APhA: Annual Pediatric, Adult Immunization Update

The past year has been a busy one for vaccines. The Advisory Committee on Immunization Practices (ACIP) met more than 20 times, said ACIP committee member and independent pharmacy consultant Steve Foster, PharmD, FAPhA, retired Captain in the United States Public Health Service Commissioned Corps. This year’s annual immunization update from the CDC includes important changes for herpes zoster, pneumococcal, hepatitis B, and dengue vaccines.

“Pharmacists delivered more than 77% of all the COVID-19 vaccines administered in the US,” said Foster. “The ACIP is expecting pharmacists to give newly approved vaccines just as they have with COVID-19. Vaccines may be a major change in our practices going forward.”

Foster and Jeffrey Goad, PharmD, MPH, Associate Dean of Academic Affairs at Chapman University School of Pharmacy shared the latest vaccine recommendations during their presentation, “Know the Facts: Annual Immunization Update” at the APhA 2022 Annual Meeting & Exposition held in San Antonio, Texas.

“There was a huge pandemic dip for our routine common pediatric vaccines,” Goad said. “Vaccination is starting to come back, but we have a huge catch up to do.”

Vaccination rates for adults took a similar hit during the pandemic, but adult vaccinations have been slower to recover. Routine pediatric vaccination is driven largely by school requirements and pediatricians, but there are fewer drivers for adult vaccines.

The good news, though, is that the pandemic focused attention on the pharmacy as a safe, easy, reliable place to get vaccines. There is growing pressure at both federal and state levels to make permanent many of the pharmacy practice waivers put in place during the COVID-19 public health emergency to maintain and increase vaccine access.

Influenza

The prevalence of influenza is significantly higher this year than during the 2020-2021 season, Foster noted, though hospitalization and mortality rates remain below prepandemic levels. All currently recommended flu vaccines are quadrivalent, with some egg-based and some not egg-based.

There are no preferences by brand, he added, which gives pharmacies more flexibility to administer whatever product is easiest to obtain based on age. FluMist, for example, is not approved for those younger than 2 or older than 49, while Afluria, Fluarix, FluLaval, and Fluzone are approved for those 6 months and older. Fluad and Fluzone High-Dose are approved for adults 65 and older.

Pneumococcal

With approximately 100 distinct serotypes of pneumococcal disease, pneumococcal vaccine development has been an exercise in adding more and more serotypes to each successive product, Goad said. The newest vaccine covers 23 serotypes.

The latest pneumococcal vaccine recommendations are relatively straightforward: Adults 65 ad older who are pneumococcal vaccine-naïve or whose pneumococcal vaccine history is unknown should receive a single dose of either the pneumococcal 20-valent conjugate vaccine (PCV 20; Prevanr 20) or the pneumococcal 15-valent conjugate vaccine (PCV 15; Vacneuvance). If PCV 15 is used, it should be followed by a dose of the pneumococcal polysaccharide vaccine (PPSV23; Pneumovax23).

Similarly, adults aged 19 to 64 with underlying medical conditions or with other risk factors who are pneumococcal vaccine-naïve or whose pneumococcal vaccine history is unknown should receive a single dose of either PCV 20 or PCV 15. If PCV 15 is used, it should be followed by a dose of PPSV23.

Currently, there are no comparative studies on efficacy of PCV 20 vs PCV15 plus PPSV23. “If you’re going to give 1 dose, use PCV20 and you’re done,” Foster said.

Hepatitis B

New for this year is a tacit recommendation for universal adult vaccination against Hepatitis B, said Foster.

Recommendations approved in November 2021 say that all adults aged 19 to 50 and those 60 and older with risk factors for hepatitis B infection should receive hepatitis B vaccine. Adults 60 and older without known risk factors for hepatitis infection may receive the vaccine.

“[The] hepatitis [B] vaccine is more effective when given at a younger age, but you can now say that everybody gets vaccinated,” Foster said. “We have multiple vaccine options on the market, including a new one, PreHevbrio [hepatitis B vaccine (recombinant)], approved in November 2021.”

Herpes Zoster

The latest recommendations call for 2 doses of the recombinant zoster vaccine (Shingrix) for all adults aged 19 and older who are, or who will be, immunodeficient or immunosuppressed due to disease or therapy.

Dengue

The dengue vaccine (dengue tetravalent vaccine, live; Dengvaxia) is now recommended for individuals who are seropositive from a prior infection to reduce the risk of severe disease if infected again. Vaccination is not recommended for those without prior infection.

“You have to know the patient has an active antibody response before you vaccinate, which makes it very difficult to operationalize,” Goad said. “But if you give dengue vaccine without a prior infection, it puts the patient is at high risk for severe disease.”

References

Foster SL, Goad J. Know the facts: Annual immunization update. Presented at: American Pharmacists Association 2022 Annual Meeting & Exposition; March 18-21, 2022; San Antonio, TX