During its Oct. 21 meeting,(www.cdc.gov) the CDC's Advisory Committee on Immunization Practices (ACIP) voted to reconfigure its pediatric recommended immunization schedule to list vaccines from earliest to latest age at which each is first administered.
AAFP liaison to the ACIP Margot Savoy, M.D., M.P.H., told AAFP News this decision was intended to improve the readability of the schedule by aligning the routine recommendation gold bars under the age when a vaccine is first given. Thus, when viewing vaccines recommended for a patient 2 months of age, for example, all recommended vaccines will be listed in a single unbroken column rather than the current layout that displays the vaccines in different rows.
The ACIP unanimously supported both the pediatric and adult immunization schedules for 2016, which will be finalized for distribution to the AAFP and other partner organizations by January for publication in February.
ACIP members also discussed the Category B(www.cdc.gov) recommendation on the serogroup B meningococcal (MenB) vaccine the group made during its June meeting and that was published Oct. 23 in the CDC's Morbidity and Mortality Weekly Report.(www.cdc.gov)
- During its Oct. 21 meeting, the CDC's Advisory Committee on Immunization Practices (ACIP) voted to reconfigure its pediatric recommended immunization schedule to list vaccines from earliest to latest age at which each is first administered.
- The group also discussed the Category B recommendation on the serogroup B meningococcal vaccine the group made during its June meeting.
- In addition, a representative from the Immunization Action Coalition presented information about the Take a Stand! standing orders training initiative, which seeks to increase adult immunization rates.
In addition, a representative from the Immunization Action Coalition (IAC) presented information about the Take a Stand!(www.psna.org) standing orders training initiative, which seeks to increase adult immunization rates.
MenB Vaccine Recommendation Implications
In June, the ACIP finalized its Category B recommendation stating that adults ages 16-23 may be vaccinated to provide short-term protection against most strains of serogroup B meningococcus.
The committee had previously recommended use of either of the two available MenB vaccines -- Pfizer's Trumenba, which is given as a three-dose series, or Novartis' Bexsero, which is given as a two-dose series -- for people ages 10 and older who are at increased risk for serogroup B meningococcal disease. These high-risk groups include those with persistent complement component deficiencies, anatomic or functional asplenia, microbiologists who work with serogroup B meningococcal bacteria, and populations at risk because of outbreaks.
The routine recommendation to immunize children age 11 or 12 with a quadrivalent meningococcal conjugate vaccine (MenACWY) remains unchanged.
Although the committee has indicated no preference for either MenB vaccine, Savoy said it's important to note that the two products aren't interchangeable once the series is started. Both the MenB and MenACWY vaccines may be administered during the same office visit; however, using different injection sites is recommended.
"Because it is now ACIP policy, the MenB vaccine will be covered through Vaccines for Children and (Patient Protection and) Affordable Care Act health plans," Savoy said.
Furthermore, because this is a B recommendation, she expects private insurers will cover the MenB vaccine, as well.
Savoy said now family physicians will have to decide how they talk with their patients about serogroup B meningococcal disease and whether they should stock the MenB vaccine.
"How many people are going to get a vaccine that is Category B that they are going to have to come in and talk about?" she asked. "If the answer is not very many, then you aren't going to stock it because you don't want your vaccine to expire and not get paid back for it. Then, the question is, 'Who do you refer this patient to in order to get this vaccine?'"
Because Savoy works in a medical group, she said she can swap vaccines with other physicians, including the pediatricians in her health system, so there is less concern about wasting product and losing money. But if a family physician owns his or her practice, this likely wouldn't be an option, and that risk must be taken into consideration when deciding whether to stock the MenB vaccine.
Take a Stand! Initiative
During the meeting's Take a Stand! presentation, it was noted that in practices with standing orders to vaccinate adults against influenza and pneumonia and in which nurses administer the shots to patients waiting in the exam room to see the physician, adult immunization rates spiked, Savoy said.
The initiative is a partnership between the IAC and Pfizer that promotes training on standing orders for adult immunization(www.immunize.org) that is delivered in four-hour workshops(www.standingorders.org) held across the country that are free to any practices that currently administer at least one adult vaccine. These practices also can receive standing order implementation support for one year after the workshop.
"We have talked about methods on how to improve standing orders in the past, but we didn’t specifically go into detail about how you would implement them," Savoy said. "This would be nice for a physician who wanted to try (standing orders) but didn't know how to get started."
February 2016 ACIP Meeting
At the upcoming Feb. 26 ACIP meeting, Savoy said the HPV vaccine work group, of which she is a part, will present for discussion the first report to compare a two- versus three-dose HPV vaccine regimen to determine whether dropping the third dose would be a viable option to recommend.
Also at the February meeting, data will be presented on a Japanese encephalitis vaccine expected to be released in the United States soon after final FDA approval is obtained, she said.
In addition, there is an oral cholera vaccine currently awaiting FDA approval that hasn't previously been available in the United States but that has been used in Australia, Canada and Switzerland. The ACIP restarted the cholera work group to conduct a grade evaluation on data previously available on the vaccine, with a recommendation vote expected in June 2016.
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