ACIP Approves Updates to 2021 Immunization Schedules

COVID-19 Vaccines and More Also Discussed at October Meeting

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.

Immunization Schedules

The ACIP voted unanimously to adopt edited immunization schedules for adults and children for 2021. Among the updates:

MenQuadfi (MenACWY-TT), a vaccine approved by the FDA in April for use in children and adults ages 2 and older, was added as an option to prevent meningococcal disease caused by serogroups A, C, W and Y.
The committee’s recommendations on prevention and control of seasonal influenza with vaccines for the 2020-21 season, published in August 2020, were formally adopted.
A link was added to the “Helpful Information” section of the adult immunization schedule to answer common questions about shared clinical decision-making recommendations.

Several edits were made to tables and notes of other vaccines. Among them:

Zostavax, a live zoster vaccine that was taken off the market over the summer, was removed from the adult immunization schedule.
Shared clinical decision-making between patients and clinicians should be used when considering hepatitis B vaccine for individuals with diabetes who are 60 and older.
Twinrix, a vaccine against disease caused by hepatitis A virus and infection by all known subtypes of hepatitis B virus, may be administered on an accelerated schedule of three doses at 0, 7, and 21-30 days, followed by a booster at 12 months, to individuals traveling to countries that have high or intermediate rates of hepatitis A infection.
Booster dose recommendations for the MenB and MenACWY vaccines were added for groups listed under “Special Situations” and individuals in an outbreak setting.
Shared clinical decision-making language regarding the use of pneumococcal conjugate vaccine was added for adults age 65 and older.

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:

Quadrivalent LAIV should not be used in children younger than 2 years, or in patients who have received oseltamivir or zanamivir within the previous 48 hours, peramivir within the previous five days, or baloxavir within the previous 17 days.
For patients who show an egg allergy with symptoms other than hives (e.g., angioedema, respiratory distress, or need for emergency medical services or epinephrine), any influenza vaccine other than Flublok or Flucelvax should be administered in a medical setting under supervision of clinicians who can recognize and manage severe allergic reactions.
Health care professionals were advised that severe allergic reactions may occur even in the absence of a history of previous allergic reaction and that all clinicians who administer vaccines should be familiar with the office emergency plan and be certified in CPR.
A previous severe allergic reaction to influenza vaccine is a contraindication to future receipt of the vaccine.

Story Highlights

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.

Influenza Season Review

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.

COVID-19 Update

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.

Up Next

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.