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Immunize.org summarizes ACIP’s February 23–24 meeting on tick-borne encephalitis, cholera, and other vaccines The Advisory Committee on Immunization Practices (ACIP) met on February 23–24, 2022 and approved recommendations for use of tick-borne encephalitis and cholera vaccines. The Committee also received updates on influenza, hepatitis B, MMR, and pneumococcal vaccines. Highlights of the meeting are provided below.
Tick-Borne Encephalitis Vaccine
Tick-borne encephalitis (TBE) virus is transmitted by Ixodes species ticks in parts of Europe and Asia; it does not occur in the Western Hemisphere. Approximately 5,000–10,000 cases of TBE are reported annually. The disease is extremely rare in U.S. travelers: 11 cases were reported in U.S. civilian travelers from 2001–2020 and 9 cases in military personnel from 2006–2020. However, the consequences of TBE may be severe. Most infected people require hospitalization, and up to half of cases may suffer permanent physical or neurological disability. Case fatality rates range from 1–20%.
The TBE vaccine approved by FDA in 2021 (Ticovac, Pfizer) has been used in parts of Europe for more than 20 years. The vaccine is administered to people age 1 year or older in a primary series of 3 IM injections given over a period of 6–12 months, with an optional booster dose at least 3 years later if ongoing exposure is expected. Following its final policy review, ACIP voted to recommend use of this vaccine for laboratory workers with a potential for exposure to TBE virus and for persons who are traveling or moving to a TBE-endemic area who will have extensive exposure to ticks based on their planned outdoor activities and itinerary. The vaccine may also be considered for other persons traveling or moving to a TBE-endemic area based on their planned activities and itinerary, risk factors for a poor medical outcome, and personal perception and tolerance of risk.
Cholera Vaccine
Cholera bacteria (Vibrio cholerae) spread through contaminated water or food in areas where sanitation is poor and there is limited access to safe drinking water. The illness is extremely rare in the U.S. and other high-income countries. The severe, watery diarrhea of cholera can lead to death from dehydration if fluids and electrolytes are not adequately replaced.
Since 2016, Vaxchora (Emergent) live, oral cholera vaccine (lyophilized CVD 103-HgR) has been licensed by FDA and available for adults age 18 through 64 years who are traveling to an area of active cholera transmission; it was licensed in 2020 for children and adolescents age 2 through 17 years. Vaccine production was suspended during the COVID-19 pandemic, but has resumed, with availability beginning May 1, 2022. Following its review, ACIP voted to extend its existing recommendation for adults to include children and adolescents age 2 through 17 years traveling to an area with active cholera transmission. Vaccine preparation and administration are complicated; the vaccine must be reconstituted in a buffer solution and drunk by the recipient at the vaccination visit. Providers must carefully follow the age-specific preparation instructions provided in the package insert. Certain sweeteners are approved to make it more palatable for children. Timing is also important for optimal effectiveness: the vaccine must not be administered within 14 days after antibiotics and it must be given at least 10 days before initiating chloroquine for malaria prophylaxis.
Influenza Surveillance and Vaccine
Although sporadic influenza activity continues throughout the country, the 2021–2022 season has been mild when compared to the four seasons prior to the COVID-19 pandemic. Influenza A/H3N2 has been the predominant subtype this season: the circulating strain is not closely matched to the vaccine strain. Early estimates indicate low vaccine effectiveness against influenza A (8%) among patients age 6 months and older this season.
ACIP reviewed data and discussed the pros and cons of preferentially recommending the use of certain “enhanced” influenza vaccines (i.e., high-dose, adjuvanted, recombinant) over standard dose vaccines in adults age 65 years and older. Approximately 80% of adults in this age range already receive an enhanced vaccine. Although data are limited, overall evidence suggests modest benefits from the use of enhanced vaccines over standard dose vaccines in this population, as long as they are readily available when people seek vaccination. The Influenza Vaccine Workgroup concluded that there is currently not strong evidence favoring one enhanced vaccine over another. ACIP will consider refining its recommendation for older adults during a future meeting.
Pneumococcal Conjugate Vaccines
Following publication of ACIP’s revised pneumococcal vaccine recommendations for adults in January 2022, the Committee is considering the use of PCV15 (Vaxneuvance, Merck) in children as an alternative to PCV13. PCV15 is expected to be approved by FDA for use in children in April 2022, with FDA approval of PCV20 (Prevnar20, Pfizer) projected to follow in mid-2023. ACIP currently recommends PCV13 for routine and catch-up vaccination, and a series of PCV13 plus PPSV23 for children age 24 months or older with certain underlying medical conditions. PCV15 vaccine contains the serotypes found in PCV13, with the addition of serotypes 22F and 33F, which cause 8–17% of remaining pneumococcal disease in children younger than age 5 years. ACIP is not considering a change to the recommended pneumococcal vaccination dosing or schedule. ACIP is expected to vote on PCV15 as an option for vaccination of children during its June 2022 meeting.
Hepatitis and MMR Vaccine Workgroup Updates
CDC experts presented the ACIP Hepatitis Vaccine Workgroup assessment of PreHevbrio (VBI), a trivalent hepatitis B vaccine licensed in 2021 for use in adults age 18 or older as a 3-dose series given over 6 months. Because the addition of PreHevbrio as an option for adult vaccination against hepatitis B does not require any schedule or policy change, ACIP did not take a vote. The vaccine will be added to CDC’s hepatitis B vaccination guidance and the immunization schedule as documents are updated.
The MMR Vaccine Workgroup presented initial information on a new MMR vaccine (Priorix, GSK). Priorix has been licensed in Germany since 1997 and is in use in over 100 countries. Data were presented to demonstrate the vaccine’s equivalence to the currently licensed MMR (M-M-R II, Merck). If Priorix receives FDA approval, ACIP will consider use of this vaccine at a future meeting.
The next scheduled ACIP meeting will be held June 22–23, 2022. However, ACIP may hold additional ACIP meeting(s) before then to discuss COVID vaccines. Information about past and future ACIP meetings may be found on the ACIP website.
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CDC updates COVID-19 vaccine schedule, adding considerations for 8-week interval between first and second doses of a primary mRNA vaccination series CDC updated their Interim Clinical Considerations for Use of COVID-19 Vaccines Currently Approved or Authorized in the United States on February 22. This guidance provides important details on use of COVID-19 vaccines. All healthcare professionals administering or counseling patients on COVID-19 vaccination should review all changes on the web page. Immunize.org updated its popular Ask the Experts: COVID-19 section on February 25 to reflect the changes in its clinical guidance.
CDC’s February 22 change is summarized as follows:
- An 8-week interval between the first and second doses of a primary mRNA vaccine schedule may be optimal for some people age 12 years or older, especially males age 12 through 39 years at the highest risk of myocarditis following dose 2. Compared to shorter intervals, an 8-week interval produced higher antibody levels and was associated with a lower risk of myocarditis following the second dose.
- The original 3- or 4-week intervals remain the recommended intervals for people who need to be protected from COVID-19 more quickly, including those who are moderately or severely immunocompromised, adults 65 years or older, children under 12, and others who need rapid protection related to community transmission or risk of severe disease.
View the CDC’s Interim Clinical Considerations for Use of COVID-19 Vaccines Currently Approved or Authorized in the United States web page.
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March 4 is International HPV Awareness Day; spread the word that HPV vaccine can reduce the risk of certain cancers Friday, March 4 is International HPV Awareness Day, a great time to spread the word about how the HPV vaccine can reduce the risk of certain cancers. HPV-related cancers include cervical, vaginal, vulvar, anal, penile, and head and neck. Vaccination before sexual contact is the most effective way to protect against HPV and HPV-related cancers. Research shows that vaccination prevents almost 90% of cervical cancer cases. Both men and women are at risk for HPV-related cancer so it's important that all people receive the HPV vaccine series according to the recommended vaccination schedules.
You can raise awareness with International Papillomavirus Society (IPVS) campaign resources in 10 languages, and by including #onelessworry in your social media posts.
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“Use of Ebola Vaccine: Expansion of Recommendations of the Advisory Committee on Immunization Practices to Include Two Additional Populations—United States, 2021” published in MMWR
CDC published Use of Ebola Vaccine: Expansion of Recommendations of the Advisory Committee on Immunization Practices to Include Two Additional Populations—United States, 2021 on February 25 in MMWR. A portion of the summary appears below.
Preexposure vaccination against Ebola virus disease is currently recommended for adults aged ≥18 years in the United States who are at highest risk for occupational exposure to Ebola virus.…
The Advisory Committee on Immunization Practices has expanded recommendations to include two additional populations at high risk for potential occupational exposure to Ebola virus: health care personnel at special pathogens treatment centers and laboratorians and support staff members at Laboratory Response Network facilities.…
Ebola virus remains an international and domestic public health threat. Preexposure vaccination can protect those at occupational risk for exposure to Ebola virus.
Access the MMWR article in HTML or PDF.
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CDC updates its “General Best Practice Guidelines for Immunization” for zoster vaccine and altered immunocompetence CDC recently updated their "General Best Practice Guidelines for Immunization" for zoster vaccines and altered immunocompetence. The February 17 changes are listed below.
- Zoster – Zoster vaccine (Shingrix) has been added to the list of vaccines for which altered immunocompetence is the basis for recommending vaccination among people age 19 years and older. View pages 125 and 136.
- Altered Immunocompetence – The term “anti-B-cell agents” has replaced “anti-B-cell antibodies” because the latter is not sufficiently broad. Several drugs directed against the recipient’s B cells are composed of molecules other than antibodies. View page 135.
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2022 U.S. recommended immunization schedules for children and adolescents and for adults released along with MMWR articles detailing changes On February 18, CDC posted the 2022 recommended immunization schedules for children and adolescents as well as for adults on CDC's Immunization Schedules for Healthcare Providers web page.
The updated schedules for children and adolescents include:
Access the full-color, 10-page PDF of the child/adolescent schedule.
View what has changed on the child/adolescent schedule for 2022.
The updated schedule for adults includes:
Access the full-color, 8-page PDF of the adult schedule.
View what has changed on the adult schedule for 2022.
As it does each year, Immunize.org will be producing sturdy, waterproof, laminated copies of these schedules for sale. Look for your opportunity to pre-order very soon in a special Shop Edition of IZ Express.
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In some areas influenza remains active; keep vaccinating if it is in your area
Influenza Surveillance
For week 7, ending on February 19, CDC's Weekly U.S. Influenza Surveillance Report, FluView summary reports that seasonal influenza activity in the United States continues in parts of the country, varying from community to community.
Influenza Vaccination Dashboard
CDC's new Weekly Flu Vaccination Dashboard shares preliminary vaccination data. This week’s key fact: Influenza vaccination coverage among children under age 18 years varies widely among the states and DC as of February 12, 2022, ranging from just 30.2% to a high of 73.7%; overall, national vaccination coverage is 52.5%.
CDC recommends everyone age 6 months and older get an annual influenza 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.
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IZ Express keeps readers up to date on what’s new in vaccines each week; invite your colleagues to subscribe!
IZ Express, the free weekly e-newsletter produced by Immunize.org, succinctly summarizes each week’s important vaccine developments, including new and updated recommendations from CDC and the latest vaccine decisions by FDA. IZ Express also features:
- Newly posted Vaccine Information Statements and their translations
- Educational materials from Immunize.org, CDC, AAP, and others
- Notices about online and in-person educational opportunities, many offering free continuing education credit
We appreciate you as a subscriber! Encourage your co-workers to subscribe to IZ Express themselves so they get everything that matters to vaccinators in their own inbox each Wednesday.
Spotlight: Check out the Immunize.org resources to help with your vaccine advocacy In this week's Spotlight, we summarize resources at Immunize.org that focus on aiding in your vaccine advocacy efforts.
Our State Laws and Mandates by Vaccine main page contains links to vaccine-specific requirements state-by-state for daycare, K-12, and post-secondary education settings. State-specific information about exemption policies is available as well.
Our State Exemptions main page offers information on state mandates by vaccine-preventable disease. It includes policy statements from medical organizations endorsing strong school and childcare vaccination requirements and the elimination of non-medical exemptions.
Our State Information: Exemptions Permitted for State Immunization Requirements web page shows which states allow medical, religious, and personal vaccination exemptions and offers a map of exemptions permitted for school and child care.
Our State Information: Direct Links to State Immunization Websites main page offers links to each state's vaccination policy web page.
Our Talking about Vaccines main page provides medical professionals with background information and practical resources divided into different topics that will help them discuss immunization with concerned parents or patients.
Our Unprotected People Stories main page features 109 real-life accounts of people who have suffered or died from vaccine-preventable diseases: compelling personal testimonies, remembrances, case reports, and newspaper articles.
These recent articles convey the potential risks of vaccine-preventable diseases and the importance of vaccination.
Featured Resources
AAP releases pediatric COVID-19 vaccine campaign toolkit American Academy of Pediatrics (AAP) created a toolkit to encourage COVID-19 vaccination of children, adolescents, and young adults. The toolkit offers ways to help reassure parents and caregivers about the COVID-19 vaccine. It includes videos, social media posts, articles, and printable resources. Find these attractive resources on AAP's COVID-19 Vaccine Campaign Toolkit main page.
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Hepatitis B Foundation and Hep B United create new patient fact sheet on co-administration of COVID-19 and hepatitis A, hepatitis B, or influenza vaccines
Hepatitis B Foundation and Hep B United created a new patient-focused fact sheet Vaccines You Need on the co-administration of COVID-19 vaccine with hepatitis A, hepatitis B, or influenza vaccines. The fact sheet also includes the current U.S. adult hepatitis A and hepatitis B vaccine schedules, including the new recommendation for routine hepatitis B vaccination of all adults age 19 through 59 years.
 
View the Vaccines You Need fact sheet.
Voices for Vaccines releases podcast with Tara Smith, PhD, titled “Your Vaccine Refusing Family” Voices for Vaccines (VFV) has posted a new entry in its Vax Talk podcast series: Your Vaccine Refusing Family featuring Tara Smith, PhD. She will discuss having crucial conversations with family members who do not trust scientific vaccine information. Before the interview, Dr. Nathan Boonstra and Karen Ernst will discuss COVID-19 vaccination for children less than age 5 years.
Voices for Vaccines is a national organization of parents and others dedicated to raising the level of the voices of immunization supporters. VFV invites everyone who values vaccines to become a member, use VFV tools in their own community, and get involved with VFV.
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CHOP’s Vaccine Education Center adds new videos in its series featuring Paul Offit, MD, answering key questions
The Vaccine Education Center (VEC) at Children's Hospital of Philadelphia (CHOP) added new videos to its series of short videos, Dr. Offit Answers Your Questions @ Vaccines, that can be accessed on YouTube. The video series will address common vaccine questions being asked by interested parents and family members.
Examples of the new videos include:
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65+ Flu Defense website offers resources for healthcare professionals serving older adults 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. Resources include:
Check out the updated 65+ Flu Defense website at www.influenza-defense.org to assist your efforts in protecting this vulnerable population.
Explore the updated www.Give2MenACWY.org website to increase coverage for the MenACWY booster and other adolescent vaccinations Immunize.org's www.Give2MenACWY.org website promotes the importance of adolescent vaccination, including administering the recommended booster dose of MenACWY vaccine at age 16. Many teens are behind on vaccines because of the pandemic, so adolescent vaccination is more important than ever.
Original materials on this colorful website for healthcare professionals have been updated to incorporate the 2020 ACIP meningococcal vaccine recommendations and the most recent vaccine coverage statistics from CDC’s National Immunization Survey–Teen (NIS–Teen). One particularly popular resource on the site is the updated Algorithm for MenACWY Immunization in Adolescents 11–18 Years of Age.
The website is divided into five easy-to-access sections:
The site also categorizes materials according to whether they are primarily of interest to providers, to adolescents, or to parents.
Visit Give2MenACWY.org and enjoy browsing (and deploying) its bountiful resources.
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Notable Publications
CDC publishes “COVID-19 Vaccination Coverage, Behaviors, and Intentions among Adults with Previous Diagnosis, United States” in Emerging Infectious Diseases In the March issue, CDC published COVID-19 Vaccination Coverage, Behaviors, and Intentions among Adults with Previous Diagnosis, United States in Emerging Infectious Diseases. The abstract appears below.
To determine the extent of gaps in coronavirus disease (COVID-19) vaccine coverage among those in the United States with and without previous COVID-19 diagnoses, we used July 21–August 2, 2021, data from a large, nationally representative survey (Household Pulse Survey). We analyzed vaccine receipt (≥1 dose and full vaccination) and intention to be vaccinated for 63,266 persons. Vaccination receipt was lower among those who had a prior diagnosis of COVID-19 compared to those without: >1 dose: 73% and 85%, respectively, p<0.001; full vaccination: 69% and 82%, respectively, p<0.001. Reluctance to be vaccinated was higher among those with a previous COVID-19 diagnosis (14%) than among those without (9%). These findings suggest the need to focus educational and confidence-building interventions on adults when they receive a COVID-19 diagnosis, during clinic visits, or at the time of discharge if hospitalized and to better educate the public about the value of being vaccinated, regardless of previous COVID-19 status.
Upcoming Events
Today! Virtual: CDC hosts live, 1-hour webinar followed by live chat, “Updates on the 2022 Child/Adolescent and Adult Immunization Schedules,” on March 2 CDC will host its live, 1-hour webinar Updates on the 2022 Child/Adolescent and Adult Immunization Schedules on March 2, from 12:00–1:00 p.m. (ET). The didactic session will be followed by a live chat question and answer period.
Attendance for the live webinar is limited to 1,500 registrants, so log in early to secure a "seat." If you miss the live event, you can watch the archived version once it is posted on CDC’s website.
Virtual: CHOP Vaccine Education Center’s 1-hour webinar titled “Approving COVID-19 Vaccines for Children: When Do We Know Enough?” on March 16 features Paul Offit, MD; CE available The Vaccine Education Center (VEC) at Children's Hospital of Philadelphia will present a 1-hour webinar titled “Approving COVID-19 Vaccines for Children: When Do We Know Enough?” Beginning at 12:00 p.m. (ET) on March 16, this edition of the Current Issues in Vaccines series will feature Paul Offit, MD, director of the VEC.
Register for the webinar.
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