In a paper published in the Journal of Adolescent Health, study authors outline the potential changes in the Advisory Committee on Immunization Practices’ (ACIP) vaccine recommendations that are in the pipeline which may “destabilize” the immunization platform’s structure that has been in place and improved vaccination rates among adolescents since 1996. Specifically, the authors evaluate the 2 most notable and potential issues, which include changes in policy in relation to the recommendations for the meningococcal and the human papillomavirus (HPV) vaccines.
In 2005, the MenACWY vaccine (Penbraya; Pfizer) was recommended for children 11 to 12 years of age as well as 15 years of age and those entering college as a temporary vaccination strategy, if previously unvaccinated. In 2010, a routinely recommended booster dose at 16 years of age was added after studies indicated that the efficacy faded after 3 to 5 years. With the introduction of the pentavalent MenABCWY vaccine, which is the MenACWY vaccine with the MenB (Trumenba, Bexsero; Pfizer, GSK) vaccine, the ACIP has indicated that it would re-examine the overall meningococcal vaccine dosing schedule.
Currently, the recommendation is either 1 of the following regimens: a MenACWY quadrivalent vaccine (Q) at 11 or 12 years of age, quadrivalent vaccine at 16 years, and a shared clinical decision-making recommendation for a MenB vaccine (B) at 16 to 23 years of age (with a preference for 16 to 18 years of age) along with a second MenB dose as instructed per product (Q-Q-B-B); or a MenACWY quadrivalent vaccine (Q) at 11 or 12 years of age, a MenABCWY pentavalent vaccine (P) at 16 years followed by a MenB vaccine dose (B) as indicated by product information (Q-P-B). According to the authors, the Q-P-B schedule is currently considered complicated because of the lack of interchangeability of the MenB component of the currently available pentavalent product with the MenB vaccine from a different manufacturer.
With guidelines potentially changing, the authors express their concern for removing the MenACWY vaccine dose at age 11 to 12 years. They note that although there have been decreases in the overall US rates of meningococcal disease in recent decades, they have hesitation removing the dose entirely because of lack of evidence that doing so would not result in further deaths or other serious consequences. Additionally, a weakening of established immunization platform visits by shifting when vaccines are administered may also negatively impact the provision of other primary prevention strategies that are in place for adolescents.
According to the authors, more research is needed before effectively changing dosing schedules. Specifically, they note that this could be an opportunity to both strengthen the 11- to 12-year and 16-year immunization platforms by creating both a Q-P-P or P-P-P recommendation (which provides MenB without a significant increase in cost compared with Q-Q-B-B), and a 17- to 18-year visit for a second—or third, if applicable—pentavalent dose and o complete any remaining vaccines that are needed before youths become adults and are no longer eligible for programming and vaccines that are free and more accessible.
Additionally, the authors note the potential change of the routine HPV vaccination to ages 9 to 10 years instead of 11 to 12. The ACIP recommends targeting those 11 to 12; however, the vaccination series can begin as early as 9 years of age and has been licensed for this indication since 2006. In the US, the ACIP currently recommends that a 2-dose series for HPV vaccination is administered if the first dose is given before the age of 15 years.
Ket Takeaways
- Potential Changes in Meningococcal Vaccine Schedule: The ACIP may revise the current meningococcal vaccine dosing, with concerns about removing the MenACWY dose those who are 11 to 12 years of age. The authors stress caution, citing potential risks of increased meningococcal disease without clear evidence to support such a change, and worry that it could disrupt the established adolescent immunization schedule.
- Shifting HPV Vaccine Recommendations: There is a potential shift to begin routine HPV vaccination at ages 9 to 10 years instead of 11 to 12, based on emerging evidence of stronger immune responses and increased vaccination rates. However, authors express concern that this could destabilize the current adolescent immunization platform, potentially lowering overall vaccination rates.
- Focus on Simplified and Consistent Recommendations: To ensure vaccination adherence, the authors advocate for streamlined vaccine schedules, such as maintaining the 11- to 12-year visit for second doses of HPV vaccines and promoting consistent public messaging about the long-term benefits of vaccines, particularly in a post-pandemic context.
Further, emerging evidence suggests that 1 dose of the HPV vaccine may be sufficient for long-term protection from infections, with some countries adopting a single-dose regimen. Finalized results of ongoing randomized clinical trials are necessary to confirm whether 1 dose is suitable for long-lasting immunity. Currently, the US recommendation is for an interval of 6 to 12 months between 2 doses; however, a longer interval is considered acceptable, and regardless of the interval, the regimen does not need to be restarted.
The following factors have been identified by the US National HPV Roundtable to support the shift of HPV vaccination to 9 to 10 years: allows more time to complete vaccination series by age 13; leads to a strong immune response to HPV vaccination; increased probability of vaccinating prior to first HPV exposure; decreases questions about sexual activity by parents or guardians; decreases requests for only vaccines required for school entry; decreases the number of shots given to patients per visit; increases vaccination coverage and, as a result, the number of cancers that are prevented; increases vaccination rates for those aged 9 to 10 years, according to several health systems; and has shown to be highly acceptable to health systems, providers, and parents.
Despite the factors, the authors express concern that the change may weaken the currently established platform, unintentionally resulting in lower overall adolescent vaccination rates. They suggest that a potential solution would be to recommend the second dose of the 2-dose series administered at the 11- to 12-year visit, maintaining the early adolescent immunization platform while simplifying the HPV vaccination regimen. The authors stress that the primary discussion related to HPV vaccines should always include cancer prevention and, despite potential discomfort, sexual health and preventing sexual health consequences.
The authors conclude by emphasizing that simplified recommendations that adhere to current guidelines and also decrease the number of injections patients need, can help adherence and are often preferred. In addition, they stress the importance of consistent messaging for the public about the benefits of vaccination throughout a child’s lifespan, and this is more necessary that ever post-pandemic.
REFERENCE
Middleman, AB, Zimet, GD. Potential Changes to the Adolescent Immunization Schedule: Implications for the Stability of Adolescent Immunization Platform Visits. J Adolesc Health. 2024;75(4):538-542 doi:10.1016/j.jadohealth.2024.07.010
