Vaccine primer: Flu, meningococcal and pneumococcal disease

The latest recommendations from the Centers for Disease Control and Prevention (CDC) Advisory Committee on Immunization Practices, reported by AOA liaison Stanley E. Grogg, DO, cover vaccinating young adults against meningococcal disease, when to give seniors pneumococcal vaccines and a preview of what’s in next year’s flu shot. Here’s a closer look.

Meningococcal vaccines

Meningococcal disease can have a very rapid onset with flu-like symptoms, including high fever, muscle aches and cough. Antibiotics only help if started during the first few hours of the disease. The ACIP recently reviewed MenB, the newest of the FDA-approved meningococcal vaccines. The B serotype is the most common to cause meningococcal disease in adolescents.

• According to the ACIP, “MenB may be administered to adolescents and young adults 16-23 years of age to provide short term protection against most strains of serogroup B meningococcal disease. The preferred age for MenB vaccination is 16 through 18 years of age.” This is considered a Category B or permissive recommendation.
• Two B-strain vaccines for ages 10 to 25 were licensed in the U.S. recently: Bexsero, by GlaxoSmithKline, was approved in January. It’s given in two doses, at a retail price of $160 per dose. Pfizer’s Trumenba was licensed in October. That’s a three-dose series at $115 a shot.

Influenza vaccine

A new flu vaccine for the 2015-16 seasons has been approved by the World Health Organization and the CDC.

• The trivalent vaccines will include an A/California/7/2009 (H1N1) pdm09-like virus, an A/Switzerland/9715293/2013 (H3N2)-like virus and a B/Phuket/3073/2013-like virus.
• The quadrivalent vaccines will also include a B/Brisbane/60/2008-like virus.

The algorithm for one or two doses of influenza vaccine for a child 6 months to 8 years of age was simplified as follows:

• If a child received 2 or more total doses of trivalent or quadrivalent influenza vaccine during any prior season(s), only one dose is needed.
• If the child has only received one dose in the past or if it is unknown if the child has received 1 or 2 doses in the past, then 2 doses separated by at least 4 weeks should be administered.

Pneumococcal vaccine spacing

The time interval for pneumococcal vaccines was changed for adults 65 years of age or older:

• If the patient had no previous pneumococcal vaccine (PCV13-Prevnar by Pfizer or PPSV23=Pneumovax by Merck), a dose of PPSV23 should be given at least one year following a dose of PCV13.
• The two vaccines should not be co-administered.
• If a dose of PPSV23 is given earlier than the recommended interval, the dose need not be repeated.

Previously, the spacing was 6-12 months.

No changes were made in the spacing for patients aged 24 months to 64 years of age. If a PCV13 is given, one should wait at least 8 weeks for PPSV23 vaccine for high-risk patients.