Immunization Update and ACIP Highlights - June 2012

August 08, 2012
The Advisory Committee on Immunization Practices (ACIP) of the CDC met June 20 and 21 to provide updates on vaccines. Below are the key highlights:

 

        PCV13 (Prevnar 13) is recommended for individuals 19 years of age and older who are immunocompromised in addition to PPSV23 (Pneumovax 23)
        The 2012-2013 influenza recommendations were approved with new strains recommended and a revised two dose schedule for children ages six months through eight years of age
        ACIP will develop language for no routine recommendation of MenACWY-CRM (Menhiberix) which was approved by the FDA on June 14

 Pneumococcal Vaccine

Rates of pneumococcal disease are 20-fold higher in the immunocompromised population than in the general adult population.  PPSV23 includes serotypes accounting for greater than 70 percent of pneumococcal illness in this population.  PPSV has been shown to be effective against invasive pneumococcal disease in adults with HIV, and the vaccine is been demonstrated to be safe in this population.  ACIP reviewed the efficacy data and cost effectiveness of pneumococcal vaccine around four subpopulations, those with HIV/AIDS, hematologic cancer, organ transplant, and dialysis.  The following recommendation was approved by the committee: 

Adults 19 years of age or older with immunocompromising conditions, functional or anatomic asplenia, CSF leaks or cochlear implants who have not previously received PCV13 or PPSV23 should receive a single dose of PCV13 followed by a dose of PPSV23 at least 8 weeks later.  

If the high risk adult defined above has previously received one or more dose of PPSV23, a dose of PCV13 should be given one or more years after the last PPSV23 dose.  For persons with functional or anatomic asplenia or an immunocompromising condition, a second dose of PPSV23 is recommended one or more years after the PCV13 dose and five or more years after the first dose of PPSV23.

The one year separation between doses was recommended because of a study showing hyporesponsiveness in immunocompetent individuals within a five-year period after PPSV.  Because immunocompromised individuals may not have as much immune suppression, a one year interval was assumed adequate, but a longer interval may have a better response.

Influenza

The key changes in the 2012-2013 influenza seasonal vaccine recommendations include two new strains, and a modification of the two-dose vaccine recommendation for children ages six months through eight years. This season’s trivalent influenza vaccine contains the same H1N1 strain that was contained in the 2010-11 season; A/California/7/2009 (H1N1)-like.  It also contains two new strains; A/Victoria/361/2011 (H3N2)-like, and B/Wisconsin/1/2010-like (Yamagata lineage) antigens. A quadrivalent intranasal seasonal vaccine containing two A strains and two B strains was approved by the FDA this year, but it will not be marketed by its manufacturer and will not be available for purchase until the 2013-2014 season.
In order to optimize immune response to the new strains of the vaccine, and in order to provide protection against the novel pandemic 2009 (H1N1) strain, children six months through eight years of age should receive two doses of the 2012-2013 influenza vaccine administered at least four weeks apart if they have not previously received two doses of seasonal trivalent influenza vaccine after July 1, 2010.  If they have received two doses of seasonal vaccine after July 1, 2010, they may receive only one dose.  Also, children ages six months through eight years who have received two doses of seasonal vaccine total in any previous season (even prior to 2010), and have received at least one dose of vaccine containing the 2009 (H1N1) pandemic strain, may also receive one dose of 2012-2013 and be sufficiently protected.
Recommendations for egg allergic patients were updated for the 2011-2012 season and since that time, there has not been any disproportionate reporting for allergy or anaphylaxis following influenza vaccine administration in egg allergic patients.
The new high-dose influenza and intradermal vaccines continue to be monitored for safety.  No safety concerns have been seen with either product.
Meningococcal-Hib Combination Vaccine

MenACWY-CRM (MenHibrix®)was approved by the FDA on June 14th for use in infants at two, four, six and twelve months of age.  Language recommending no routine use of the vaccine will be proposed at the October 2012 meeting.   
Future Recommendations

ACIP continues to review:
·         PCV13 vaccination in healthy adults
·         Measles post-exposure prophylaxis with immunoglobulin products
·         Revaccination schedule for Tdap
If you have any questions regarding immunization, feel free to contact Tamara Sheffield, MD, MPA, MPH, Medical Director, Community Health and Prevention, Intermountain Healthcare, at (801) 442-3946.
 
 
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