ACIP votes to update general recommendations

The Advisory Committee on Immunization Practices voted unanimously to support several changes to the general recommendations for immunizations.

These included:

the timing and spacing of vaccines for those with altered immunocompetence;
updates to the vaccination records and information systems;
and updates to the guidelines for special vaccination situations.

Recommendations made by the ACIP are routinely adopted by the CDC, but must be approved before becoming official policy.

The ACIP added a new specific conditions/medications category to its recommendations labeled “Altered Immunocompetence.” This category covers which vaccinations to administer to patients with altered immunocompetence, as well as when a vaccination should be withheld. The changes also add altered immunocompetence to the list of “reason to administer vaccinations outside of the ACIP recommended age range.”

The conditions recognized by the ACIP to cause altered immunocompetence are interferon gamma/interleukin 12 axis deficiency, interferon alpha deficiency, interferon gamma deficiency and phagocyte function disorders such as Chédiak-Higashi syndrome. Medications such as immunoglobulins, anti-B cell antibodies and induction/consolidation chemotherapy also can cause altered immunocompetence.

The altered immunocompetence portion of the ACIP’s recommendations also covered vaccination of patients who had received a bone marrow transplant. These patients also experience complete immunoablation that requires revaccination.

Updates to vaccination record-keeping systems, known as immunization information systems (IIS), also were part of the changes made. Language was added to the general recommendations to elaborate on the importance and usefulness of IIS. This system can be used to prevent duplicate vaccinations, prevent missed doses, forecast a future dose, reduce vaccine waste and reduce the burden on medical staff to produce vaccination records. These recommendations also focused on encouraging doctors to use the IIS on adult patients.

Language was added to the recommendations in order to highlight changes made to vaccination coverage as a result of the Affordable Care Act. All vaccinations that are part of the ACIP immunization schedule must be covered by insurance companies with no copay or deductible.

The area most hotly debated by voting committee members was language regarding IIS. Committee members recommended further guidelines to help make physicians aware of the practical use of IIS.

“Many adult providers don’t realize, but with meaningful use and the forcing of providers to send the information to IIS, we are getting the word out that providers of immunizations can send their information to IIS in most states,” Kelly Moore, MD, MPH, medical director of the state immunization program of the Tennessee Department of Health, said during the voting session. “We really want people to use those IIS, but more effectively, and to be aware of their capacity, so programs are certainly key to educating adult providers as well about their benefits.”

Other ACIP changes included breast-feeding precautions for women who had received yellow fever vaccine because of the danger of vaccine-derived disease transmission and guidelines for physicians to administer intramuscular vaccines to patients with bleeding disorders. – by David Costill