ACIP Discusses LAIV for Young Children, PCV13 Dose Schedule for Infants

Candidate HPV Vaccine Would Cover Five More Types

March 19, 2014 10:23 am Chris Crawford

The CDC's Advisory Committee on Immunization Practices (ACIP) addressed a wide range of topics during its Feb. 26-27 meeting(www.cdc.gov) in Atlanta. Among them: Consider whether to recommend preferential use of the live attenuated influenza vaccine (LAIV) in young children.

Influenza, Pneumococcal Vaccines Come Under Scrutiny

Although no vote was taken during the meeting, Jamie Loehr, M.D., of Ithaca, N.Y., the AAFP's liaison to the ACIP, said the influenza workgroup presented Grading of Recommendations Assessment, Development and Evaluation information and other data that indicated LAIV is more effective than inactivated influenza vaccine (IIV) in young children.

"There will likely be a vote in June to decide if the ACIP wants to recommend LAIV preferentially over IIV for children age 2-8 years," Loehr told AAFP News, adding that such a recommendation would probably be approved at that time. The workgroup also plans to clarify the differences between contraindications and precautions when using LAIV, he said.

Story highlights
  • During its recent meeting in Atlanta, the CDC's Advisory Committee on Immunization Practices (ACIP) considered the possibility of recommending that live attenuated influenza vaccine be used preferentially rather than inactivated influenza vaccine for children ages 2-8 years.
  • The ACIP pneumococcal workgroup presented data about the relative benefits of a three-dose versus four-dose schedule for pneumococcal conjugate vaccine for infants.
  • Committee members also reviewed favorable data on Merck's candidate nine-valent human papillomavirus vaccine.

Also of note, the pneumococcal workgroup presented additional data about the relative benefits of a three-dose versus the current four-dose schedule for pneumococcal conjugate vaccine (PCV13) for infants. "Many other countries have successfully implemented three-dose schedules, and some have successfully moved from a four-dose to a three-dose schedule," he said. "There was a wide-ranging discussion (comparing the two schedules) with sharply divergent views. The topic will be reviewed again in June."

On one hand, said Loehr, advocates for the three-dose-schedule argue that vaccinating 4 million children with one extra shot because some people aren't executing the schedule correctly is inappropriate. On the flip side, according to ACIP member and family physician Doug Campos-Outcalt, M.D., M.P.A., of Phoenix, the evidence to support equal effectiveness of the two options (three doses versus four doses) was not very high level. As a result, he noted, "Many thought, if it's not broken, don't fix it."

Although Loehr expects there to be a vote on the PCV13 dose schedule recommendation at the June meeting, he doesn't think the recommendation will change, "because enough people are worried that the three-dose schedule occasionally will be a two-dose schedule when a child misses a dose, which might lead to more disease."

New HPV Vaccine Could Be on the Horizon

The future of human papillomavirus (HPV) prevention also was a hot topic during the meeting. According to Loehr, vaccine manufacturer Merck and Co. Inc. presented favorable data on its candidate nine-valent HPV vaccine. "The vaccine is very effective and has a similar safety profile when compared to the quadrivalent HPV vaccine (Merck's Gardasil)," he said. "About 25 percent of (carcinoma in situ)2+ lesions and 11 percent of HPV-associated cancers are attributable to the additional five HPV types in the nine-valent vaccine."

The workgroup will continue to monitor the studies and, if the FDA licenses the vaccine, Loehr said he anticipates a vote on a possible ACIP recommendation during the February 2015 meeting.

Adult Immunization Coverage Remains Low

Although Loehr said time ran out for the full adult immunization committee presentation, a quick summary showed that vaccine coverage remains low for most routinely recommended adult vaccines and, overall, is far below HHS' Healthy People 2020 targets.

According to the 2012 National Health Interview Survey, modest improvements were seen compared with the previous year for only three vaccines:

  • HPV immunization with at least one dose for women ages 19-26 years rose from 29.5 percent to 34.5 percent;
  • tetanus, diphtheria and acellular pertussis immunization in people ages 19-64 years was up by about 3 percent; and
  • administration of herpes zoster vaccine rose by slightly more than 4 percent.

"The ACIP is still discouraged by the low percentage of adults who are getting vaccinated, said Loehr. Furthermore, he added, "Racial and ethnic disparities remain."

Two votes were taken during the meeting. The ACIP voted unanimously to reaffirm the recommendation for annual influenza vaccination for all people ages 6 months and older. The committee also voted unanimously to adopt an updated HPV vaccine policy statement that consolidates and clarifies previous policy statements. Information about the updated statement(www.cdc.gov) appears beginning on page 124 of the summary report from the committee's October 2013 meeting.


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