ACIP: LAIV No Longer Preferentially Recommended for Young Children

Committee Also Addresses Vaccines for HPV, Serogroup B Meningitis, Yellow Fever

March 04, 2015 11:45 am Chris Crawford

Preliminary data from the 2014-15 influenza season have shown that the live attenuated influenza vaccine (LAIV; FluMist) was ineffective against the influenza A (H1N1) virus for healthy children ages 2-8. This year's data affirm the trend first seen the previous flu season.

[Little girl wearing stripped shirt getting vacciinated in arm]

In response, the CDC's Advisory Committee on Immunization Practices (ACIP) reversed its June 2014 preferential recommendation for LAIV use in young children during its abbreviated meeting( on Feb. 26. (The scheduled Feb. 25 session was canceled due to inclement weather.) The committee also voted on vaccines for HPV, serogroup B meningitis and yellow fever.

AAFP liaison to the ACIP Jamie Loehr, M.D., of Ithaca, N.Y., told AAFP News that going forward, both LAIV and inactivated influenza vaccine will be recommended for this group, as well as for people ages 9-49.

Loehr said there had been many other flu seasons during which LAIV was very effective. "So on balance, an argument could be made that LAIV still has more data in favor of its use than against, but not enough data to recommend it preferentially," he said.

On a more general note, ACIP members voted to recommend the annual influenza vaccine for everyone age 6 months or older.

Story highlights
  • The CDC's Advisory Committee on Immunization Practices (ACIP) reversed its preferential recommendation for live attenuated influenza vaccine use in young children at its most recent meeting.
  • The ACIP also voted to recommend use of nine-valent HPV vaccine for both males and females ages 9-26.
  • Committee members voted to recommend two FDA-approved serogroup B meningococcal vaccines for use in males and females age 10 and older.

Nine-valent HPV Vaccine

The ACIP also voted to recommend use of the nine-valent HPV (HPV9) vaccine marketed by Merck Inc. for males and females ages 9-26. Specifically, the ACIP recommended routinely giving the HPV9 vaccine at age 11-12, but it can be given as early as age 9, and is included in catch-up schedules for women ages 13-26 and for men ages 13-21. In addition, certain high-risk men ages 22-26 can receive the vaccine.

Calling the HPV9 vaccine "Gardasil plus five," Loehr explained that the vaccine showed 96 percent efficacy against five additional HPV types, as well as noninferior immunogenicity against the original four types in women ages 16-26. And bridging studies showed comparable benefits for younger women and men.

If a patient is an HPV vaccine candidate who has never received Gardasil, Loehr said the best course would be to give her/him the three-dose schedule using HPV9. For patients who have already received the full schedule of HPV4, no additional HPV9 vaccination is recommended.

Serogroup B Meningococcal Vaccines

During the past five months, the FDA has approved the use of two serogroup B meningococcal vaccines for males and females ages 10-25: Pfizer's Trumenba, which is given as a three-dose series, and Novartis' Bexsero, which is given as a two-dose series. Either vaccine may also be used in people age 10 or older who have high-risk conditions.

High-risk groups include those with persistent complement component deficiencies, anatomic or functional asplenia, microbiologists working with serogroup B meningitis, and populations at risk because of outbreaks. Combined, these groups represent about 300,000 people in the United States.

Meningococcal infection caused by serogroup B is a rare disease, with only about 50-100 cases per year in the United States. For people at higher risk for the disease, paying for meningococcal vaccine is probably worthwhile, Loehr said. But, he asked, "What do you do for everybody else who is just an average risk? Meningitis B is a horrible disease but the vaccines are very expensive."

The discussion on meningococcal vaccine for routine use, including among first-year college students living in residence halls, was deferred until the June ACIP meeting.

Yellow Fever Vaccine

The ACIP voted to approve its previously proposed recommendation that a single dose of 17D yellow fever (YF) vaccine is adequate for most travelers, meaning that the 10-year booster dose is no longer required, Loehr said.

Exceptions include those who may not have received full protection from the initial dose. These populations include women who were pregnant when they received the first dose, people who have had a stem-cell transplant since their last YF vaccine and people who were HIV-infected when they received their first dose.

"You can also consider a booster dose for travelers who are in higher-risk settings based on season, location, activities or duration of travel," said Loehr.

Finally, laboratory workers who continue to work with YF virus 10 years after their initial YF dose should either receive a booster or have antibody titers assessed to confirm ongoing protection.

June ACIP Meeting

At the next ACIP meeting, June 24-25, committee members will discuss a recommendation to vaccinate people at high risk of contracting the avian influenza virus (H3N5), which includes laboratory workers who work with the virus.

Loehr said the committee also may review a couple of recent studies that suggest the children of mothers who get the tetanus, diphtheria and acellular pertussis (Tdap) vaccine during pregnancy have fewer pertussis infections.

This was one of the key questions that hadn't been answered when the ACIP recommended Tdap vaccination for expectant mothers in November 2012 based on an extrapolation of data. But now, said Loehr, hard data suggest that the vaccine works exactly in this way.

"There are two pieces of good news," he said. "The safety for two doses of the pertussis vaccine seems to be excellent. But no one, so far, has done a study on the safety of three, four or five doses, which would be happening if a woman was having multiple children."

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