November 18, 2021, 12:40 p.m. News Staff — While pediatric vaccines for COVID-19 grabbed much of the public’s attention at the Nov. 2-3 virtual meeting of the CDC’s Advisory Committee on Immunization Practices, the committee devoted the second day of that meeting to discussing key issues focused on vaccines for other infectious diseases. In particular, the committee issued several recommendations on vaccines for hepatitis B, orthopoxviruses and Ebola, and cast votes on the recommended child, adolescent and adult immunization schedules for 2022.
To protect more adults against the effects of hepatitis B virus infection, the committee revised its vaccination recommendations for adults.
First, the committee voted to recommend that hepatitis B vaccine should be administered to all adults through age 59, and to all adults age 60 and older with any risk factor for HBV infection.
The committee then voted to recommend that any individual age 60 and older with no known risk factors for HBV infection may receive the vaccine if they choose, while acknowledging that HBV infection rates in this age group are low and that vaccination efforts aimed at younger adults would be more effective.
The CDC estimates that about 862,000 people in the United States have chronic HBV infection, although some resources have put that number as high as 2.2 million. Most cases of HBV infection are asymptomatic; left untreated, it can lead to serious liver-related conditions such as cirrhosis and liver cancer.
In its most recent strategic plan, the CDC’s Division of Viral Hepatitis announced a goal of reducing HBV infections by 90% and HBV-related deaths by 65% by 2030. Similarly, the Department of Health and Human Services announced earlier this year a goal to eliminate viral hepatitis as a public health threat in the United States by 2030.
The CDC also is in the process of drafting recommendations for all adults to receive universal screening for HBV infection at least once in their lifetime, based in part on results from a Clinical Infectious Diseases study published in May. That recommendation will not be discussed or voted on until 2022.
In February 2020, the committee initially recommended pre-exposure vaccination with Ervebo, a genetically engineered live, attenuated vaccine that protects against Zaire ebolavirus, for individuals responding to Ebola outbreaks, health care personnel stationed at federally designated Ebola treatment centers, and laboratory workers at level 4 biosafety facilities.
At the Nov. 3 meeting, the committee voted unanimously to expand this recommendation to include two additional groups: health care personnel involved in the transport and treatment of patients with suspected or confirmed Ebola virus infection at special pathogen treatment centers, and laboratory or support staff at Laboratory Research Network facilities who work with or may handle Ebola virus specimens.
In September 2019 the FDA approved Jynneos, a replication-deficient orthopoxvirus vaccine, for use in adults age 18 and older who are at increased risk of smallpox or monkeypox infection. Previously, the agency had recommended ACAM2000, a live vaccinia virus vaccine that, via lesions at the injection site, could cause the virus to be transmitted by touch to another part of the recipient’s body or to close contacts. In addition, ACAM2000 is contraindicated for individuals with immunocompromising conditions.
In a series of unanimous votes, the ACIP voted to recommend Jynneos as an alternative to ACAM2000 for those at risk of infection due to potential occupational exposure. Among other details, the recommendations covered the primary Jynneos vaccination series, booster doses for individuals who remain at increased risk of infection, and the option of using Jynneos as a booster for individuals who previously were inoculated with ACAM2000. Additional guidance on the use of Jynneos will be published in an upcoming issue of the CDC’s Morbidity and Mortality Weekly Report.
The committee’s Combined Immunization Schedule Work Group presented its 2022 vaccination schedule recommendations for children, adolescents and adults. Proposed changes to the schedules included links to COVID-19 vaccination pages, updated recommendations on vaccinations for dengue and influenza, suggested revisions to language on the use of certain vaccines in pregnant patients, a QR code displayed on the cover page to afford easy access to immunization schedules, and an appendix to make it easier for clinicians to detect contraindications and precautions for many commonly used vaccines.
Following a brief discussion, the ACIP voted to approve the recommended child and adolescent immunization schedule and the recommended adult immunization schedule. The revised schedules will be announced in MMWR and posted on the CDC’s Immunization Schedules webpage in February 2022.
Although not discussed at the Nov. 3 meeting, the ACIP did vote on two recommendations pertaining to pneumococcal vaccines at its Oct. 20 meeting.
Specifically, the committee voted to recommend that adults age 65 or older who have not previously received a pneumococcal conjugate vaccine or whose previous vaccination history is unknown should receive the vaccine (either PCV20 or PCV15). If PCV15 is used, the vaccine should be followed by a dose of pneumococcal polysaccharide vaccine (PPSV23).
The committee also voted to recommend that adults age 19 to 64 with certain underlying medical conditions or other risk factors who have not previously received a PCV vaccine or whose vaccination history is unknown should receive a PCV20 or PCV15 vaccine. If PCV15 is used, the vaccine should be followed by a dose of PPSV23.
The medical conditions and risk factors for adults age 19 or older include alcoholism; cerebrospinal fluid leak; chronic heart, liver or lung disease; chronic renal failure; cigarette smoking; cochlear implant; congenital or acquired asplenia; diabetes; generalized malignancy; HIV infection; Hodgkin lymphoma; iatrogenic immunosuppression; immunodeficiency; leukemia; lymphoma; multiple myeloma; nephrotic syndrome; sickle cell disease or other hemoglobinopathies; and solid organ transplants.
In addition, the ACIP voted to recommend two doses of recombinant zoster vaccine for the prevention of herpes zoster and its complications in adults age 19 and older who are or will be immunodeficient or immunosuppressed due to disease or therapy.
The recommendations from the Oct. 20 meeting have been adopted by CDC Director Rochelle Walensky, M.D., M.P.H., and will become official once they are published in MMWR.
The ACIP is scheduled to host its next meeting Nov. 19 to discuss COVID-19 booster recommendations, with the first meeting of 2022 scheduled for Feb 23-24, 2022. AAFP members are invited to visit the ACIP Meeting Information webpage for meeting agendas, slide decks and other meeting materials as they become available.