(Last updated June 2, 2022)
On May 6, 2022 MMWR Weekly Report published “Use of a Modified Preexposure Prophylaxis Vaccination Schedule to Prevent Human Rabies: Recommendations of the Advisory Committee on Immunization Practices — United States, 2022.”
Preexposure prophylaxis (PrEP) does not eliminate the need for postexposure prophylaxis (PEP); however, it does simplify the rabies PEP schedule (i.e., eliminates the need for rabies immunoglobulin and decreases the number of vaccine doses required for PEP). As rabies epidemiology has evolved and vaccine safety and efficacy have improved, Advisory Committee on Immunization Practices (ACIP) recommendations to prevent human rabies have changed. The ACIP Rabies Work Group considered updates to the 2008 ACIP recommendations by evaluating newly published data, reviewing frequently asked questions, and identifying barriers to adherence to previous ACIP rabies vaccination recommendations. The following modifications to PrEP are summarized in the recent MMWR report: 1) redefined risk categories; 2) fewer vaccine doses in the primary vaccination schedule; 3) flexible options for ensuring long-term protection, or immunogenicity; 4) less frequent or no antibody titer checks for some risk groups; 5) a new minimum rabies antibody titer (0.5 international units [IUs]) per mL); and 6) clinical guidance, including for ensuring effective vaccination of certain special populations.
A recent CMS Medicare Learning Network® (MLN) fact sheet on Vaccines coverage under Medicare Part D was released in January 2022. Recent changes in ACIP’s recommendations for hepatitis B immunization may prompt increased use of hepatitis B vaccines. Page 3 of the document has specific information on Part D coverage for Hepatitis B vaccine.
In addition to groups for whom HepB vaccination is already recommended, the Advisory Committee on Immunization Practices recommends that all adults aged 19–59 years should receive HepB vaccines.
Details can be found in Universal Hepatitis B Vaccination in Adults Aged 19–59 Years: Updated Recommendations of the Advisory Committee on Immunization Practices — United States, 2022 MMWR. 2022;71(13);477–83.
Two new pneumococcal conjugate vaccines (PCV15 and PCV20) are now recommended as pneumococcal vaccination options for all adults age 65 and older and for adults age 19 through 64 with certain medical conditions or other risk factors for pneumococcal disease; ACIP no longer recommends PCV13 for adults. When PCV15 is used routinely, it should be used in series with PPSV23 given one year later.
For adults eligible for pneumococcal vaccine as a result of age or a high-risk condition who have no or unknown history of pneumococcal conjugate vaccination, the same vaccination schedule options apply to all of them: either give one dose of PCV20 alone, or give a dose of PCV15 followed by a dose of PPSV23 one year later (with a minimum interval option of 8 weeks for people with immunocompromise, CSF leak, or cochlear implant). People age 19 through 64 with immunocompromising and non-immunocompromising underlying medical conditions and other risk factors for pneumococcal disease no longer have separate recommendations for different types of vaccines or numbers of doses.
Details of the recommendations can be found in the ACIP recommendations at www.cdc.gov/mmwr/volumes/71/wr/pdfs/mm7104a1-H.pdf. These recommendations are to be used in conjunction with CDC clinical considerations for the use of pneumococcal vaccines at: www.cdc.gov/vaccines/vpd/pneumo/hcp/recommendations.html.
CDC has released Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices—United States, 2020–21 Influenza Season in the August 21 MMWR Recommendations and Reports. Excerpts from the Summary section appear below.
Inactivated influenza vaccines (IIVs), recombinant influenza vaccine (RIV4), and live attenuated influenza vaccine (LAIV4) are expected to be available. Most influenza vaccines available for the 2020–21 season will be quadrivalent, with the exception of MF59-adjuvanted IIV, which is expected to be available in both quadrivalent and trivalent formulations.
… Primary updates to this report include the following two items. First, the composition of 2020–21 U.S. influenza vaccines includes updates to the influenza A(H1N1)pdm09, influenza A(H3N2), and influenza B/Victoria lineage components. Second, recent licensures of two new influenza vaccines, Fluzone High-Dose Quadrivalent and Fluad Quadrivalent, are discussed. Both new vaccines are licensed for persons aged ≥65 years. Additional changes include updated discussion of contraindications and precautions to influenza vaccination and the accompanying Table, updated discussion concerning use of LAIV4 in the setting of influenza antiviral medication use, and updated recommendations concerning vaccination of persons with egg allergy who receive either cell culture–based IIV4 (ccIIV4) or RIV4.
… Influenza vaccination of persons aged ≥6 months to reduce prevalence of illness caused by influenza will reduce symptoms that might be confused with those of COVID-19. Prevention of and reduction in the severity of influenza illness and reduction of outpatient illnesses, hospitalizations, and intensive care unit admissions through influenza vaccination also could alleviate stress on the U.S. health care system. Guidance for vaccine planning during the pandemic is available at https://www.cdc.gov/vaccines/pandemic-guidance/index.html.
… A brief summary of the recommendations and a link to the most recent Background Document containing additional information are available at https://www.cdc.gov/vaccines/hcp/acip-recs/vacc-specific/flu.html. … Updates and other information are available from CDC’s influenza website (https://www.cdc.gov/flu).
CDC released guidance as online FAQs that specifically address who is considered a health care provider with regard to its Advisory Committee on Immunization Practices’ (ACIP) shared clinical decision-making recommendations. “In this context, CDC defines a health care provider as anyone who provides or administers vaccines: primary care physicians, specialists, physician assistants, nurse practitioners, registered nurses, and pharmacists,” the agency wrote. This guidance is intended to aid states in implementing the recommendations. Read the FAQs.
IAC has developed Don’t Be Guilty of These Preventable Errors in Vaccine Administration, a 4-page print resource describing common but preventable errors made in vaccine administration. This resource also provides information about what to do when errors are made and links to resources that will help prevent errors in the future.
This new resource is a companion piece to IAC's Don't Be Guilty of these Preventable Errors in Vaccine Storage and Handling!
Immunization Action Coalition (IAC) recently updated the following checklists for vaccine contraindications.
The most current information for health care professionals regarding influenza vaccine recommendations (including persons with egg allergy), vaccine supply, and recommendations for using antiviral agents for influenza can be found on the CDC website at www.cdc.gov/flu/professionals/vaccination/index/htm.
ICDC's Vaccine Storage and Handling Toolkit web page for healthcare professionals contains a link to the newly updated Vaccine Storage and Handling Toolkit PDF guide for 2021. The Vaccine Storage and Handling Toolkit reflects best practices for vaccine storage and handling from Advisory Committee on Immunization Practices (ACIP) recommendations, product information from vaccine manufacturers, and scientific studies.
The Toolkit is designed to help health care providers find the information they need quickly and easily. The beginning chapters address the three main elements of an effective cold chain: a well-trained staff, reliable storage and temperature monitoring equipment, and accurate vaccine inventory management. The remaining chapters focus on emergency management of vaccine and developing plans and standard operating procedures for routine and emergency storage and handling.
Note: For more detailed information on storage and handling recommendations and guidance for individual vaccines, please refer to manufacturers’ package inserts found on the Immunization Action Coalition (IAC) website.
OPA annually drafts immunization protocols in compliance with the Ohio State Board of Pharmacy’s rules. Updated protocols for 2022 are now available. Use the following link to purchase the protocol package: Immunization Protocol Package form