ACIP Approves Recommended Immunization Schedules for 2014, Discusses Other Vaccine Trends

October 30, 2013 02:31 pm Matt Brown

The CDC's Advisory Committee on Immunization Practices (ACIP) voted unanimously to approve updated adult, child/adolescent and catch-up immunization schedules for the coming year during its Oct. 23-24 meeting(www.cdc.gov) in Atlanta. Committee members also discussed a number of other vaccine-related issues of interest to family physicians.

According to Jamie Loehr, M.D., of Ithaca, N.Y., the AAFP's liaison to the ACIP, several footnotes were modified to clarify existing recommendations or to reflect revised ones in both the child/adolescent and catch-up schedules; small changes also were made to the adult schedule.

All three schedules will be released officially on Feb. 1.

Loehr told AAFP News Now the committee also voted 13-1 -- with one abstention -- to recommend that Novartis Vaccines' meningococcal vaccine Menveo (MenACWY-CRM) be approved for use in infants at increased risk for the disease.

"The vaccine has now been approved for use in high-risk infants at ages 2, 4, 6 and 12 months," Loehr said. "Everyone agreed it was a good choice. The debate, if you wanted one, would be about whether it should be a broader recommendation and that we should be giving it to more people."

Story highlights
  • The CDC's Advisory Committee on Immunization Practices (ACIP) voted unanimously to approve updated adult, child/adolescent and catch-up recommended immunization schedules during its Oct. 23-24 meeting in Atlanta.
  • ACIP members also voted 13-1 to recommend approving Novartis Vaccines' meningococcal vaccine -- Menveo (MenACWY-CRM) -- for use in high-risk infants.
  • The ACIP's herpes zoster workgroup will continue to recommend that the minimum age at which adults receive the herpes zoster vaccine remains 60.

One of the more interesting developments, according to Loehr, was the data Sanofi Pasteur presented on its Fluzone High-Dose seasonal influenza vaccine, which indicate the vaccine has superior efficacy compared with regular Fluzone in patients ages 65 and older. Sanofi's research found that this benefit, which is consistent among different age groups and strains of influenza, resulted in 25 percent fewer cases of flu in the high-dose group compared with those who received regular Fluzone.

"That was always the assumption, but now we've got evidence that it's better," said Loehr. "Having said that, the actual number of flu cases prevented would be 4.6 cases per every 1,000 doses. That should be compared against the higher rate of side effects of high-dose Fluzone."

Loehr said the ACIP also heard a presentation on the efficacy of the herpes zoster vaccine. Currently, the FDA has approved the vaccine for use in adults ages 50 and older, and the ACIP recommends it be given starting at age 60. Information presented during the meeting showed a 50 percent decrease in shingles incidence and a 67 percent decrease in post-herpetic neuralgia (PHN) incidence at three years after vaccination. Results also indicated some continued protection against shingles and PHN as long as seven years after vaccination. However, protection against shingles drops off significantly at year nine or 10 after the vaccine is administered, he said.

"(The vaccine's efficacy) seems to wane after eight to 10 years, and, unfortunately, there's no indication that there will be a study on booster doses," Loehr said. "So if you've no evidence on booster doses -- working or not working -- and you've got to pick one date to give this, you probably wouldn't want to give it at age 50 because (the vaccine's protective effects) would wane before the highest risk period, which is in the 60s and 70s. So, the workgroup reaffirmed that age 60 appears to offer the best balance of cost and benefits."

Regarding the human papillomavirus (HPV) vaccine, Loehr said some promising ideas came out of discussions about the disappointing HPV vaccination coverage numbers being reported by the CDC. Much of the talk, he noted, centered on trying to delink HPV vaccination from sexual activity discussions and instead get people to think of the vaccine as a cancer-prevention tool.

Loehr said family physician and ACIP Chair Jonathan Temte, M.D., Ph.D., of Madison, Wis., shared a particularly insightful analogy on the issue during the recent committee meeting.

"He told us he tells kids, 'You don't put the bike helmet on right before you hit the car or after the car hits you, you put it on before you start riding your bike, right?'" Loehr said. "So, you get the vaccine at 11 or 12 -- before you might get exposed to the 'car' -- you don't wait until you're 18 and are already having sex. You just get it early before you are ever in danger of getting hit by the car."

One promising idea for boosting HPV vaccination rates comes from Tennessee, Loehr said, where the state's "3-Star" program(www.immunizationmanagers.org) has led to significant increases in rates of immunization with tetanus, diphtheria and pertussis (Tdap) vaccine; conjugated meningococcal vaccine; and HPV vaccine among young teens eligible for the Vaccines for Children program who present to local health departments.

"It's very common for people to recommend that you get the Tdap at age 11, as well as the meningitis vaccine, and Tennessee is now tracking how many people give those two, plus the HPV, at same visit," said Loehr. "From there, they are grading relative practices as a way of measuring how often those three vaccines are given together."

Regarding the ongoing vaccine supply shortage that has plagued Sanofi since May, ACIP members heard a mixed report on three of the company's vaccines:

  • diphtheria and tetanus toxoids and acellular pertussis adsorbed, inactivated poliovirus and Haemophilus influenzae type b conjugate vaccine (DTaP-IPV-Hib: Pentacel);
  • diphtheria and tetanus toxoid and acellular pertussis vaccine adsorbed (Daptacel); and
  • tetanus toxoids, reduced diphtheria and acellular pertussis vaccine adsorbed (Adacel).

"It looks like Daptacel, Adacel and Pentacel are starting to ship, but they are constrained," Loehr said. "So there will probably still be some delay through December."

GlaxoSmithKline's Tdap vaccine Boostrix also is "slightly constrained" at this time, he added.


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