ACIP Updates Recommended Vaccines and Immunization Schedules after 2-Day Meeting

The CDC’s Advisory Committee on Immunization Practices voted to recommend hepatitis B, orthopoxviruses, and Ebola vaccines to certain populations, as well as approving 2022 immunization schedules for children, adolescents, and adults.

Updated at 5:29 p.m. EST

Today concluded a 2-day meeting of the Centers for Disease Control and Prevention’s (CDC) Advisory Committee on Immunization Practices.

The Advisory Committee on Immunization Practices unanimously voted to recommend hepatitis B vaccination for adults 19-59 years of age and adults 60 years and older with risk factors for hepatitis B infection. They voted adults 60 years and older with no risk factors may receive hepatitis B infection.

Next, the ACIP unanimously voted to approve the Recommended Child and Adolescent Immunization Schedule, United States, 2022, and the Recommended Adult Immunization Schedule, United States, 2022.

For the orthopoxviruses vaccines, ACIP voted 15-0 on all 5 recommendations (detailed below).

ACIP voted 11-4 to recommend pre-exposure vaccination with the rVSVΔG-ZEBOV-GP Ebola vaccine for healthcare personnel involved in the care and transport of suspected or confirmed Ebola virus disease patients at Special Pathogens Treatment Centers.

The second Ebola vaccine vote was also 11-4, with ACIP voting to recommend pre-exposure vaccination with rVSVΔG-ZEBOV-GP vaccines for laboratorians and support staff at Laboratory Response Network (LNR) facilities that handle specimens that may contain replication-competent Ebola virus (species Zaire Ebolavirus) in the United States.

Yesterday, ACIP unanimously voted to recommend the Pfizer-BioNTech COVID-19 vaccine for children 5-11 years of age under the US Food and Drug Administration’s (FDA) Emergency Use Authorization (EUA).

Hepatitis Vaccines

1.89 Americans are currently living with chronic HBV, and the US Department of Health & Human Services (HHS) called to eliminate viral hepatitis as a public health threat by the year 2030.

ACIP debated the proposed recommendation that all adults not previously vaccinated for hepatitis B should receive the vaccination.

Risk-based hepatitis B vaccinations are down, leading the Hepatitis Vaccine Work Group to recommend a new strategy. The argument was that a universal hepatitis B vaccine would serve to boost the number of risk-based vaccinations. Some ACIP panelists voiced that hepatitis B is a complicated disease to understand, making health literacy very low, and many at-risk people may be confused whether they should receive the vaccine. Additionally, minority populations disproportionately affected by hepatitis B would benefit from a universal vaccine.

The Hepatitis Vaccine Work Group argued that an age cut-off should not be applied, as one dose of a hepatitis B vaccine offers lifelong protection. People respond better to vaccination at younger ages, before they have developed comorbidities or other complications.

There were some concerns raised by ACIP members about recommending the hepatitis B vaccine for adults over 59 years; this age group sees a minority of hepatitis B infections but a majority of hepatitis B vaccination complications.

ACIP panelists opted to amend the language of the proposed recommendation to: “All adults aged ≤59 y are recommended to receive hepatitis B vaccination; Adults >59 y would continue to follow existing risk based recommendations.” The amendment narrowly passed, with 8 “yes” and 7 “no” votes. Most of the ACIP members in opposition voiced objections to the age recommendations.

Immunization Schedules

At 12:36 p.m. EST, the Combined Immunization Schedule Work Group presented their 2022 vaccination schedule recommendations for children, adolescents, and adults. They summarized all the ACIP’s updated recommendations for 2022, including dengue vaccination (use of dengue vaccine in children 9-16 years in endemic areas) and influenza vaccination (minimum age for cell culture-based inactivated influenza vaccine; contraindications and precautions for influenza vaccine). ACIP disagreed about the language regarding vaccines for pregnant women. Several vaccines were marked as “Not Recommended” for pregnant women, but some ACIP members pointed out for the sake of safety these should really be marked as “Contraindicated.”

At 1:55 p.m. EST, ACIP voted to approve the Recommended Child and Adolescent Immunization Schedule, United States, 2022, as well as the corresponding Recommended Adult Immunization Schedule.

Orthopoxviruses Vaccines

During the presentation on orthopoxviruses, 2 vaccines, ACAM2000 and JYNNEOS, were considered. JYNNEOS and ACAM2000 have the same shipping conditions, but JYNNEOS had 3 fewer adverse events per 1000 subjects than ACAM2000. After minor revisions to language, the ACIP nominated 5 proposed recommendations for voting.

The first proposed recommendation was: “The ACIP recommends JYNNEOS as an alternative to ACAM200 for laboratory personnel, clinical laboratory personnel performing diagnostic testing for orthopoxviruses, and for designated response team members at risk for occupational exposure to orthopoxviruses.”

The second proposed recommendation was: “The ACIP recommends JYNNEOS, based on shared clinical decision-making, as an alternative to ACAM2000 for healthcare personnel who administer ACAM2000 or for patients infected with replication competent orthopoxviruses.”

The third proposed recommendation was: “The ACIP recommends persons who are at continued risk for occupational exposure to more virulent orthopoxviruses like variola virus or monkeypox virus receive booster doses of JYNNEOS every 2 years after the primary JYNNEOS series.”

The fourth proposed recommendation was: “The ACIP recommends persons who are at continued risk for occupational exposure to replication competent orthopoxviruses like vaccinia or cowpox receive booster doses of JYNNEOS at least every 10 years after the primary JYNNEOS series.”

The fifth and final proposed recommendation was: “The ACIP recommends persons who are at continued risk for occupational exposure to orthopoxviruses, and who received an ACAM2000 primary vaccination, receive a booster dose of JYNNEOS as an alternative to a booster dose of ACAM2000.”

Ebola Vaccine

The one-dose rVSV Ebola vaccine and its survey and trial results were next presented to ACIP. Across 12 clinical trials, 0.02% of participants had severe adverse events.

The first policy question moved to a vote by ACIP was: “Should pre-exposure vaccination with the rVSVΔG-ZEBOV-GP vaccine be recommended for healthcare personnel involved in the care and transport of suspect or confirmed Ebola virus disease patients at Special Pathogens Treatment Centers?”

The second was: “Should pre-exposure vaccination with the rVSVΔG-ZEBOV-GP vaccine be recommended for laboratorians and support staff at Laboratory Response Network (LNR) facilities that handle specimens that may contain replication-competent Ebola virus (species Zaire Ebolavirus) in the United States?”

ACIP moved to approve both questions for subsequent voting.