Q&A: AAP endorses giving routine immunizations, COVID-19 vaccines at same time
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The AAP has endorsed giving childhood and adolescent immunizations at the same time as COVID-19 vaccines.
Previously, it was recommended that children and adults not receive any other vaccine within 14 days of receiving a COVID-19 vaccine — a recommendation that was made out of an abundance of caution, a CDC scientist said Wednesday during a meeting of the CDC’s Advisory Committee on Immunization Practices.
The ACIP voted unanimously to recommend the Pfizer-BioNTech vaccine for children aged 12 to 15 years. During the meeting, the CDC said that COVID-19 vaccines “may now be administered, without regard to timing” with other vaccines in both children and adults, and the AAP released a policy statement supporting the new guidance.
Infectious Diseases in Children spoke with Flor M. Munoz, MD, MSc, FAAP, an associate professor of pediatrics and infectious diseases at Baylor College of Medicine, who cowrote the policy statement.
Healio: Did the AAP compose the new policy statement supporting the administration of adolescent immunizations at the same time as COVID-19 vaccines independent of the CDC, or was it aware that the CDC also was going to suggest this during Wednesday’s meeting?
Munoz: The process is no different from what normally happens with all kinds of policy statements and all kinds of discussions regarding immunization in children. There is a representative of the CDC at the AAP, so these types of discussions — just like we do every year with influenza vaccination, or any new vaccine that becomes available — are always in harmony with CDC. So, it is not an independent recommendation, and it is not a recommendation that is done blindly. The CDC is aware of what AAP’s Committee on Infectious Diseases discusses and vice versa.
Healio: Are there data that support the new policy?
Munoz: The policy is really looking at providing opportunities for vaccination, in making sure that for this particular age group, which includes 12-to-15-year-old children, there is no further delay in immunization. The data that were used to consider this recommendation are not from the adolescent group, because clearly the COVID-19 vaccine study in that population was not done with concomitant administration.
There are some data from adult studies that are still ongoing, some not in the United States, some related to specific vaccines. For the most part, the coadministration considerations are related to influenza vaccines in that we know that there will be a need for coadministration to be able to be efficient, from a practical standpoint.
There are some data that were available for the adult population that were considered, and the reality is that the discussion for children 12 years and older, which is still a pediatric population, is still not a population that is immunologically a lot different from the young adults.
Part of what also is considered when you make this decision, in terms of coadministration data, is that other vaccines have been evaluated for coadministration in the past and coadministration has not raised concerns, regarding immunogenicity for the majority of vaccines that are inactivated.
We know, for example, that if you give a live vaccine like the measles or the varicella vaccine, you could have some effects in the immune response to other vaccines that you give shortly after that. But when it comes to giving inactivated vaccines, or non-live vaccines, at the same time, that effect has not been seen.
These are also some of the data that were considered, just looking historically at other experiences with coadministration of non-live vaccines, and noting that from a immunogenicity standpoint, there really is little to no concern raised from the knowledge about any interference with how the vaccine responses will occur.
Certainly, one of the reasons for COVID-19 vaccine studies is to have that window of 14 days around the decision for the COVID-19 vaccine, because in a clinical study, you want to make sure that you don't have any confounders with the assessment of the reactogenicity. So, any side effect that could be associated with the vaccinations, if you give other vaccines at the same time, you will not be able to know which one caused the side effect.
Knowing the safety profile, and what kind of reactions to expect with the COVID-19 vaccine, was also another piece of data that was taken into consideration because we know what to expect now, and we also know what to expect in terms of reactogenicity from other already available vaccines, like the influenza vaccine, or Tdap, which are other vaccines that are given to teenagers. All of those are very safe vaccines with very few reactions that occur after administration. Again, we now have a distinct understanding of which types of side effects can be associated with each vaccine.
Keeping in mind that we're still in a pandemic, the issue is really ensuring that there's no delay in receiving the COVID-19 vaccine for this population, and if having to wait because the administration of other vaccines was going to be a barrier, it's really more of an implementation in public health type of decision involving access and making sure that we don't miss opportunities to vaccinate, not just for COVID-19 but for the other infections as well.
Healio: How should pediatricians proceed in implementing this new policy? How should they talk to patients and their parents about it?
Munoz: We are seeing tremendous enthusiasm from pediatricians. Actually, this was a highly anticipated approval. This week has been wonderful for pediatrics. One of the questions that pediatricians had is precisely this coadministration because having to wait 14 days after the last dose, that actually was going to be more difficult to implement. So, what we're seeing is really welcome enthusiasm from the pediatricians with the recommendation that allows them to really not have to worry too much about when the vaccines are given. It gives them more flexibility, it gives them an opportunity to really make sure that children are up to date with their vaccines before school starts.
So, from an implementation standpoint, some children already started getting vaccinated yesterday, as the vaccine recommendations became available, as the approval became available. I know our institution is vaccinating already.
The implementation is geared toward catching up everybody with the COVID-19 vaccine. So, bringing them in to get a COVID-19 vaccine is also going to provide an opportunity to have the pediatricians review with the parents and the children their immunization records and be able to provide them with other vaccines that they need or an appointment to get those vaccines, if that's possible.
From a practical standpoint, I think pediatricians were happy with this, and they're able to really do more than just COVID-19.
Healio: What about pediatricians whose patients may seek a COVID-19 vaccine outside of their practice?
Munoz: It still is possible that because of the storage requirements of some of the vaccines, they might not be available at all pediatricians’ offices but certainly will be much more available in the clinics and hospitals or distribution centers that are able to give it. Coordinating that vaccine administration and making sure that the records are updated in the pediatricians’ offices is going to be another logistical piece that will be important.
Summertime is usually a time for school physicals, for maybe some travel advice, summer camps that are starting to open up again, where the vaccinations are required. There are many opportunities during this time of the year for pediatricians to review immunizations. Everybody is given a card right now with their COVID-19 vaccination. I think it's going to be in the best interest of parents and pediatricians to make sure that the record of that vaccine exists in their medical records, so that if they lose a card or something, the pediatrician will have that information.
I think there will be an effort to educate all of the vaccine centers that are vaccinating young children to provide information to parents so that they can communicate or share that information with their pediatrician. I'm sure that pediatricians are in contact with their families, when it comes to providing vaccination. It’s become a lot more common now to do telehealth and other types of online communications.
Healio: How far behind are America’s adolescents on routine immunizations?
Munoz: That's an important point. They are more behind than what I thought they would be, to be honest with you. There was a sharp drop in vaccinations last year, as soon as all of the social distancing and closings occurred. So, it's been a year of that. It looks like we did a pretty good job with influenza vaccines.
I have to say, the uptake of influenza vaccine is not great. It's not as high as it should be. About two-thirds of children get their influenza vaccine every year. As of Thanksgiving last year, it was pretty much similar to previous seasons. I think, overall, there is usually a drop in uptake after the holidays, and this year without influenza, we did see a little bit of a drop of uptake in flu vaccines.
But among other vaccines, one concern is that coverage for the MMR vaccine has dropped significantly during the pandemic. There has been some uptick, after vaccinations began for COVID-19. I know that there's been some increase in vaccination. We are either getting close, but not quite there yet to prepandemic coverage rate.
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