ACIP Offers Revised, Single-dose HepB Infant Revaccination Option

February 28, 2017 01:04 pm Chris Crawford

At the CDC's Advisory Committee on Immunization Practices (ACIP) meeting Feb. 22-23(www.cdc.gov), the group voted to approve an updated recommendation for single-dose revaccination of unprotected infants born to hepatitis B surface antigen (HBsAg)-positive mothers.

Additionally, the ACIP highlighted a correction made to the recently released 2017 adult immunization schedule and discussed the CDC's efforts to help vaccine manufacturers uniform their bar coding on vaccine boxes and doses.

HepB Infant Revaccination Update

At its February meeting, the ACIP voted to approve revised language for its recommendation on revaccinating unprotected infants who are born to HBsAg-positive mothers with hepatitis B (HepB) vaccine.

Story highlights
  • At the CDC's Advisory Committee on Immunization Practices (ACIP) meeting Feb. 22-23, the group updated its recommendation for revaccination of unprotected infants born to hepatitis B surface antigen-positive mothers.
  • Additionally, the ACIP highlighted a correction made to the recently released 2017 adult immunization schedule and discussed the CDC's efforts to help vaccine manufacturers standardize their bar coding on vaccine boxes and individual vaccine doses.
  • The remaining ACIP meetings this year will likely cover topics such as whether a third dose of the measles, mumps and rubella vaccine should be recommended to control outbreaks.  

The amended revised language reads

  • HBsAg-negative infants with antibody to HBsAg (anti-HBs) less than 10 mIU/mL should be revaccinated with a single dose of HepB vaccine and receive post-vaccination serologic testing (PVST) one to two months later. Infants whose anti-HBs remains less than 10 mIU/mL following single-dose revaccination should receive two additional doses of HepB vaccine, followed by PVST one to two months after the last dose.
  • Based on clinical circumstances or family preferences, HBsAg-negative infants with anti-HBs less than 10mIU/mL may instead be revaccinated with a second complete three-dose series, followed by PVST performed one to two months after the final dose of vaccine.
  • Available data do not suggest a benefit from administering additional HepB vaccine doses to infants who have not attained anti-HBs greater than or equal to 10mIU/mL following receipt of two complete three-dose HepB vaccine series.

AAFP liaison to the ACIP Margot Savoy, M.D., M.P.H., of Wilmington, Del., told AAFP News, "Ideally, the ACIP's recommendation is to use the least number of shots possible to get the best coverage for the child. If the infant's serologic test is still negative and they're covered by the hepatitis B vaccine, you are done. If you are worried the child is a nonresponder at the end of their serologic testing, you can reimmunize with the three doses, which you would do anyway."

Savoy added that if a family wanted to do the full course of six doses, that's still acceptable, but is no longer the default option.

"The take-home point here is the ACIP is trying to minimize vaccine exposure and also shorten the time when you can say the child is released from case management," she said.

Adult Immunization Schedule MenB Correction

An error appeared in the 2017 adult immunization schedule in the serogroup B meningococcal (MenB) vaccine recommendation; a correction will be published March 3 in Morbidity and Mortality Weekly Report.

Under the footnote heading "Meningococcal vaccination," the bullet point dealing with teens and young adults should have read: "Young adults aged 16 through 23 (preferred age range is 16 through 18 years) who are healthy and not at increased risk for serogroup B meningococcal disease (described above) may receive either a two-dose series of MenB-4C (Bexsero) at least one month apart or a two-dose series of MenB-FHbp (Trumenba) at 0 and 6 months for short-term protection against most strains of serogroup B meningococcal disease." The original schedule footnote had included a three- rather than two-dose MenB-FHbp series option.

Vaccine Lot Number Confusion

The ACIP also discussed confusion that has risen from vaccine manufacturers using different bar codes on the boxes vaccines are shipped in and on the doses themselves.

"It turns out the box has a lot number and the individual syringes have lot numbers and they are not always the same number, depending on the manufacturer," Savoy said.

"Depending on what you are using your bar scanner for determines when this might create a problem for you," she said. "For practices using bar scanning for inventory purposes only, they might scan the box. However, for those who are scanning each dose to enter into an electronic health record (EHR), that number can be different."

Savoy said this could be particularly problematic if there is a vaccine recall and the manufacturer recalls an individual dose lot number but only the box lot number is entered into your EHR.

She added that most EHRs don't have separate fields for box and vaccine lot numbers, so that incorrectly bolstered the assumption these were the same numbers. "Apparently, that has created huge IT problems for immunization information systems," she said.

The CDC is currently working with the vaccine manufactures and health care professionals to figure out a single lot number solution.

"We don't do bar coding in our office, and I have never asked my staff if they are using the lot number off of the box or the vial. So it's on my list of things to discuss with them next. Family physicians might have a problem they don't even know about yet," Savoy said.

Coming Up Next

Savoy said she anticipates the remaining ACIP meetings this year will cover a variety of topics, such as

  • the expected presentation by manufacturer Seqirus of a plan to reduce the increase in febrile seizures associated with its Afluria vaccine by introducing a new formulation;
  • a discussion regarding whether and when Flumist might return to the U.S. market (it will not be used during the 2017-2018 flu season);
  • presentation of a new herpes zoster subunit (HZ/su) vaccine;
  • MenB booster dosing recommendations for groups at increased risk for the disease; and
  • discussion of administering a third dose of the measles, mumps and rubella vaccine in an attempt to control ongoing mumps outbreaks.

Related AAFP News Coverage
CDC, AAFP Release 2017 Immunization Schedules
Updates Include New HPV, MenB and HepB Vaccine Recommendations
(2/6/2017)

ACIP Recommends Two-dose Regimen for HPV Vaccine
Group Offers Additional Recommendations for Hep B, MenB-FHbp, Tdap Vaccines
(10/26/2016)

ACIP Recommends MenACWY-D for HIV-infected Patients, Cholera Vaccine
(6/29/2016)