ACIP Revises Immunization Best Practice Guidelines

“The ACIP General Best Practice Guidelines Work Group has been meeting regularly to update CDC immunizations recommendations as new FDA-approved vaccines become available for use,” Pamela Rockwell, D.O., of Ann Arbor, Mich., the AAFP’s liaison to the advisory committee, told AAFP News. “These updated guidelines not only keep physicians updated on new recommendations, but also offer more clarity on older vaccine recommendations, often answering common questions physicians have posed regarding vaccinations.”

The revisions were published online Aug. 10 and cover three general areas:

Timing and Spacing of Immunobiologics

• Vaxelis, a combination vaccine indicated for immunization against diphtheria, tetanus, pertussis, polio, hepatitis B and invasive disease caused by Haemophilus influenzae type b, was added to the table of FDA-licensed combination vaccines. Vaxelis was licensed in 2018 for use in children 6 weeks through 4 years of age. It is administered in a three-dose series, with the first dose recommended at age 2 months and subsequent doses at 4 months and 6 months.
• The word “live” was added to the column header of the interval column in Table 3-5 to read “Recommended interval before measles- or live varicella-containing vaccine administration (months).” The change was made to indicate that intervals following passive immunobiologics is not applicable to the Shingrix vaccine, as it is the only licensed varicella-containing vaccine available in the United States that is not live.

Contraindications and Precautions

• Footnote “e” for Table 4-1 (“Contraindications and Precautions”) was revised to clarify the reason that use of influenza antivirals are contraindications to live attenuated influenza vaccine. According to the footnote, quadrivalent LAIV should not be administered to patients who have taken oseltamivir or zanamivir within the previous 48 hours, peramivir within the previous five days or baloxavir within the previous 17 days. However, this designation is not because of an increased concern of adverse reactions, but because of a concern about the effectiveness of the vaccine.

Altered Immunocompetence

• A paragraph on children with HIV infection has been modified to remove a sentence pertaining to vaccination against varicella.
• Table 8-1, “Vaccination of Persons With Primary and Secondary Immunodeficiencies,” was modified, with Ultomiris added to the row on complement inhibition as an agent that mimics complement deficiency.
• Also in Table 8-1, in the row on HIV infection, zoster was removed from the column on contraindicated vaccines, as moderate or severe immunodeficiency from HIV is not considered a contraindication to the Shingrix vaccine.

The ACIP maintains a list of previous updates, along with the complete General Best Practice Guidelines for Immunization, on its Vaccine Recommendations and Guidelines of the ACIP webpage.