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ACIP changes recommendations for HPV, pneumococcal vaccines
The CDC’s Advisory Committee on Immunization Practices, or ACIP, voted today on new recommendations for HPV and pneumococcal vaccination in adults.
The committee voted unanimously to raise the upper age for catch-up vaccination against HPV in men to age 26 years — in harmony with the recommendation for women — and recommended that patients aged up to 45 years speak with their doctors about receiving the vaccine. The FDA expanded approval for the vaccine for adults aged 27 to 45 last October.
In a close vote, members decided not to recommend the 13-valent pneumococcal conjugate vaccine (Prevnar13, Pfizer; PCV13) for all adults age 65 or older who have not previously received it, reversing a 2014 recommendation. Instead, they recommended that the decision be left to doctors and patients.
The 8-6 vote against recommending PCV13 for all older adults follows continued reductions in PCV13-type disease due to the indirect effects from pediatric PCV13 use, which the committee foresaw as potentially limiting the 2014 recommendation’s utility, leading to the new vote.
The ACIP pneumococcal working group had not reached a consensus on this and two other pneumococcal vaccine policy options prior to the meeting, and requested that a decision be made by voting ACIP members based on available data.
Three motions were introduced — one for each policy option — and voting took place in order of the motions.
The committee voted 13-1 against the second policy option, “ACIP no longer recommends PCV13 for adults 65 years or older who do not have an immunocompromising condition. All adults 65 years or older should receive a dose of PPSV23.”
It voted 13-1 to recommend that PCV13 be administered “based on shared clinical decision making” in adults 65 years or older who do not have an immunocompromising condition and who have not previously received PCV13. It recommends that all adults 65 years or older receive a dose of the 23-valent pneumococcal polysaccharide vaccine (PPSV23).
“I really think we need a lot more research and thought in the whole area of shared decision making and identifying high risk groups,” ACIP voting member Peter Szilagyi, MD, MPH, executive vice-chair of the department of pediatrics at the University of California, Los Angeles, said at the meeting. “Obviously, the over-65-year-old, non-immunocompromised [population] is not a homogenous group.”
The ACIP previously recommended routine vaccination with the HPV 9-valent vaccine (Gardasil 9, Merck) for adolescents aged 11 to 12 years and catch-up vaccination for females aged up to 26 years and for males aged up to 21 years. Males aged between 22 to 26 years are also recommended for vaccination, particularly in several risk categories including men who have sex with men and those with immunocompromising conditions.
The ACIP HPV vaccines working group reviewed evidence over the past year on age-related policy and sought to address two policy questions in its recommendations for voting members:
Should catch-up HPV vaccination be recommended for primary prevention of HPV infection and HPV-related disease for all persons through age 26 years?
Should catch-up HPV vaccination be recommended for primary prevention of HPV infection and HPV-related disease for all persons aged 27 through 45 years?
For the first question, the group reached a consensus prior to the meeting and recommended harmonization of the upper age for catch-up vaccination for males and females through age 26 years, concluding that this would simplify the immunization schedule and communication about HPV vaccination.
The group did not reach consensus prior to the meeting on the second question. The majority opinion was stated as “a recommendation for individual clinical decision making for persons aged 27 through 45 years,” with a large minority opinion favoring “no recommendation for catch-up vaccination for persons older than 26 years,” according to the document.
The committee voted 10-4 to recommend HPV vaccination based on shared clinical decision making for individuals ages 27 through 45 years who are not adequately vaccinated.
“I think this is going to be a frequent issue that the ACIP is going to be dealing with in the future as vaccines become more complex and more targeted for certain populations,” ACIP chair José Romero, MD, FAAP, director of the pediatric infectious diseases section at the University of Arkansas for Medical Sciences and Arkansas Children’s Hospital, said at the meeting. – by Joe Gramigna
Disclosures: ACIP voting members report no relevant financial disclosures.
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