Vaccine Update: What Pharmacists Need to Know About ACIP’s New Guidelines

The CDC’s Advisory Committee on Immunization Practices (ACIP) has been hard at work over the past year. Updated guidelines around certain vaccines and newly approved products have been on the committee’s agenda throughout 2023. These include respiratory syncytial virus (RSV) vaccines, updates regarding influenza vaccines, and potential vaccine candidates in the pipeline, among a few others.

During a presentation at the National Community Pharmacists Association (NCPA) 2023 Annual Convention and Expo, Jean-Venable R. Goode, PharmD, director of the PGY1 Community Based Residency Program at Virginia Commonwealth University, discussed in detail the new guidelines from ACIP.¹

Flu Vaccines

“You're probably already in the thick of influenza vaccines. So, this might be just a little bit late,” Goode told a room of pharmacists. “But we'll cover a couple things.”

The composition of flu vaccines have changed slightly this year to include a new strain. “They still have the same strain for H1N1, Victoria, and Wisconsin, but it’s a different strain number found in a different year,” Goode said.

Although recommendations around flu vaccines did not change, ACIP did make an update for people with egg allergies. People with the allergy no longer need to take any additional safety measures when it comes to receiving a flu vaccination. Unless a contraindication exists, anyone 6 months or older can receive any flu vaccine that’s appropriate for their age and health status.

RSV Vaccines

The FDA approved 2 vaccines for the prevention of lower respiratory tract disease caused by RSV in adults ages 60 years and older. GSK’s Arexvy was the world’s first RSV vaccine when it was approved on May 3. This was followed quickly by the approval of Pfizer’s Abrysvo. Both of the vaccines demonstrated significant efficacy over at least 2 RSV seasons in their respective clinical trials.

ACIP recommends adults 60 years of age and older receive a single dose before the onset of RSV activity in their community. Co-administration with other vaccines is acceptable, but providers should think about giving Arexvy with the recombinant zoster vaccine, as they contain the same adjuvant.

Abrysvo was also approved for use in pregnant individuals to prevent lower respiratory tract disease caused by RSV in infants from birth to 6 months. The vaccine should be given as a single dose between 32 and 36 weeks gestational age.

Polio Vaccines

In regard to polio vaccinations, ACIP made an updated recommendation that all adults who are unvaccinated or incompletely vaccinated should complete a primary series with the inactivated polio vaccine.

“Almost every adult born in the US that comes through our vaccination system should be immune to polio,” Goode said. “So, unless you have a record that shows otherwise, you really don't need to vaccinate people.”

Pneumococcal Vaccines

Pfizer’s Prevnar 20 vaccine was approved by the FDA for infants and children in April and offers the broadest serotype coverage of any pediatric pneumococcal vaccine. ACIP recommends using either PVC15 or PVC20 for children ages 2 to 23 months.

The committee did make a few updates regarding PVC vaccinations. Healthy children ages 24 to 59 months with an incomplete PVC vaccination status should receive PVC15 or PVC20 unless they have a specified risk condition, including chronic kidney disease, chronic lung disease, and chronic liver disease. Children aged 2 to 18 years with any risk condition who have received all recommended doses before age 6 years should receive 1 dose of PVC20. Children aged 6 to 18 years with any risk conditions who have not received any dose of PCV13, PCV15, or PCV20, should receive a single dose of PCV15 or PCV20.

COVID-19 Vaccines

The FDA has recently approved updated COVID-19 vaccines from Pfizer, Moderna, and Novavax. Unvaccinated children ages 6 months to 4 years should complete a multi-dose, initial series with at least one dose of the updated vaccines. Everyone ages 5 years and older is recommended to receive 1 dose of an updated vaccine.

“The efficacy data was pretty good,” Goode said. “It's really looking at prevention of hospitalizations, severe COVID, and long COVID.”

New Vaccines on the Horizon

Goode touched on a few different vaccines that are coming through the pipeline. These include the meningococcal conjugate pentavalent vaccine, which is expected to be approved in Q3, the Tak-003 dengue vaccine, which is also expected to be approved in Q3, and the chikungunya vaccine, which is expected to be approved sometime this year.

At the end of her presentation, Goode also discussed patient engagement and foundations for success. She said that consistent messaging within your practice, team engagement, and building relationships outside of the pharmacy are all important when it comes to having a good vaccination program.

“Make sure that you know you’re part of the reason people will get vaccinated,” Goode said.

Reference

1. Goode JVR. 2023 Vaccine Update. Presented at: National Community Pharmacists Association 2023 Annual Convention; October 13-17, 2023; Orlando, Fl.