Lauren Howell, PharmD
ACIP gathered to discuss several vaccine recommendations in June 2023. As a result of the meeting, recommendations surrounding the influenza virus vaccine, adult respiratory syncytial virus (RSV) vaccine, polio virus vaccine, and pneumococcal vaccine for children, among others, were all updated.
ACIP meets approximately three times per year to make new recommendations for existing vaccines and discuss vaccines that may be on the horizon. CDC uses the recommendations made by ACIP to set the U.S. adult and childhood vaccination schedules. While FDA evaluates the safety and efficacy of vaccines before they come to market, ACIP bases their recommendations on the severity of the disease, the number of people who get the disease if there is no vaccine, how well a vaccine works for people of different ages, and how practical the recommendations are to put into practice.
Influenza vaccination updates
ACIP continues to recommend an annual influenza virus vaccination for all people who are 6 months or older and do not have contraindications. Additionally, no changes were made to the recommendations regarding timing of vaccination from the 2022–2023 influenza season. Most people who need only one dose of influenza vaccine should receive the vaccination in September or October. Vaccination during July and August are not recommended for most individuals, but can be considered in some circumstances. For most adults and for pregnant people in the first or second trimester, vaccination during July and August should be avoided unless there is concern that vaccination later in the season will not be possible.
For children who require two doses, the first dose should be given as early as possible, including in July or August, to allow the second dose to be administered prior to the end of October. For children who only require one dose of influenza vaccine, vaccination during July and August can be considered. During the third trimester of pregnancy, vaccination during July and August can be considered in an effort to reduce risk for illness in infants during the first months after birth, before they can receive the vaccine themselves. Influenza vaccination should continue throughout the flu season as long as viruses are circulating and unexpired vaccine is available.
In a change from previous recommendations, ACIP now recommends that all persons 6 months or older with an egg allergy should receive the influenza vaccine and any vaccine—egg-based or non–egg-based—that is otherwise appropriate for the patient can be used.
RSV adult vaccine
Both Pfizer’s bivalent RSV prefusion F (RSVpreF) and GSK’s adjuvanted prefusion RSV F glycoprotein antigen (RSVPreF3) vaccines have demonstrated efficacy against lower respiratory tract illness caused by RSV among older adults over at least two seasons.
However, ACIP determined that the trials used to determine efficacy were underpowered to show efficacy in adults 75 years and older and in adults who are frail. Additionally, the trials were underpowered to show efficacy against RSV hospitalization. Therefore, efficacy against symptomatic illness may indicate that the vaccine is also efficacious against more severe disease.
Cases of inflammatory neurologic events were reported within 42 days after vaccination with both vaccines; however, the clinical trials were not sufficiently powered to determine whether the small number of these cases occurred due to random chance. Because of this, ACIP decided that whether there is an increased risk of inflammatory neurologic events from RSV vaccination is not known at this time.
ACIP recommends that adults 60 years and older may receive a single dose of RSV vaccine using shared clinical decision-making. Factors that should be considered during shared clinical decision-making include chronic lung diseases, chronic CV diseases, immune compromise, hematologic disorders, neurologic disorders, endocrine disorders, kidney and liver disorders, other underlying conditions that may increase the risk of severe respiratory illness, and whether the patient is a resident of a nursing home or other long-term care facility.
Optimally, RSV vaccination should occur before the onset of increased RSV activity in the community. For the 2023–2024 season, ACIP recommends that RSV vaccination is offered as soon as the vaccine is available. Coadministration with other vaccines is acceptable; however, it should be considered that simultaneous administration of multiple vaccines could increase reactogenicity. Additionally, it should be considered that the recombinant zoster vaccine, GSK’s Shingrix, contains the same adjuvant as the RSVPreF3 vaccine, GSK’s Arexvy.
Polio virus
ACIP recommends that adults 18 years and older who are known or suspected to be unvaccinated or incompletely vaccinated against polio should complete a primary vaccination series with inactivated polio vaccine (IPV). Adults who have received a primary series of IPV or trivalent oral polio vaccine (tOPV) in any combination and who are at increased risk of poliovirus exposure may receive another dose of IPV. Available data do not indicate the need for more than a single lifetime booster dose with IPV for adults.
Pneumococcal vaccine for children
Use of either PCV15 or PCV20 is recommended for all children ages 2 months to 23 months, according to the currently recommended pneumococcal conjugate vaccine dosing and schedules.
Based on this, all children under the age of 2 years have the same pneumococcal vaccine recommendations. A primary series of vaccines should be given at 2 months, 4 months, and 6 months followed by a booster at between 12 months and 15 months old. For healthy children ages 24 months to 59 months with an incomplete PCV vaccination status and children with specified risk conditions aged 24 months to 71 months with an incomplete PCV vaccination status, use of either PCV15 or PCV20 according to currently recommended PCV dosing and schedules is recommended.
ACIP recommends that for children ages 2 years to 18 years with any risk condition who have received all recommended doses before 6 years using at least one dose of PCV20, no additional doses of pneumococcal vaccine are indicated.
For children ages 2 years to 18 years with any risk condition who have received all recommended doses before 6 years using PCV13 or PCV15, a dose of PCV20 or PPSV23 using previously recommended doses and schedule is recommended. For children ages 6 years to 18 years with any risk conditions who have not received any dose of PCV13, PCV15, or PCV20, a single dose of PCV15 or PCV20 is recommended. When PCV15 is used, it should be followed up by a dose of PPSV23 at least 8 weeks later if it was not previously given.
COVID-19 vaccine updates
It is anticipated that COVID-19 vaccines and treatments will transition to the commercial marketplace in the fall of 2023. Many Americans with insurance coverage will continue to receive the vaccine for no charge out-of-pocket. However, individuals without insurance may begin to have to pay for COVID-19 vaccination.
A temporary measure has been put into place to prevent the loss of access to COVID-19 vaccines and treatments for these patients. The Bridge Access Program for COVID-19 Vaccines and Treatments is a public–private partnership that will work to provide COVID-19 vaccines and treatments at no-cost after commercialization later this year.
Implications for pharmacists
With changes to the COVID-19 vaccine, flu season, and the new RSV vaccines all coming this fall, pharmacists may be extra busy. Pharmacists should be prepared to answer questions about new vaccines and stay up to date on current recommendations. Additionally, pharmacists should be prepared to participate in shared clinical decision-making to help patients make the best possible choice for their health. ■