Advisory Committee On Immunization Practices Recommendations Research Articles

Advisory Committee on Immunization Practices Recommended Immunization Schedule for Children and Adolescents Aged 18 Years or Younger - United States, 2019.

At its October 2018 meeting, the Advisory Committee on Immunization Practices (ACIP)* voted to recommend approval of the Recommended Immunization Schedule for Children and Adolescents Aged 18 Years or Younger, United States, 2019. The 2019 child and adolescent immunization schedule summarizes ACIP recommendations, including several changes from the 2018 immunization schedule,† on the cover page, three tables, and notes found on the CDC immunization schedule website (https://www.cdc.gov/vaccines/schedules/index.html). This immunization schedule is recommended by ACIP and approved by the CDC Director, the American Academy of Pediatrics, the American Academy of Family Physicians, and the American College of Obstetricians and Gynecologists. Health care providers are advised to use the tables and the notes together.

Persistence of bactericidal antibodies 4 years after a booster dose of quadrivalent meningococcal diphtheria toxoid conjugate vaccine (MenACWY-D)

One dose of quadrivalent meningococcal conjugate vaccine (MenACWY) was first recommended for US adolescents (ages 11–12 years) in 2005 to protect against invasive meningococcal disease (IMD). In 2010, after evidence emerged about waning protection within 5 years after MenACWY vaccination, the US Advisory Committee on Immunization Practices (ACIP) recommended a MenACWY booster at age 16 years. We used a serum bactericidal assay with human complement (hSBA) to evaluate antibody persistence after a MenACWY-D booster in a sample of 110 participants who received the booster 4 years earlier in a phase 2 study. High proportions (89.9–98.2%) of participants maintained hSBA titers (≥1:4) associated with protection against IMD; a majority (81.7–97.2%) also had hSBA titers ≥1:8, a more conservative threshold. These findings support ACIP recommendations regarding MenACWY booster vaccination, which are aimed at protecting adolescents and young adults throughout the period in which they are at increased risk of IMD.

Licensure, Approval, and Uptake of Vaccines in the United States.

Immunization is one of the most effective public and private preventive health interventions, resulting in significant reductions in vaccine-preventable diseases and in substantial cost savings to the US healthcare system. Vaccine licensure, development of recommendations for use, and implementation of those recommendations leading to uptake, community protection, and effect on disease burden represent a complex system that requires collaboration in the areas of basic science, public health, vaccine delivery, outcome monitoring, and public perception. The Advisory Committee on Immunization Practices (ACIP) sets standards for immunization delivery for both public and private vaccine providers, and state immunization programs can use these ACIP recommendations to develop school immunization requirements.

Prevention of pneumococcal disease in high risk adults: A pharmacist‐based assessment of adult immunization protocols in clinical practice

BackgroundPneumococcal immunization rates in adults at high‐risk for pneumococcal disease fall below the Healthy People 2020 goal of 60%. Implementation of recommendations from the Advisory Committee on Immunization Practices (ACIP) provides an opportunity to improve patient care. We assessed whether pneumococcal immunization protocols (PIPs) exist for high‐risk adults across diverse clinical settings, determined protocol concordance with the 2012 ACIP recommendations, and identified tactics to improve ACIP recommendation implementation.MethodsWe conducted a multicenter, cross‐sectional survey of members of the American College of Clinical Pharmacy Practice‐Based Research Network, with practice responsibilities for high‐risk adult populations, from September 2014 to May 2015. Pediatric and travel vaccine practices were excluded. Objective survey measures evaluated the PIPs in three areas: (a) development, (b) maintenance, and (c) education. Subjective measures evaluated barriers to ACIP recommendation implementation.ResultsA total of 94 surveys representing 56 inpatient and 38 outpatient sites across 29 states were completed. Twenty‐five of the 45 inpatient PIPs (56%) were concordant with ACIP recommendations. Regular assessment for updates to and a formalized educational and accountability process was in place for 49 (91%) and 46 (85%) of the 54 inpatient PIPs evaluable in these categories, respectfully. Half of the outpatient sites did not have a standardized, written PIP in place. Of the 17 evaluable outpatient PIPs, 9 (53%) were concordant with ACIP recommendations. The most common perceived barriers to ACIP recommended immunization in adults were a lack of knowledge regarding national recommendations, a lack of accountability for recommendation implementation, and outdated PIPs.ConclusionOur study demonstrated that only 36% (34 out of 94) of the clinical sites had adopted the ACIP recommendations. While roughly half of the sites had PIPs in place, education of and accountability for immunizers was lacking, particularly in the outpatient setting. A system that enhances PIP prioritization, education, and accountability would likely address the gaps in adult pneumococcal immunization for high‐risk adults.

2459. Meningococcal ACWY (MenACWY) Vaccination of Adolescents in the United States: How Compliant Are We With the Advisory Committee on Immunization Practices (ACIP) Recommendations?

BackgroundSince 2011, ACIP guidelines for routine meningococcal ACWY vaccination (MenACWY) include a primary dose before age 16 (preferably at ages 11–12) and a booster dose (preferred age 16). Data on rates and drivers of meningococcal vaccination completion and compliance with ACIP recommendations down to state level are limited.MethodsThe 2011–2016 US National Immunization Survey-Teen data among adolescents aged 17 were used (GSK study identifier: HO-17-18202). National and state prevalence were estimated for MenACWY completion (receipt of primary dose at ages 11–15 and booster dose at age 16 or older) and compliance (receipt of primary dose at ages 11–12 and booster dose at age 16). Determinants such as state of residence, demographics, clinical/provider characteristics, vaccine mandates were assessed using multivariable logistic regression. Survey sampling weights were used to obtain population-based estimates.ResultsThe estimated national average prevalence based on 2011–2016 data were 23.2% for MenACWY vaccine completion and 12.1% for compliance in US adolescents. Across states, prevalence varied from 8.7–39.7% for completion and 3.1–26.2% for compliance (Figure 1). Beyond state of residence, factors significantly associated with higher likelihood of both completion and compliance included being male, being up-to-date on other routine vaccines, having private or hospital-based vaccine providers (vs. public), and having >1 child in the household. Factors associated only with completion included having an 11- to 12-year-old well-child examination (OR [95% CI]: 1.5 [1.0–2.2]), >1 annual healthcare visit (2–5 vs. none) (1.4 [1.1–1.8]), and an existing state booster dose vaccine mandate (2.0 [1.5–2.8]) while factors associated with only compliance included history of asthma (1.3 [1.1–1.6]) and high-risk health conditions (1.4 [1.0–2.0]).ConclusionAdolescent completion and compliance rates for MenACWY vaccination in the United States are suboptimal, with significant variability across states. Determinants of completion and compliance with ACIP recommendations identified in this study may help guide clinical, policy, and educational interventions to promote healthcare access/utilization among adolescents in order to increase vaccine uptake. Disclosures W. Cheng, Analysis Group, Inc.: Employee, Research grant. R. Chang, Analysis Group, Inc.: Employee, Research grant. P. Novy, GSK: Employee, Salary. C. O’Connor, Analysis Group, Inc.: Employee, Research grant. M. S. Duh, Analysis Group, Inc.: Employee, Research grant. C. Hogea, GSK: Employee, Salary.

2278. Maternal Immunization Rates With Tetanus–Diphtheria–Acellular Pertussis and Influenza Vaccines in the United States: A Retrospective Claims Database Analysis

BackgroundThe Advisory Committee on Immunization Practices (ACIP) recommends maternal immunization (MI) with tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine during every pregnancy, preferably between 27–36 weeks of gestation, as well as influenza vaccination for all women who are pregnant or who might be pregnant in the influenza season.MethodsThis retrospective cohort analysis characterizes the rate of Tdap and influenza vaccination among large national samples of pregnant women in the United States using administrative claims data. The MarketScan® Commercial Claims and Encounters (“Commercial”) and the Multi-State Medicaid Databases (“Medicaid”) were used to identify pregnancies between January 1, 2010 and April 30, 2017. Diagnosis and procedure codes that describe gestational age at pregnancy end were used to estimate the date of last menstrual period (LMP) or the index date (Figure 1). Eligible pregnancies had ≥6 months of continuous enrollment prior to index date (“baseline”) through 60 days after pregnancy end (“follow-up”). Maternal Tdap and influenza immunization rates are described by calendar year of pregnancy end. Analyses are reported separately for Commercial and Medicaid cohorts.ResultsA total of 1,862,705 and 628,079 eligible pregnancies in the Commercial and Medicaid databases, respectively, were identified. After the 2013 ACIP recommendation to administer Tdap vaccination during each pregnancy, the proportion of pregnancies vaccinated against Tdap was 39% in 2014 and increased to 54% in 2016 for the Commercial cohort (Figure 2). A similar trend for Tdap MI was observed for the Medicaid cohort (Figure 3). In 2016, 41% and 25% of all pregnancies received influenza vaccination in the Commercial and Medicaid cohorts, respectively. Tdap and influenza MI rates also varied by several factors, including maternal age group, geographic region, urban/rural location, and race/ethnicity. ConclusionIn this analysis of large claims databases, for pregnancies ending in 2016 in the Commercial cohort, over 50% received Tdap vaccination and over 40% received influenza vaccination, whereas, in the Medicaid cohort, 30% of all pregnancies were vaccinated against Tdap and 25% received influenza vaccination.Disclosures P. Ghaswalla, GSK: Employee and Shareholder, GSK stock options or restricted shares and Salary. J. E. Poirrier, GSK: Employee and Shareholder, GSK stock options or restricted shares and Salary. E. Packnett, GSK: Research Contractor, Research support. D. Irwin, GSK: Research Contractor, Research support. S. Gray, GSK: Research Contractor, Research support. P. Buck, GSK: Employee and Shareholder, GSK stock options or restricted shares and Salary.

2463. Post-licensure Surveillance of 9-Valent Human Papillomavirus Vaccine (9vHPV) in the Vaccine Adverse Event Reporting System (VAERS), United States, 2014–2017

Background9-valent human papillomavirus vaccine (9vHPV) was licensed in December 2014 and recommended by the Advisory Committee on Immunization Practices (ACIP) in February 2015. 9vHPV is FDA-approved for females and males aged 9–26 years; ACIP recommends routine vaccination at 11–12 years and through age 26 for women and 21 for males. About 29 million doses of 9vHPV were distributed in the United States through the end of 2017. We analyzed the first 3 years of US post-licensure safety data in the Vaccine Adverse Event Reporting System (VAERS).MethodsWe searched VAERS, a spontaneous reporting system, for US reports of adverse events (AEs) following 9vHPV from December 1, 2014 to December 31, 2017. We conducted descriptive analysis of reports and assessed the most common signs and symptoms of AEs. Physicians reviewed reports and available medical records for reports classified as serious (death, life-threatening illness, hospitalization, prolongation of hospitalization and permanent disability) and for selected pre-specified conditions of interest.ResultsVAERS received 7,244 reports following 9vHPV; 186 (2.6%) were classified as serious. In 5,411 (74.7%), 9vHPV was administered alone. The most frequently reported symptoms were dizziness (579; 8.0%), syncope (517; 7.1%), headache (418; 5.8%), nausea (361; 5.0%), and injection site pain (324; 4.5%). Median time from vaccination to symptom onset was <1 day (range 0–751 days). There were 7 (0.1%) death reports; 2 verified from autopsy report, death certificate, and/or medical records (causes of death were cardiac arrest and cerebellar aneurysm) and 5 “hearsay” reports with no verifiable medical information. Reports of selected pre-specified conditions of interest included anaphylaxis (9; 0.1%), Guillain–Barré syndrome (8; 0.1%), postural orthostatic tachycardia syndrome (17; 0.2%), primary ovarian insufficiency (3; <0.1%), and complex regional pain syndrome (1; <0.1%). No unusual clustering around onset interval was observed.ConclusionIn our VAERS review, the safety profile of 9vHPV was consistent with that observed from pre-licensure clinical trials and from post-licensure safety monitoring of other HPV vaccines. We did not observe any new safety signals or unexpected patterns of AEs.Disclosures All authors: No reported disclosures.

Update: Recommendations of the Advisory Committee on Immunization Practices for Use of Hepatitis A Vaccine for Postexposure Prophylaxis and for Preexposure Prophylaxis for International Travel.

Postexposure prophylaxis (PEP) with hepatitis A (HepA) vaccine or immune globulin (IG) effectively prevents infection with hepatitis A virus (HAV) when administered within 2 weeks of exposure. Preexposure prophylaxis against HAV infection through the administration of HepA vaccine or IG provides protection for unvaccinated persons traveling to or working in countries that have high or intermediate HAV endemicity. The Advisory Committee on Immunization Practices (ACIP) Hepatitis Vaccines Work Group conducted a systematic review of the evidence for administering vaccine for PEP to persons aged >40 years and reviewed the HepA vaccine efficacy and safety in infants and the benefits of protection against HAV before international travel. The February 21, 2018, ACIP recommendations update and supersede previous ACIP recommendations for HepA vaccine for PEP and for international travel. Current recommendations include that HepA vaccine should be administered to all persons aged ≥12 months for PEP. In addition to HepA vaccine, IG may be administered to persons aged >40 years depending on the provider's risk assessment. ACIP also recommended that HepA vaccine be administered to infants aged 6-11 months traveling outside the United States when protection against HAV is recommended. The travel-related dose for infants aged 6-11 months should not be counted toward the routine 2-dose series. The dosage of IG has been updated where applicable (0.1 mL/kg). HepA vaccine for PEP provides advantages over IG, including induction of active immunity, longer duration of protection, ease of administration, and greater acceptability and availability.

Immunosuppression Does Not Affect Antibody Concentrations to Measles, Mumps, and Rubella in Patients with Inflammatory Bowel Disease.

The Advisory Committee on Immunization Practices (ACIP) recommends using the immunization record and not serologic testing to determine immunity against measles and rubella in the general population, due to potential false negatives. However, it is unknown whether the immune response is less durable among patients who are immunosuppressed. The primary aim of this study was to evaluate sustained vaccine-induced measles, mumps, and rubella (MMR) antibody concentrations in immunosuppressed patients with inflammatory bowel disease (IBD). We performed a cross-sectional study to compare antibody concentrations following the two-dose (MMR) vaccine among 46 patients with IBD and 20 healthy controls (HC). Three IBD groups stratified by the immunosuppressive regimen that preceded study entry for at least 3 months: (1) thiopurine monotherapy, (2) anti-TNF monotherapy, or (3) combination therapy (anti-TNF agent combined with an immunomodulator) were enrolled. All subjects had measurable antibody concentrations to the three vaccine viruses. Age and time since receipt of MMR series were similar in both groups. There were no difference in the antibody concentration of measles (IBD 667mIU/ml vs HC 744mIU/ml; p = 0.45), mumps (IBD 339EU/ml vs HC 402EU/ml; p = 0.62), or rubella (IBD 25mIU/ml vs HC 62mIU/ml; p = 0.11) among the groups. No differences in antibody concentrations were found among the IBD treatment groups. Immunosuppressed patients with IBD have sustained antibody concentrations comparable to healthy controls. Thus, gastroenterologist should follow the ACIP recommendations and use the immunization record when available to determine immunity to measles and rubella in patients with IBD. Clinical Trials Registry # NCT02434133.

Discrepancies Between US Food and Drug Administration Vaccine Licensure Indications and Advisory Committee on Immunization Practices Recommendations: Provider Knowledge and Attitudes

PurposeIn the United States, the Center for Biologics Evaluation and Research at the US Food and Drug Administration (FDA) is responsible for licensure of vaccines. The Advisory Committee on Immunization Practices (ACIP) is a federal advisory committee that provides guidance to the Centers for Disease Control and Prevention (CDC) on use of vaccines. Discrepancies between FDA licensure indications and ACIP/CDC vaccine recommendations exist, challenging health care providers. The objectives of this study were: (1) to categorize differences between FDA vaccine licensure indications and ACIP/CDC vaccine recommendations for vaccines; and (2) to assess knowledge, attitudes, and practices of pediatricians, family physicians, and obstetrician-gynecologists regarding their understanding of differences. MethodsInformation was extracted from FDAvaccine package inserts, and corresponding information was collected for ACIP/CDC vaccine recommendations (2000–2014) for vaccines in the childhood and adult immunization schedules. Surveys regarding knowledge of discrepancies were distributed electronically to members of the Georgia chapters of the American Academy of Pediatrics (GA-AAP) and the American Academy of Family Physicians (GA-AAFP), and the national American College of Obstetricians and Gynecologists (ACOG) in 2014. FindingsDifferences were identified in 20 instances: differences in age group indications were identified in 6, in dosing administration schedules in 4, and in immunocompromised hosts and pregnant women in 10. We received 145 (8.5%) responses from GA-AAP, 237 (9.5%) from GA-AAFP, and 869 (1.5%) from national ACOG members. A total of 105 (72%) GA-AAP respondents reported that they follow AAP recommendations and 168 (71%) GA-AAFP respondents follow ACIP recommendations. GA-AAP and GA-AAFP respondents generally were not aware of data the FDA considers for vaccine licensure or data that pharmaceutical company representatives are permitted to discuss. Respondents remain current with vaccine recommendations through review of materials from professional organizations, the CDC, and package inserts; Continuing Medical Education; and information from pharmaceutical representatives. A total of 780 (90%) ACOG respondents had no concerns regarding routinely recommended reduced diphtheria toxoid and acellular pertussis vaccines (n = 730 [84%]) and influenza during pregnancy vaccines (n = 852 [98%]) to pregnant patients. However, these findings must be interpreted within the context of a low overall ACOG survey response rate. ImplicationsEducation regarding existence of and reasons for discrepancies between FDA licensure of and ACIP/CDC recommendations for vaccines and reasons for these differences could optimize immunization delivery.

Prevention of Pertussis, Tetanus, and Diphtheria with Vaccines in the United States: Recommendations of the Advisory Committee on Immunization Practices (ACIP).

SummaryThis report compiles and summarizes all recommendations from CDC's Advisory Committee on Immunization Practices (ACIP) regarding prevention and control of tetanus, diphtheria, and pertussis in the United States. As a comprehensive summary of previously published recommendations, this report does not contain any new recommendations and replaces all previously published reports and policy notes; it is intended for use by clinicians and public health providers as a resource. ACIP recommends routine vaccination for tetanus, diphtheria, and pertussis. Infants and young children are recommended to receive a 5-dose series of diphtheria and tetanus toxoids and acellular pertussis (DTaP) vaccines, with one adolescent booster dose of tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine. Adults who have never received Tdap also are recommended to receive a booster dose of Tdap. Women are recommended to receive a dose of Tdap during each pregnancy, which should be administered from 27 through 36 weeks’ gestation, regardless of previous receipt of Tdap. After receipt of Tdap, adolescents and adults are recommended to receive a booster tetanus and diphtheria toxoids (Td) vaccine every 10 years to assure ongoing protection against tetanus and diphtheria.

Knowledge and Attitudes Regarding Category B ACIP Recommendations Among Primary Care Providers for Children

ObjectiveIn 2015, the Advisory Committee on Immunization Practices (ACIP) made a category B recommendation for use of serogroup B meningococcal (MenB) vaccines, meaning individual clinical decision-making should guide recommendations. This was the first use of a category B recommendation pertaining to a large population and the first such recommendation for adolescents. As part of a survey regarding MenB vaccine, our objectives were to assess among pediatricians (Peds) and family physicians (FPs) nationally: 1) knowledge of the meaning of category A versus B recommendations and insurance coverage implications, and 2) attitudes about category A and B recommendations. MethodsWe surveyed a nationally representative sample of Peds and FPs via e-mail and mail from October to December 2016. ResultsThe response rate was 72% (660 of 916). Although >80% correctly identified the definition of a category A recommendation, only 24% were correct about the definition for category B. Fifty-five percent did not know that private insurance would pay for vaccines recommended as category B, and 51% did not know that category B-recommended vaccines would be covered by the Vaccines for Children program. Fifty-nine percent found it difficult to explain category B recommendations to patients; 22% thought ACIP should not make category B recommendations; and 39% were in favor of category B recommendations because they provide leeway in decision-making. ConclusionsFor category B recommendations to be useful in guiding practice, primary care clinicians will need to have a better understanding of their meaning, their implications for insurance payment, and guidance on how to discuss them with parents and patients.

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Hepatitis A vaccination coverage among adolescents (13–17 years) in the United States, 2008–2016

BackgroundThe hepatitis A (HepA) vaccine was recommended by the Advisory Committee on Immunization Practices (ACIP) incrementally from 1996 to 1999. In 2006, HepA vaccine was recommended (1) universally for children aged 12–23 months, (2) for persons who are at increased risk for infection, or (3) for any person wishing to obtain immunity. Catch-up vaccination can be considered. ObjectiveTo assess HepA vaccine coverage among adolescents and factors independently associated with vaccination administration in the US. MethodsThe 2008–2016 National Immunization Survey–Teen was utilized to determine 1 and ≥2 dose HepA vaccination coverage among adolescents aged 13–17 years. Factors associated with HepA vaccine series initiation (1 dose) were determined by bivariate and multivariable analyses. Data were stratified by state groups based on ACIP recommendation: universal child vaccination recommended since 1999 (group 1); child vaccination considered since 1999 (group 2); universal child vaccination recommendation since 2006 (group 3). ResultsIn 2016, national vaccination coverage for 1 and ≥2 doses of HepA vaccine among adolescents was 73.9% and 64.4%, respectively. Nationally, a 40 percentage point increase in vaccination coverage occurred among adolescents born in 1995 compared to adolescents born in 2003. Nationally, the independent factors associated with increased vaccine initiation was race/ethnicity (Hispanic, American Indian/Alaskan Native, Asian), military payment source and provider recommendation for HepA vaccination (2008–2013). Living in a suburban or rural region, living in poverty (level <1.33–5.03), and absence of state daycare or school HepA requirement were common factors associated with decreased likelihood of vaccine initiation. ConclusionsEfforts to increase HepA vaccine coverage in adolescents in all regions of the country would strengthen population protection from hepatitis A virus (HAV).

Advisory Committee on Immunization Practices Recommended Immunization Schedule for Adults Aged 19 Years or Older - United States, 2018.

In October 2017, the Advisory Committee on Immunization Practices (ACIP) voted to approve the Recommended Immunization Schedule for Adults Aged 19 Years or Older, United States, 2018. The 2018 adult immunization schedule summarizes ACIP recommendations in two figures and a table of contraindications and precautions for vaccines recommended for adults, and is intended is to assist health care providers in implementing the current ACIP recommendations for vaccinating adults. The schedule can be found at https://www.cdc.gov/vaccines/schedules.* The full ACIP recommendations for each vaccine are available at https://www.cdc.gov/vaccines/hcp/acip-recs/index.html. The 2018 adult immunization schedule has also been approved by the American College of Physicians (https://www.acponline.org), the American Academy of Family Physicians (https://www.aafp.org), the American College of Obstetricians and Gynecologists (https://www.acog.org), and the American College of Nurse-Midwives (http://www.midwife.org). The ACIP-recommended use of each vaccine is developed after an in-depth review of vaccine-related data, including data on disease epidemiology, vaccine efficacy and effectiveness, vaccine safety, feasibility of program implementation, and economic aspects of immunization policy (1).

Advisory Committee on Immunization Practices Recommended Immunization Schedule for Children and Adolescents Aged 18 Years or Younger - United States, 2018.

In October 2017, the Advisory Committee on Immunization Practices (ACIP) approved the Recommended Immunization Schedule for Children and Adolescents Aged 18 Years or Younger - United States, 2018. The 2018 child and adolescent immunization schedule summarizes ACIP recommendations, including several changes from the 2017 immunization schedules, in three figures and footnotes to the figures. These documents can be found on the CDC immunization schedule website (https://www.cdc.gov/vaccines/schedules/index.html). These immunization schedules are approved by ACIP (https://www.cdc.gov/vaccines/acip/index.html), the American Academy of Pediatrics (https://www.aap.org), the American Academy of Family Physicians (https://www.aafp.org), and the American College of Obstetricians and Gynecologists (https://www.acog.org). Health care providers are advised to use the figures and the footnotes together. The full ACIP recommendations for each vaccine, including contraindications and precautions, can be found at https://www.cdc.gov/vaccines/hcp/acip-recs/index.html. Providers should be aware that changes in recommendations for specific vaccines can occur between annual updates to the childhood/adolescent immunization schedules. If errors or omissions are discovered within the child and adolescent schedule, CDC posts revised versions on the CDC immunization schedule website.

Administration Rates of the Tdap Vaccine in Obstetric Patients.

Infants younger than 6 months of age are at high risk for contracting pertussis because of not being fully vaccinated. The Advisory Committee on Immunization Practices (ACIP) recommends vaccinating all pregnant women with tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine (Tdap) between 27 and 36 weeks to offer passive immunity to the infant to help protect them until they are able to receive the full pertussis series. To assess and compare compliance with the 2013 ACIP recommendation of vaccinating pregnant women with Tdap at 27 to 36 weeks' gestation in 2 obstetric clinics. This cross-sectional, retrospective chart review evaluated Tdap vaccine compliance in a random sample of obstetric patients from October 2013 to September 2014. The primary outcome evaluated the proportion of patients who received Tdap between 27 and 36 weeks' gestation. Secondary outcomes included the proportion of patients who received Tdap at any point in pregnancy and within 30 days postpartum. The charts of 573 patients were reviewed, and 237 met inclusion criteria. For the primary outcome, 142 patients (59.9%) received the Tdap vaccine. Overall, 156 patients (65.8%) received Tdap at some point during the pregnancy. Factors associated with receiving the Tdap vaccination were insurance status, prenatal care risk level and site of prenatal care, receipt of the influenza vaccine, and preterm labor in the current pregnancy. The Tdap vaccine rate was 65.8%, with 59.9% of patients receiving the vaccine within the recommended ACIP timeframe. Further education, improvements in documentation, and chart reminders are needed to enhance administration.

Recommendation of the Advisory Committee on Immunization Practices for Use of a Third Dose of Mumps Virus-Containing Vaccine in Persons at Increased Risk for Mumps During an Outbreak.

A substantial increase in the number of mumps outbreaks and outbreak-associated cases has occurred in the United States since late 2015 (1,2). To address this public health problem, the Advisory Committee on Immunization Practices (ACIP) reviewed the available evidence and determined that a third dose of measles, mumps, rubella (MMR) vaccine is safe and effective at preventing mumps. During its October 2017 meeting, ACIP recommended a third dose of a mumps virus-containing vaccine* for persons previously vaccinated with 2 doses who are identified by public health authorities as being part of a group or population at increased risk for acquiring mumps because of an outbreak. The purpose of the recommendation is to improve protection of persons in outbreak settings against mumps disease and mumps-related complications. This recommendation supplements the existing ACIP recommendations for mumps vaccination (3).

Beneficiary characteristics and vaccinations in the end-stage renal disease Medicare beneficiary population, an analysis of claims data 2006-2015.

The Advisory Committee on Immunization Practices (ACIP) routinely recommends three vaccines - influenza, hepatitis B, and pneumococcal vaccines - for End-Stage Renal Disease (ESRD) dialysis patients. We sought to assess vaccination coverage among fee-for-service (FFS) Medicare beneficiaries with ESRD who received Part B dialysis services at any point from January 1, 2006 through December 31, 2015 (through June 30, 2016 for influenza). To assess influenza vaccination rates in a given influenza season, we restricted the population to beneficiaries who were continuously enrolled in Medicare Parts A and B throughout all twelve months of that season. To assess hepatitis B and pneumococcal vaccine coverage following dialysis initiation, we developed a Kaplan-Meier curve for all patients who began dialysis between 2006 and 2015. For influenza vaccination, we identified an average of approximately 325,000 ESRD dialysis beneficiaries enrolled through each influenza season from 2006-2015. Seasonal influenza vaccination rates steadily increased during the 10-year period, from 52% in 2006-2007 to 71% in 2015-2016. The greatest increases in influenza vaccination appear in non-white beneficiaries with overall utilization in non-whites higher than in whites (p < .001). For the hepatitis B and pneumococcal vaccinations, we identified over 350,000 ESRD dialysis beneficiaries who began dialysis over the 10-year study window. The probability of receiving a hepatitis B vaccine within the first three years of entering into the ESRD program was higher (77%) than the probability of receiving any pneumococcal vaccine (53%). 45% of ESRD patients completed at least one dose of the two hepatitis B series (three-dose or four-dose) at any time during the study period. Opportunities exist at regional and facility levels to improve vaccination coverage. Compliance to ACIP recommendations may directly affect risk for ESRD dialysis patients for complications from diseases that can be mitigated by vaccination.

Perspectives from the Society for Pediatric Research: Decreased Effectiveness of the Live Attenuated Influenza Vaccine.

The intranasal live attenuated influenza vaccine (LAIV), FluMist, has been widely appreciated by pediatricians, parents, and children alike for its ease of administration. However, concerns regarding lack of effectiveness in recent influenza seasons led to the CDC Advisory Committee on Immunization Practices (ACIP) recommendation to administer inactivated influenza vaccines (IIVs), and not LAIV, during the 2016-17 and 2017-18 seasons. Given that data from previous years demonstrated equivalent and even improved efficacy of LAIV compared with IIV, these recent data were surprising, raising many questions about the potential mechanisms underlying this change. This review seeks to summarize the history of LAIV studies and ACIP recommendations with a focus on the recent decrease in vaccine effectiveness (VE) and discordant results among studies performed in different countries. Decreased VE for A/H1N1pdm09 viruses represents the most consistent finding across studies, as VE has been low every season these viruses predominated since 2010-11. Potential explanations underlying diminished effectiveness include the hypothesis that prior vaccination, reduced thermostability of A/H1N1pdm09, addition of a fourth virus, or reduced replication fitness of A/H1N1pdm09 strains may have contributed to this phenomenon. Ongoing studies and potential alterations to LAIV formulations provide hope for a return of effective LAIV in future influenza seasons.