ACIP Recommends MenACWY-D for HIV-infected Patients, Cholera Vaccine

June 29, 2016 04:34 pm Chris Crawford
[Woman receiving intramuscular injection in arm]

During the CDC's Advisory Committee on Immunization Practices (ACIP) meeting June 23-24, at which the group recommended against use of live attenuated influenza vaccine during the 2016-17 flu season, members also considered and voted on other important business. This included a pair of votes on the use of quadrivalent meningococcal conjugate vaccine (MenACWY-D; Menactra, Menveo) for HIV-infected patients and on use of an oral cholera vaccine.

MenACWY-D Vaccine

ACIP members unanimously voted to recommend routine administration of the MenACWY-D vaccine to HIV-infected patients ages 2 months and older using a two-dose series two months apart, AAFP liaison to the ACIP Margot Savoy, M.D., M.P.H., of Wilmington, Del., told AAFP News. According to the committee's Grading of Recommendations, Assessment, Development and Evaluation( (GRADE) approach, this is a Category A recommendation.

MenACWY-D vaccine is also recommended for routine vaccination of adolescents, preferably at age 11 or 12, with a booster dose given at age 16.

Story highlights
  • The CDC's Advisory Committee on Immunization Practices (ACIP) voted during its June 23-24 meeting on the use of the quadrivalent meningococcal conjugate vaccine (MenACWY-D; Menactra; Menveo) with HIV-infected patients and on use of an oral cholera vaccine.
  • First off, the ACIP unanimously voted to recommend routine administration of the MenACWY-D vaccine with HIV-infected patients age 2 months and older.
  • The ACIP also voted to recommend cholera vaccine Vaxchora from international vaccine manufacturer PaxVax Bermuda Ltd., which the FDA approved June 10.

The ACIP also voted at this meeting to recommend that the MenACWY-D vaccine be covered under the Vaccines for Children program.

The ACIP's previous recommendation, which did not change at the June meeting, was for HIV-infected patients who have already been vaccinated to receive a booster dose as soon as possible and then continue to receive boosters every three years if they were younger than age 7 at their previous dose and every five years if they were age 7 or older at the previous dose.

Cholera Vaccine

ACIP members also voted to recommend use of PaxVax Bermuda Ltd.'s cholera vaccine Vaxchora, which gained FDA approval on June 10(, for the prevention of toxigenic Vibrio cholerae O1 for travelers ages 18-64 to areas of active cholera transmission.

The ACIP gave a Category A recommendation to use of this single-dose, live attenuated oral vaccine, which should be administered 10 days or more before travel.

"I don't think this will affect a whole lot of family physicians," said Savoy, "but it may be helpful for them to know if they have a patient traveling to a cholera-affected area, they may want to send them to a travel clinic to get this vaccine.

"Secondly, if they have a patient who is on a proton-pump inhibitor (PPI), physicians may want to have a conversation about stopping the PPI prior to going on this trip, because this could reduce a risk factor for getting sick from cholera."

Up Next

Savoy said for the Oct. 19-20 ACIP meeting, she anticipates a possible vote on a preferential recommendation for the serogroup B meningococcal (MenB) three-dose series of Pfizer's Trumenba over a two-dose series of the drug -- which the FDA approved only in specific situations.

The meningococcal workgroup is leaning toward recommending the three-dose schedule for healthy adolescents, which is the target group for protecting against MenB, she said.

"I have a feeling that even though there is a two-dose schedule option, the workgroup will say it doesn't provide adequate protection, so we should continue to use three doses of Trumenba in adolescents and two doses for the other vaccine (Novartis' Bextero)," Savoy said.

Depending on how long it takes the FDA to review its data on the nine-valent HPV vaccine (HPV9; Gardasil 9), the ACIP also could be voting in October on a recommendation for a two-dose versus three-dose regimen of the drug for patients younger than age 15.

The ACIP previously has recommended use of HPV9 for patients ages 9-26, including routine administration at ages 11-12.

Discussion on this topic at the June meeting included how a variable recommendation could complicate automated reminder schedules and what to do if a patient starts an HPV9 schedule before 15 and finishes it after that age.

"On the other hand, if you only have two shots, you have a much better chance of getting patients to complete the series than a three-dose series," Savoy said. "So you could still improve the overall rate of immunization even with these added complications."

Savoy said if AAFP members have strong feelings about a two-dose series versus three doses of HPV9 for patients younger than age 15, now is the time to let the AAFP know, as the recommendation is still being informed.

Finally, when the ACIP made its recommendation in 2012 for use of the tetanus, diphtheria and acellular pertussis (Tdap) vaccine in all pregnant women, it didn't have published data on the safety of Tdap use in this group.

At the June meeting, data from postlicensure studies and the Vaccine Adverse Event Reporting System were presented with the goal of demonstrating any increased adverse signal after the increase in uptake of Tdap in pregnant women; the results showed there was not.

"They didn't see any rise in congenital defects or serious adverse events for the women," Savoy said.

However, pregnant women did seem to experience more pain from the shots than did nonpregnant women, although not enough to affect their daily activities.

"In the end, this was reassuring that Tdap was recommended for pregnant women," she said.

Savoy said future discussions on this topic will now likely focus on the timing of Tdap administration during a pregnancy.

The upcoming October meeting also is when the ACIP will discuss the influenza schedule updates for the 2016-17 season, including footnote changes.

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