The Advisory Committee on Immunization Practices (ACIP) met on January 12, 2022, to discuss updates on vaccines against influenza, pneumococcal disease, hepatitis B, respiratory syncytial virus, cholera, and tick-borne encephalitis. No votes were taken at this meeting; some topics may be voted on at the regular February ACIP meeting. Key discussion points and plans for each vaccine are outlined below.

Influenza – In recent years, the ACIP Influenza Work Group has evaluated the available evidence to inform ACIP’s consideration of a preferential recommendation for certain vaccines in older adults. Influenza vaccine effectiveness (VE) is generally lower among adults age 65 years and older. Three vaccine products are being assessed for “enhanced” effectiveness in this age group compared to standard influenza vaccines: high-dose inactivated (Fluzone HD, Sanofi Pasteur), adjuvanted inactivated (Fluad, Seqirus) and recombinant influenza vaccine (Flublok, Sanofi Pasteur). The nature and quality of evidence available to evaluate the performance of these products varies. Multiple viral and host factors make it challenging to compare VE among these vaccines. In light of this, ACIP has not expressed a preference for one vaccine over another for older adults. CDC experts provided background information on this topic, including a portion of a systematic review of randomized and observational studies. This discussion will continue at the February ACIP meeting.

Pneumococcal Disease – During its October 2021 meeting, ACIP recommended the use of either 20-valent pneumococcal conjugate vaccine (PCV20) or a series of 15-valent PCV (PCV15) followed by 23-valent pneumococcal polysaccharide vaccine (PPSV23) for all adults age 65 years and older. The same ACIP recommendation applies to adults age 19 years and older with certain underlying medical conditions or risk factors who had not previously received a PCV or whose previous vaccination history is unknown. ACIP’s Pneumococcal Vaccine Work Group (WG) was charged with developing clinical guidance to assist healthcare providers in implementing these recommendations. The WG determined that the previously adopted language was more restrictive than ACIP intended and suggested that more clarity and flexibility were needed. ACIP members agreed and also recommended a brief delay in publication of the guidance until additional information could be included on use of these vaccines in adults who previously received PCV13. During the discussion, the ACIP was informed that licensure of these vaccines for children is anticipated in 2022 (PCV15) and 2023 (PCV20). Discussions on these topics will continue at the regular February and June ACIP meetings. No change in ACIP recommendations for children will occur before the vaccines are licensed for those younger age groups.

Hepatitis B – PreHevbrio (VBI Vaccines) is an FDA-licensed recombinant hepatitis B vaccine that contains the S, pre-S2, and pre-S1 HBV surface antigens. It is licensed as a 3-dose series for people age 18 years and older. ACIP heard a presentation on the safety and relative immunogenicity of PreHevbrio. Clinical trials show that PreHevbrio is safe and produces higher rates of seroprotection than a 3-dose adult hepatitis B vaccine (Engerix-B, GSK) in certain adults, including people with diabetes or obesity. Further discussion will take place at the February ACIP meeting. No vote is planned, because the availability of this new product does not require a change in adult hepatitis B vaccine policy. 

Respiratory Syncytial Virus (RSV) – ACIP received an initial briefing from the new Maternal/Pediatric RSV Work Group. A separate WG has been established to consider RSV prevention in older adults and immunocompromised individuals. Several RSV vaccines and long-acting monoclonal antibodies are currently in Phase 3 trials, and at least two are likely to be submitted for FDA licensure consideration within the next 6–12 months. No votes are anticipated before 2023. 

Cholera – ACIP members received updates on Vaxchora (Emergent), a live, oral cholera vaccine licensed by FDA since 2016 for adults age 18 through 64 years and since 2020 for children and adolescents age 2 through 17 years. Following a structured review using the ACIP Evidence to Recommendation (EtR) framework, the Cholera Vaccine Work Group recommended extending recommendation of this vaccine for people age 2 through 17 years traveling to an area with active cholera transmission. ACIP is expected to vote on this recommendation at its February meeting. The Committee also reviewed studies demonstrating that the vaccine remained effective when diluted in a smaller volume of water and sweetened with sugar or Stevia to make this oral vaccine more palatable for young children. 

Tick-borne Encephalitis (TBE) – TBE is a rare, but serious, viral illness transmitted by ticks in certain parts of Europe and Asia. In August 2021, FDA licensed Ticovac (Pfizer), a TBE vaccine used for many years in Europe. The ACIP TBE Vaccine Work Group presented draft language that the vaccine be recommended as a 3-dose primary series for two groups: (a) people age 1 year and older traveling to or residing in TBE risk areas (based on shared clinical decision making), and (b) laboratory workers with a potential for exposure to TBE virus. ACIP will vote on this recommendation at its February meeting. 

The next scheduled ACIP meeting will be held February 23–24, 2022. Information about past and future ACIP meetings may be found on the ACIP website. 

Related Links

• ACIP main page for content from previous meetings, as well as information about future meetings
• CDC: ACIP Presentation Slides: January 12, 2022 Meeting web page

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Confident recommendations for influenza vaccine from healthcare providers are powerfully persuasive. To assist you in maximizing protection for your patients, Immunize.org, in collaboration with Seqirus, has updated the "65+ Flu Defense" website at www.influenza-defense.org.

A new fact sheet on the site, The Importance of Preventing Influenza during a Pandemic, offers responses to help guide discussions with patients on the increased importance of flu vaccination during the COVID-19 pandemic. Age increases risks associated with COVID-19 infection including hospitalization and death. Preliminary studies suggest coinfection with influenza B and SARS-CoV-2 may elevate the risk of poor outcomes.



This helpful site includes information, tools, and tips for communicating with these adults about the scope and severity of influenza, for example:

• Influenza in Adults 65+: The Facts
• Influenza Vaccination: Questions Patients Age 65 and Older Frequently Ask Their HCP

Check out the updated "65+ Flu Defense" website at www.influenza-defense.org to assist your efforts in protecting this vulnerable population.

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On January 13, CDC issued a press release CDC Study Shows Flu Vaccination Prevents Severe Flu Illness in U.S. Children: Vaccine Protects, Even When Vaccine Virus and Circulating Viruses Are Different. It described a new study, Vaccine Effectiveness Against Life-Threatening Influenza Illness in U.S. Children, published in the January 13 issue of Clinical Infectious Diseases. A portion of CDC's press release appears below.

The CDC study reports that flu vaccination reduced the risk of severe flu in children by 78% against similar flu A viruses and 47% against flu A viruses that had drifted from the vaccine virus. Further, the vaccine was 76% effective at preventing life-threatening influenza, which included invasive mechanical ventilation, CPR, and other severe complications including death. This study adds to evidence showing that some people who are vaccinated still get sick, but the vaccination can decrease illness severity.

CDC has launched their influenza digital media toolkit, which includes social media content and a new poster aimed at parents of young children, to help share critical messages about the importance of flu vaccination.



Related Links

• CDC Press Release: CDC Study Shows Flu Vaccination Prevents Severe Flu Illness in U.S. Children: Vaccine Protects, Even When Vaccine Virus and Circulating Viruses Are Different (1/13/22)
• Clinical Infectious Diseases: Vaccine Effectiveness against Life-Threatening Influenza Illness in U.S. Children (1/13/22)
• CDC: Digital Media Toolkit: 2021–22 Flu Season
• CDC: Social Media Toolkit

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Influenza Surveillance
For week 1 of 2022, ending January 8, CDC's Weekly U.S. Influenza Surveillance Report, FluView summary reports that seasonal influenza activity in the United States declined slightly this week but remains elevated and is expected to continue for several weeks. The amount of activity varies by region. The high levels of acute respiratory illness reflected in the national map include both influenza and non-influenza (e.g., COVID-19) respiratory illnesses.



Influenza Vaccination Dashboard
CDC's new Weekly Flu Vaccination Dashboard shares preliminary vaccination data. This week’s key fact: as of December 13, CDC-sponsored omnibus surveys indicated that 47.7% of adults 18 and older had received an influenza vaccine while 9.5% of adults definitely planned to receive it but had not yet done so. It is critical to continue to offer influenza vaccination in order to reach the 1 in 10 who want to be vaccinated but have not had the opportunity.

CDC recommends everyone age 6 months and older get an annual flu vaccine. Influenza and COVID-19 vaccines may be given at the same visit, if needed. COVID-19 vaccination alone provides no protection from influenza or any other respiratory virus. 

Vaccine Finder
If you don’t provide influenza vaccine at your site, please strongly recommend vaccination and refer people to sites that do vaccinate. Use VaccineFinder, a user-friendly website to help people of all ages find influenza, COVID-19, and other vaccines. Participating providers can update their vaccine inventory estimates on VaccineFinder. For questions or more information, contact vaccine@healthmap.org.

Related Links

• CDC: Weekly Flu Vaccination Dashboard main page 
• CDC: FluView main page
• CDC: Influenza (Flu) main page
• Immunize​.org: free educational materials and patient handouts related to influenza
• Immunize​.org: Influenza: Vaccines main page
• Immunize​.org: Ask the Experts: Influenza main page
• VaccineFinder website
• Families Fighting Flu: Flu Resources for Healthcare Professionals main page

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