Issue 1,659: October 26, 2022
Top Stories
Notable Publications
Global News
Top Stories summarizes ACIP’s October 19–20 meeting allowing PCV20 vaccination for previously vaccinated adults, adding COVID-19 vaccines to the VFC program, and more

The Advisory Committee on Immunization Practices (ACIP) met on October 19–20, 2022. Votes included recommendations for use of 20-valent pneumococcal conjugate vaccine (PCV20, Prevnar 20, Pfizer) in certain previously vaccinated adults, adding COVID-19 vaccines to the Vaccine for Children (VFC) program, and approval of the 2023 recommended immunization schedules. The Committee also received informational updates on vaccines for chikungunya, meningococcal disease, influenza, dengue, respiratory syncytial virus (RSV), polio, and monkeypox. Presentation slides are available online. Highlights of the meeting, focused on the votes, are provided below.
PCV20 for adults who received previous PCV13 (Prevnar 13, Pfizer) vaccination
In October 2021, ACIP recommended that all people age 65 years and older as well as adults age 19 through 64 years at high risk of pneumococcal disease who had no (or unknown) history of vaccination with a PCV should receive either PCV20 alone or PCV15 (Vaxneuvance, Merck) followed in 1 year by 23-valent pneumococcal polysaccharide vaccine (PPSV23, Pneumovax 23, Merck). At the time, ACIP did not address the question of PCV20 vaccination of prior PCV13 recipients. Conjugate vaccines provide longer-lasting and superior (B- and T-cell) immune response to vaccination for the serogroups included when compared to PPSV23 (B-cell only). PCV13 recipients can benefit from protection against the 7 additional serotypes included in PCV20, especially if it has been at least 5 years since receipt of PPSV23.
After extensive deliberation on the economic costs and potential benefits of the additional dose, ACIP approved new recommendations for people who previously received PCV13, summarized in the table below.
Use of PCV20 in adults who previously received PCV13:

Population Pneumococcal
vaccine history
Vaccine(s) recommended to complete pneumococcal vaccine series
Adults with an immunocompromising condition, cochlear implant, or cerebrospinal fluid leak PCV13 and one or more PPSV23 doses (before age 65), but have not completed all previously recommended doses of PPSV23 Option A: PCV20 at least 5 years after the most recent pneumococcal vaccine dose
Option B: PPSV23 as previously recommended
Adults age 65 years and older PCV13 and PPSV23 PCV20 may be given at least 5 years after the most recent pneumococcal vaccine dose (shared clinical decision-making)
Adults age 19 years and  older previously recommended to receive PCV13 followed by PPSV23, but who have received only PCV13 PCV13 only Option A: PCV20 at least 1 year after the PCV13 dose
Option B: PPSV23 as previously recommended
COVID-19 vaccines
ACIP voted to add COVID-19 vaccines to the Vaccines for Children (VFC) program. This action ensures that when the federal government ends public health emergency distribution of COVID-19 vaccines to the public at no cost to recipients (anticipated in early 2023), affordable access to these vaccines will continue through the VFC program for uninsured and underinsured children. Contrary to widespread misinformation online, this action by ACIP does not trigger any type of vaccination mandate.
ACIP reviewed the growing body of evidence affirming the safety, effectiveness, and importance of COVID-19 vaccination during pregnancy. Substantial health benefits after vaccination are gained for both pregnant people and their infants. Data from CDC’s multiple safety surveillance systems indicate these vaccines are safe, with no increased risk of birth defects or spontaneous abortions following COVID-19 vaccination during pregnancy. Vaccination of the mother during pregnancy protects the infant from potentially serious outcomes of COVID-19 infection. ACIP noted that many people wrongly believe that COVID-19 is not dangerous to healthy infants. However, 3 out of 4 infants younger than 6 months of age hospitalized with COVID-19 were healthy and full-term; 18% of hospitalized infants were admitted to an intensive care unit. Between January 2020 and October 2022, 265 COVID-related infant deaths were reported to CDC.
In spite of these benefits, 2022 data indicate only 43% of pregnant people have received a primary COVID-19 series and monovalent booster.
Recommended 2023 immunization schedules
ACIP approved updates for the upcoming 2023 recommended schedules for children, adolescents, and adults. These updates ensure the 2023 schedules are consistent with all ACIP recommendations made during 2022, including recommendations for COVID-19 vaccination. The 2023 schedules will become effective when published on the CDC website in February 2023.
Additional vaccine discussion highlights
Influenza – The first randomized clinical trial comparing the safety of quadrivalent recombinant influenza vaccine (RIV4) to the safety of quadrivalent, egg-based inactivated influenza vaccines (IIV4) during pregnancy showed RIV4 was as safe as IIV4, supporting the existing ACIP recommendation to include RIV4 as an option for pregnant people.
Final vaccine effectiveness estimates from the 2021–22 influenza season indicate that influenza vaccines used during the 2021–2022 season provided low to non-significant protection against the predominant A/H3N2 strain.
Chikungunya – Chikungunya, a widespread mosquito-borne viral disease, causes a febrile rash illness, often with persistent joint pain, and can cause very large outbreaks. It does not circulate in the United States at this time. Valneva has submitted initial data to FDA supporting potential U.S. licensure of the world’s first chikungunya vaccine, anticipating a decision in 2023. Phase 3 trial data showed the vaccine to be safe and demonstrated a protective immune response lasting at least 6 months after a single dose in more than 95% of adult recipients. As the FDA considers licensure, ACIP has convened a chikungunya work group to consider potential recommendations.
Respiratory syncytial virus (RSV) – RSV is a common seasonal respiratory virus that can cause serious lower respiratory tract illness (LRTI), especially in infants and older adults. Almost all (97%) of U.S. children are infected with RSV by age 2 years. Although death is rare, approximately 2–3% of infants are hospitalized with RSV. It is the leading cause of hospitalization of U.S.-born infants. Healthy, full-term infants account for about 80% of RSV hospitalizations. Among U.S. adults age 60 years and older, recent seasonal estimates suggest that RSV LRTI causes between 64,000 and 85,000 hospitalizations annually.
ACIP received informational updates about two RSV vaccines designed for adults (GSK, Pfizer), in addition to a long-acting monoclonal antibody against RSV for infants (developed by Sanofi with AstraZeneca). The monoclonal antibody is intended to provide protection at least 5 months after a single dose, covering a single RSV season. Clinical trials and evaluations are ongoing; products may be licensed by FDA sometime during 2023. ACIP intends to issue recommendations soon after licensure.
Polio – CDC provided an overview on the use of polio vaccine in the United States and internationally, followed by an update on an unvaccinated adult diagnosed earlier this year with paralytic polio caused by a vaccine-derived type 2 poliovirus in a community in New York State with very low rates of childhood vaccination. Wastewater virus surveillance indicates transmission of the virus is ongoing in the community and nearby areas.
ACIP has reinstated its polio vaccine workgroup to consider additional adult IPV vaccination recommendations in response to this outbreak. Because IPV prevents paralysis but cannot prevent asymptomatic infection and transmission, the workgroup also will discuss a novel monovalent oral poliovirus vaccine (nOPV2) not licensed in the United States that is used in other countries to interrupt virus transmission in locales with evidence of ongoing transmission.
Meningococcal disease – ACIP heard presentations about a newly licensed one-vial, liquid presentation of GSK’s MenACWY vaccine (Menveo) that does not require reconstitution. The original version of Menveo is a lyophilized vaccine reconstituted with a diluent containing the serogroup A component. The original Menveo is licensed for use in people age 2 months through 55 years, and CDC states it may be used in adults age 56 years or older who need MenACWY vaccination. The youngest licensed age for the new one-vial presentation is 10 years, not 2 months. Because the new formulation is not licensed for use in infants and young children, GSK plans to maintain a limited supply of the two-vial presentation for children under age 10 years who are recommended to receive MenACWY vaccination.  MenQuadfi (Sanofi) is licensed for individuals age 2 years and older, with no upper age limit. The meningococcal workgroup also discussed its workplan for assessing two new pentavalent MenABCWY vaccines from GSK and Pfizer that are currently in clinical trials.
Dengue – CDC reviewed the epidemiology of dengue, a mosquito-borne arbovirus. Dengue is widespread throughout the world and is endemic in 6 U.S. territories and freely associated states. Puerto Rico accounts for over 95% of U.S. cases. CDC provided an update on the gradual implementation of Dengvaxia (Sanofi), which received ACIP recommendation in 2021 as a 3-dose vaccination series for children age 9 through 16 years with laboratory evidence of past dengue infection. See the ACIP recommendations for details of why vaccination is not recommended for dengue-naïve individuals. The slow introduction is, in part, attributable to complex logistics and the challenges faced in selecting and implementing a serologic testing strategy with acceptably high sensitivity and specificity for use in screening before vaccination. A new tetravalent live attenuated dengue vaccine (Takeda) is currently in clinical trials and under review by the workgroup; it is not yet known whether this vaccine will require screening for previous infection.
Monkeypox – CDC provided a brief update on the current epidemiology of monkeypox in the United States and use of Jynneos (Bavarian Nordic) vaccine. Monkeypox cases have been decreasing in the United States since the peak in early August, but the virus is expected to continue to circulate. Over 900,000 doses of pre- and post-exposure Jynneos have been administered during the outbreak. ACIP will continue to evaluate the safety and effectiveness of the vaccines and identify areas where additional data is needed to help refine vaccination recommendations for individuals at risk.
The next scheduled ACIP meeting will be held on February 22–23, 2023, although additional emergency meetings may be announced before that time. Information about past and future ACIP meetings may be found on the ACIP website. 
Related Links
CDC allows current monovalent Novavax COVID-19 Vaccine as a first booster dose option for adults age 18 and older who cannot or will not receive a bivalent mRNA booster

On October 19, FDA authorized and CDC recommended the use of the current monovalent Novavax COVID-19 Vaccine as a first booster dose option for adults age 18 or older who cannot or will not receive a bivalent mRNA COVID-19 vaccine. A portion of CDC’s news release appears below. 

This action gives people ages 18 years and older the option to receive a Novavax monovalent booster instead of an updated (bivalent) Pfizer-BioNTech or Moderna booster if they have completed primary series vaccination but have not previously received a COVID-19 booster—and if they cannot or will not receive mRNA vaccines.

Some may be unable to receive an mRNA vaccine as a result of an allergy to a component of an mRNA COVID-19 vaccine, or as a result of a history of a severe allergic reaction (such as anaphylaxis) after a previous dose of an mRNA COVID-19 vaccine, or a lack of availability of an mRNA vaccine. People ages 18 and older may also choose to receive a Novavax monovalent booster if they are unwilling to receive mRNA vaccines, and would otherwise not receive a booster dose.

Related Links

“Influenza Hospitalizations and Vaccination Coverage by Race and Ethnicity—United States, 2009–10 through 2021–22 Influenza Seasons” published in MMWR Early Release

CDC published Influenza Hospitalizations and Vaccination Coverage by Race and Ethnicity—United States, 2009–10 through 2021–22 Influenza Seasons in the October 18 issue of MMWR Early Release. Excerpts from the summary appear below.

Historically, persons from some racial and ethnic minority groups have had higher rates of influenza hospitalization and death and lower influenza vaccination coverage than White persons. . . .

Racial and ethnic disparities in influenza disease severity and vaccination coverage, along with disparities in access to care, have persisted since the 2009–10 and 2010–11 influenza seasons. . . .

Tailored efforts to increase access to influenza vaccination and improve vaccine confidence among racial and ethnic minority communities, including creating culturally relevant communication campaigns and offering vaccination in nontraditional settings, are critical and might decrease disparities in influenza vaccination and disease severity.

CDC also featured these findings in its Vital Signs report issued on October 18. CDC Vital Signs reports cover an important health threat and what can be done to drive down the disease. Access the images below, plus other information from the Vital Signs website.

Access the MMWR article in HTML.

Related Links

Get influenza vaccination now: early increases in influenza activity nationwide with higher activity in southeast and south-central states

Now is the time for you and your patients to be vaccinated against influenza. CDC’s surveillance systems continue to report increases in seasonal influenza activity in most of the United States, with the southeast and south-central areas reporting higher levels of activity. CDC expects influenza activity to continue to increase in coming weeks. CDC’s Weekly U.S. Influenza Surveillance Report, FluView, provides a valuable snapshot of influenza activity state-by-state.

Influenza Surveillance
For week 41, ending October 15, CDC's Weekly U.S. Influenza Surveillance Report, FluView reports that 3% of patient visits reported through the Outpatient Influenza-Like Illness Surveillance Network (ILINet) were due to respiratory illness that included fever plus a cough or sore throat: above the epidemic threshold and higher than the previous week’s report of 2.6%. Multiple respiratory viruses are co-circulating; the relative contribution of influenza virus infection to ILI varies by location.

Influenza Vaccination Dashboard
CDC's Weekly Flu Vaccination Dashboard shows that 115.8 million doses of influenza vaccine were distributed in the United States through October 21, 2022. Because pregnant people, especially those in the third trimester, are recommended to receive influenza vaccination as soon as it is available to protect themselves and their infant, CDC has published early estimates of influenza vaccination coverage of pregnant people through the end of September 2022. Coverage is lower compared to the same time last year and far below the same time in 2020. Overall coverage at the end of September 2022 was 5.4 percentage points lower compared with the end of September 2021 (21.0% compared with 26.4%) and 17 percentage points lower than at the end of September 2020 (21.0% compared with 38.0%). 

CDC recommends everyone age 6 months and older get annual influenza vaccination. “” offers VaccineFinder, a service of Boston Children’s Hospital, to help people find influenza and COVID-19 vaccines for any age group. To be listed as a provider by VaccineFinder, see the information at this website.

Coadministration of influenza and COVID-19 bivalent booster vaccinations when both are due is safe, recommended, and efficient. COVID-19 vaccination alone provides no protection from influenza or any other respiratory virus. To gain confidence in your approach to administering multiple intramuscular vaccinations to an adult, download’s printable document How to Administer Multiple Intramuscular Vaccines to Adults during One Visit.

Related Links

Back to top

AIM updates COVID-19 Vaccination Social Media Toolkit for outreach to minority adults

The Association of Immunization Managers (AIM) updated its COVID-19 Vaccination Social Media Toolkit with tips and sample posts for encouraging COVID-19 vaccination among racial and ethnic minority adults. The messages and images in the toolkit are based on feedback from community health workers in Alabama, Arizona, Georgia, Florida, Kentucky, Michigan, and Texas.

Additional materials will be released in upcoming months. Use AIM's COVID-19 Vaccination Social Media Toolkit to encourage vaccination among minority adults in your practice.

Spotlight: resources focused on enhancing clinical operations

In this week's Spotlight, we summarize resources at that focus on enhancing clinic and practice operations.

Our topic index on Clinic Tools main page is a one-stop source of practical information for vaccine providers. You will find "how-to" information about vaccinating in any setting.

Our Clinic Tools: Storage and Handling main page offers printable temperature logs to monitor freezers and refrigerators. This site also includes a troubleshooting record to document the occurrence and resolution of questionable or unacceptable vaccine storage events. 

Our Clinic Tools: Documenting Vaccination main page offers forms to document vaccination or declination of vaccination, as well as various forms and checklists useful to healthcare personnel. 

Our Key Vaccination Resources for Healthcare Professionals is a 5-page annotated list of resources for people who vaccinate or oversee vaccination clinics. The document lists foundational content with which every vaccinator should be familiar, supplemental content useful after completing foundational training, and additional tools to help providers grow in vaccination expertise.

Our free downloadable book, Vaccinating Adults: A Step-by-Step Guide, is a "how to" guide that provides easy-to-use, practical information covering essential adult vaccination activities.

Journalists interview experts

Journalists seek out experts to help explain vaccines to the public and policy makers. We help the media understand and communicate the complex work vaccinators do. Here is a recent citation.

Vaccines in the news

These recent articles convey the potential risks of vaccine-preventable diseases and the importance of vaccination.

Notable Publications

"Reductions in Deaths and Hospitalizations Associated with COVID-19 Vaccinations among Medicare Beneficiaries: Full Year 2021 Estimates" published by HHS in Assistant Secretary for Planning and Evaluation Reports

In the October 7 issue, Assistant Secretary for Planning and Evaluation Reports published Reductions in Deaths and Hospitalizations Associated with COVID-19 Vaccinations among Medicare Beneficiaries: Full Year 2021 Estimates. The web page summary appears below.

This study updates ASPE’s previous analysis of the associations between COVID-19 hospitalizations and deaths among Medicare beneficiaries and COVID-19 vaccination rates, with full year data through the end of 2021. The study uses a combination of person-level Medicare claims and county-level vaccination data to estimate reductions in COVID-19 hospitalizations and deaths among Medicare beneficiaries associated with COVID-19 vaccinations in 2021. We find that vaccines were associated with 670,000–680,000 fewer hospitalizations and 330,000–370,000 fewer deaths among Medicare beneficiaries in 2021, with the largest reductions during the summer Delta surge. This represents a 39–47 percent reduction in these outcomes. Reductions in hospitalization and deaths linked to vaccination rates occurred in all racial and ethnic groups and in all 50 states.

“Influenza and COVID-19 Vaccination Coverage among Health Care Personnel—United States, 2021–22” published in MMWR

CDC published Influenza and COVID-19 Vaccination Coverage among Health Care Personnel—United States, 2021–22 on October 21 in MMWR. Excerpts from the summary appear below. 

Influenza and COVID-19 vaccines are recommended for all persons aged ≥6 months, including health care personnel (HCP). . . .

HCP influenza vaccination coverage was 79.9% during the 2021–22 season; 87.3% completed primary COVID-19 vaccination, 67.1% of whom received a COVID-19 booster dose. Influenza, primary COVID-19, and COVID-19 booster coverage was higher among HCP who reported employer vaccination requirements for those vaccines; coverage was lowest among HCP working in long-term care settings. . . .

Enhanced efforts are needed to improve HCP vaccination coverage, especially with COVID-19 booster doses and annually for influenza vaccines. Staying up to date with COVID-19 and influenza vaccines can protect HCP and their patients.

Access the MMWR article in HTML or PDF.

Related Link

“Effectiveness of Monovalent mRNA Vaccines against COVID-19–Associated Hospitalization among Immunocompetent Adults during BA.1/BA.2 and BA.4/BA.5 Predominant Periods of SARS-CoV-2 Omicron Variant in the United States—IVY Network, 18 States, December 26, 2021–August 31, 2022” published in MMWR

CDC published Effectiveness of Monovalent mRNA Vaccines against COVID-19–Associated Hospitalization among Immunocompetent Adults during BA.1/BA.2 and BA.4/BA.5 Predominant Periods of SARS-CoV-2 Omicron Variant in the United States—IVY Network, 18 States, December 26, 2021–August 31, 2022 on October 21 in MMWR. Excerpts from the summary appear below.

COVID-19 vaccine effectiveness (VE) data among immunocompromised persons during SARS-CoV-2 Omicron variant predominance are limited. . . .

Among immunocompromised adults hospitalized with a COVID-like illness, 2-dose monovalent mRNA COVID-19 vaccine VE against COVID-19–associated hospitalization during Omicron predominance was 36%. VE was 67% ≥7 days after a third dose during BA.1 predominance but declined during BA.2/BA.2.12.1 and BA.4/BA.5 predominance to 32% ≥90 days after dose 3 and 43% ≥7 days after dose 4. . . .

Monovalent COVID-19 vaccine protection among persons with immunocompromising conditions during Omicron predominance was moderate after a 3-dose primary series or booster dose. Persons with immunocompromising conditions might benefit from updated bivalent boosters that target circulating BA.4/BA.5 sublineages.

Access the MMWR article in HTML or PDF.

Related Link

“Effectiveness of COVID-19 mRNA Vaccines against COVID-19–Associated Hospitalizations among Immunocompromised Adults during SARS-CoV-2 Omicron Predominance—VISION Network, 10 States, December 2021—August 2022” published in MMWR

CDC published Effectiveness of COVID-19 mRNA Vaccines against COVID-19–Associated Hospitalizations among Immunocompromised Adults during SARS-CoV-2 Omicron Predominance—VISION Network, 10 States, December 2021—August 2022 on October 21 in MMWR. Excerpts from the summary appear below.

Monovalent mRNA vaccine effectiveness (VE) against COVID-19–associated hospitalization wanes over time; less is known about durability of protection during the SARS-CoV-2 Omicron BA.4/BA.5–predominant period. . . .

Three-dose monovalent mRNA VE estimates against COVID-19–associated hospitalization decreased with time since vaccination. Three-dose VE during the BA.1/BA.2 and BA.4/BA.5 periods was 79% and 60%, respectively, during the initial 120 days after the third dose and decreased to 41% and 29%, respectively, after 120 days from vaccination. . . .

Eligible adults aged ≥18 years should receive an updated bivalent COVID-19 mRNA vaccine to maximize protection against BA.4/BA.5 lineages and to prevent COVID-19–associated hospitalization.

Access the MMWR article in HTML or PDF.

Related Link

Global News

“Progress toward Poliomyelitis Eradication—Pakistan, January 2021–July 2022” published in MMWR

CDC published Progress toward Poliomyelitis Eradication—Pakistan, January 2021–July 2022 on October 21 in MMWR. Excerpts from the summary appear below.

Pakistan is one of two countries (including Afghanistan) where wild poliovirus type 1 (WPV1) transmission has never been interrupted. . . .

WPV1 cases in Pakistan decreased from 147 in 2019 and 84 in 2020 to a single case in 2021 but increased to 14 cases in 2022 as of July 31. These 14 WPV1 cases are clustered among children in southern Khyber Pakhtunkhwa province, many of whom have never received poliovirus vaccine (zero-dose children). . . .

Ensuring the highest quality vaccination activities in priority areas of Pakistan will enable the polio program to improve the chances of interrupting ongoing transmission of WPV1.

Access the MMWR article in HTML or PDF.

Related Link

Upcoming Events

Virtual: NFID offers webinar “Hepatitis B Prevention Strategies” on October 31

The National Foundation for Infectious Diseases (NFID) will host a webinar titled Hepatitis B Prevention Strategies on October 31 from 2:00–3:00 p.m. (ET). Participants will learn about current recommendations for hepatitis B vaccination among adults, along with strategies for healthcare professionals to effectively communicate current recommendations. NFID designates this enduring material for a maximum of 1.0 AMA PRA Category 1 Credit.

Register for the webinar

For more upcoming events, visit our Calendar of Events.

About IZ Express

IZ Express is supported in part by Grant No. 1NH23IP922654 from CDC’s National Center for Immunization and Respiratory Diseases. Its contents are solely the responsibility of and do not necessarily represent the official views of CDC.

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Editorial Information

  • Editor-in-Chief
    Kelly L. Moore, MD, MPH
  • Managing Editor
    John D. Grabenstein, RPh, PhD
  • Associate Editor
    Sharon G. Humiston, MD, MPH
  • Writer/Publication Coordinator
    Taryn Chapman, MS
    Courtnay Londo, MA
  • Style and Copy Editor
    Marian Deegan, JD
  • Web Edition Managers
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    Jermaine Royes
  • Contributing Writer
    Laurel H. Wood, MPA
  • Technical Reviewer
    Kayla Ohlde

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