Respiratory Vaccines Update
Robert H. Hopkins, Jr., MD, medical director, National Foundation for Infectious Diseases (NFID) and ACIP liaison, offers guidance and insights on a variety of respiratory vaccines.
Thus far into the respiratory virus season, COVID-19, influenza, and RSV vaccine uptakes have been low across all 3 immunizations, with the flu shot having the highest utilization. A Centers for Disease Control and Prevention’s (CDC) MMWR report published yesterday offered insights on the statistics so far into the respiratory virus season (Table).
“As of November 9, 2024, cumulative estimated coverage with 2024–2025 influenza and COVID-19 vaccines among adults aged ≥18 years was 34.7% and 17.9%, respectively. Estimated RSV vaccination coverage was 39.7% among adults aged ≥75 years and 31.6% among those aged 60–74 years at increased risk,” the authors wrote.1
And in addition to the low uptake for respiratory virus vaccines, federal public health guidance and FDA approvals have been evolving. This year, federal public health officials have made changes and updated recommendations on a number of these vaccines, including RSV, COVID-19, and pneumococcal disease. Updates have been reflected in the CDC Advisory Committee on Immunization Practices (ACIP) meeting in October as well as recent FDA approval decisions. Here is some more information about a few of the changes regarding respiratory virus vaccines.
RSV Vaccines.
Last month, the FDA approved Pfizer’s RSV vaccine for adults aged 18 to 59 years who are at increased risk. This is a departure from previous approvals and guidance.
“RSV vaccines, manufactured by Pfizer, GlaxoSmithKline and Moderna are all now FDA approved for use in older adults,” said Robert H. Hopkins, Jr, MD, medical director, National Foundation for Infectious Diseases (NFID) and ACIP liason. “Pfizer sought expanded approval from FDA based on a clinical trial which looked at immunogenicity, and looked at safety and tolerability of this vaccine in persons 18 to 49 with chronic medical conditions...It's important to note that ACIP also approved the GlaxoSmithKline RSV vaccine for use in adults 50 to 59 in June based on somewhat similar data in a trial.”
COVID-19 Vaccines.
During the CDC’s ACIP meeting in October, the committee recommended a second COVID-19 vaccine dose for individuals aged 65 and older and younger individuals with moderate to severe immunocompromised conditions, spaced 6 months apart.2
Although ACIP offered a recommendation looking at seniors and the immunocompromised, Hopkins believes vaccine coverage should extend beyond those populations.
“I would strongly recommend that everyone 6 months of age and older—who's not already done so since September—to get the 2024-2025 COVID 19 vaccine,” Hopkins said.
As part of his reasoning, he points to racial and ethnic disparities in terms of groups being more susceptible to severe forms of COVID-19. “It's much less well known that we continue to have significant racial and ethnic disparities in the rate of COVID-19 hospitalizations,” Hopkins said. “The rate for Native American, Alaskan natives, and Black Americans are significantly higher than for white, Hispanic, and Asian Americans.
Lastly, he points to the pediatric population and hospitalization.
“The highest rate of hospitalization for COVID in children is less than 4 years and particularly in children from 6 months to 40 or 6 months and younger. Kids 6 months and younger are too young to be vaccinated on their own, obviously, and they're best protected by maternal vaccination during pregnancy, only half of the kids admitted to the hospital with COVID 19 had underlying medical conditions. Eighteen percent of those kids ended up in the ICU. Of children 6 months to 17 years admitted to the hospital, less than 5% had received the current vaccine prior to admission,” Hopkins said.
“So, this all comes down to the fact we're missing far too many opportunities to save lives, hospitalizations, and morbidity with the COVID vaccine.”
Table. This was created through ChatGPT using data in a CDC MMWR.
Pneumococcal Vaccines.
During that same round of ACIP meetings, the committee recommended the pneumococcal conjugate vaccine for PCV-naive adults aged 50 and older. Again this recommendation is a departure from previous guidance.2
Hopkins says this change is from 2 newer pieces of information that includes risk-based criteria.
“A significant portion of persons 50 and older who have chronic medical conditions, which would put them into a risk-based recommendation that we previously had in place, either are unvaccinated and know they have those risk factors, or don't know they have those risk factors,” Hopkins said. “Second, there's a significant risk disparity based on race and ethnicity. For example, Black men are at increased risk for invasive pneumococcal disease in that 50 plus age group, and that's not been a risk-based group. And so, it's the hope that moving to an age-based recommendation will allow us to close some of these gaps, protect more of these people from hospitalization and other adverse outcomes, including death.”
The Continued Need for Vaccination
The beginning of the holiday season is starting next week with Thanksgiving, and typically incidence rates for seasonal viruses increase during this time of year as people travel and gather together with family and friends. This is another good reason for people to protect themselves as well as loved ones, especially those who are in vulnerable populations including seniors, people with existing health conditions, and those who are immunocompromised.
