November 13, 2020, 4:02 pm News Staff -- The CDC’s Advisory Committee on Immunization Practices devoted the first two days of its Oct. 28-30 meeting to discussing 2021 immunization schedule revisions that include more harmonization for adults and children; reviewing a summary of the 2019-20 influenza season; and considering updates on vaccines, including two new pneumococcal vaccines with anticipated licensure in 2022 and 2023.
The committee dedicated the third day of the meeting to COVID-19, including discussion of vaccine development progress and allocation plans, as well as safety and surveillance.
The ACIP voted unanimously to adopt edited immunization schedules for adults and children for 2021. Among the updates:
Several edits were made to tables and notes of other vaccines. Among them:
The ACIP also made substantial revisions to recommendations for specific vaccines, such as egg-based influenza vaccines and quadrivalent live attenuated influenza vaccines. Among the revisions:
In addition, the ACIP approved revised language regarding the administration of vaccines that contain tetanus toxoid when managing wounds in children and adults.
Finally, the ACIP revised the color palette key to Table 2 of the recommended adult immunization schedule by medical condition and other indications. The “delay vaccination until after pregnancy if vaccine indicated” box changed from pink to red and now includes an asterisk and additional language indicating that clinicians should delay giving vaccines for human papillomavirus, measles/mumps/rubella and varicella until after pregnancy.
“There were few major updates made to the 2020-21 immunization schedules per se, but the many changes to the tables and the clarifying language added to the notes help to successfully interpret and understand the growing and elaborate immunization schedules, especially when special circumstances exist with patients,” said Pamela Rockwell, D.O., of Ann Arbor, Mich., the AAFP’s liaison to the ACIP. “I find the notes and tables a must-read when recommending vaccines to my patients.”
The updated immunization schedules will be published in the CDC’s Morbidity and Mortality Weekly Report in February 2021. The Academy is currently reviewing the schedules; final immunization schedules will also be published on AAFP.org early next year.
The CDC presented data showing that an estimated 38 million people became ill from influenza during the 2019-20 influenza season, resulting in 18 million visits to a health care professional, 400,000 hospitalizations and 22,000 deaths. While the burden of illness for the 2019-20 influenza season was characterized as moderate, there were fewer instances of illness, hospitalization and death than in some more recent seasons.
Nearly 52% of the U.S. population aged 6 months and older received an influenza vaccination. The CDC estimated that influenza vaccination prevented 7.5 million illnesses, 3.7 million medical visits, 105,000 hospitalizations and 6,300 deaths during the 2019-20 influenza season.
The ACIP also provided an update on the status of two COVID-19 vaccine candidates: NVX-CoV2373, a recombinant nanoparticle vaccine from Novavax, and Ad26COVS1, a monovalent vaccine from Janssen. The committee stated that nine vaccines were being studied in the United States; four were in active phase 3 clinical trials and five were in active phase 1 or 2 clinical trials. One of the vaccines in phase 3, BNT162b2, has since been reported by Pfizer and BioNTech to be about 90% effective in preventing COVID-19 in participants without evidence of prior SARS-CoV-2 infection.
With regard to safety and surveillance, a presentation by the Center for Biologics Evaluation and Research outlined plans for passive and active surveillance of vaccines post-licensure. Passive surveillance would take place under the Vaccine Adverse Event Reporting System, with management shared by CDC and FDA, while active monitoring would occur via the FDA’s Biologics Effectiveness and Safety System as well as a federal partnership between the FDA and CMS.
As for allocation, representatives from the committee’s Data, Analytics and Modeling Task Force proposed stratifying populations into five age groups (0-4, 5-17, 18-49, 50-64 and 65 and older), with individuals in each group being classified as low risk or high risk depending on medical conditions such as heart disease, diabetes, kidney disease, obesity or COPD. The task force also noted that about 40% of adults ages 18-64 are classified as essential workers.
A separate presentation discussed ethical considerations for vaccine allocation, including maximizing benefits, minimizing harms, promoting justice and transparency, and mitigating health inequities.
The ACIP will hold its next meeting Feb. 24-25. The committee has yet to announce if the meeting will be held virtually or in person.