued vaccination of adults was minimal.
Although PCV13 resulted in a 75% reduction in vaccine-type invasive pneumococcal disease and a 45% reduction in vaccine-type nonbacteremic pneumonia in 2014, the annual number needed to vaccinate to prevent a single case of outpatient pneumonia was 2,600, said Dr. Matanock.
Dr. Matanock presented key issues from the Evidence to Recommendations Framework for and against the recommendation for PCV13 in older adults. Work group comments in favor of continuing the recommendation for PCV13 in older adults included effective disease prevention and the potential negative impact on the importance of adult vaccines if the vaccine was no longer recommended. However, some work group members and committee members expressed concern about resource allocation and steering vaccines away from younger age groups in whom they have been more consistently effective.
Paul Hunter, MD, of the City of Milwaukee Health Department, voted against the shared clinical decision making, and instead favored discontinuing the recommendation for PCV13 for older adults. “I think clinicians need a clear message,” he said, adding that “the public health bang for the buck is with the kids.”
“I think there was a recognition that the population level benefit is minimal,” said work group chair Grace Lee, MD.
Although the work group recognized some benefit for older adults, the burden of disease for PCV-specific disease is low, compared with all-cause pneumonia, said Dr. Lee of Lucile Packard Children’s Hospital at Stanford, Calif. However, the recommendation for shared clinical decision making allows for potential insurance coverage of the vaccine for adults who decide after discussion with their health care provider that they would benefit.
“We are still unpacking this construct” of shared clinical decision making, which in this case applies to adults without immunocompromising conditions, and is more of a provider assessment than a risk assessment, she said.
The ACIP members had no financial conflicts to disclose.
REPORTING FROM AN ACIP MEETING
ACIP extends HPV vaccine coverage
according to a unanimous vote at a meeting of the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices.
This change affects males aged 22 through 26 years; the HPV vaccine is currently recommended for males and females aged 11 or 12 years, with catch-up vaccination through age 21 for males and age 26 for females.
The change was supported in part by increased interest in simplifying and harmonizing the vaccine schedule, said Lauri Markowitz, MD, of the CDC’s National Center for Immunization and Respiratory Diseases (NCIRD), who presented the HPV work group’s considerations.
In addition, the committee voted 10-4 in favor of catch-up HPV vaccination, based on shared clinical decision making, for all adults aged 27 through 45 years.
Although the current program of HPV vaccination for youth has demonstrated effectiveness, data from multiple models suggest that widespread HPV vaccination for adults older than 26 years is much less cost effective, and would yield relatively small additional health benefits, Dr. Markowitz said.
The HPV work group reviewed data from a range of clinical trials, epidemiology, and natural history, as well as results from five different health economic models. They concluded that an assessment of benefits and harms favors expanding the catch-up vaccination to all individuals through 26 years, said Elissa Meites, MD, of the CDC, who presented the official work group opinion. The group’s opinion on the second question was that the additional population level benefit of expanding HPV vaccination to all adults would be minimal and not a reasonable and effective allocation of resources, but that shared clinical decision making would allow flexibility.
The committee expressed strong opinions about the potential for shared clinical decision making as a policy for vaccination for adults older than 26 years. Some felt that this option was a way to include adults at risk for HPV, such as divorced women with new partners, or women getting married for the first time later in life who might not have been exposed to HPV through other relationships. In addition, supporters noted that the shared clinical decision-making option would allow for potential insurance coverage, and would involve discussion between doctors and patients to assess risk.
However, other committee members felt that any recommendation for older adult vaccination would distract clinicians from the importance and value of HPV vaccination for the target age group of 11- and 12-year-olds, and might divert resources from the younger age group in whom it has shown the most benefit.
Resource allocation was a concern voiced by many committee members. Kelly Moore, MD, MPH, of Vanderbilt University, Nashville, Tenn., said she voted no on expanding vaccination to older adults because “we didn’t have details on shared clinical decision making, in the absence of information on what that meant, and in the presence of supply questions, I didn’t feel comfortable expanding vaccination to a huge population,” she said.
Paul Hunter, MD, of the City of Milwaukee Health Department, also voted no, and expressed concern that expanding the HPV vaccination recommendations to older adults would send the message that vaccination for children and teens is not effective or important.
The text of the new recommendations for routine and catch-up vaccination states that the recommendations “also apply to MSM [men who have sex with men], transgender people, and people with immunocompromising conditions.”
The ACIP members had no financial conflicts to disclose.
according to a unanimous vote at a meeting of the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices.
This change affects males aged 22 through 26 years; the HPV vaccine is currently recommended for males and females aged 11 or 12 years, with catch-up vaccination through age 21 for males and age 26 for females.
The change was supported in part by increased interest in simplifying and harmonizing the vaccine schedule, said Lauri Markowitz, MD, of the CDC’s National Center for Immunization and Respiratory Diseases (NCIRD), who presented the HPV work group’s considerations.
In addition, the committee voted 10-4 in favor of catch-up HPV vaccination, based on shared clinical decision making, for all adults aged 27 through 45 years.
Although the current program of HPV vaccination for youth has demonstrated effectiveness, data from multiple models suggest that widespread HPV vaccination for adults older than 26 years is much less cost effective, and would yield relatively small additional health benefits, Dr. Markowitz said.
The HPV work group reviewed data from a range of clinical trials, epidemiology, and natural history, as well as results from five different health economic models. They concluded that an assessment of benefits and harms favors expanding the catch-up vaccination to all individuals through 26 years, said Elissa Meites, MD, of the CDC, who presented the official work group opinion. The group’s opinion on the second question was that the additional population level benefit of expanding HPV vaccination to all adults would be minimal and not a reasonable and effective allocation of resources, but that shared clinical decision making would allow flexibility.
The committee expressed strong opinions about the potential for shared clinical decision making as a policy for vaccination for adults older than 26 years. Some felt that this option was a way to include adults at risk for HPV, such as divorced women with new partners, or women getting married for the first time later in life who might not have been exposed to HPV through other relationships. In addition, supporters noted that the shared clinical decision-making option would allow for potential insurance coverage, and would involve discussion between doctors and patients to assess risk.
However, other committee members felt that any recommendation for older adult vaccination would distract clinicians from the importance and value of HPV vaccination for the target age group of 11- and 12-year-olds, and might divert resources from the younger age group in whom it has shown the most benefit.
Resource allocation was a concern voiced by many committee members. Kelly Moore, MD, MPH, of Vanderbilt University, Nashville, Tenn., said she voted no on expanding vaccination to older adults because “we didn’t have details on shared clinical decision making, in the absence of information on what that meant, and in the presence of supply questions, I didn’t feel comfortable expanding vaccination to a huge population,” she said.
Paul Hunter, MD, of the City of Milwaukee Health Department, also voted no, and expressed concern that expanding the HPV vaccination recommendations to older adults would send the message that vaccination for children and teens is not effective or important.
The text of the new recommendations for routine and catch-up vaccination states that the recommendations “also apply to MSM [men who have sex with men], transgender people, and people with immunocompromising conditions.”
The ACIP members had no financial conflicts to disclose.
according to a unanimous vote at a meeting of the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices.
This change affects males aged 22 through 26 years; the HPV vaccine is currently recommended for males and females aged 11 or 12 years, with catch-up vaccination through age 21 for males and age 26 for females.
The change was supported in part by increased interest in simplifying and harmonizing the vaccine schedule, said Lauri Markowitz, MD, of the CDC’s National Center for Immunization and Respiratory Diseases (NCIRD), who presented the HPV work group’s considerations.
In addition, the committee voted 10-4 in favor of catch-up HPV vaccination, based on shared clinical decision making, for all adults aged 27 through 45 years.
Although the current program of HPV vaccination for youth has demonstrated effectiveness, data from multiple models suggest that widespread HPV vaccination for adults older than 26 years is much less cost effective, and would yield relatively small additional health benefits, Dr. Markowitz said.
The HPV work group reviewed data from a range of clinical trials, epidemiology, and natural history, as well as results from five different health economic models. They concluded that an assessment of benefits and harms favors expanding the catch-up vaccination to all individuals through 26 years, said Elissa Meites, MD, of the CDC, who presented the official work group opinion. The group’s opinion on the second question was that the additional population level benefit of expanding HPV vaccination to all adults would be minimal and not a reasonable and effective allocation of resources, but that shared clinical decision making would allow flexibility.
The committee expressed strong opinions about the potential for shared clinical decision making as a policy for vaccination for adults older than 26 years. Some felt that this option was a way to include adults at risk for HPV, such as divorced women with new partners, or women getting married for the first time later in life who might not have been exposed to HPV through other relationships. In addition, supporters noted that the shared clinical decision-making option would allow for potential insurance coverage, and would involve discussion between doctors and patients to assess risk.
However, other committee members felt that any recommendation for older adult vaccination would distract clinicians from the importance and value of HPV vaccination for the target age group of 11- and 12-year-olds, and might divert resources from the younger age group in whom it has shown the most benefit.
Resource allocation was a concern voiced by many committee members. Kelly Moore, MD, MPH, of Vanderbilt University, Nashville, Tenn., said she voted no on expanding vaccination to older adults because “we didn’t have details on shared clinical decision making, in the absence of information on what that meant, and in the presence of supply questions, I didn’t feel comfortable expanding vaccination to a huge population,” she said.
Paul Hunter, MD, of the City of Milwaukee Health Department, also voted no, and expressed concern that expanding the HPV vaccination recommendations to older adults would send the message that vaccination for children and teens is not effective or important.
The text of the new recommendations for routine and catch-up vaccination states that the recommendations “also apply to MSM [men who have sex with men], transgender people, and people with immunocompromising conditions.”
The ACIP members had no financial conflicts to disclose.
REPORTING FROM AN ACIP MEETING