ACIP OKs Changes to 2021 Vax Schedule

Changes to the 2021 immunization schedules included a new vaccine against meningococcal groups A, C, W, and Y; stronger language about influenza vaccines in those with severe allergic reactions; and added language about tetanus toxoid-containing vaccines for wound management, according to the CDC’s Advisory Committee on Immunization Practices (ACIP) on Thursday.

In a virtual meeting, the ACIP voted 14-0 to adopt the edited schedules for adults and children. This vote was delayed from Wednesday due to a discussion about how to best indicate vaccinations, such as HPV, measles, mumps, and rubella (MMR), and varicella, that should be delayed until after pregnancy.

Though the action is largely a formality, the ACIP is required to vote on all changes made to the adult and child immunization schedule since October 2019, prior to publication in the Morbidity and Mortality Weekly Report in February 2021.

For 2021, new vaccine MenACWY-TT (MenQuadfi) was added as an option to prevent disease from meningococcal serogroups A, C, W, and Y. The FDA approved MenQuadfi in April 2020 for use in people ages 2 and older.

Zoster vaccine live (Zostavax), or ZVL, was removed from the adult immunization schedule, with the CDC website noting it is no longer sold in the U.S. after July 1, 2020.

Other terminology changes included a new abbreviation for live attenuated influenza vaccine (LAIV4 vs LAIV).

However, the majority of changes related to language within the recommendations themselves. Some of the more extensive changes related to severe allergic reactions to egg-based influenza vaccines, as well as how vaccination interacted with antivirals.

• For an egg allergy with symptoms other than hives, language was added to warn how severe allergic reactions can occur in the absence of a history of previous allergic reaction, stating: “all vaccine providers should be familiar with the office emergency plan and be certified in cardiopulmonary resuscitation” and that a previous severe allergic reaction to influenza vaccine is a “contraindication to future receipt of the vaccine”

• LAIV4 should not be used if the patient received influenza antivirals oseltamivir or zanamivir within the previous 48 hours, peramivir within the previous 5 days, or baloxavir within the previous 17 days

• LAIV4 should not be used in children younger than age 2

ACIP also approved extensive additions about wound management for both children and adults in terms of administering tetanus toxoid-containing vaccines.

• For children younger than age 7 with any wounds other than “clean or minor wounds,” those who received three or more doses of tetanus toxoid-containing vaccine should be administered diphtheria/tetanus/pertussis (DTaP) vaccine if more than 5 years since their last dose

• For people older than age 7 with clean or minor wounds, those with three or more doses of tetanus toxoid-containing vaccine should be administered tetanus/diphtheria/acellular pertussis (Tdap) or Td vaccine if more than 10 years since their last dose. For all other wounds, administer Tdap or Td if more than 5 years since the last dose

• Tdap is preferred for people over age 11 who have not previously received Tdap, whose vaccination status is unknown, and pregnant women

As well, the recommendations include cosmetic changes meant to streamline their presentation. For example, the pink “delay” box for vaccines in pregnancy is now a red box, with an asterisk and additional wording indicating that clinicians should delay HPV, MMR, and varicella vaccines until after pregnancy.

The schedule also added some language to make it clearer that Tdap vaccine is recommended during pregnancy.

Other changes to the adult vaccination schedule included that shared clinical decision-making should be used for hepatitis B vaccine for people with diabetes age 60 and older, and HepA-HepB vaccine (Twinrix) may be administered on an accelerated schedule to those traveling to countries with high or intermediate rates of hepatitis A.

The 2021 child and adult immunization schedules are generally published in Pediatrics and Annals of Internal Medicine, respectively, in the beginning of the year.