ACIP Streamlines Pneumococcal Vaccine Recs

Streamlined pneumococcal vaccine suggestions, and recombinant zoster vaccine (Shingrix) for immunocompromised adults, were endorsed by the CDC’s Advisory Committee on Immunization Practices (ACIP) in unanimous votes on Wednesday.

ACIP voted 15-0 for a revised age-based mostly mostly recommendation and 15-0 for a revised threat-based mostly mostly recommendation for pneumococcal vaccines. All adults ages 65 and up and adults ages 19-64 with certain underlying medical situations or assorted threat components who maintain no longer beforehand received a pneumococcal conjugate vaccine or in whom outdated vaccine history is unknown ought to peaceable receive one among the pneumococcal vaccines, PCV20 (Prevnar 20) or PCV15 (Vaxneuvance). If PCV15 is outdated school, this ought to be followed by the polysaccharide vaccine, PPSV23 (Pneumovax 23).

Nonetheless, an modification proposed earlier in the assembly to knock the age-based mostly mostly suggestions down to 50 did no longer pass in a 4-11 vote.

The rationale for rejecting the modification used to be the dearth of efficacy recordsdata on the pneumococcal conjugate vaccines, as effectively as the premise that since children are now being immunized with pneumococcal conjugate vaccine, the landscape of illness has the functionality to commerce.

Present CDC suggestions are for PPSV23 for adults ages 65 and up, of us ages 2-64 with certain medical situations, and adults ages 19-64 who smoke cigarettes, and for PCV13 (Prevnar 13) in children younger than 2 years, of us older than 2 years with certain medical situations, and for adults ages 65 and older through shared medical decision making.

Amanda Cohn, MD, of the CDC, stated of the separate age-based mostly mostly and threat-based mostly mostly votes, “discussions took place at CDC among the workgroup [that] two age-based mostly mostly suggestions would possibly be confusing.”

Helen Keipp Talbot, MD, MPH, of Vanderbilt University in Nashville, used to be the committee member who proposed animated the age suggestions down to 50, speaking from her journey as an grownup internist.

“The extensive majority of physicians who took care of adults genuinely wanted the age … starting at age 50,” she stated, adding that while they draw no longer know the duration of safety, she would possibly be “more than cosy to trust in thoughts a booster in some unspecified time in the future.”

Beth Bell, MD, MPH, of the University of Washington in Seattle, pointed out that three-quarters of adults ages 50-64 already maintain chronic situations, doubtlessly making them eligible to receive the vaccine anyway, and puzzled what the “incremental relieve would possibly be dropping the age restrict down to 50.”

While these in favor of starting customary vaccination at age 50 also pointed out it would easiest address concerns about equity, ACIP chair Grace Lee, MD, of Stanford University College of Treatment in California, stated that the appropriate intervention is arguably the pneumococcal conjugate vaccines delivered in childhood.

“I’d argue that childhood vaccination applications are going to address equity at a inhabitants stage more than individual vaccines,” she stated.

After the vote, Oliver Brooks, MD, of Watts Healthcare Company in Los Angeles, illustrious that weight problems and hypertension are no longer among the chronic situations lined by a threat-based mostly mostly recommendation among younger adults, adding that he used to agonize that “the disparities in outcomes linked to pneumococcal illness would possibly well well no longer entirely be addressed by our/my vote.” He proposed revisiting these situations in some unspecified time in the future.

Camille Kotton, MD, of Massachusetts Classic Hospital in Boston, added that these choices were being made largely in step with immunogenicity, and it’d be well-known to “bag medical recordsdata” and “track the topic” to make certain they “proceed to gape tough medical safety” from the vaccines.

The varied vote regarding the two-dose recombinant zoster vaccine for adults ages 19 and up who are immunodeficient or immunosuppressed attributable to illness or remedy also handed 15-0, with diminutive fanfare. CDC workers illustrious that the dosing time desk would possibly be at month 0 followed by a 2nd dose 2 to 6 months later; nonetheless, if immunocompromised folk would relieve from a shorter immunization time desk, the 2nd dose would possibly be 1 to 2 months later.

All suggestions from ACIP are no longer thought about final till they are published in the Morbidity and Mortality Weekly Document.

  • Molly Walker is deputy managing editor and covers infectious ailments for MedPage This day. She is a 2020 J2 Success Award winner for her COVID-19 coverage. Note

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