The serogroup B meningococcal (MenB) vaccination recommendations have been updated to include booster doses in “special situations” and in an outbreak setting. Children aged ≥10 years with persistent complement deficiency, those who use complement inhibitors; persons with asplenia; microbiologists; and those determined by public health officials to be at increased risk during an outbreak should receive MenB vaccine.  The first booster dose should be given 1 year after the primary series and repeated every 2 to 3 years as long as the increased risk is present.  Booster doses are not recommended for healthy adolescents routinely vaccinated with MenB vaccine.8

A recent study evaluated the efficacy of vaccination with the multicomponent meningococcal group B (4CMenB) vaccine for actual vs expected incidence of the disease in young children. The study concluded that the 4CMenB vaccine had a positive effect against meningococcal group B disease. Protection from the disease lasted ≥2 years after receiving 3 doses.9 In an Australian study, researchers looked at whether the 4CMenB vaccine can build herd immunity in teenagers. The results of the study indicated that the vaccine does not invoke heard immunity, making it even more imperative that children receive the vaccine when they are young.10

Detailed information has been added regarding which oral polio vaccine (OPV) doses may be counted toward the US vaccination requirements. Doses of OPV administered before April 1, 2016, should be counted (unless specifically noted as administered during a campaign). Doses of OPV administered outside the United States on or after April 1, 2016, should not be counted; however, doses of inactivated polio vaccine (IPV) or trivalent OPV (tOPV) are counted. For those vaccinated outside the United States, the total number of doses needed to complete either mixed OPV-IPV or OPV-only series is the same as that recommended by the CDC.11 As part of the World Health Organization’s polio eradication strategy, withdrawal of OPVs began in April 2016 with a switch from tOPV to bivalent OPV.12 

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The Tdap (tetanus, diphtheria, pertussis) note has been updated to allow either Td or Tdap for decennial tetanus booster doses and catch-up series doses in persons who have previously received Tdap. Additionally, the note has been edited to reflect recent updates to the clinical guidance for children aged 7 to 18 years who received doses of Tdap or DTaP at aged 7 to 10 years.

A dose of Tdap or DTaP administered at 10 years of age may now be counted as the adolescent Tdap booster. A dose of Tdap or DTaP administered between 7 and 9 years of age should not be counted as the adolescent dose, and a Tdap booster dose should be administered at 11 to 12 years of age. The DTaP note has been updated to reflect that dose 5 is not necessary if dose 4 was administered at age ≥4 years and at least 6 months after dose 3.5

Adults

Pneumococcal vaccine recommendations for adults have been updated. One dose of pneumococcal polysaccharide vaccine (PPSV23) is recommended for those aged 19 to 64 years with chronic medical conditions (diabetes or chronic heart [excluding hypertension], lung, or liver disease) or alcoholism, or who are current cigarette smokers. Individuals aged ≥19 years with conditions that compromise the immune system (congenital or acquired immunodeficiency [including B- and T-lymphocyte deficiency, complement deficiencies, phagocytic disorders, or HIV infection], chronic renal failure, nephrotic syndrome, leukemia, lymphoma,Hodgkin disease, generalized malignancy, iatrogenic immunosuppression [eg, drug or radiation therapy], solid organ transplant, multiple myeloma) or anatomical or functional asplenia (including sickle cell disease and other hemoglobinopathies) have a different vaccination schedule. The new schedule includes:

  • 1 dose PCV13 followed by 1 dose PPSV23 ≥8 weeks later, then another dose PPSV23 ≥5 years after previous PPSV23
  • At age ≥65 years, administer 1 dose PPSV23 ≥5 years after most recent PPSV23 (note: only 1 dose PPSV23 is recommended at age ≥65 years)

For patients aged ≥19 years with cerebrospinal fluid leak or cochlear implant, the dosing schedule includes:

  • 1 dose PCV13 followed by 1 dose PPSV23 ≥8 weeks later
  • At age ≥65 years, administer another dose PPSV23 ≥5 years after PPSV23 (note: only 1 dose PPSV23 is recommended at age ≥65 years)13

Although zoster vaccine was not updated in the 2020 schedule, it is important to note recommendations for this critical vaccine. For individuals aged ≥50 years, a2-dose series of recombinant zoster vaccine (RZV; Shingrix®) given 2 to 6 months apart is recommended (minimum interval: 4 weeks; repeat dose if administered too soon) regardless of previous herpes zoster or history of live zoster vaccine (ZVL; Zostavax®) vaccination (administer RZV at least 2 months after ZVL).14 Testing for varicella antibody prior to or after giving the vaccine is not recommended.15

Mary Koslap-Petraco, DNP, PPCNP-BC, CPNP, FAANP, is an adjunct clinical assistant professor at Stony Brook School of Nursing and a consultant for the Immunization Action Coalition. She is also the owner of Pediatric Nurse Practitioner House Calls.

References

  1. Centers for Disease Control and Prevention. Advisory Committee on Immunization Practices (ACIP). Vaccine Recommendations and Guidelines of the ACIP. https://www.cdc.gov/vaccines/hcp/acip-recs/index.html. Accessed June 25, 2020.
  2. Vaccine Adverse Even Reporting System. https://vaers.hhs.gov/. Accessed June 25, 2020.
  3. Centers for Disease Control and Prevention. Suspension of rotavirus vaccine after reports of intussusception — United States, 1999. MMWR Morb Mortal Wkly Rep. 1999;48:577-581.
  4. Centers for Disease Control and Prevention. CDC Vaccine Schedules App for Health Care Providers. https://www.cdc.gov/vaccines/schedules/hcp/schedule-app.html. Accessed June 25, 2020.
  5. Robinson CL, Bernstein H, Poehling K, Romero JR, Szilagyi P. Advisory Committee on Immunization Practices recommended immunization schedule for children and adolescents aged 18 years or younger — United States, 2020. MMWR Morb Mortal Wkly Rep. 2020;69:130-132.
  6. Schillie S, Vellozzi C, Reingold A, et al. Prevention of hepatitis B virus infection in the United States: recommendations of the Advisory Committee on Immunization Practices. MMWR Recomm Rep. 2018;67(No. RR-1):1-31.
  7. Centers for Disease Control and Prevention. Administering meningococcal vaccines. https://www.cdc.gov/vaccines/vpd/mening/hcp/administering-vaccine.html. July 26, 2019. Accessed June 25, 2020.
  8. Immunization Action Coalition. Ask the Experts: Meningitis B vaccine. https://www.immunize.org/askexperts/experts_meningococcal_b.asp. Accessed June 25, 2020.
  9. Ladhani SN, Andrews N, Parikh SR, et al. Vaccination of infants with meningococcal group B vaccine (4CMenB) in England. N Engl J Med. 2020;382(4):309-317.
  10. Marshall HS, McMillan M, Koehler AP, et al. Meningococcal B vaccine and meningococcal carriage in adolescents in Australia. N Engl J Med. 2020;382(4):318-327.
  11. Marin M, Patel M, Oberste S, Pallansch MA. Guidance for assessment of poliovirus vaccination status and vaccination of children who have received poliovirus vaccine outside the United States. MMWR Morb Mortal Wkly Rep. 2017;66:23-25.
  12. World Health Organization. Replacing trivalent OPV with bivalent OPV. https://www.who.int/immunization/diseases/poliomyelitis/endgame_objective2/oral_polio_vaccine/en/. Accessed June 25, 2020.
  13. Freedman MS, Hunter P, Ault K, Kroger A. Advisory Committee on Immunization Practices recommended immunization schedule for adults aged 19 years or older — United States, 2020. MMWR Morb Mortal Wkly Rep. 2020;69:133-135.
  14. Centers for Disease Control and Prevention. Immunization Schedules. Recommended adult immunization schedule for ages 19 years or older, United States, 2020. https://www.cdc.gov/vaccines/schedules/hcp/imz/adult.html#note-zoster. February 3, 2020. Accessed June 25, 2020.
  15. Immunization Action Coalition. Ask the Experts: Zoster vaccine. https://www.immunize.org/askexperts/experts_zos.asp#:~:text=No.,or%20after%20giving%20the%20vaccine. July 11, 2019. Accessed July 25 2020.

This article originally appeared on Clinical Advisor

From the July/August 2020 Issue of Medical Bag

Topics:

Immunization Medicine Preventive Medicine Vaccination Vaccines