ACIP Updates Vaccine Recommendations for 2020: What Pharmacists Need to Know
At the Advisory Committee on Immunization Practices' June 2020 meeting, the agenda included discussions of the meningococcal vaccine, influenza vaccine, and coronavirus disease 2019 (COVID- 19).
The Advisory Committee on Immunization Practices (ACIP) is a branch of the CDC that comprises medical and public health experts who develop recommendations related to use of vaccines.1 The committee has 15 voting members: 14 experts from the fields of vaccinology, immunology, pediatrics, internal medicine, virology, public health, and other related fields, and 1 member who represents consumers with consideration to the social and community aspects of vaccination.2
The ACIP typically meets 3 times a year, in February, June, and October, and meetings are open to the public.3 ACIP meetings traditionally have been held at the CDC headquarters in Atlanta, Georgia, but the June 2020 meeting was the first to be held virtually.3 During the February 2020 meeting, the ACIP discussed updated recommendations for the anthrax vaccine, as well as the diphtheria, tetanus, and pertussis vaccines (DTaP/Tdap/Td) [see “2020 Anthrax and DTaP/ Tdap/Td Vaccine Updates” on page 9]. At the June 2020 meeting, the agenda included discussions of the meningococcal vaccine, influenza vaccine, and coronavirus disease 2019 (COVID- 19).4 The recommendations made during this meeting are discussed next.
MENINGOCOCCAL DISEASE VACCINE
The June 2020 ACIP meeting began with a discussion of the public burden of meningococcal disease. Invasive meningococcal disease is devastating worldwide, in large part because it can take a person’s life within 24 to 48 hours of infection, and it has a fatality rate of 8% to 15%, even with treatment.5 Additionally, 1 out of 5 infections result in limb amputation, deafness, or brain damage.6
MenACWY vaccines cover meningococcal serogroups A, C, W, and Y.7 Since the vaccines were introduced, invasive meningococcal disease caused by these serogroups covered by the vaccine has declined more than 90% among adolescents.7 The first MenACWY meningococcal conjugate vaccine, Menactra (Sanofi Pasteur), was introduced in 2005.8 Menactra was followed by Menveo (GlaxoSmithKline) in 2010. In April 2020, a new vaccine, MenQuadfi (Sanofi Pasteur), was approved by the FDA.9 MenQuadfi is approved for use in a broader age range (ages 2 years and older) than Menactra or Menveo, which are indicated up to age 55 (9 months to 55 years, and 2 months to 55 years, respectively).8,10,11
During the June 2020 meeting, the ACIP approved a new meningococcal vaccination resolution (6/20-1) for the Vaccines For Children (VFC) program, a federally funded program that provides free vaccines to children, including all the meningococcal conjugate vaccines that prevent meningococcal disease from serogroups A, C, W, and Y.12 ACIP-recommended vaccine schedules, intervals, dosages, contraindications, and precautions remain the same, and no changes were made to the VFC recommendations for serogroup B meningococcal vaccines.13
The ACIP influenza work group estimated that between October 1, 2019, and April 4, 2020, there were more than 39 million influenza cases in the United States, which led to more than 18 million influenza-related medical visits, more than 410,000 hospitalizations, and as many as 62,000 deaths.14 As of August 10, 2020, estimated vaccine effectiveness for any type influenza across all age groups was 39%.15
Looking to the 2020-2021 influenza season, the ACIP followed the recommendations for the upcoming season’s vaccine components from the World Health Organization.16 These include A/H1N1pdm09-like viruses, A/H3N2-like viruses, and B/Victoria lineage-like viruses for trivalent vaccines with the addition of B/Yamagata lineage-like viruses for quadrivalent vaccines.16,17 The ACIP carried over its core recommendation that everyone aged 6 months and older without contraindications should receive an annual influenza vaccination.18 In addition, 2 recently licensed vaccines, Fluzone High-Dose Quadrivalent (Sanofi Pasteur) and Fluad Quadrivalent (Seqirus), were added to the list of available vaccines for the 2020-2021 influenza season.19,20 Both vaccines are licensed for patients ages 65 years and over.21,22 Fluzone High-Dose Quadrivalent will replace Fluzone High- Dose (trivalent).16,23
As of August 11, 2020, there have been more than 5 million cases of COVID-19 diagnosed in the United States, of which 162,407 occurred in health care providers.24
The ACIP announced that a new work group had been organized in April 2020 to create evidence-based approaches to advise on COVID-19-related vaccination policies for discussion, deliberation, and vote by the ACIP.25 The work group is reviewing COVID-19 epidemiology, characteristics of vaccine candidates that are in development, and evidence-based vaccine recommendations, ethics, and equity frameworks.
According to the ACIP, work group goals include26:
- ensuring safety and effectiveness of new vaccines;
- reducing transmission, morbidity, and mortality from COVID-19;
- minimizing the pandemic’s disruption to society and the economy, while maintaining health care capacity; and
- ensuring equitable distribution of vaccines. Based on these goals, the proposed priority group includes26:
- essential health care personnel,
- essential workers, • adults aged 65 years and older;
- residents in long-term care, regardless of age; and
- people with high-risk medical conditions.
However, the work group intends to adjust and refine this prioritization plan as new COVID-19 data and vaccine information become available.
Ordinarily, the next meeting of the ACIP would be held in October 2020; however, the ACIP recently announced 2 additional virtual meetings, which will be held August 26, 2020, and September 22, 2020. The live webcast meetings are open to anyone who wants to watch; registration is not required.3
The June 2020 ACIP meeting included customary discussions of the annual influenza vaccine and availability of a new meningococcal vaccine, but the meeting was unprecedented in its virtual delivery method and discussion of a vaccine for a global pandemic. In the coming months, the proposed priority groups will likely evolve as the possibility of a vaccine for COVID-19 draws closer.
Kimberly C. McKeirnan, PharmD, BCACP, is a clinical assistant professor in the department of pharmacotherapy at the Washington State University College of Pharmacy and Pharmaceutical Sciences in Spokane, Washington.
- General committee-related information. CDC. Updated October 23, 2018. Accessed July 15, 2020. https://www.cdc.gov/vaccines/acip/committee/index.html
- ACIP committee members. CDC. Updated October 17, 2019. Accessed July 20, 2020. https://www.cdc.gov/vaccines/acip/members/index.html
- ACIP meeting information. CDC. Updated July 14, 2020. Accessed July 15, 2020. https://www.cdc.gov/vaccines/acip/meetings/index.html
- Meeting of the advisory committee on immunization practices. CDC. June 16, 2020. Accessed July 21, 2020. https://www.cdc.gov/vaccines/acip/meetings/ downloads/agenda-archive/agenda-2020-06-508.pdf
- Meningococcal meningitis. World Health Organization. February 19, 2018. Accessed July 21, 2020. https://www.who.int/news-room/fact-sheets/detail/ meningococcal-meningitis#:~:text=Even%20when%20the%20disease%20 is,%25%20to%2020%25%20of%20survivors
- Clinical information: meningococcal disease: technical and clinical information. CDC. Updated May 31, 2019. Accessed July 21, 2020. https://www.cdc.gov/ meningococcal/clinical-info.html
- Meningococcal vaccination: what everyone should know. CDC. Updated July 26, 2019. Accessed July 21, 2020. https://www.cdc.gov/vaccines/vpd/mening/ public/index.html
- Menactra. Prescribing information. Sanofi Pasteur Inc; 2018. Accessed July 20, 2020. https://www.fda.gov/media/75619/download
- MenQuadfi. Approval letter 2020. FDA. Accessed July 21, 2020. https://www. fda.gov/media/137331/download
- MenQuadfi. Prescribing information. Sanofi Pasteur Inc; 2020. Accessed July 21, 2020. https://www.fda.gov/media/137306/download
- Menveo. Prescribing information. GlaxoSmithKline Biologicals SA; 2020. Accessed July 21, 2020. https://www.fda.gov/media/78514/download
- VFC-ACIP vaccine resolutions. CDC. Updated July 10, 2019. Accessed July 21, 2020. https://www.cdc.gov/vaccines/programs/vfc/providers/resolutions.html
- Resolution no. 6/20-1: advisory committee on immunization practices vaccines for children program vaccines to prevent meningococcal disease. June 24, 2020. CDC. Accessed July 21, 2020. https://www.cdc.gov/vaccines/programs/vfc/ downloads/resolutions/mening-508.pdf
- 2019-2020 U.S. flu season: preliminary burden estimates. CDC. Updated April 17, 2020. Accessed July 21, 2020. https://www.cdc.gov/flu/about/burden/ preliminary-in-season-estimates.htm.
- US flu VE data for 2019 — 2020. CDC. Updated June 29, 2020. Accessed July 22, 2020. https://www.cdc.gov/flu/vaccines-work/2019-2020.html
- Frequently asked influenza (flu) questions: 2020-2021 season. CDC. Updated July 28, 2020. Accessed July 22, 2020. https://www.cdc.gov/flu/season/faq-fluseason- 2020-2021.htm
- Recommended composition of influenza virus vaccines for use in 2020-2021 northern hemisphere influenza season. WHO. February 28, 2020. Accessed July 22, 2020. https://www.who.int/influenza/vaccines/virus/recommendations/ 2020-21_north/en/
- ACIP recommendations. CDC. Updated July 6, 2020. Accessed July 15, 2020. https://www.cdc.gov/vaccines/acip/recommendations.html
- Fluzone Quadrivalent and Fluzone High-Dose Quadrivalent. Approval letter 2020. FDA. Accessed July 22, 2020. https://www.fda.gov/media/139728/ download
- Fluad Quadrivalent. Prescribing information. Seqirus Inc; 2020. Accessed July 22, 2020. https://www.fda.gov/media/135432/download
- Fluzone High-Dose Quadrivalent. Prescribing information. Sanofi Pasteur Inc; 2020. Accessed July 22, 2020. https://www.fda.gov/media/139731/download
- Fluzone High-Dose. Prescribing information. Sanofi Pasteur Inc; 2019. Accessed July 22, 2020. https://www.fda.gov/media/119870/download
- June 2020 ACIP Meeting - Welcome & Introductions. CDC. Accessed July 27, 2020. https://www.youtube.com/watch?v=W1SV2DSJsaQ
- Cases in the U.S. CDC. Updated August 10, 2020. Accessed August 11, 2020. https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/cases-in-us.html
- June 2020 ACIP Meeting - COVID-19 Vaccines Introduction. CDC. Accessed July 22, 2020. https://www.youtube.com/watch?v=bhrxX8T8-Jc&list=PLvrp9i- OILTQb6D9e1YZWpbUvzfptNMKx2&index=5&t=0s
- June 2020 ACIP Meeting - COVID-19 Vaccine Prioritization Considerations. CDC. Accessed July 22, 2020. https://www.youtube.com/watch?v=0q3qXfnXbac& list=PLvrp9iOILTQb6D9e1YZWpbUvzfptNMKx2&index=4
- Bower WA, Schiffer J, Atmar RL, et al. Use of Anthrax vaccine in the United States; recommendations for the Advisory Committee on Immunization Practices, 2019. MMWR Recomm Rep. 2019;68(No.RP-4):1-13. doi:10.15585/ mmwr.rr6804a1
- Havers FP, Moro PL, Hunter P, et al. Use of tetanus toxoid, reduced Diphtheria toxoid, and acellular pertussis vaccines: updated recommendations of the Advisory Committee on Immunization Practices—United States, 2019. MMWR Morb Mortal Wkly Rep. 2020;69:77-83. doi:10.15585/mmwr.mm6903a5