ACIP Meeting

Based on the available evidence of the impact “cocooning” has on transmission of pertussis to infants, no changes are currently recommended in the use of Tdap vaccine for close contacts of infants, Jennifer Liang, D.V.M., said at a meeting of the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices.

Presenting the conclusions of ACIP’s pertussis vaccines work group review on the impact of cocooning strategies, Dr. Liang, the CDC’s lead member of the work group, said that pertussis vaccination programs should be focused on vaccinating women during every pregnancy, maintaining high levels of DTap coverage, sustaining Tdap coverage in adolescents, and improving Tdap coverage in adults.

In 2005, ACIP recommended the “cocooning” strategy: vaccinating with Tdap for all close contacts of infants under age 12 months to reduce the risk of transmitting pertussis, including parents, siblings, grandparents, child care providers, and health care personnel, in addition to vaccinating pregnant women immediately post partum. In 2011, ACIP recommended Tdap during pregnancy for women who had not previously received the vaccine, or a postpartum dose for women who did not receive the vaccine during pregnancy and had not previously received the vaccine. In 2012, the recommendation was expanded to every pregnancy, whether or not the woman had received the vaccine before.

The optimal strategy to prevent the transmission of pertussis is vaccinating women during pregnancy, which has been shown to be highly effective in reducing transmission to infants, but rates of vaccination in pregnant women have not been high, said Dr. Liang, an epidemiologist in the CDC’s National Center for Immunization and Respiratory Diseases.

Rates of Tdap coverage, however, among pregnant women in the United States have ranged from 14% to 23% in studies using different sources, including a Michigan Medicaid study, she said.

Implementing and sustaining cocooning programs remain a challenge. Although uptake of Tdap has been highest in postpartum women, there has been limited success in vaccinating fathers or other family members, she said, noting that, in 2012, the rate of Tdap coverage among adults aged 19-64 years who reported living with an infant under age 1 year was 26%.

The effect of cocooning in preventing infant pertussis also is “unclear and inconclusive,” and evidence of the effectiveness of the postpartum dose in preventing infant pertussis is limited and the data are conflicting, Dr. Liang said. Another issue is that, over the past decade, the source of transmission to infants has shifted from parents (usually mothers) as the most common source to siblings, who have more recently been identified as the most common source, she said. A CDC study determined that, between 2006 and 2013, family members were the source of the infection in 66%-85% of infant pertussis cases in which the source of infection was known. Siblings were the most common source, linked to almost 40% of cases.

“Even if additional Tdap doses are recommended, this would not address the observed shift to siblings as the source of pertussis to infants and puts greater emphasis on the importance of providing newborns with antipertussis antibodies, and there is an optimal strategy in place – vaccinating women during pregnancy,” she said.

This message is emphasized in a recently launched CDC campaign to improve Tdap vaccination rates during pregnancy, which includes fact sheets for health care professionals that point out that Tdap during pregnancy provides the best protection for infants, postpartum Tdap administration is not optimal, and “cocooning alone may not be effective and is hard to implement.”

Several meeting participants pointed out that vaccine uptake during pregnancy is higher in settings where the vaccine is available on site, as high as 80%-90% of pregnancies, and that having to get the vaccine outside of the office, such as at a pharmacy, can markedly reduce the likelihood of vaccination. The CDC’s updated materials, including fact sheets and posters, are available for health care professionals at http://www.cdc.gov/pertussis/materials/hcp.html.

A single dose of Tdap is recommended for people aged 11-64 years: one dose is routinely administered at age 11 or 12 years and one dose of Tdap is recommended for pregnant women during every pregnancy. DTaP vaccine is used to vaccinate younger children starting at age 2 months and is not licensed for adolescents, adults, or children 7 years of age and older.

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Based on the available evidence of the impact “cocooning” has on transmission of pertussis to infants, no changes are currently recommended in the use of Tdap vaccine for close contacts of infants, Jennifer Liang, D.V.M., said at a meeting of the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices.

Presenting the conclusions of ACIP’s pertussis vaccines work group review on the impact of cocooning strategies, Dr. Liang, the CDC’s lead member of the work group, said that pertussis vaccination programs should be focused on vaccinating women during every pregnancy, maintaining high levels of DTap coverage, sustaining Tdap coverage in adolescents, and improving Tdap coverage in adults.

In 2005, ACIP recommended the “cocooning” strategy: vaccinating with Tdap for all close contacts of infants under age 12 months to reduce the risk of transmitting pertussis, including parents, siblings, grandparents, child care providers, and health care personnel, in addition to vaccinating pregnant women immediately post partum. In 2011, ACIP recommended Tdap during pregnancy for women who had not previously received the vaccine, or a postpartum dose for women who did not receive the vaccine during pregnancy and had not previously received the vaccine. In 2012, the recommendation was expanded to every pregnancy, whether or not the woman had received the vaccine before.

The optimal strategy to prevent the transmission of pertussis is vaccinating women during pregnancy, which has been shown to be highly effective in reducing transmission to infants, but rates of vaccination in pregnant women have not been high, said Dr. Liang, an epidemiologist in the CDC’s National Center for Immunization and Respiratory Diseases.

Rates of Tdap coverage, however, among pregnant women in the United States have ranged from 14% to 23% in studies using different sources, including a Michigan Medicaid study, she said.

Implementing and sustaining cocooning programs remain a challenge. Although uptake of Tdap has been highest in postpartum women, there has been limited success in vaccinating fathers or other family members, she said, noting that, in 2012, the rate of Tdap coverage among adults aged 19-64 years who reported living with an infant under age 1 year was 26%.

The effect of cocooning in preventing infant pertussis also is “unclear and inconclusive,” and evidence of the effectiveness of the postpartum dose in preventing infant pertussis is limited and the data are conflicting, Dr. Liang said. Another issue is that, over the past decade, the source of transmission to infants has shifted from parents (usually mothers) as the most common source to siblings, who have more recently been identified as the most common source, she said. A CDC study determined that, between 2006 and 2013, family members were the source of the infection in 66%-85% of infant pertussis cases in which the source of infection was known. Siblings were the most common source, linked to almost 40% of cases.

“Even if additional Tdap doses are recommended, this would not address the observed shift to siblings as the source of pertussis to infants and puts greater emphasis on the importance of providing newborns with antipertussis antibodies, and there is an optimal strategy in place – vaccinating women during pregnancy,” she said.

This message is emphasized in a recently launched CDC campaign to improve Tdap vaccination rates during pregnancy, which includes fact sheets for health care professionals that point out that Tdap during pregnancy provides the best protection for infants, postpartum Tdap administration is not optimal, and “cocooning alone may not be effective and is hard to implement.”

Several meeting participants pointed out that vaccine uptake during pregnancy is higher in settings where the vaccine is available on site, as high as 80%-90% of pregnancies, and that having to get the vaccine outside of the office, such as at a pharmacy, can markedly reduce the likelihood of vaccination. The CDC’s updated materials, including fact sheets and posters, are available for health care professionals at http://www.cdc.gov/pertussis/materials/hcp.html.

A single dose of Tdap is recommended for people aged 11-64 years: one dose is routinely administered at age 11 or 12 years and one dose of Tdap is recommended for pregnant women during every pregnancy. DTaP vaccine is used to vaccinate younger children starting at age 2 months and is not licensed for adolescents, adults, or children 7 years of age and older.

[email protected]

Based on the available evidence of the impact “cocooning” has on transmission of pertussis to infants, no changes are currently recommended in the use of Tdap vaccine for close contacts of infants, Jennifer Liang, D.V.M., said at a meeting of the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices.

Presenting the conclusions of ACIP’s pertussis vaccines work group review on the impact of cocooning strategies, Dr. Liang, the CDC’s lead member of the work group, said that pertussis vaccination programs should be focused on vaccinating women during every pregnancy, maintaining high levels of DTap coverage, sustaining Tdap coverage in adolescents, and improving Tdap coverage in adults.

In 2005, ACIP recommended the “cocooning” strategy: vaccinating with Tdap for all close contacts of infants under age 12 months to reduce the risk of transmitting pertussis, including parents, siblings, grandparents, child care providers, and health care personnel, in addition to vaccinating pregnant women immediately post partum. In 2011, ACIP recommended Tdap during pregnancy for women who had not previously received the vaccine, or a postpartum dose for women who did not receive the vaccine during pregnancy and had not previously received the vaccine. In 2012, the recommendation was expanded to every pregnancy, whether or not the woman had received the vaccine before.

The optimal strategy to prevent the transmission of pertussis is vaccinating women during pregnancy, which has been shown to be highly effective in reducing transmission to infants, but rates of vaccination in pregnant women have not been high, said Dr. Liang, an epidemiologist in the CDC’s National Center for Immunization and Respiratory Diseases.

Rates of Tdap coverage, however, among pregnant women in the United States have ranged from 14% to 23% in studies using different sources, including a Michigan Medicaid study, she said.

Implementing and sustaining cocooning programs remain a challenge. Although uptake of Tdap has been highest in postpartum women, there has been limited success in vaccinating fathers or other family members, she said, noting that, in 2012, the rate of Tdap coverage among adults aged 19-64 years who reported living with an infant under age 1 year was 26%.

The effect of cocooning in preventing infant pertussis also is “unclear and inconclusive,” and evidence of the effectiveness of the postpartum dose in preventing infant pertussis is limited and the data are conflicting, Dr. Liang said. Another issue is that, over the past decade, the source of transmission to infants has shifted from parents (usually mothers) as the most common source to siblings, who have more recently been identified as the most common source, she said. A CDC study determined that, between 2006 and 2013, family members were the source of the infection in 66%-85% of infant pertussis cases in which the source of infection was known. Siblings were the most common source, linked to almost 40% of cases.

“Even if additional Tdap doses are recommended, this would not address the observed shift to siblings as the source of pertussis to infants and puts greater emphasis on the importance of providing newborns with antipertussis antibodies, and there is an optimal strategy in place – vaccinating women during pregnancy,” she said.

This message is emphasized in a recently launched CDC campaign to improve Tdap vaccination rates during pregnancy, which includes fact sheets for health care professionals that point out that Tdap during pregnancy provides the best protection for infants, postpartum Tdap administration is not optimal, and “cocooning alone may not be effective and is hard to implement.”

Several meeting participants pointed out that vaccine uptake during pregnancy is higher in settings where the vaccine is available on site, as high as 80%-90% of pregnancies, and that having to get the vaccine outside of the office, such as at a pharmacy, can markedly reduce the likelihood of vaccination. The CDC’s updated materials, including fact sheets and posters, are available for health care professionals at http://www.cdc.gov/pertussis/materials/hcp.html.

A single dose of Tdap is recommended for people aged 11-64 years: one dose is routinely administered at age 11 or 12 years and one dose of Tdap is recommended for pregnant women during every pregnancy. DTaP vaccine is used to vaccinate younger children starting at age 2 months and is not licensed for adolescents, adults, or children 7 years of age and older.

[email protected]

A recommendation to expand serogroup B meningococcal vaccination to include adolescents and young adults, including college students, was supported by the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices, at a meeting on June 24.

The panel voted 14-1 in favor of the following recommendation proposed by ACIP’s meningococcal work group: The serogroup B meningococcal (MenB) vaccine series “may be administered to adolescents and young adults 16 through 23 years of age to provide short-term protection against most strains of serogroup B meningococcal disease,” specifying that 16-18 years is “the preferred age for MenB vaccination.” In reference to the two MenB vaccines now licensed in the United States, the proposal also states that the vaccine be administered as a two- or three-dose series, using the same vaccine product for all doses, with no preference of one product over the other. “Based on available data and expert opinion,” the MenB vaccine used “may be administered concomitantly with other vaccines, indicated for this age, but at a different anatomic site, if feasible.”

The two vaccines licensed by the Food and Drug Administration are Trumenba, a three-dose series marketed by Pfizer, and Bexsero, a two-dose series marketed by GlaxoSmithKline; they are indicated for preventing meningococcal disease caused by Neisseria meningitidis serogroup B in people aged 10-25 years.

The work group’s recommendation is a category B recommendation, so whether the vaccine is recommended is subject to individualized clinical decisions. A university may choose to recommend vaccination for students. In contrast, under a “category A” recommendation, all people in an age- or risk factor–based group would be candidates for immunization. During the discussion before the vote, several panelists raised concerns that while they would not support a category A recommendation at this time, the category B recommendation could create confusion among clinicians and parents about who should get the vaccine and could result in unequal access to the vaccine. One panelist noted that in the past, pediatric practices have not stocked vaccines with a category B recommendation in their offices.

The reasons for choosing the category B recommendation include the current low burden of disease, and the high number of individuals needed to vaccinate to prevent one case or one death of serogroup B disease, explained Jessica MacNeil, an epidemiologist and member of the work group, who is with the CDC’s National Center for Immunization and Respiratory Diseases. Another reason is that the number of cases prevented “may be comparable to the number of serious adverse events” associated with the vaccine, she said.

At the meeting, the panel also voted 15-0 for the statement that children aged 16 though 18 years “without high risk conditions may also be vaccinated” be added to the groups eligible or MenB vaccination in the Vaccines for Children program. The eligible groups currently listed are those aged 10-18 years at increased risk for meningococcal disease “attributable to serogroup B,” which includes those at increased risk because of an outbreak attributed to serogroup B meningococcal disease. These groups were recommended at the last ACIP meeting in February, when the panel recommended MenB vaccination for several groups at increased risk for serogroup B disease, including students during outbreaks at college campuses.

Vaccines with a category B recommendation are covered under Vaccines for Children and the Affordable Care Act.

There was an unprecedented number of public speakers and letters sent to the panel, overwhelmingly in support of broadening the recommendation for vaccination. Many letters were sent from universities or college. Speakers included parents and siblings of young people who had died of meningococcal serogroup B disease, as recently as the fall of 2014, including both college and high school students, and one 20-year-old who was not a college student. One college student whose sister died of meningococcal B disease said it took 6 months for her to get vaccinated, and she eventually was able to get immunized through a travel vaccine clinic. Others said they have gone to Canada to get the vaccine.

Since 2009, there have been seven outbreaks or clusters of serogroup B meningococcal disease reported to the CDC, including two in 2015, for a total of 41 cases. The outbreak at the University of Oregon, Eugene, which started in mid-January, included six cases in students, with one death from meningococcemia in February. In May, the Oregon public health department announced that a 52-year-old man had developed meningococcal disease after visiting his daughter at the university – the seventh confirmed case linked to the outbreak.

ACIP is composed of medical and public health experts who develop recommendations on how to use vaccines to control diseases in the United States.

[email protected]

A recommendation to expand serogroup B meningococcal vaccination to include adolescents and young adults, including college students, was supported by the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices, at a meeting on June 24.

The panel voted 14-1 in favor of the following recommendation proposed by ACIP’s meningococcal work group: The serogroup B meningococcal (MenB) vaccine series “may be administered to adolescents and young adults 16 through 23 years of age to provide short-term protection against most strains of serogroup B meningococcal disease,” specifying that 16-18 years is “the preferred age for MenB vaccination.” In reference to the two MenB vaccines now licensed in the United States, the proposal also states that the vaccine be administered as a two- or three-dose series, using the same vaccine product for all doses, with no preference of one product over the other. “Based on available data and expert opinion,” the MenB vaccine used “may be administered concomitantly with other vaccines, indicated for this age, but at a different anatomic site, if feasible.”

The two vaccines licensed by the Food and Drug Administration are Trumenba, a three-dose series marketed by Pfizer, and Bexsero, a two-dose series marketed by GlaxoSmithKline; they are indicated for preventing meningococcal disease caused by Neisseria meningitidis serogroup B in people aged 10-25 years.

The work group’s recommendation is a category B recommendation, so whether the vaccine is recommended is subject to individualized clinical decisions. A university may choose to recommend vaccination for students. In contrast, under a “category A” recommendation, all people in an age- or risk factor–based group would be candidates for immunization. During the discussion before the vote, several panelists raised concerns that while they would not support a category A recommendation at this time, the category B recommendation could create confusion among clinicians and parents about who should get the vaccine and could result in unequal access to the vaccine. One panelist noted that in the past, pediatric practices have not stocked vaccines with a category B recommendation in their offices.

The reasons for choosing the category B recommendation include the current low burden of disease, and the high number of individuals needed to vaccinate to prevent one case or one death of serogroup B disease, explained Jessica MacNeil, an epidemiologist and member of the work group, who is with the CDC’s National Center for Immunization and Respiratory Diseases. Another reason is that the number of cases prevented “may be comparable to the number of serious adverse events” associated with the vaccine, she said.

At the meeting, the panel also voted 15-0 for the statement that children aged 16 though 18 years “without high risk conditions may also be vaccinated” be added to the groups eligible or MenB vaccination in the Vaccines for Children program. The eligible groups currently listed are those aged 10-18 years at increased risk for meningococcal disease “attributable to serogroup B,” which includes those at increased risk because of an outbreak attributed to serogroup B meningococcal disease. These groups were recommended at the last ACIP meeting in February, when the panel recommended MenB vaccination for several groups at increased risk for serogroup B disease, including students during outbreaks at college campuses.

Vaccines with a category B recommendation are covered under Vaccines for Children and the Affordable Care Act.

There was an unprecedented number of public speakers and letters sent to the panel, overwhelmingly in support of broadening the recommendation for vaccination. Many letters were sent from universities or college. Speakers included parents and siblings of young people who had died of meningococcal serogroup B disease, as recently as the fall of 2014, including both college and high school students, and one 20-year-old who was not a college student. One college student whose sister died of meningococcal B disease said it took 6 months for her to get vaccinated, and she eventually was able to get immunized through a travel vaccine clinic. Others said they have gone to Canada to get the vaccine.

Since 2009, there have been seven outbreaks or clusters of serogroup B meningococcal disease reported to the CDC, including two in 2015, for a total of 41 cases. The outbreak at the University of Oregon, Eugene, which started in mid-January, included six cases in students, with one death from meningococcemia in February. In May, the Oregon public health department announced that a 52-year-old man had developed meningococcal disease after visiting his daughter at the university – the seventh confirmed case linked to the outbreak.

ACIP is composed of medical and public health experts who develop recommendations on how to use vaccines to control diseases in the United States.

[email protected]

A recommendation to expand serogroup B meningococcal vaccination to include adolescents and young adults, including college students, was supported by the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices, at a meeting on June 24.

The panel voted 14-1 in favor of the following recommendation proposed by ACIP’s meningococcal work group: The serogroup B meningococcal (MenB) vaccine series “may be administered to adolescents and young adults 16 through 23 years of age to provide short-term protection against most strains of serogroup B meningococcal disease,” specifying that 16-18 years is “the preferred age for MenB vaccination.” In reference to the two MenB vaccines now licensed in the United States, the proposal also states that the vaccine be administered as a two- or three-dose series, using the same vaccine product for all doses, with no preference of one product over the other. “Based on available data and expert opinion,” the MenB vaccine used “may be administered concomitantly with other vaccines, indicated for this age, but at a different anatomic site, if feasible.”

The two vaccines licensed by the Food and Drug Administration are Trumenba, a three-dose series marketed by Pfizer, and Bexsero, a two-dose series marketed by GlaxoSmithKline; they are indicated for preventing meningococcal disease caused by Neisseria meningitidis serogroup B in people aged 10-25 years.

The work group’s recommendation is a category B recommendation, so whether the vaccine is recommended is subject to individualized clinical decisions. A university may choose to recommend vaccination for students. In contrast, under a “category A” recommendation, all people in an age- or risk factor–based group would be candidates for immunization. During the discussion before the vote, several panelists raised concerns that while they would not support a category A recommendation at this time, the category B recommendation could create confusion among clinicians and parents about who should get the vaccine and could result in unequal access to the vaccine. One panelist noted that in the past, pediatric practices have not stocked vaccines with a category B recommendation in their offices.

The reasons for choosing the category B recommendation include the current low burden of disease, and the high number of individuals needed to vaccinate to prevent one case or one death of serogroup B disease, explained Jessica MacNeil, an epidemiologist and member of the work group, who is with the CDC’s National Center for Immunization and Respiratory Diseases. Another reason is that the number of cases prevented “may be comparable to the number of serious adverse events” associated with the vaccine, she said.

At the meeting, the panel also voted 15-0 for the statement that children aged 16 though 18 years “without high risk conditions may also be vaccinated” be added to the groups eligible or MenB vaccination in the Vaccines for Children program. The eligible groups currently listed are those aged 10-18 years at increased risk for meningococcal disease “attributable to serogroup B,” which includes those at increased risk because of an outbreak attributed to serogroup B meningococcal disease. These groups were recommended at the last ACIP meeting in February, when the panel recommended MenB vaccination for several groups at increased risk for serogroup B disease, including students during outbreaks at college campuses.

Vaccines with a category B recommendation are covered under Vaccines for Children and the Affordable Care Act.

There was an unprecedented number of public speakers and letters sent to the panel, overwhelmingly in support of broadening the recommendation for vaccination. Many letters were sent from universities or college. Speakers included parents and siblings of young people who had died of meningococcal serogroup B disease, as recently as the fall of 2014, including both college and high school students, and one 20-year-old who was not a college student. One college student whose sister died of meningococcal B disease said it took 6 months for her to get vaccinated, and she eventually was able to get immunized through a travel vaccine clinic. Others said they have gone to Canada to get the vaccine.

Since 2009, there have been seven outbreaks or clusters of serogroup B meningococcal disease reported to the CDC, including two in 2015, for a total of 41 cases. The outbreak at the University of Oregon, Eugene, which started in mid-January, included six cases in students, with one death from meningococcemia in February. In May, the Oregon public health department announced that a 52-year-old man had developed meningococcal disease after visiting his daughter at the university – the seventh confirmed case linked to the outbreak.

ACIP is composed of medical and public health experts who develop recommendations on how to use vaccines to control diseases in the United States.

[email protected]