Updates to recommendations for hepatitis A and meningococcal vaccines were approved, while recommendations for the influenza vaccine remained unchanged, after the CDC's Advisory Committee for Immunization Practices (ACIP) meeting in Atlanta on Thursday.
Committee members also voted unanimously to leave the current recommendation for influenza vaccination as is. The annual influenza vaccine should continue to be offered to everyone 6 months or older who do not have contraindications.
The following updated components of the trivalent flu vaccines were announced:
- A/Brisbane/02/2018 (H1N1) pdm09-like virus
- A/Kansas/14/2017 (H3N2)-like virus
Vaccines For Children (VFC) updates were also made for the influenza vaccine. The inactivated products now approved in the VFC program include Afluria, Fluarix, Flucelvax, Flulaval, and Fluzone. New age indications for each vaccine were also presented.
For the 2018-2019 season, flu severity was classified as moderate. There were no substantial changes to the influenza vaccine development statement for 2019 to 2020.
Hepatitis A
Moreover, ACIP voted unanimously that all children and teens ages 2 through 18 years who have not had the hepatitis A vaccine before should receive the vaccination at any age. Current recommendations are that the hepatitis A vaccination be provided for all children ages 12 to 23 months.
The committee also unanimously voted in favor of hepatitis A vaccines for all persons 1 year or older with HIV.
Notably, hepatitis A vaccines have been proven to be safe and effective for over two decades. People with HIV, who are also infected with Hepatitis A virus infection, may have elevated HIV viral loads and transmission.
The VFC hepatitis A vaccine resolution received a unanimous vote that allowed for four doses of Twinrix to be administered on an accelerated schedule of 0 days, 7 days, 21 to 30 days, or 1 year for an accelerated schedule and for VFC guidelines for select special categories to include that if only vaccine or only immune globulin is available, either should be used as quickly as possible.
"We have coming up a cohort of kids, where hepatitis A is cyclical and as they get to adulthood, we would expect there to be another cycle of outbreaks. So the goal here is to catch them up on their vaccination at a time when we know that they are more likely to seek medical care with the expectation that the vaccine will last long enough that when they get to their risk period that they will then be protected," said Nancy Messonnier, MD, of the CDC in Atlanta.
"Our great concern was that our long standing risk base recommendations for adults have just been poorly implemented for many reasons. And many of the adults, who find themselves at risk later, are often ones with poor access to health care and utilization of health services and this vaccine can provide long-term, possibly lifelong protection. And we have an opportunity to have the entire cohort cared for before they become adults and acquire risk factors or express risk factors," agreed Kelly Moore, MD, of Vanderbilt University in Nashville.
Meningococcal vaccination
ACIP voted unanimously in favor of recommendations that individuals who are microbiologists and who are age 10 years or older with complement inhibitor use, asplenia complement deficiency should receive a MenB booster dose 1 year after completion of the MenB primary series. Then, MenB boosters doses should be administered every 2 to 3 years after as long as there are elevated risks.
The recommendation also extends to patients age 10 years or older that were identified by public health experts to be at a greater risk during an outbreak. For this group, ACIP suggests "a one-time booster dose if it has been ≥ 1 year since completion of a MenB primary series" and depending on vaccination strategy, predicted duration of heightened risk, and specific outbreak, public health officials may consider a booster dose interval of ≥ 6 months.
Current ACIP recommendations suggest that individuals age 10 years or older be an elevated risk for serogroup B meningococcal disease get a MenB primary series and that teens and young adults ages 16 to 23 years may be vaccinated with a MenB primary series as determined by the physician through clinical decision making.
For the VFC meningococcal vaccines, the group voted 14 to 0 in favor of removing the conjugate vaccine HibMenCY from the list of currently available vaccines and for new guidelines regarding serogroup B meningococcal vaccine booster doses.
Robert Atmar, MD, of the Baylor College of Medicine in Houston, pointed out that the recommendations are primarily based on immunogenicity.
"Immunogenicity data for both vaccines was reviewed when making the recommendations for persons at increased risk as well as for adolescents who are not at increased risk. We don't have any vaccine effectiveness data or duration of protection estimates that inform that policy," said Sarah Mbaeyi, MD, MPH, of the Emory University School of Medicine in Atlanta.
"I am a little bit bothered by a booster recommendation with the limited information that we have, but based on the rationale for the initial approval and the risk group being definitely at risk ... I was persuaded by the discussion," said Atmar.
Paul Hunter, MD, of the City of Milwaukee Health Department in Wisconsin, added, "I am reassured that we have some assurance that there will be follow-up by the CDC that we will be able to kick this can down after we leave."
As always, ACIP's recommendations do not become official until published in the Morbidity and Mortality Weekly Report.