ACIP issues recommendations for zoster, pneumococcal vaccines

Abstract

At a recent meeting of CDC’s Advisory Committee of Immunization Practices (ACIP), the group recommended recombinant zoster vaccine (RZV) for adults 19 years and older who are immunodeficient or immunosuppressed as well as the routine use of select pneumococcal vaccines in adults 65 years and older and those aged 19 to 64 years with certain underlying medical conditions or other risk factors. The pneumococcal vaccine recommendation only applies to those who have not yet received a pneumococcal conjugate vaccine or those whose vaccination history is unknown. Data presented at the ACIP meeting on October 20, 2021, revealed the complications of herpes zoster (e.g., post-herpetic neuralgia, hospitalizations), and how the risk of zoster infection is heightened for those who are immunocompromised. The ACIP group recommended that adults (19 years and older) who are immunodeficient or immunosuppressed due to disease or therapy receive 2 doses of RZV for the prevention of herpes zoster and its complications. Clinicians may be challenged, however, in identifying those who are immunodeficient or immunosuppressed, as conditions in this group of patients might not appear as straightforward as those who have cancer or a transplant. “I don’t think a Medrol Dose Pack is immunosuppressive, but dispensing software may flag it as such—so the pharmacist needs to be able to work through that decision-making,” said Adam Welch, PharmD, MBA, FAPhA, associate dean for assessment and academic affairs at East Tennessee State University’s Bill Gatton College of Pharmacy. “Pharmacists should review guidance from ACIP on altered immunocompetence to help them.” This guidance can be found on CDC’s website at apha.us/ACIPrecs Another consideration is the timing and spacing of the 2 doses. “It’s best to give RZV prior to the next cycle/dose of an immunosuppressive drug if it can’t be given in anticipation of immunosuppression,” said Welch. Additionally, the second dose can be given 1 to 2 months after the first dose (minimum of a 4-week spacing period) for immunocompromised adults, whereas those who are immunocompetent can continue to receive the 2 doses 2 to 6 months apart. Welch also noted that RZV has been studied concomitantly with other vaccines (e.g., Fluarix, PPSV23, and Boostrix) with no evidence of immune response interference or safety concerns and it can be administered with COVID-19 vaccines. The new ACIP recommendations state that eligible patients should receive a pneumococcal conjugate vaccine, either the PCV20 (20-valent pneumococcal conjugate vaccine) or PCV15 (15-valent pneumococcal conjugate vaccine). If PCV15 is used, this should be followed by a dose of PPSV23 (23-valent pneumococcal polysaccharide vaccine). Based on these new recommendations, PCV13 is no longer recommended for use in adults. This is the first time any pneumococcal conjugate vaccine has been routinely recommended for certain risk populations ages 19 to 64, such as those with diabetes and asthma. The table below lists certain medical conditions and other risk factors for those 19 to 64 years. “Based on this new recommendation it’s important to note that if a patient already received PCV13, it looks like they wouldn’t need PCV15/PPSV23 or PCV20,” said Welch. “Also, clear documentation is essential, using the correct abbreviations.” He said it will be important for clinicians to not call it pneumococcal vaccine, since that is now too vague. It should be identified more specifically as either PPSV23, PCV15, or PCV20. The ACIP recommendations are not final until they receive approval from CDC and HHS. Underlying medical conditions or other risk factors▪Alcohol use disorder▪Chronic heart/liver/lung disease▪Cigarette smoking▪Diabetes mellitus▪Chronic renal failure▪Nephrotic syndrome▪Immunodeficiency▪Iatrogenic immunosuppression▪Generalized malignancy▪HIV▪Hodgkin disease, leukemia, lymphoma, multiple myeloma▪Solid organ transplants▪Congenital or acquired asplenia▪Sickle cell disease or other hemoglobinopathies▪CSF leak or cochlear implant ▪Alcohol use disorder▪Chronic heart/liver/lung disease▪Cigarette smoking▪Diabetes mellitus▪Chronic renal failure▪Nephrotic syndrome▪Immunodeficiency▪Iatrogenic immunosuppression▪Generalized malignancy▪HIV▪Hodgkin disease, leukemia, lymphoma, multiple myeloma▪Solid organ transplants▪Congenital or acquired asplenia▪Sickle cell disease or other hemoglobinopathies▪CSF leak or cochlear implant