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The Centers for Disease Control and Prevention (CDC) on Wednesday recommended additional COVID-19 vaccine doses for immunocompromised children and adults and anyone 65 years and older.
The CDC’s Advisory Committee on Immunization Practices (ACIP) also discussed a new respiratory syncytial virus (RSV) immunization on the horizon for infants and chikungunya vaccines for adolescents and adults.
COVID-19 vaccines
ACIP members voted 15-0 in favor of additional vaccine doses for people who are immunocompromised and adults 65 years and older. The CDC director approved the recommendation shortly after the meeting.
“This vote allows people to make the best decisions possible to keep themselves and their loved ones safe from COVID-19,” CDC Director Mandy Cohen, M.D., M.P.H., said in a statement. “CDC will continue to educate the public on how and when to get their updated vaccinations so they can risk less severe illness and do more of what they love.”
About one in six people hospitalized with COVID has an immunocompromising condition, according to CDC data. Adults 65 years and older comprise about two-thirds of all COVID-associated hospitalizations among adults.
“A harmonized recommendation for older adults and immunocompromised persons would ease implementation and help simplify an already complicated immunization schedule,” said Lauren Roper, M.P.H., summarizing input from the ACIP COVID-19 work group that she co-leads. Simplification may increase uptake.
The CDC recommends people ages 6 months and older who are moderately or severely immunocompromised and have never been vaccinated receive an initial multidose series with a 2024-’25 vaccine plus one additional dose six months after the initial series (minimum interval of two months).
Immunocompromised people who previously completed a vaccine series are recommended to receive two doses of the 2024-’25 COVID vaccine, ideally spaced six months apart (minimum interval of two months). Additional doses beyond these two may be given to this population based on shared clinical decision-making.
For people ages 65 years and older, the CDC is recommending two doses of the 2024-’25 COVID-19 vaccine ideally spaced six months apart (minimum interval of two months).
Clinicians can find guidance for special situations like age transitions, interchangeability of COVID vaccines and vaccination after prior infection on the CDC website.
RSV immunization
Clinicians may get another option for immunizing infants against RSV next year. ACIP members reviewed data on clesrovimab, a monoclonal antibody from Merck.
The immunization is intended for infants born during or entering their first RSV season to prevent RSV lower respiratory disease. A phase 2b/3 trial found efficacy of 91% against hospitalization and 60% for medically attended RSV. Adverse events were similar between immunization and placebo groups. The most common adverse events were sleepiness and irritability.
An ACIP work group has requested additional data and will continue to discuss the immunization at its February 2025 meeting. A vote on use of the product would depend on Food and Drug Administration (FDA) licensure.
Last fall, the CDC approved nirsevimab from Sanofi and AstraZeneca, but its rollout was plagued by supply issues and other logistical hurdles. The AAP has been working with the manufacturers, payers and the CDC on these issues in an effort to have a smoother second season.
In two new developments, the CDC is increasing doses available for ordering each week through the Vaccines for Children (VFC) program. Pediatricians can follow up with their state VFC program to confirm it has placed additional orders. In addition, Anthem recently said it is removing prior authorization requirements for nirsevimab administration for infants under 8 months.
Families also have the option of protecting infants from RSV through pregnant parent vaccination with Abrysvo. Data presented Wednesday showed vaccination during pregnancy was not linked with preterm birth or having a baby who was small for gestational age.
Chikungunya vaccines
Vaccines to protect adolescents from chikungunya also could be available next year.
The mosquito-borne disease typically is found in tropical or subtropical regions and sickens about 100-200 U.S. travelers each year, according to the CDC.
Bavarian Nordic’s virus-like particle vaccine is undergoing FDA review for ages 12 and older, and a licensure decision is expected by mid-February 2025.
The CDC said Wednesday immunogenicity data from clinical trials show a “robust” response that appears to be maintained at six months after vaccination. There were no safety concerns in trials of about 3,000 people.
In addition, manufacturer Valneva is expected to submit data to the FDA this year on its live attenuated chikungunya vaccine for ages 12-17 years. The vaccine already is licensed for adults and recommended for certain travelers and lab workers.
ACIP is expected to discuss both of these vaccines next year and make additional recommendations for use in travelers, lab workers and residents of U.S. states and territories with transmission risk.
ACIP will continue its meeting Thursday with discussions of meningococcal and HPV vaccines as well as anticipated approval of the 2025 immunization schedules.
