With the spread of COVID-19, influenza, respiratory syncytial virus (RSV), and other viruses, now is the time for pharmacists to stay up to date on vaccine recommendations, says BCIDP Infectious Diseases. Manager David Ha said. In session at Stanford Health Care, National Association of Community Pharmacists’ 2024 Annual Convention and Exhibition.
So far this year, Ha said, CDC data shows a significant increase in cases of COVID-19, as well as rhinoviruses and adenoviruses. Although the rise in influenza and RSV cases has not yet begun, it is inevitable, Ha said. The seasonal peak hospitalization burden in 2024 and 2025 is expected to be similar to or slightly lower than the 2023-2024 season. 1
“But we’ve been fooled before, so I just want to remind you to be careful about it,” Ha said. “Now or yesterday was the time to get vaccinated.”
Woman receiving vaccine | Photo image credit: wavebreak3 | stock.adobe.com
COVID-19 vaccine
The 2024-2025 formulation of COVID-19 vaccines is for the monovalent Omican JN.1 strain of SARS-CoV and KP.2 (formerly XBB), and includes mRNA vaccines and protein-based vaccines available from Moderna and Pfizer. The Novavax vaccine will be used. Mr. Ha emphasized the importance and responsibility of community pharmacies, noting that approximately 80% of U.S. adults have received a COVID-19 vaccine from a pharmacy. 1
“As you may know, vaccination rates have been declining in recent years, with data from earlier this year showing that perhaps less than a third of patients are up to date with their COVID-19 vaccine. “That suggests something,” Ha said.
Across all age groups, the 2023-2024 vaccine was effective against infectious diseases and hospitalizations, particularly emergency and emergency department visits. The efficacy of the 2023-2024 vaccine will last at least six months after vaccination, and the 2024-2025 vaccine is expected to be similar. 1
Safety data shows side effects similar to previous seasons. Guillain-Barre syndrome has been seen in Pfizer vaccine recipients over the age of 65, with an incidence of 4.1 cases per million people. Ha said it was unclear whether this was related to the vaccine or a coincidence. Ischemic strokes can occur among Pfizer or Moderna vaccine recipients who are 50 to 64 years old or Moderna vaccine recipients who are 65 and older, but this is inconsistent across age groups. 1
Importantly, Ha said, the CDC’s Vaccine Safety Datalink shows that there is no risk of myocarditis or pericarditis in men ages 12 to 39 who receive the COVID-19 vaccine, which has been a concern for some time. 2 said no signs were found. However, this uptake in this patient population may be limited by low vaccine doses.
The CDC Advisory Committee on Immunization Practices (ACIP) recommends one dose of the 2024-2025 mRNA vaccine for everyone age 5 and older, with the Novavax vaccine an option for patients age 12 and older. It becomes. One dose of the mRNA vaccine is recommended regardless of previous vaccination, and three doses are recommended for moderately to severely immunocompromised patients. For people who have not been previously vaccinated, two doses of Novavax (at least three weeks apart) are recommended. 1
There have been several new updates to the ACIP recommendations ahead of the 2024-2025 season. In particular, a second dose is now recommended for people aged 65 and over, ideally 6 months (minimum 2 months) from the first or previous dose. A second dose is also recommended for people 6 months and older with moderate to severe immunodeficiency. 1
“The period of reduced immunity lasts about four to six months, which is a problem for higher-risk groups, especially those over 65 and those with moderate to severe immunodeficiency.” he said. “These two groups have a disproportionate number of hospitalizations and severe illness, so we want additional protection for these people.”
Ideally, ACIP recommends using the same manufacturer for the second vaccine. However, the two mRNA vaccines can be used interchangeably if the same vaccine is not available. For patients receiving the Novavax vaccine, the first two doses must be the same, but if more than 8 weeks have passed since the first dose, the mRNA vaccine can be substituted if Novavax is not available. 1
Ha also pointed out that self-certification of moderate to severe immunodeficiency is sufficient and no special documentation is required. This also applies to RSV vaccination for older adults, which we will discuss later.
“What I want to say is that now is the time to get vaccinated against COVID-19,” Ha concluded.
influenza
Although there were no major ACIP updates to the influenza vaccine this year, there were notable changes to the formulation. Mr Ha said the new formulation is trivalent as opposed to the previous quadrivalent formulation, and since no cases have been detected since 2020 due to the novel coronavirus disease (COVID-19) intervention, influenza B/Yamagata He said the stock has been removed. Instead, the 2024-2025 strains are A/H1N1 (Victoria), A/H3N2, and B/Austria (a Victoria-like strain). 1
ACIP recommends routine influenza vaccination for everyone 6 months of age and older, and for those 65 and older, a high-dose adjuvant vaccine such as Fluzone High-Dose, Fluad, or Flublok or a recombinant You should receive the vaccine as a priority. Solid organ transplant recipients may also receive one of these options. 1
“This data makes it very convincing that these vaccines are much more effective than standard-dose vaccines for solid organ transplant recipients,” Ha said. “We hope that in the future, ACIP will extend this recommendation to all immunocompromised patients.”
One notable update for the 2025-2026 season is the planned availability of FluMist’s at-home vaccination option. This provides patients with a new, more convenient way to benefit from influenza vaccination. 3 Mr Ha said this could be particularly helpful for children.
Avian influenza type A (H5N1), commonly referred to as avian influenza, is not related to vaccination, but patients may have questions, Ha said. So far, 324 farms in 14 states have been affected, with 31 human infections as of October 18. All of these cases involved contact with animals, and the symptoms were mild, and no markers of human-to-human transmission or antiviral resistance have been found.
RSV
Focusing mainly on RSV vaccination in the elderly, Ha said that despite low public awareness, the vaccine is at least as important as COVID-19 or influenza vaccination. Older adults, people living in long-term care facilities, and people with heart and lung disease are particularly at risk for severe RSV. 1
“We see RSV on a daily basis, but it is a very difficult disease to manage,” Ha said. “It can cause more severe illness than the flu, and it can cause more severe illness than COVID-19. RSV vaccination is at least effective against COVID-19. It is equally important and should be considered the norm for those eligible for vaccination.”
The RSV vaccine is highly effective and fairly durable, highlighted by the fact that revaccination is not recommended, but Ha said questions remain about this. Although there is some decrease in effectiveness from season to season (approximately 89% to 78%), data shows that effectiveness lasts up to three seasons. 1
ACIP recommends routine RSV vaccination for unvaccinated individuals age 75 and older. Regular vaccinations are recommended for people aged 60 to 74 who have not been vaccinated and are at high risk of severe disease. Revaccination is not indicated for those who have been previously vaccinated. 1
Ha said that similar to COVID-19, self-certification is sufficient evidence of the presence of risk factors and no one should be denied RSV vaccination due to lack of documentation. There are no official recommendations regarding the timing of vaccination, but it is recommended between August and October for maximum effectiveness. Importantly, Ha noted that healthy individuals between the ages of 60 and 74 are no longer eligible for the CDC’s RSV vaccine recommendations.
pneumococcus
Finally, Mr. Ha briefly touched on pneumococcal vaccination. Capvaxive (Merck) is a modern pneumococcal vaccine that does not cover serogroup 4.1 but has improved coverage of serotypes that cause invasive pneumococcal disease.
Most recently, ACIP voted 14-1 to lower the age for routine vaccination from 65 to 50, expanding the number of people eligible for this vaccine. The CDC currently recommends the 20-valent pneumococcal conjugate vaccine (Prevnar 20; Pfizer) and the 21-valent pneumococcal conjugate vaccine (Capvaxive; Merck). 4
Individuals ages 19 to 49 with certain underlying medical conditions or risk factors may also be eligible for pneumococcal vaccination. Mr. Ha pointed out that for people aged 19 to 49 who took PCV13 but not PPSV23, ACIP prefers a series of PCV20 or PCV21 rather than ending with PPSV23.1.
“While the complexity of these recommendations may be onerous, they are actually a very welcome change,” Ha concluded. “There are some other vaccines in development, but these new vaccines are actually targeting changes in the epidemiology of pneumococcal disease, and that’s what we really need. So these Changing recommendations is actually part of all of these growing pains.”
References 1. Ha D. Inhale, exhale, immunize: the latest respiratory vaccines. Presentation location: National Association of Community Pharmacists 2024 Annual Conference and Exhibition. October 26, 2024.2. Abraham N, Spruin S, Rossi T, et al. Risk of myocarditis and/or pericarditis after mRNA COVID-19 vaccination: a Canadian head-to-head comparison of the BNT162b2 and mRNA-1273 vaccines. vaccine. 2022;40(32):4663-4671. doi:10.1016/j.vaccine.2022.05.0483. Antrim A. FDA approves first home nasal spray influenza vaccine. Pharmacy Times. September 20, 2024. Accessed October 26, 2024. https://www.pharmacytimes.com/view/fda-approves-first-at-home-nasal-spray-flu-vaccine4. Gallagher A. ACIP lowers recommended age for pneumococcal vaccination to 50 years. Pharmacy Times. October 24, 2024. Accessed October 26, 2024. https://www.pharmacytimes.com/view/acip-lowers-pneumococcal-vaccination-recommendation-to-age-50
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