ACIP Updates Vaccine Recommendations for 2021: What Pharmacists Need to Know

Supplements, August 2021 Immunization Supplement,

Vaccine-related updates seem to be made on a weekly basis and keeping up to date on recommendations can be difficult.

The past year has been an unprecedented time for pharmacists and our role as immunizers. Vaccine-related updates seem to be made on a weekly basis and keeping up to date on recommendations can be difficult. This article provides an update on the vaccine recommendations that have been made and approved during 2021.

WHERE DO THE VACCINE RECOMMENDATIONS COME FROM?

The Advisory Committee on Immunization Practices (ACIP) is a branch of the CDC that develops recommendations for vaccine use in the United States. The ACIP is comprised of 15 voting members whose medical and public health expertise includes vaccinology, immunology, pediatrics, internal medicine, nursing, family medicine, virology, public health, infectious diseases, and/or preventive medicine.1 In addition to the voting members, the ACIP also has 8 ex officio members who represent other federal agencies with responsibility for immunization programs in the United States and 30 nonvoting members who act as liaisons from external organizations with related immunization expertise.

Historically, the ACIP meets in person 3 times each year at the CDC offices in Atlanta, Georgia, to review new information and vote on vaccine recommendations.2 Recommendations made by the ACIP are reviewed by the Director of the CDC and, if accepted, are published in the CDC’s Morbidity and Mortality Weekly Report (MMWR) as official recommendations.3,4 However, because of the COVID-19 pandemic, the ACIP has already convened 9 times in 2021 as of July 22.5 The 2021 meetings and a description of the vaccines discussed during each meeting are displayed in TABLE 1.5

Several changes were recommended by the ACIP in 2021 and published as recommendations in the MMWR. The following is a brief outline of the changes.

ACIP RECOMMENDATIONS FOR COVID-19 VACCINES

Three important recommendations were made by the ACIP about COVID-19 vaccines since the beginning of 2021. First, on February 27, 2021, the FDA issued an Emergency Use Authorization (EUA) for the Janssen (also known as Johnson & Johnson) COVID-19 vaccine.6 The Janssen COVID-19 vaccine was recommended for use in persons aged 18 years and older,6 making it the third vaccine to receive an EUA from the FDA for prevention of COVID-19.7

Next, on April 13, 2021, the CDC and FDA recommended a pause in using the Janssen COVID-19 vaccine because of concerns about thrombosis with thrombocytopenia syndrome among individuals who had received the vaccine. After reviewing the available information, the ACIP recommended resuming the use of the vaccine on April 23, 2021, maintaining that the benefits outweighed the risks. Additional guidance about the use of the Janssen COVID-19 vaccine was published on April 30, 2021, and included a new warning about the risk of rare clotting events among women ages 18 to 49 years.8

Finally, on May 14, 2021, the ACIP recommended the use of the Pfizer-BioNTech COVID-19 vaccine for adolescents aged 12 to 15 years following the extended EUA issued for the vaccine on May 12, 2021. The vaccine was found to have high efficacy against symptomatic COVID-19 and to be important to protect adolescents against COVID-19 disease and SARS-CoV-2 transmission.9

Although many pharmacists and patients alike may be anxiously awaiting information from the ACIP about the necessity of booster vaccines and use of COVID-19 vaccines for children, the CDC and FDA currently do not foresee the need for it at this time.10

ACIP RECOMMENDATIONS FOR OTHER VACCINES

Most of the publicity about vaccines this year has been on COVID-19 vaccines; however, important updates were made regarding other vaccines. On February 12, 2021, the ACIP published its Recommended Immunization Schedule for Adults Aged 19 Years or Older.11 Vaccine-related data such as disease epidemiology and societal impacts, vaccine efficacy and safety, feasibility of implementation, and economic analysis are used to create these recommendations.

Changes in the 2021 Adult Immunization Schedule include revised recommendations regarding influenza vaccines, pneumococcal vaccines, hepatitis A and hepatitis B vaccine, human papillomavirus vaccine, meningococcal serogroups A, C, W, and Y vaccines, meningococcal B vaccines, and zoster vaccines. A summary of the changes is shown in TABLE 2.11

Similar adjustments were also made to the Recommended Child and Adolescent Immunization Schedule for ages 18 years or younger. These include recommendations on COVID-19 vaccines, diphtheria and tetanus toxoids and acellular pertussis vaccines, tetanus toxoid, reduced diphtheria toxoid, acellular pertussis vaccine, and varicella vaccine. Additionally, the Child and Adolescent schedule was updated to clarify that with an accelerated 4-dose series of combined hepatitis A and B vaccine, the fourth dose (given at month 12) is considered a booster dose. The recommendation for Haemophilus influenzae type B was also clarified with the addition that no further doses are needed if a dose was administered at age 15 months or older.12

At the February 2021 meeting, the ACIP approved a recommendation for a 2-dose intramuscular rabies vaccine series when pre-exposure prophylaxis (PrEP) is needed for patients aged 18 years and older. The second dose is given 7 days after the initial dose. A booster vaccine also can be administered to people with sustained and elevated risk in as soon as 21 days but no later than 3 years after the PrEP series. At the June 2021 meeting, these changes were recommended for individuals younger than 18 years as well. Although recommendations for both age groups have not yet been published in the MMWR, they have been adopted by the CDC director.4

CONCLUSIONS

Pharmacists interested in learning the most up-to-date information about vaccine recommendations in the United States may consider watching upcoming ACIP meetings, which are livestreamed free for the public. Additionally, the CDC considers written public comments and requests to make oral public comments for upcoming meetings. Dates for upcoming meetings, agendas, registration information, and directions on submitting a public comment are available on the ACIP Meeting Information website. After each meeting, the presentation slides and videos are available online.2

Kimberly C. McKeirnan, PharmD, BCACP, is an associate professor in the Department of Pharmacotherapy and the director for the Center of Pharmacy Practice Research at Washington State University College of Pharmacy and Pharmaceutical Sciences in Spokane.

REFERENCES

1. ACIP committee members. CDC. February 5, 2021. Accessed July 14, 2021. https://www.cdc.gov/vaccines/acip/members/index.html

2. ACIP meeting information. CDC. July 13, 2021. Accessed July 14, 2021. https://www.cdc.gov/vaccines/acip/meetings/index.html

3. Vaccine-specific recommendations (by date published). CDC. May 10, 2021. Accessed July 14, 2021. https://www.cdc.gov/vaccines/hcp/acip-recs/recsby-date.html#yr2021

4. ACIP recommendations. CDC. July 13, 2021. Accessed July 14, 2021. https://www.cdc.gov/vaccines/acip/recommendations.html

5. ACIP meeting agendas. CDC. July 14, 2021. Accessed July 14, 2021. https://www.cdc.gov/vaccines/acip/meetings/agenda-archive.html#yr2021

6. Oliver SE, Gargano JW, Scobie H, et al. The Advisory Committee on Immunization Practices’ interim recommendation for use of Janssen COVID-19 vaccine — United States, February 2021. MMWR Morb Mortal Wkly Rep. 2021;70(9):329-332. doi:10.15585/mmwr.mm7009e4

7. COVID-19 vaccines. FDA. July 13, 2021. Accessed July 14, 2021. https://www.fda.gov/emergency-preparedness-and-response/coronavirus-disease-2019-covid-19/covid-19-vaccines

8. MacNeil JR, Su JR, Broder KR, et al. Updated recommendations from the Advisory Committee on Immunization Practices for use of the Janssen (Johnson & Johnson) COVID-19 vaccine after reports of thrombosis with thrombocytopenia syndrome among vaccine recipients — United States, April 2021. MMWR Morb Mortal Wkly Rep. 2021;70(17):651-656. doi:10.15585/mmwr.mm7017e4

9. Wallace M, Woodworth KR, Gargano JW, et al. The Advisory Committee on Immunization Practices’ interim recommendation for use of Pfizer-BioNTech COVID-19 vaccine in adolescents aged 12–15 years — United States, May 2021. MMWR Morb Mortal Wkly Rep. 2021;70(20):749-752. doi:10.15585/mmwr.mm7020e1

10. Joint CDC and FDA statement on vaccine boosters. HHS. July 8, 2021. Accessed July 14, 2021. https://www.hhs.gov/about/news/2021/07/08/jointcdc-and-fda-statement-vaccine-boosters.html

11. Freedman MS, Ault K, Bernstein H. Advisory Committee on Immunization Practices recommended immunization schedule for adults aged 19 years or older — United States, 2021. MMWR Morb Mortal Wkly Rep. 2021;70(6):193-196. doi:10.15585/mmwr.mm7006a2

12. Wodi AP, Ault K, Hunter P, McNally V, Szilagyi PG, Bernstein H. Advisory Committee on Immunization Practices recommended immunization schedule for children and adolescents aged 18 years or younger — United States, 2021. MMWR Morb Mortal Wkly Rep. 2021;70(6):189-192. doi:10.15585/mmwr.mm7006a1