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CONTENTS OF THIS ISSUE
Winter 2019 Issue

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ACIP Report

Meeting of the Advisory Committee
on Immunization Practices

By Stan Grogg, DO
AOA Liaison

 
February 27-28, 2019

Centers for Disease Control and Prevention
Atlanta, Georgia


Stan Grogg, DO

Stan Grogg, DO

Meeting Highlights

1. Japanese Encephalitis Vaccine: Ixiaro 

Part 1: JE is a very low risk disease for most U.S. travelers to JE-endemic countries. However, some travelers will be an increased risk of infection based on their planned itinerary. Factors that increase the risk of JE virus exposure include:

  • Longer duration of travel
  • Moving to a JE-endemic country to take up residence
  • JE vaccine should be considered for shorter-term (e.g., <1 month) with an increased risk of JE based on planned travel, duration, season, location activities and accommodation.
  • Vaccination should be considered for travelers to endemic areas who are uncertain of specified duration of travel destinations
  • Travel during the JE virus transmission season
  • Spending time in rural areas
  • Participating in extensive outdoor activities
  • Staying in accommodation without air conditioners, screens, or bed net

JE vaccine is not recommended for travelers with very low risk itineraries, such as short-term travel limited to urban areas or travel that occurs outside of a well-defined JE virus transmission season.

Part 2: Added accelerated JE vaccine: In adults aged 18-65 years, the primary vaccination schedule is two doses administered on days 0 and 7-28.

Part 3: Booster dose (3rd) should be given at one year or > after completion of the primary JE-VC series if ongoing exposure or re-exposure to JE virus is expected.

2. Anthrax Vaccine
A booster dose of AVA should be given every 3 years to persons not currently at high risk of exposure to B. anthracis who have been previously primed with AVA and wish to maintain protection. (Passed 15/0)

Informational

  • New anthrax vaccine, AV7909, for post-exposure prophylaxis (PEP)
  • Use of AV7909 for post-exposure prophylaxis (PEP) in persons with suspected or known exposure to aerosolized Bacillus anthracis spores when anthrax vaccine adsorbed (AVA) availability is limited
  • AV7909 is the next-generation anthrax vaccine and is only available for emergency use authorization

3. Influenza Vaccines

  • Update influenza surveillance and vaccine effectiveness updates
  • Primarily A Influenza virus. Reginal activity varies
  • 43 Pediatric deaths, mostly H1N1
  • Effectiveness of 2018-19 Flu vaccine
    1. Fluarix Quadrivalent (IIV4, GSK) 0.5 ml
    2. FluLaval Quadrivalent (IIV4, Biomedical Corp/GSK) 0.5 ml
    3. Fluzone Quadrivalent (IIV4, Sanofi Pasteur) 0.25 or 0.5 ml
    4. Afluria (IIV3, Sequirus) 0.25 ml
    5. Afluria Quadrivalent (IIV4, Seqirus) 0.25 ml

Note: CDC recommends that health care providers continue to administer influenza vaccine because influenza activity is ongoing and the vaccine can still prevent illness, hospitalization, and death associated with currently circulating influenza viruses, or other influenza viruses that might circulate later in the season

Influenza activity in the United States was low during October and November, increased in late December, and remained elevated through early February

  • Spontanious abortion follow-up study found no association with flu vaccine
  • Five IIV licensed for 6 – 35 months. After 36 months all given at 0.5ml.
    1. Fluarix Quadrivalent (IIV4, GSK) 0.5 ml
    2. FluLaval Quadrivalent (IIV4, Biomedical Corp/GSK) 0.5 mlFluzone Quadrivalent (IIV4, Sanofi Pasteur) 0.25 or 0.5 ml
    3. Afluria (IIV3, Sequirus) 0.25 ml
    4. Afluria Quadrivalent (IIV4, Seqirus) 0.25 ml

4. Human Papillomavirus Vaccine:

  • Work group continues to study persons aged 27-45 years who were not previous vaccinated
  • Health economic modeling studies have found that HPV vaccine will have the largest impact and is most cost-effective when administered in early adolescence, before exposure to HPV through sexual activity
  • Preparing for vote in June 2019

5. Zoster Vaccines:

  • After licensure the incidence of side effects same as pre-licensure.
  • Vaccine shortage will continue to be a problem

6. Agency Updates

  • CDC reports 159 cases in 10 states of Measles, as of Feb. 2. 
  • Mainly from travelers. Found in “close net” areas without vaccinations
  • DOD (Department of Defense): Yellow fever vaccine anticipated continued supply issues
  • National compensation program: For year 2019: 411 claims with $74,000,000; about 70% of claims are compensated.

7. Pneumococcal Vaccines

  • No vote. Discussion involved whether Prevnar 13 is cost effective for age 65 and over. Vote is planned in June 2019.
  • Two new vaccines are anticipated soon.
  • Merck: a PVC-15
  • Pfizer: a PVC-20

8. Meningococcal Vaccines

  • Bexsero (GSK): Vaccine antibodies persist up to 7.5 years
  • Work-group looking at timing of a booster dose Men B for high risk patients

9. Combination Vaccines

A new Pediatric Hexavalent Vaccine (Vaxelis) by Merck and Sanofi for 3 dose series (2,4,6 months): Approved by FDA Dec. 21, 2018.

  • DTaP5
  • IPV
  • Hib (PRP)
  • Hep B

To be reviewed at June meeting.

10. Hemophilus influenza type B

  • Hib is still circulating in Native American (A/I) rural and reservation-based communities
  • Alaska Eskimos (AE/AI) have 2.5 times more Hib disease than general population
  • Because of the risk of invasive Hib disease at younger ages, the IHS has recommended a preference for the PRP-OMP (Pedvax-Hib) Hib conjugate vaccine based on seroconversion rates of 60% after the first dose of PRP-OMP, compared with rates of only 20% for the other Hib conjugate vaccines
  • Consider if the new pediatric hexavalent vaccine should be preferentially recommended for AI/AN population.

11. Hepatitis Vaccines

  • Should HIV be an indication for Hep A vaccination (safe and effective)
  • Increasing proportion of adults in US are susceptible to Hep A
    1. Reduced exposure to HAV early in life
    2. Significant decreases in anti-HAV seroprevalence in older adults
    3. Low 2-dose vaccination coverage exist in adults

12. Vaccine Supplies

  • Pediatric Hepatitis B
  • Adult hepatitis B vaccine
  • Yellow fever

13. Major Updates to the Childhood Vaccine Schedule

  • Children between the ages six to 11 months of age and unvaccinated persons 12 months of age or older receive the hepatitis A vaccine for international travel.
  • The second update pertains to the word “all” that has been added to the Hep B vaccine recommendation for the birth dose for medically stable infants (more than 2000 grams or 4.4 lbs.) born to hepatitis B surface antigen-negative mothers. According to federal health officials, this clarification was added to emphasize the recommendation that all healthy infants.
  • The live nasal spray influenza vaccine, FluMist (LAIV) is an option for children 24 months and older. The AAP still has reservations about its effectiveness. The AAP says should be reserved for children who refuse to get the injection.
  • Pregnant adolescents 13-18 y/o should receive Tdap vaccine.
  • The catch-up vaccination section has been updated to indicate that those children who received a dose of Tdap or DTaP at seven to 10 years of age inadvertently, or as part of the catch-up schedule, should nevertheless receive the routine dose of Tdap at 11 to 12 years of age

14. Major Updates to the Adult Vaccine Schedule

  • Added homelessness as an indication for giving children and adults hepatitis A vaccine
  • The new single-antigen Hep B vaccine (Heplisav-B) is recommended for use in adults, except in
    pregnant women. The vaccine is administered in 2 doses given at least 4wk apart
  • LAIV is an option for most adults up to age 49

Next ACIP meeting June 26-27, 2019

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