ACIP Discusses Tick-borne Encephalitis, Cholera, Hepatitis B, More

March 10, 2022, 5:59 p.m. News Staff — The latest meeting of the CDC’s Advisory Committee on Immunization Practices, held virtually Feb. 23-24, featured votes on the use of vaccines for tick-borne encephalitis, cholera and hepatitis B. The meeting — one of three the committee regularly convenes each year — also featured discussions on influenza activity, the state of measles/mumps/rubella vaccination in the United States and the use of pneumococcal vaccines in children.

Specifically, the committee voted to recommend use of the vaccine in people who travel to or are moving to areas where TBE is endemic and will have extensive exposure to ticks based on their planned levels of outdoor activity and itinerary, and for laboratory workers and others with a potential exposure to the TBE virus.

In a third recommendation that included a shared decision-making component, the committee said that Ticovac may be considered for individuals traveling to a TBE-endemic area who may participate in outdoor activities where ticks may be prevalent based on an assessment of planned activities and itinerary, and risk factors for a poorer outcome.

Ticovac was approved by the FDA in August 2021 and was the first vaccine of its kind to receive approval in the United States.

The ACIP’s recommendation will be forwarded to the director of the CDC and to HHS for review and approval. If approved, it will be published in the Morbidity and Mortality Weekly Report along with information on avoiding tick bites.

The committee also voted 14-1 (with one abstention) to recommend vaccination with Vaxchora, a single-dose, live attenuated cholera vaccine manufactured by Emergent Travel Health Inc., for children and adolescents aged 2 to 17 years who are traveling to areas with active cholera transmission. Vaxchora initially received FDA approval for the prevention of cholera caused by the bacterium Vibrio cholerae O1 in adults ages 18 to 64 traveling to cholera-affected areas in 2016.

Although production of Vaxchora was temporarily discontinued in May 2021, it is expected to be available beginning May 1, 2022.

Finally, following a presentation from the Hepatitis Vaccines Work Group, the committee recommended that Prehevbrio, a recombinant vaccine manufactured by VBI Vaccines, be added to the adult immunization schedule as an option for adults age 18 years and older for vaccination against hepatitis B virus infection beginning in 2023.

Prehevbrio received FDA approval in November 2021 for administration in a three-dose series at zero, one and six months. It is expected to be available in the United States by the end of the first quarter of 2022.

“These vaccines offer more opportunities for family physicians to recommend protection against vaccine-preventable diseases for travelers and laboratorians and will give an additional hepatitis B vaccine choice to keep on formulary to support the goal of universal hepatitis B vaccination for all adults,” said Rockwell.

Other Items of Note

A report on recent influenza activity in the United States found that as of the week ending Feb. 12, 2022, 3% of specimens submitted to clinical laboratories have tested positive for influenza, with most of these belonging to the H3N2 subtype.

The report also stated that sporadic influenza activity is continuing throughout the country, with cases increasing in some areas, and that while the cumulative hospitalization rate is higher than that for the entire 2020-21 influenza season, it is lower than that observed at present during the four seasons that preceded the COVID-19 pandemic.

The MMR Vaccine Work Group delivered a presentation on the state of MMR vaccination in the United States, which indicated that while measles and rubella have been virtually eliminated in the U.S., they still cause some locally acquired and importation-related cases and outbreaks each year. Measles and rubella remain endemic in many parts of the world and mumps is endemic worldwide.

The work group also presented safety and immunogenicity data on Priorix, a trivalent live attenuated MMR vaccine manufactured by GlaxoSmithKline that is indicated for active immunization for the prevention of MMR in individuals ages 12 months and older.  Priorix is interchangeable with other MMR-containing vaccines. It has been approved and used in more than 100 countries outside the U.S. with over 400 million doses distributed worldwide. GlaxoSmithKline submitted a biologics license application to the FDA in August 2021.

Additional data will be presented at later meetings this year as the ACIP considers policy options.

Following these discussions, the Pneumococcal Vaccines Work Group presented detailed information on pneumococcal vaccine recommendations in children.

Currently, the ACIP recommends routine vaccination with a 13-valent pneumococcal conjugate vaccine in a four-dose series, with the vaccine administered at ages 2, 3, 6 and 12-15 months. For children ages 24-59 months with any incomplete PCV13 series, the ACIP also recommends one dose of the vaccine as a catch-up vaccination.

In its presentation, the work group provided data on the use of a 15-valent pneumococcal conjugate vaccine in children. The work group also stated that it is considering two policy questions:

• Should PCV15 be routinely recommended for U.S. children younger than 2 years old as an option for pneumococcal conjugate vaccination according to currently recommended dosing and schedules?
• Should PCV15 be recommended for U.S. children with underlying medical conditions 2-18 years of age as an option for pneumococcal conjugate vaccination according to currently recommended dosing and schedules?

The work group will provide additional evidence and cost-effectiveness data at the ACIP’s next meeting.

Coming Up

The ACIP is scheduled to hold its next meeting June 22-23, and meeting materials will be available on the ACIP Meeting Information webpage.