Highlights: What Pharmacists Need to Know about ACIP’s Latest 2023 Vaccination Schedule Updates

On October 19 and 20, the Advisory Committee on Immunization Practices (ACIP) met to discuss the 2023 vaccination schedule and offer recommended updates. These recommendations included adding COVID-19 vaccination to the routine childhood and adult vaccination schedules, updates for flu vaccines in pregnant individuals, discussion of progress in developing respiratory syncytial virus (RSV) vaccines, several pneumococcal vaccine administration changes, and more.

John D. Grabenstein, RPh, PhD, managing editor of IZ Express for Immunize.org spoke with Drug Topics® on the updates and provided a summary of the ACIP recommendations.

COVID-19 Vaccines

Of note, ACIP unanimously voted to recommend adding COVID-19 to the regular schedules of childhood and adult vaccinations. The Committee also added the COVID-19 vaccine to the Vaccines for Children program. This will ensure access to the vaccine if and when the federal government ends the public health emergency for COVID-19. Despite circulating misinformation, nothing the ACIP has done mandates the COVID-19 vaccine for children.

ACIP highlighted the safety and efficacy of COVID-19 vaccines for pregnant people and their infants. It stressed the importance of pregnant people being vaccinated for COVID-19, as pregnancy is considered a high-risk condition. However, only 43% of pregnant people have had the primary series and a monovalent booster, according to 2022 data.

“COVID-19 vaccines appearing in the routine schedules for children and for adults reflects the continuing burden of COVID in hospitalizing and killing people of all ages,” said Grabenstein. He added that COVID-19 vaccines should be considered routine and essential, with an accumulated experience of more than 630 million doses. “COVID infection can seriously harm kids, and they can avoid infection by vaccination and boosting,” he emphasized.

Influenza Vaccines

ACIP said that the quadrivalent recombinant influenza vaccine (RIV4) was added as an option for pregnant women after the first randomized clinical trial showed it was as safe as the quadrivalent, egg-based inactivated influenza vaccines (IIV4).

ACIP also reported low to no protection from the 2021-2022 flu vaccine against the A/H3N2 predominant strain. The 2022-2023 flu vaccine seems to be a better match based on early reports of the southern hemisphere flu season.

RSV Vaccines

Both GlaxoSmithKline and Pfizer adult vaccines for respiratory syncytial virus (RSV) are being evaluated after phase 3 clinical trials. Jointly, Sanofi and AstraZeneca are developing a long-acting monoclonal antibody for infants, which is designed to protect babies up to 5 months after a single dose. The FDA may license these products at some point in 2023 and recommendations from ACIP will come following licensure.

Pneumococcal Vaccines

For patients with prior pneumococcal 13-valent conjugate vaccine (PCV13; Prevnar-13) vaccination ACIP said that there is a benefit from being vaccinated for the 7 additional strains of pneumonia found in the 20-valent vaccine (pneumococcal 20-valent conjugate vaccine [PCV-20]; Prevnar-20). For patients who received PCV13 updated recommendations are:

• For adults aged 19 and older who were previously recommended to receive PCV13 followed by pneumococcal polysaccharide vaccine (PPSV23), but who have received only PCV13, ACIP recommends either PCV20 at least 1 year after the PCV13 dose, or PPSV23 as previously recommended.
• For adults aged 65 and over who have previously had PCV13 and PPSV23, ACIP advises that PCV20 may be given at least 5 years after the most recent pneumococcal vaccine dose based on shared clinical decision-making.
• For adults who are immunocompromised, who have cerebrospinal fluid leak, or who have cochlear implants who have had PCV13 and one or more PPSV23 doses (before age 65) but who have not completed all previously recommended doses of PPSV23, ACIP advises either PCV20 at least 5 years after the most recent pneumococcal vaccine dose or PPSV23 as previously recommended.

Polio Vaccines

Due to the resurgence of polio, CDC reviewed the United States and international use of polio vaccines during the meeting. They provided an update on the NY vaccine-derived type 2 paralytic polio case, and shared that wastewater surveillance shows ongoing community transmission. The polio vaccine workgroup has been reactivated to consider additional inactivated polio vaccination, in addition to considering a novel, unlicensed, monovalent oral poliovirus vaccine (nOPV2) to stop ongoing asymptomatic transmission in the United States, as IPV only stops paralytic polio but not an asymptomatic infection.

Monkeypox

The CDC has noted that monkeypox cases are decreasing; ACIP reviewed the use of the smallpox and monkeypox vaccine, live, non-replicating (Jynneos). Patients received more than 900,000 doses of pre- and post-exposure shots during the outbreak, and CDC noted that transmission is expected to continue despite the reduction in cases. Vaccine safety and efficacy is undergoing continued evaluation by ACIP, and vaccine recommendations will be updated when additional data suggests it is required.

Menningococcal Vaccines

Presentations were given on GSK’s newly licensed, non-reconstituted Menveo vaccine, a single-vial liquid version of GSK’s MenACWY. The original version is a lyophilized vaccine reconstituted with a diluent containing the serogroup A component and is licensed for ages 2 months to 55 years. According to the CDC, it may be used in adults age 56 years or older who need MenACWY vaccination. The new one-vial vaccine is for patients aged 10 years and up instead of 2 months. GSK will keep a limited supply of the two-vial vaccine for children under 10 years who need MenACWY vaccination. Sanofi’s MenQuadfi is licensed for individuals aged 2 years and up.

ACIP’s meningococcal workgroup will review 2 new pentavalent MenABCWY vaccines from GSK and Pfizer, both of which are in clinical trials.

Dengue Vaccines

The CDC gave updates on the measured use of the dengue tetravalent vaccine, live (Dengvaxia), which the ACIP recommended in 2021 as a 3-dose series for children aged 9 to 16 years who had laboratory proof of past infection (largely in Puerto Rico and other United States territories). Dengue vaccination is not recommended for people who have never been infected. “The slow introduction is, in part, attributable to complex logistics and the challenges faced in selecting and implementing a serologic testing strategy with acceptably high sensitivity and specificity for use in screening before vaccination.”¹

Takeda is currently developing a new, tetravalent live-attenuated dengue shot. It is unclear if this vaccine will require previous infection prior to administration.

Chikungunya

The FDA has received initial data from Valneva SE for possible US licensure of the world’s first chikungunya vaccine. The FDA may come to a decision in 2023. The vaccine was shown to be safe and effective in offering more than 95% of adults immunity that lasted at least 6 months. As the FDA considers licensure, ACIP has created a chikungunya work group. Chikungunya is not currently found in the United States, although it has circulated in Caribbean islands.

“It is really important for pharmacists to help their patients increase their armor, their immunity, against serious infectious diseases. This is not just for influenza and COVID-19, but pneumococcal, zoster, Tdap, and other vaccines,” Grabenstein said in an interview with Drug Topics®. Some patients, he added, will want to get caught up as fast as they can, and pharmacists can give patients multiple vaccinations simultaneously.

“Other patients will want to space things out,” Grabenstein explained, “so make them biweekly or monthly return appointments. [Patients] are vulnerable until they're all caught up."

References

1. Immunize.org summarizes ACIP’s October 19-20 meeting allowing PCV20 vaccination for previously vaccinated adults, adding COVID-19 vaccines to the VFC program, and more. Immunize.org. https://www.immunize.org/express/issue1659.asp#IZX1. Published October 26, 2022. Accessed December 23, 2022.

2. ACIP presentation slides: October 19-20, 2022, meeting slides. CDC. https://www.cdc.gov/vaccines/acip/meetings/slides-2022-10-19-20.html. October 21, 2022. Accessed December 23, 2022.