Although avian influenza A (H5N1), commonly called the bird flu, is not relevant to immunizations, Ha said patients may have questions. Thus far it has affected 324 farms in 14 states, with 31 human cases as of October 18. All of these had contact with animals and had mild disease, and there has been no human-to-human transmission or markers of antiviral resistance.

RSV

Ha focused primarily on RSV vaccination in older adults, saying it is at least as important as COVID-19 and influenza vaccination, despite lower public awareness. In particular, those who are older, who live in a long-term care residence, and those with cardiopulmonary conditions are particularly at high risk for severe RSV.

“We see RSV routinely and it is a very challenging disease to manage,” Ha said. “It can cause more severe disease than influenza and more severe disease than COVID-19. RSV vaccination is at least as important as COVID-19 and it should be considered standard for those whom it is indicated for.”

The RSV vaccines are highly effective with quite a bit of durability, highlighted by the lack of re-vaccination recommendations, although Ha said questions do remain about this. Some decline in efficacy is seen from season to season (from around 89% to 78%), but data show that efficacy persists for up to 3 seasons.

Routine RSV vaccination is recommended by the ACIP for any 75 years and older who is unvaccinated. For those aged 60 to 74 who are unvaccinated, routine vaccination is recommended if they are at high risk for severe disease. No repeat vaccine is indicated for those who were previously vaccinated.

Like COVID-19, Ha said self-attestation is sufficient evidence for the presence of risk factors, and RSV vaccination should not be denied due to lack of documentation. There are no formal recommendations regarding timing of the vaccine, although between August and October is recommended for maximal benefit. Importantly, Ha noted that healthy individuals 60 to 74 years of age are no longer covered in the CDC recommendations for RSV vaccines.

Pneumococcal

Finally, Ha touched briefly on pneumococcal vaccination. Capvaxive (Merck) is the newest pneumococcal vaccine, showing improved coverage of serotypes causing invasive pneumococcal disease, although it does not cover serogroup 4.

Most recently, the ACIP voted 14:1 to lower the routine vaccination age from 65 to 50, widening the population eligible for this vaccine. The CDC now recommends the 20-valent pneumococcal conjugate vaccine (Prevnar 20; Pfizer) and the pneumococcal 21-valent conjugate vaccine (Capvaxive; Merck).

Individuals ages 19 to 49 who have certain underlying conditions or risk factors may also be eligible for pneumococcal vaccination. Ha noted that for those aged 19 to 49 who received PCV13 but not PPSV23, ACIP prefers the series with PCV20 or PCV21 rather than finishing with PPSV23.

“While the complexity of these recommendations may be annoying, these are actually really welcome changes,” Ha concluded. “You can see some of the other vaccines that are in developmental phases, [and] these newer vaccines are really targeting the changes in pneumococcal disease epidemiology, which is really what we need. So these changing recommendations are really part of the growing pains of all of this.”

REFERENCES

1. Ha D. Inhale, Exhale, Immunize: The Latest in Respiratory Vaccines. Presented at: National Community Pharmacists Association 2024 Annual Convention and Expo. October 26, 2024.

2. Abraham N, Spruin S, Rossi T, et al. Myocarditis and/or pericarditis risk after mRNA COVID-19 vaccination: A Canadian head to head comparison of BNT162b2 and mRNA-1273 vaccines. Vaccine. 2022;40(32):4663-4671. doi:10.1016/j.vaccine.2022.05.048

3. Antrim A. FDA Approves First At-Home Nasal Spray Flu Vaccine. Pharmacy Times. September 20, 2024. Accessed October 26, 2024. https://www.pharmacytimes.com/view/fda-approves-first-at-home-nasal-spray-flu-vaccine

4. Gallagher A. ACIP Lowers Pneumococcal Vaccination Recommendation to Age 50. Pharmacy Times. October 24, 2024. Accessed October 26, 2024. https://www.pharmacytimes.com/view/acip-lowers-pneumococcal-vaccination-recommendation-to-age-50