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ARTICLE

Keeping Up With Adult Vaccinations

NOV 07, 2017 | CHRISTOPHER MCCOY, PHARMD, BCPS AQ-ID
To update the annual table, meetings are convened in June and October of each year. A notable session was held this past June, focusing on meningococcal vaccination and highlighting more reportable disease in recent years, newer product availability, the withdrawal of a product, and new published data.

The CDC reported in 2015 that the rate of reported meningococcal disease in the United States was 370 (0.11/100,000), with 60 deaths (0.02/100,000).2 One concerning trend since that time has been the increase in meningococcal subtype B infections and associated mortality. Two new subtype B vaccines have become available in recent years, one a combination of Neisserial adhesin A (NadA), Neisserial heparin binding antigen, and factor H binding protein (fHBP) MenB-4C (Bexsero) and the other a combination of two lipidated fHBP variants, one subfamily A and one from subfamily B named MenB-FHbp (Trumenba) (Table 3). The quadrivalent serotype A, C, Y, W vaccines were available as conjugate or polysaccharide vaccines similar to pneumococcal formulations; however, the polysaccharide vaccine MPSV4 (Menomune) has been withdrawn from the market, given shorter immunogenicity and lesser vaccine effectiveness versus one of the conjugated meningococcal vaccines (groups A, C, Y and W-135), eg, Menactra.

Table 3: Differentiation of Meningococcal Subtype B Vaccines

Many providers remain confused because the label for Menomune states that it is the only vaccine with proven efficacy for prevention of disease in patients over 55. This issue was discussed at the June 2017 ACIP Advisory Board meeting, and thus the MenACWY conjugate vaccine is now recommended by the ACIP for all adult age groups.3 Additionally, the ACIP recommended booster doses of MenACWY every 5 years throughout life for high-risk persons. For the MenB vaccine, the ACIP noted the same recommendations for boosters every 5 years.

Quadrivalent meningococcal B vaccines are recommended for higher-risk individuals who work in microbiology labs, those with asplenia (functional or otherwise), those with complement deficiencies, and those undergoing therapy with Soliris, given its effect on the complement system. Newer data have emerged that suggest that the protection of the vaccine for both MenACWY and MenB currently in this population is not fully effective.4 This was based on reports to the US Food and Drug Administration (FDA) of 16 cases of meningococcal infection after vaccination from 2007-2014, including 1 fatal instance. The recent death was of a 16-year-old girl who had received both vaccines prior to therapy but developed nongroupable infection 6 months after the last vaccine and a week after her first dose of eculizumab. A discussion of possible antibiotic prophylaxis with penicillin has been ongoing at the CDC.

Want more information on this topic and the opportunity to ask questions of an expert? Register for a live, ACPE accredited webinar February 28th 8-9 PM EST at this link: https://www.pharmacytimes.org/live-events/1106