ACIP Says No to LAIV for 2017-18 Flu Season

Group Updates Influenza Vaccine Recommendations for Pregnant Women

June 30, 2017 07:35 am Chris Crawford
[Young boy getting flu shot in arm]

Just as it did for the 2016-2017 influenza season, the CDC's Advisory Committee on Immunization Practices (ACIP) has again decided to recommend against use of live attenuated influenza vaccine (LAIV; FluMist) for the 2017-2018 flu season because of the vaccine's reduced efficacy. This decision was made during the ACIP's June 21-22 meeting.(www.cdc.gov)

Data presented at the meeting showed that last year's exclusion of LAIV didn't affect vaccine coverage numbers for the 2016-2017 season compared with the previous season, with the flu vaccine shown to be 42 percent effective in preventing infection from A and B viruses in patients of all ages.

For 2016-2017, influenza A accounted for 70 percent of circulating flu strains, with influenza B making up the other 30 percent. Influenza A H3N2 was the predominant influenza A virus.

No new safety concerns were detected in Vaccine Adverse Event Reporting System (VAERS) monitoring for the influenza vaccine during the 2016-2017 season.

Story highlights
  • At its June 21-22 meeting, the CDC's Advisory Committee on Immunization Practices (ACIP) recommended against use of live attenuated influenza vaccine (LAIV; FluMist) for the 2017-2018 flu season because of the vaccine's reduced efficacy.
  • The ACIP also voted to revise the influenza recommendation for pregnant women to clarify that they may receive any recommended, licensed and age-appropriate influenza vaccine, administered at any time during pregnancy, except for LAIV.
  • The Vaccine Adverse Event Reporting System (VAERS) has transitioned to VAERS 2.0 as of June 30, which means the tool's reporting format has evolved from a paper copy that's faxed to an online reporting page.

ACIP members also voted to revise the current influenza recommendation for pregnant women to clarify that they may receive any recommended, licensed and age-appropriate influenza vaccine, administered at any time during pregnancy, except for LAIV. The exact wording of this new recommendation has not yet been finalized, but previously, the recommendation for vaccinating pregnant women had referred specifically to using inactivated influenza (IIV) vaccine.

"This recommendation hasn't really changed, it's just been broadened to include all types of influenza vaccine (trivalent or quadrivalent IIV or recombinant) except LAIV," said Pamela Rockwell, D.O., of Ann Arbor, Mich., who served as the AAFP's liaison to the ACIP for this meeting.

Additionally, Rockwell told AAFP News that meeting attendees discussed an easy-to-use guide on vaccines for pregnant patients that's in the works and that represents a collaboration between the AAFP, the American Congress of Obstetricians and Gynecologists, and the American College of Nurse-Midwives. The CDC has requested that the guide be disseminated to all three organizations' members in unison by publishing it in each group's journal simultaneously.

VAERS 2.0

Another topic discussed during the meeting was the VAERS website, which has transitioned to VAERS 2.0(vaers.hhs.gov) as of June 30. That change means the tool's reporting format evolves from a paper copy that's faxed to the system to an online reporting page. However, clinicians can still fill out a paper copy and submit that, if they prefer.

Data elements added to the new writeable and savable form that previously weren’t included are pregnancy status, race and ethnicity. The original VAERS reporting form will be phased out after December.

Anthrax Vaccine Workgroup Reconvened

Rockwell said she found it interesting that as of May 2017, the anthrax vaccine workgroup was reconvened to review operational issues related to mass vaccination following a potential widespread release of Bacillus anthracis spores.

The group also plans to review

  • new data that have become available since the publication of a 2010 CDC Morbidity and Mortality Weekly Report(www.cdc.gov) that offered the ACIP's anthrax vaccination recommendations,
  • pending licensure for a new formulation of anthrax vaccine adsorbed and
  • anthrax antitoxins for use as postexposure prophylaxis.

"Anthrax is highly lethal and easy and cheap to produce, store and disperse," Rockwell said, which makes it a cause of concern for possible future bioterrorism attacks.

There hasn't been a mass attack on U.S. soil since the 2001 cases that occurred shortly after Sept. 11, when letters containing anthrax spores were mailed to several news media offices and two Democratic senators, killing five people and infecting 17 others.

Additional Meeting Notes

In other news and notes from the June ACIP meeting, Merck & Co. Inc. is not currently distributing its adult hepatitis B vaccine (Recombivax HB) and won't through the end of 2017. Supply of its dialysis formulation of the vaccine, however, will not be affected.

In addition, GlaxoSmithKline said it has plenty of supply of its hepatitis B vaccine (Engerix-B) and expects to be able to fill any vaccine supply gaps.(www.cdc.gov)

The measles, mumps and rubella (MMR) vaccine workgroup offered an updated review of studies of third-dose MMR vaccine use to control mumps outbreaks. In 2016, 6,353 cases of mumps were reported to the CDC -- the most in the past decade.

"Everybody felt that patients should get a third dose if there is an outbreak," Rockwell said. But she noted that the data wasn't a "slam dunk" for a routine third dose of MMR vaccine, and no official recommendation was made.

Continuing a discussion from the ACIP's February meeting regarding giving booster doses of the meningitis B (MenB) vaccine to patients at increased risk for serogroup B meningococcal disease, the group focused this time on the vaccine response of patients already taking eculizumab (Soliris), which is approved to treat patients with paroxysmal nocturnal hemoglobinuria to reduce hemolysis. Patients taking eculizumab have an incidence of meningococcal disease that is 1,000 to 2,000 times greater than the baseline risk for healthy patients, and vaccination may not provide complete protection for this group.

"In France, they recommend patients taking Soliris also take antibiotics for the duration of treatment and, additionally, for the 60 days afterwards," Rockwell said. "Based on the data presented, if my daughter had to go on Soliris, I would put her on antibiotics." However, there currently is no official ACIP recommendation for prophylactic antibiotic use in patients taking this drug.

GlaxoSmithKline presented a study(www.gsk.com) comparing its new two-dose herpes zoster vaccine, Shingrix, which is under FDA review, to the currently available single-dose zoster vaccine live (ZVL; Zostavax). Shingrix produced more than 90 percent efficacy in all age groups, and those levels persisted for at least four years. Patients who received the ZVL vaccine at least five years before being vaccinated with Shingrix showed an immune response that was similar to that of patients without previous exposure to the ZVL vaccine.

"No decision was made (at the meeting) on the preference of one vaccine versus another," Rockwell said. The ACIP still would need to select an age for the recommendation and review a cost-effectiveness analysis later, she added.

Additionally, the ACIP reviewed how the U.S. varicella vaccination program has affected the epidemiology of herpes zoster.

"There has been concern that by reducing varicella zoster virus circulation, varicella vaccination could reduce exogenous boosting and thus plausibly increase the risk of herpes zoster," Rockwell said. "However, incidence of chickenpox is at its lowest level ever, as is herpes zoster in children. There's no evidence that the varicella program has increased herpes zoster rates in the general population."

October ACIP Meeting

At the ACIP's Oct. 25-26 meeting, Rockwell said the hepatitis vaccine workgroup will present full recommendations on the hepatitis A vaccine for a vote. This would be an update of the ACIP's 2006 recommendations on the hepatitis A vaccine.

Related AAFP News Coverage
ACIP Offers Revised, Single-dose HepB Infant Revaccination Option
(2/28/2017)

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)