CDC Advisors Back Updated COVID, Flu Vaccines for the Fall

The CDC’s Advisory Committee on Immunization Practices (ACIP) endorsed new COVID-19 and influenza vaccines for the 2024-2025 respiratory virus season on Thursday.

In a unanimous 11-0 vote, the ACIP recommend that everyone 6 months of age and older should receive an updated COVID-19 vaccine, similar to last year’s recommendation.

The committee also voted unanimously that everyone 6 months of age and older should receive an updated 2024-2025 influenza vaccine, with rare exceptions. Also, in another unanimous vote, members voted that high-dose inactivated (HD-IIV3) and adjuvanted inactivated (aIIV3) influenza vaccines are acceptable options for influenza vaccination in solid organ transplant recipients.

Shortly after the meeting, CDC Director Mandy Cohen, MD, MPH, endorsed the recommendations.

In a final unanimous vote, members recommended that the new 21-valent pneumococcal vaccine (PCV21; Capvaxive) is an option for adults ages 19 years and older who currently have a recommendation to receive a dose of pneumococcal conjugate vaccine. Clinical recommendations that explain the different options of pneumococcal vaccines will be forthcoming, committee members said.

COVID Vaccines

The most recent data, presented at the meeting, indicate that COVID-19 continues to take a significant toll on adults ages 65 and older and young infants. According to CDC data, more than 916,300 people were hospitalized in 2023 due to COVID-19 and more than 75,500 people died of COVID-19.

From October 2023 through May 2024, population-based hospitalization rates among adults ages 75 and older were about 800-900 per 100,000 population — more than three times as high as among adults ages 65 to 74, Fiona Havers, MD, MHS, of the National Center for Immunization and Respiratory Diseases, told committee members. “Rates among adults ages 65 to 74 and infants less than 6 months of age have roughly equal rates,” she pointed out.

American Indian/Alaska Native, Hispanic, and Black populations were also more likely to be hospitalized for COVID-19 than whites during that time period.

Adults ages 65 and older during that period comprised 82% of all in-hospital deaths, Havers noted.

Waning patterns of the 2023-2024 COVID-19 vaccine effectiveness in preventing critical illness appeared to be similar to previous vaccine formulations, reported Ruth Link-Gelles, PhD, MPH, of the CDC. For example, vaccine effectiveness in preventing hospitalization in adults decreased over time from about 49% at 7 to 59 days after vaccination to 14% at 120 to 179 days.

“I think it’s really important to keep in mind that this should be interpreted as incremental or additional effectiveness in a population with a lot of underlying immunity,” Link-Gelles said, pointing to the fact that the majority of the population has had at least one COVID-19 infection along with multiple vaccinations.

Earlier in June, an FDA advisory committee voted unanimously to recommend that the COVID-19 vaccines for the 2024-2025 season target a JN.1 lineage of the virus, though FDA recently advised vaccine makers to be even more specific and target its descendent KP.2 if possible. Updated COVID-19 vaccines will be available from Moderna, Novavax, and Pfizer later this year. ACIP’s recommendation will take effect as soon as the new vaccines are available, the CDC said.

Influenza Vaccines

The committee reaffirmed that most individuals 6 months of age and older should receive an influenza vaccine. All influenza vaccines for the 2024-2025 season will be trivalent, and will protect against an H1N1, H3N2, and a B/Victoria lineage virus. The composition of this season’s vaccine compared with last season’s has also been updated with a new influenza A(H3N2) virus.

In addition, the committee voted unanimously to recommend high-dose inactivated (HD-IIV3) and adjuvanted inactivated influenza vaccines as options for solid organ transplant recipients ages 18 through 64 who are receiving immunosuppressive medication regimens, without a preference over another age-appropriate IIV3 or RIV3.

Solid organ transplant recipients require lifelong immunosuppressive medications, making lower respiratory infections more severe, with high hospitalization, mechanical ventilation, and mortality rates. “We believe that transplant patients really suffer from a lack of good protection from the lower standard dose [influenza] vaccine,” commented ACIP member Camille Kotton, MD, of Massachusetts General Hospital in Boston, noting however that the high-dose influenza vaccine is not covered by insurance for many people with solid organ transplants because of age restrictions.

“We’ve been in a situation where we have to fill out prior authorizations every single time you want to give an influenza vaccine. We’re hoping that if we voted in favor of this change, that it would enhance equity and protection for this vulnerable population,” she said.

Pneumococcal Conjugate Vaccines

In a final vote of the day, the committee unanimously voted to recommend the new 21-valent pneumococcal conjugate vaccine (PCV21) as an option for adults ages 19 years or older who are already eligible to receive a dose of pneumococcal conjugate vaccine.

The vaccine recently received FDA approval for preventing invasive pneumococcal disease and pneumococcal pneumonia in adults ages 18 and older. Based on epidemiologic data from the CDC, the serotypes included in the vaccine together cause roughly 84% of the cases of invasive pneumococcal disease in adults 50 and older. By comparison, the 20-valent pneumococcal conjugate vaccine (PCV20) covers the serotypes responsible for 52% of cases in this age group. The single-dose vaccine contains eight unique serotypes that are not covered by other available vaccines (15A, 15C, 16F, 23A, 23B, 24F, 31, and 35B).

The ACIP’s Pneumococcal Vaccines Work Group agreed that available evidence supported the use of PCV21 for adults ages 19 or older who already have a recommendation to receive a pneumococcal conjugate vaccine. However, despite the FDA approval for adults ages 50 and up, the Work Group could not reach a consensus on whether the current age-based recommendation for PCV21 should be lowered from adults ages 65 or older to adults 50 or older, without a risk-based indication.

The committee did not recommend use of PCV21 among adults ages 19 to 49 who currently do not have a risk-based pneumococcal vaccine indication.

Currently, the CDC recommends the PCV15 or PCV20 for adults who never received a PCV and are ages 65 years or older, or ages 19 through 64 with certain risk conditions. If PCV15 is used, it should be followed by a dose of PPSV23. Adults who received an earlier PCV (e.g., PCV7 or PCV13) should talk with a vaccine provider to consider available options to complete the pneumococcal vaccine series. Adults 65 or older have the option to get PCV20 if they have already received PCV13 (but not PCV15 or PCV20) at any age and PPSV23 at or after the age of 65. These adults can talk with a vaccine provider and decide, together, whether to get PCV20.

Current recommendations for the pneumococcal vaccines are “just confusing,” James Loehr, MD, chair of the Pneumococcal Vaccines Work Group group, told committee members. Despite acknowledging that lowering the eligible age for the PCV21 vaccine to age 50 would improve vaccine equity, “We were also torn by the confusion that would be in place if we lowered the recommendation for PCV21 to age 50, but not for PCV20, because then we would have three recommendations for people in their 50s,” he said.

The ACIP plans to revisit this issue at their October 2024 meeting.

All recommendations from ACIP are not considered final until published in the CDC’s Morbidity and Mortality Weekly Report.

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