• Meningococcal Disease, Mpox Added to Immunization Schedules

    CDC Adopts Several Changes for Children, Adolescents, Adults

    Nov. 16, 2023, News Staff — The CDC has added vaccines for meningococcal disease and mpox to the immunization schedules for children, adolescents and adults, following recommendations from the Advisory Committee for Immunization Practices, providing family physicians with more options in protecting patients from infectious diseases.

    cropped view of physician holding jar and syringe with vaccine near blurred patient

    In addition to making the recommendations on mpox and meningococcal disease immunization at its Oct. 25-26 meeting, the committee reviewed presentations on vaccines for respiratory syncytial virus, influenza, chikungunya, dengue, COVID-19 and pneumococcal disease, and an update on the safety of COVID-19 and influenza vaccines.

    Immunization Schedules Undergo Revisions

    The committee made several notable recommendations, which the CDC adopted:

    • Both the child/adolescent and adult 2024 schedules will include an addendum page listing updates that are made during the year after its publication.
    • Because the monoclonal antibody nirsevimab has been added to the child/adolescent immunization schedule for passive immunization, the former “Vaccines” header is now “Vaccines and Other Immunizing Agents.”
    • The CDC moved publication of the 2024 schedules up to November 2023 to give clinicians and payers more time to incorporate the changes. 

    The CDC has posted the updated child/adolescent and adult immunization schedules, as well as a summary of the 2024 updates and a mobile app version of the schedules.

    Pam Rockwell, D.O., of Ann Arbor, Mich., the AAFP’s liaison to the committee, said the decision to publish updates on the addendum pages throughout the year means, “our patients will be better covered for vaccines by their health care insurer.”

    Member can always find the latest information on AAFP’s Immunizations and Vaccines webpage.

    Story Highlights

    Mpox Vaccine Gets Interim Approval

    The ACIP voted unanimously Oct. 25 to recommend adding the Jynneos vaccine to the routine vaccination schedule for certain adults who are at increased risk for mpox infection. This is an interim recommendation that committee will reassess in two to three years based on the disease’s epidemiology.

    Those who are at increased risk for mpox infection include gay, bisexual and other men who have sex with men, and transgender or nonbinary people who, in the previous six months, has had 

    • a new diagnosis of a sexually transmitted disease,
    • more than one sex partner, or
    • sex at a commercial sex venue or in conjunction with a large public event in an area where mpox transmission is known to be occurring.

    Sexual partners of people with any of these risk factors, as well as people who expect to experience any of the factors, should also receive the vaccine.

    Rockwell called the addition of the Jynneos vaccines to the schedule “an important step to reduce vaccine-preventable disease in the clearly defined group of people at risk for mpox.”

    Jynneos is administered as a two-dose series, with the second dose given 28 days after the first dose. It can be administered subcutaneously or, under an emergency use authorization, intradermally.

    The ACIP also approved adding Jynneos to the Vaccines for Children program for eligible 18-year-olds in the 2024 recommended adult immunization schedule.

    Pentavalent Vaccine Approved for Meningococcal Disease

    Also on Oct. 25, the advisory committee voted 10-4 to recommend use of a pentavalent meningococcal vaccine as an option for some adolescents and young adults under certain circumstances.

    The current routine immunization schedule calls for administering doses of MenACWY vaccine at age 11 or 12 years and 16 years, and two doses of MenB vaccine at ages 16 to 23 years if desired through shared decision-making between a clinician and a patient or their parent or guardian.

    The ACIP voted to recommend the use of Penbraya, a combined vaccine from Pfizer Inc. that offers protection against the A, B, C, W and Y serogroups as an option when both MenACWY and MenB are indicated at the same visit. This could occur in healthy 16- to 23-year-olds who choose to receive MenB vaccination in shared decision-making, and in patients 10 years and older who are at increased risk for meningococcal disease because of certain health conditions (such as complement inhibitor use or functional or anatomic asplenia) and who are due to receive both vaccines.

    The FDA also approved inclusion of Penbraya in the Vaccines for Children program for eligible children who are indicated to receive both MenACWY and MenB vaccines.

    The FDA approved Penbraya for use in individuals ages 10 to 25 years on Oct. 20. It is administered intramuscularly as a two-dose series six months apart.

    Other Items of Note

    Because of changes in the epidemiology of meningococcal disease and the limited protection offered by MenB vaccines, the ACIP Meningococcal Vaccine Work Group expects to consider changes to the adolescent meningococcal vaccine schedule next year. A vote is planned for early 2025, after the FDA decides whether to license a pentavalent meningococcal vaccine that GSK is developing.

    Based on study data provided at the meeting, the ACIP discussed lowering the eligible age range for the RSV vaccine to include adults ages 50 through 59 at increased risk for severe RSV disease, and expects to receive more information later. Rockwell was encouraged to hear that ongoing study data is coming, and suggested that it may influence future RSV vaccination recommendations.

    The ACIP Pneumococcal Work Group is reviewing information on additional vaccines in various stages of development. These vaccines contain serotypes that are not included in currently available pneumococcal vaccines and could prove beneficial in certain patient populations.

    Committee members received updates on the potential benefits of vaccination against chikungunya for people who are at increased risk of infection. The FDA is expected to announce a decision on licensure for a one-dose live attenuated chikungunya vaccine later this month, and a vote on chikungunya vaccine recommendations is expected at the next ACIP meeting in February.

    Finally, ACIP discussed findings from an implementation update on COVID-19 vaccines for 2023-2024. Among other things, the update cited National Immunization Survey results showing that as of Oct. 14, 2023, only 7.1% of adults and 2.1% of children had received the updated COVID-19 vaccine since it became available in September. Nearly 40% of adults said they probably or definitely would not get the updated vaccine, and a similar percentage of parents did not plan to vaccinate their children.

    “I believe family physicians need to continue to educate our patients on the importance of keeping up to date on COVID-19 vaccination and recommend it as strongly and routinely as we do other vaccines,” said Rockwell, noting that COVID-19 vaccines have been shown to reduce the severity and mortality rates of the disease.

    “We need to educate our patients that with every new COVID-19 variant that develops, the risk of infection or reinfections remains, and with every new COVID-19 infection one may develop, the risk of long COVID increases,” she added.