ACIP Recommendations for Non-Respiratory Immunizations Remain Largely Unchanged | NCPA 2024

Even outside of respiratory virus season, vaccination is an important tool to decrease rates of vaccine-preventable diseases. In part 2 of his immunization presentation, David Ha, PharmD, BCIDP, infectious diseases manager at Stanford Health Care, presented at the National Community Pharmacists Association 2024 Annual Meeting and Expo, reviewed the latest CDC Advisory Committee on Immunization Practices (ACIP) updates on vaccines for meningococcal disease, human papillomavirus, and tetanus, diphtheria, and pertussis, among others.

Meningococcal Disease

According to data from the CDC, 2023 had the highest rate of cases of meningococcal disease in adults since 2014, man of which were driven by bacterial strains that compose serogroup Y. In adolescents, meningococcal disease cases associated with serogroups ACWY have decreased due to routine vaccination, but cases due to serogroup B remain similar—and college students are at the highest risk for serogroup B meningococcal disease.

Table adapted from David Ha, PharmD

In October 2023, a pentavalent meningococcal vaccine targeting serogroups ABCW and Y (Penbraya) was approved by the FDA for use in individuals aged 10 to 25 years. Other meningococcal vaccines are available as well: a quadrivalent vaccine targeting serogroups ACWY (Menveo and MedQuadfi), and a vaccine targeting serogroup B (Bexsero and Trumenba).

“One of the unfortunate challenges with meningococcal B vaccination is, this vaccine—as opposed to the quadrivalent [vaccine]—is not quite as immunogenic,” Ha said. “You get protection for maybe 2 years or so after vaccination, so it really is ideal to time that second dose as close as possible to when [patients] are matriculating into college.”

“I would highly recommend checking your local college websites; in my home state, for example, all state schools require Men B vaccination,” Ha said. State public health websites should also provide this information. “These are great resources if you’re trying to push the marketing of Men B vaccination, because it’s really important that we get future students vaccinated—ideally on time—for their matriculation.”

Human Papillomavirus

While human papillomavirus (HPV) vaccine recommendations have stayed largely the same, there have been “really great data” around the outcomes of this vaccine.

“[The HPV vaccine] is one of the most effective vaccines that we have to date,” Ha explained. “It is highly immunogenic, especially if you give it at a young age; the earlier you give it, the better.” Clinical outcomes, he added, have been “fantastic.” Looking at data from sequential cohorts of vaccinated patients, “we’re seeing lower and lower and lower rates of vaccine-type HPV, which has led to reduced pre-cancer incidence rates and reduced cervical cancer incidence rates in the United States,” Ha said.

With only one vaccine available—a 9-valent HPV vaccine (Gardasil-9), ACIP recommendations have remained unchanged. Gardasil-9 should be administered in a 2-dose series in adolescents aged 9 to 14 years, with the first dose ideally at age 11 or 12. The second dose should be administered 6 to 12 months later, but if more than 5 months have passed, a third dose should be administered. For those catching up—including adolescents and young adults aged 15 to 26 years, a 3-dose series administered at months 0, 1to 2, and 6 is recommended.

READ MORE: Patient-Level Interventions Can Increase HPV Vaccination Rates in Communities | IDWeek 2024

Although the vaccine is more effective if given earlier, there is an option for adults aged 27 to 45 to catch up. Using shared clinical decision making, a 3-dose series can be considered for adults at high risk—for example, those with new sex partners or those with limited prior sexual exposure. If patients in this population previously received a bivalent or quadrivalent vaccine (Cervarix or Gardasil, respectively, discontinued in 2016 and 2017), the vaccination series may be completed with the 9-valent vaccine. Perhaps most importantly for this age group, prior HPV infection does not preclude these individuals from vaccination.

Mpox

There are 2 clades of Mpox currently circulation: Clade I, which is responsible for ongoing outbreaks in countries such as the Democratic Republic of Congo, and Clade II, which has continued to circulate at low levels in the US.

“[Mpox] is one of the more under-recognized, and more limited, [vaccines] in terms of access,” Ha said. “it’s a very important vaccine, and maybe only about 25% of patients in the US who are indicated for the vaccine have actually received it.” For pharmacists who care for patient populations where Mpox vaccination would make sense, Ha recommended incorporating routine Mpox vaccination as part of practice.

“I’ve personally seen a couple of cases of Mpox, and it can be quite severe,” Ha added. “I can’t underscore enough for really all of these [diseases]—but for Mpox in particular—the importance of vaccination those who it is indicated for.” This list includes individuals with known exposure to someone diagnosed with mpox; gay, bisexual, or other men who have sex with a partner who has more than 1 sex partner or a new diagnosis of a sexually transmitted infection; individuals who have sex at commercial sex venues or locations where mpox transmission is occurring; or those who have a sex partner with any of the previous risks.

The Smallpox and Monkeypox vaccine, live, non-replicating (Jynneos) is the only vaccine available to vaccinate against Mpox. For Clade II—currently endemic in the US—a 2-dose series of Jynneos protected against both severe disease and hospitalization, with approximately 86% effectiveness with 2 doses and approximately 75% effectiveness with 1 dose. For Clade I, Jynneos is “likely to be effective.”

Dengue Virus

There has been a massive spike in Dengue virus cases this year, especially in Puerto Rico, American Samoa, the Marshall Islands, the US Virgin Islands, Micronesia, and Palau. “Paired with the fact that our dengue vaccine, [dengue tetravalent vaccine, live; Dengvaxia] has been discontinued—and so the supply that we have access to now is being…distributed on a limited basis to these areas [with transmission],” Ha explained that there is no end in sight for the current Dengue virus outbreak.

Dengvaxia was initially approved in May 2019 for children and adolescents aged 9 to 16 years, and recently discontinued by Sanofi Pasteur due to lack of demand. Additionally, Takeda withdrew their company’s FDA application for a dengue vaccine.

Diphtheria, Tetanus, and Pertussis

ACIP recommendations for diphtheria, tetanus, and pertussis vaccination remain unchanged, Ha said: Adults aged 19 and older should receive 1 dose of the Tdap vaccine regardless of the timing of their last dose, followed by a Tdap booster ever 10 years.

“There is an active Td [tetanus and diphtheria vaccine] shortage, so [the preference is for] Tdap for these boosters,” Ha said. Pregnant women should receive 1 dose of Tdap with every pregnancy, “regardless of how many Tdap [vaccinations] they have in the past.”

“There’s been a massive uptick in pertussis cases in the US, and a lot of this has to do with the lifting of COVID-19 restrictions, so we’re starting to see more transmission,” Ha said. Adult Tdap vaccine coverage is hovering at approximately 40%, and there has been a 4-fold increase in cases of pertussis from September 2023 to September 2024. “If you’ve seen a case of pertussis, it is a very tough disease, with high morbidity and a significant mortality rate as well. I can’t stress [enough] the importance of Tdap vaccination.”

Herpes Zoster Vaccination

ACIP recommendations for herpes zoster (shingles) remain unchanged as well. Adults aged 50 years and older should receive 2 doses of zoster vaccine, recombinant, adjuvanted (Shingrix), regardless of history of herpes zoster or varicella infection or previous vaccination with the herpes zoster vaccine (Zostavax). Adults 19 and older who are immunocompromised should receive 2 doses of Shingrix as well.

Check out the rest of our NCPA coverage here.

Coverage of the National Community Pharmacists Association 2024 Annual Convention and Expo was supported by Red Sail, with independent editorial content creation on-site by the Drug Topics team.

Reference

1. Ha D. Dose of protection: Travel and nonrespiratory vaccine updates. Presented at: National Community Pharmacists Association 2024 Annual Convention and Expo; October 26-29, 2024; Columbus, OH.