Immunization Update for Pharmacists

Changes to immunization schedules, a review of this season’s flu shot, and potential vaccines in the pipeline were just a few of the topics broached at the American Pharmacist Association’s Annual Meeting and Exposition session on immunizations.

During the session held in San Diego, California, on March 28, 2015, Stephan L. Foster, PharmD, FAPhA, a University of Tennessee professor and liaison representative of the Advisory Committee on Immunization Practices (ACIP), and Jeff Goad, PharmD, MPH, FAPhA, professor and chairman at Chapman University, also addressed the latest vaccines for meningococcal type B and human papillomavirus (HPV).

Drs. Foster and Goad focused mostly on recommendations from the ACIP, but they also touched on guidelines from the Infectious Disease Society of America (IDSA), including those for vaccinating individuals with altered immunocompetence.

Vaccines may prompt serious infections among immunodeficient patients, so pharmacists should look out for certain conditions or drugs that may cause immunodeficiency. The IDSA’s latest recommendations include a differentiation between high- and low- levels of immunodeficiency. The society labeled cancer patients undergoing chemotherapy and those who have had solid organ transplant rejection therapy 2 months ago as high-level conditions, while a lower-level classification may include those taking alternate doses of corticosteroid therapy. IDSA’s guidelines recommended withholding live and inactivated vaccines at least 2 weeks before beginning therapy.

ACIP’s most recent general guideline, which was published in 2011, is “something all pharmacists should have,” Dr. Foster said. Once recommendations are published, the committee immediately gets involved in updating them. Dr. Foster mentioned that there has been some talk amongst the committee of an online document that is continually updated. Therefore, pharmacists could soon see new general recommendations from ACIP.

Influenza vaccine

Currently, the ACIP recommends that children aged 2 to 8 years receive only 1 dose of the influenza vaccine if they received the vaccine last year for the first time and were administered just 1 dose. However, this will not hold true next year, Dr. Foster said.

There has also been a slight change in wording for pharmacists who receive flu vaccine supplies early, such as in June. In the past, pharmacists were instructed that they could administer the vaccine as soon as they received it. Now, it is recommended that pharmacists provide immunizations shortly after receiving the vaccine.

Needle-fearing patients may receive Afluria, which the FDA approved in 2014 as the first needle-free delivery system for the inactivated influenza vaccine.

“Do not tell patients it is a pain-free injection,” Dr. Foster advised. “It is a needle-free injection.”

Pharmacists can also expect patient resistance to the flu vaccine next season, considering the drift of the influenza strain in the most recent season.

Drs. Foster and Goad also reminded attendees that the flu vaccine must be shaken.

HPV vaccines

Drs. Foster and Goad reviewed Gardasil 9, which the FDA approved in December 2014. The vaccine prevents certain cancers caused by 5 more types of HPV and increases coverage rates for cervical cancer serotypes to 90% and still covers 90% of genital warts. It is approved for use in girls aged 9 to 26 years and boys aged 9 to 15 years.

Dr. Goad pointed to graphs showing a slow increase in the number of boys receiving the HPV vaccine.

“We’re still nowhere near where we’d like them to be,” Dr. Goad said.

Dr. Foster mentioned that, in New York, success with boys’ vaccination rates could be attributed to the approach of showing adolescent boys what genital warts really look like.

Meningococcal B vaccines

The meningococcal B vaccine, Trumenba, was approved in October 2014 for individuals aged 10 to 25 years. It has a 3-dose series of 0, 2, and 6 months.

Back in the 2013-2014 season, there was a meningococcal B disease outbreak with 9 cases in Princeton and several at the University of California, Santa Barbara. About 30,000 Princeton students were vaccinated with Bexsero, which, at the time, was under a new drug application to prevent serogroup B meningococcal disease. This vaccine was approved as a 2-dose regimen for those aged 10 to 25 years.

While meningococcal outbreaks garner a lot of media attention, only about 2% of all meningococcal disease occurs as an outbreak, Dr. Goad said.

Future vaccines

An Ebola vaccine has completed phase 1 trials, and phase 2 and 3 trials will take place in 2015, Drs. Foster and Goad noted. Meanwhile, a vaccine for dengue, which has potential for domestic and international traveler use, is undergoing phase 3 trials.

Dr. Goad also mentioned that a vaccine for Chikungunya is in the works.