IAC provides summary article about votes taken at Oct 19–20 ACIP meeting

The Advisory Committee on Immunization Practices (ACIP) met in Atlanta on October 19–20. In addition to the votes described below, topics discussed at the meeting included herpes zoster, pneumococcal, influenza, yellow fever, and respiratory syncytial virus (RSV) vaccines. Six votes were taken at the meeting.

Hepatitis B Vaccine
The rate of acute hepatitis B virus (HBV) infections in the United States has declined by more than 90 percent since recommendations for hepatitis B vaccine (HepB) were first issued in 1982. Since that time, HepB recommendations have been updated multiple times; since 2005, five statements have been published which offered recommendations based on differing criteria such as the recipient’s age, chronic health condition, pregnancy status, or occupation.

At the October meeting, ACIP voted to approve a single guidance document that consolidated these previously published recommendations into a comprehensive statement. The committee reemphasized the importance of the HepB birth dose as a safety net against chronic HBV infection passed from a mother to her infant by recommending that all infants of hepatitis B surface antigen (HBsAg)-negative mothers should be immunized with HepB within 24 hours of birth. This removes previous policy language that allowed for a delay in administering the birth dose in certain rare circumstances and on a case-by-case basis. Additional areas updated on the statement include prioritization of HBsAg-positive women for HBV management and therapy, guidance on post-vaccination serologic testing for infants whose mother’s HBsAg status remains unknown indefinitely (e.g., infant surrendered anonymously after birth), and provision of specific examples of chronic liver disease to further define whom to vaccinate.

Tdap Vaccine
Previous ACIP recommendations called for prenatal care providers to vaccinate all pregnant women with tetanus-diphtheria-acellular pertussis (Tdap) vaccine during each pregnancy with optimal timing for this dose designated between 27 and 36 weeks gestation. Following a presentation of data indicating increased immunogenicity of the vaccine when mothers were vaccinated earlier, ACIP voted to recommend administering Tdap vaccination early in the 27- through 36-week “window” to maximize passive antibody transfer to the infant. The new recommendations also clarify that persons 7–10 years of age who receive Tdap as part of a catch-up series may be given an additional Tdap for the routinely recommended adolescent dose at 11–12 years of age.

Human Papillomavirus (HPV) Vaccine
Although HPV vaccine has been recommended for females since 2006 and males since 2011, the 2015 NIS-Teen indicated that for adolescents 13–17 years of age, less than one-half (41.9%) of girls and less than one-third (28.1%) of boys had received the recommended three doses. On October 7, the Food and Drug Administration (FDA) approved adding a 2-dose schedule for 9vHPV (Gardasil 9, Merck) vaccine for adolescents 9–14 years of age. After reviewing the immunogenicity data and efficacy trials of the 2-dose schedule, ACIP voted to recommend that younger adolescents who begin the series at 9 through 14 years of age receive two doses of HPV at least six months apart, rather than the previously recommended 3-dose series. Two doses (not three) are recommended for anyone who receives the first dose before the 15th birthday, regardless of age at series completion. It is anticipated this schedule will increase vaccine initiation and series completion in the U.S. Teens and young adults who start the series later, at 15–26 years of age, will continue to need three doses.

According to CDC’s official press release, “CDC encourages clinicians to begin implementing the 2-dose schedule in their practice to protect their preteen patients from HPV cancers.” The 9vHPV vaccine will soon be the only HPV vaccine available in this country; Merck will distribute only 9vHPV after the end of October, and supplies of 2vHPV (Cervarix, GlaxoSmithKline) in the U.S. are expected to be depleted by November. 9vHPV may be used to complete a series begun with 4vHPV or 2vHPV.

To assist providers in implementing the new recommendation, CDC is offering a webinar as part of its Current Issues in Immunization NetConference (CIINC) series. Recommendations for HPV Vaccination: 2016 Update will be presented on October 28, 2016, from 12 noon –1 p.m. ET.

Meningococcal Serogroup B Vaccine
In 2015, ACIP recommended routine meningococcal serogroup B (MenB) vaccination for persons 10 years of age or older who were at increased risk of meningococcal infection. The committee also recommended the vaccine may be provided to healthy adolescents and young adults 16 through 23 years of age. ACIP did not express a preference for use of MenB-4C (Bexsero, GlaxoSmithKline) or MenB-FHbp (Trumenba, Pfizer), although the same product must be used for the entire series.

Bexero has previously been recommended for use with a 2-dose schedule for high-risk individuals and in outbreak settings, and may be administered to healthy individuals 16 through 23 years of age. In April, the FDA approved a label change giving Trumenba a 2-dose (0, 6 months) or 3-dose (0, 1–2, 6 months) schedule. The ACIP voted to recommend that providers who use Trumenba continue to use the 3-dose schedule when vaccinating persons at increased risk of meningococcal serogroup B disease (e.g., persons with persistent complement component deficiencies or anatomical or functional asplenia) or during serogroup B outbreaks. The 2-dose schedule of Trumenba at 0, 6 months can be used for routine vaccination for healthy persons 16 through 23 years of age.

Child and Adolescent Immunization Schedule
ACIP annually updates the recommended immunization schedule for children and adolescents. Although ACIP voted on edits for the 2017 schedule during the October meeting, the final schedule is not slated to be published until February 2017. Many changes approved for the 2017 schedule incorporate policies previously approved by ACIP during 2016. The majority of the edits involve changes to help improve readability and usability of the document. Users should review the schedule when it is published in 2017 for specific details.

One of the significant formatting changes in the schedule was made to the age columns. The vaccine recommendations for adolescents 16 years of age have been emphasized by placing them in a separate column from the recommendations for persons 17 through 18 years of age. In making this distinction, ACIP is highlighting the importance of the 16-year-old visit to administer the recommended meningococcal conjugate (Men-ACWY) booster dose, as well as to provide the opportunity to deliver MenB vaccine and catch-up on other recommended adolescent vaccines such as HPV and Tdap. Previously there was one column for ages 16 through 18 years.

Adult Immunization Schedule
Similar to the child and adolescent schedule, the updated adult immunization recommendations are scheduled for publication in early 2017. In addition to multiple revisions being made to improve the readability and clarity of the schedule, a significant change to the table format is that the ages 27 through 59 years will be shown as one age group in a single column. Previously the age groups were in two columns, one for 27 through 49 years, and the other for 50 through 59 years.

All recommendations approved by ACIP are provisional until they are approved by the director of CDC and published in MMWR. Presentation slides from the October meeting should be posted on the ACIP website in the next 4–6 weeks.

Related Links

• ACIP Meeting Information
• Current Issues in Immunization NetConference on Updated HPV recommendations

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CDC reports on status of new vaccine introduction worldwide in MMWR

CDC published Status of New Vaccine Introduction—Worldwide, September 2016in the October 21 issue of MMWR (pages 1136–40). A summary made available to the press is reprinted below.

Historically, new vaccines became available in low- and middle-income countries decades after being introduced in high-income countries. However, this gap is rapidly decreasing with support from global partners. As of September 2016, nearly all countries have introduced hepatitis B vaccine. Over three-quarters have introduced Haemophilus influenzae type b (Hib), second dose of measles-containing (MCV2), and rubella vaccines. Two-thirds have introduced pneumococcal conjugate vaccine (PCV) and fewer than half have introduced rotavirus or human papillomavirus vaccine (HPV). Despite donor support, countries might choose not to introduce a vaccine because of country policies, financial constraints, lack of disease burden data, or vaccine hesitancy. Vaccine introduction provides opportunities for strengthening a country’s immunization program and overall health system.

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CDC NetConference about vaccines during pregnancy scheduled for November 9

CDC will present a one-hour "Current Issues in Immunization NetConference" on November 9 at 12:00 p.m. (ET). The topic is "Vaccines during Pregnancy: A Strong Record of Safety." The NetConference will be moderated by Andrew Kroger, MD, MPH, medical officer, CDC, NCIRD.

This is a limited registration event. Registration is required.

Related Link

• Current Issues in Immunization NetConference web section

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Join Voices for Vaccines for a November 10 conference call about online vaccine advocacy

If you work in healthcare or are a healthcare consumer, you are invited to join Voices for Vaccines' speaker Melody Butler on the next Voices for Vaccines conference call on November 10 at 12:00 (ET). Ms. Butler, founder and director of Nurses Who Vaccinate, will explore how professionalism and advocacy intersect. The call is free and open to the public but you must register online ahead of time.

Voices for Vaccines is a national organization of parents and others who are dedicated to raising the level of the voices of immunization supporters. VFV invites everyone who appreciates vaccines to become a member of their organization. Please spread the word to your friends and colleagues to register for the conference call and to join VFV!

Related Links

• Visit the Voices for Vaccines website
• Join Voices for Vaccines
• Follow Voices for Vaccines on Facebook

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Join CDC’s #FightFlu campaign on social media

CDC's #FightFlu social media campaign captures and shares flu vaccination activities. During or after getting a flu shot, share photos and videos of yourself using the hashtag #FightFlu on digital platforms (Twitter, Facebook, Instagram, and YouTube). CDC will post weekly updates to the campaign timeline. For more information, contact fluinbox@cdc.gov.

Related Links

• CDC's Social Media web section
• CDC Flu's Twitter feed @CDCFlu

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