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Letters to the Editor  |   January 2013
Update on Advisory Committee on Immunization's Practices (ACIP) Vaccine Recommendations, October 2012
Author Affiliations
  • Stanley E. Grogg, DO
    American Osteopathic Association liaison to the ACIP; Oklahoma State University Center for Health Sciences, Tulsa
Article Information
Pediatrics / Preventive Medicine
Letters to the Editor   |   January 2013
Update on Advisory Committee on Immunization's Practices (ACIP) Vaccine Recommendations, October 2012
The Journal of the American Osteopathic Association, January 2013, Vol. 113, 13-15. doi:10.7556/jaoa.2013.113.1.13
The Journal of the American Osteopathic Association, January 2013, Vol. 113, 13-15. doi:10.7556/jaoa.2013.113.1.13
To the Editor: 
At its October 2012 meeting, the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC) approved and provided the following recommendations and updates:
  •  
    Tdap (combined tetanus, diphtheria and pertussis) immunization during every pregnancy
  •  
    Hib-MenCY-TT (GlaxoSmithKline) meningococcal vaccination down to age 2 months for high risk infants only
  •  
    measles–mumps–rubella (MMR) vaccine updates for select immunocompromised patients
  •  
    combined pediatric immunization schedule for 2013
  •  
    quadrivalent influenza vaccine expected to be available as a live attenuated influenza vaccine and inactivated vaccines for the 2013-2014 influenza season
  •  
    Centers for Medicare & Medicaid Services (CMS) incentive reimbursement to primary care providers for administration of immunizations
Tdap Immunization During Pregnancy
Recent outbreaks of pertussis in Washington State and other areas of the United States (Figure) resulted in the ACIP voting to take additional steps to protect mothers, fetuses, and infants from pertussis by recommending Tdap immunization for all pregnant women. As stated in a media release2 from the CDC,
 

Health-care personnel should administer a dose of Tdap during each pregnancy, irrespective of the patient's prior history of receiving Tdap. If not administered during pregnancy, Tdap should be administered immediately postpartum.

 
Figure.
Pertussis incidence by state, 2011-2012.1
Figure.
Pertussis incidence by state, 2011-2012.1
Hib-MenCY-TT Meningococcal Vaccine for High-Risk Infants
The ACIP recommended that infants who are at increased risk for meningococcal disease should receive 4 doses of the Hib-MenCY-TT vaccine at ages 2, 4, and 6 months and between ages 12 and 15 months.3 
Children at risk include those with recognized persistent complement pathway deficiencies and those with anatomic or functional asplenia, including sickle cell disease. The vaccine also can be used in infants aged 2 to 18 months who live in communities with outbreaks of serogroup C and Y meningococcal disease.3 However, the newly approved vaccine is not recommended as a routine meningococcal vaccination for infants because the amount of preventable meningococcal disease cases in children younger than 5 years is low and because for those younger than 1 year, most cases are caused by serogroup B, which the vaccine does not protect against.3 
MMR Vaccine
Intramuscular immune globulin prophylaxis for measles after exposure is recommended at a dose of 0.5 mL/kg of body weight, with a maximum dose of 15 mL.4 The dosage of intravenous immune globulin is 400 mg/kg.4 Other recommended updates include the following4:
  •  
    Intramuscular immune globulin should be given to infants younger than 12 months who have been exposed to measles. For infants aged 6 to 11 months, the MMR vaccine can be given in place of intramuscular immune globulin if administered within 72 hours of exposure.
  •  
    Intravenous immune globulin should be given to pregnant women who do not have evidence of measles immunity and who have been exposed to measles.
  •  
    Intravenous immune globulin should be given to immunocompromised persons without evidence of measles immunity and who have been exposed to measles.
  •  
    Asymptomatic individuals with HIV who do not have evidence of severe immunosuppression (CD4 cell count <15%) should receive the vaccine. Consideration should be given to administering a second dose 28 days after the first dose.
  •  
    Individuals with perinatal HIV infection who were vaccinated prior to establishment of effective antiretroviral therapy should be revaccinated.
  •  
    The distinction between asymptomatic and symptomatic HIV infection should be removed.
  •  
    The timing of the 2 doses should be changed to ages 12 through 15 months and ages 4 through 6 years.
Once these revised recommendations are accepted by the director of the CDC and the secretary of the US Department of Health and Human Services, they will be published in the CDC's Morbidity and Mortality Weekly Report (MMWR). 
Combined Pediatric Immunization Schedule
The new pediatric schedule will combine the 0- to 6-month and 7- to 18-month schedules into 1 schedule.5 The footnotes will be on separate pages with a larger font to make them more readable. The catch-up schedule will remain as a separate schedule. The 2013 pediatric schedule is scheduled to be published in the MMWR in February 2013 pending approval by the American Academy of Pediatrics and the American Academy of Family Physicians.5 
Influenza Vaccines
As reported in an August 2012 article in MMWR,6
 

In February 2012, [the] FDA [Food and Drug Administration] approved a new seasonal quadrivalent LAIV [live-attenuated influenza vaccine], FluMist Quadrivalent (Medimmune). This vaccine currently is not anticipated to be available until the 2013–14 influenza season, at which time it is expected to replace the currently available seasonal trivalent FluMist formulation. Inactivated quadrivalent influenza vaccines currently are in development. These vaccines will be addressed in the ACIP influenza statement as they are approved and become available commercially.

 
The CDC believes that the quadrivalent vaccine could result in a “modest reduction in influenza-associated outcomes.”6 
Incentive Reimbursement to Primary Care Providers
The CMS will be implementing an increase in Medicaid payment rates for certain primary care and immunization services to at least those of Medicare level.7 The rule extends the payment increase to physicians with a primary specialty designation of family medicine, general internal medicine, or pediatric medicine, and it specifies that the increase will also apply to many pediatric subspecialists. The payment increase takes effect in 2013 and extends through the end of 2014.8 
   Financial Disclosures: Dr Grogg is a primary investigator for vaccine research and has received grants from GlaxoSmithKline plc; Merck & Co, Inc; MedImmune LLC; Novartis Pharmaceuticals; Pfizer Inc; and sanofi-aventis US LLC. He serves on the speakers' bureaus for MedImmune LLC; Merck & Co, Inc; Novartis Pharmaceuticals; and sanofi-aventis US LLC. He is also a consultant for Merck & Co, Inc (for the human papillomavirus), and Novartis Pharmaceuticals (for meningitis).
 
References
Pertussis (whooping cough): outbreaks. Centers for Disease Control and Prevention website. http://www.cdc.gov/pertussis/outbreaks.html. Accessed November 30, 2012.
Advisory Committee for Immunization Practices recommends Tdap immunization for pregnant women [media advisory]. Atlanta, GA: Centers for Disease Control and Prevention; October 24 , 2012. http://www.cdc.gov/media/releases/2012/a1024_Tdap_immunization.html. Accessed November 30, 2012.
Mechcatie E. ACIP backs meningococcal vaccine for high-risk infants only. Internal Medicine News. October 25 , 2012. http://www.internalmedicinenews.com/index.php?id=495&cHash=071010&tx_ttnews[tt_news]=138049. Accessed November 30, 2012.
ACIP approves revised MMR recommendations. Medscape. October 29 , 2012. http://www.medscape.com/viewarticle/773454?src=rss. Accessed November 30, 2012.
ACIP recommends combined immunization schedule for 2013. Infect Dis Child. November 2012. http://www.healio.com/pediatrics/vaccine-preventable-diseases/news/online/%7BEAE00F18-7A37-489B-A3C1-E95749ABB028%7D/ACIP-recommends-combined-immunization-schedule-for-2013-. Accessed November 30, 2012.
Centers for Disease Control and Prevention. Prevention and control of influenza with vaccines: recommendations of the Advisory Committee on Immunization Practices (ACIP)—United States, 2012-13. MMWR Morb Mortal Wkly Rep. 2012;61(32):613-618. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6132a3.htm. Accessed November 30, 2012.
Primary Care Incentive Payment Program (PCIP): Medicare PCIP payments for 2011 will exceed $560 million. Centers for Medicare & Medicaid Services website. http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/Downloads/PCIP-2011-Payments.pdf. Accessed November 30, 2012.
CMS releases Medicaid primary care physician payment rule. Health Reform GPS website. November 6 , 2012. http://www.healthreformgps.org/resources/cms-releases-medicaid-primary-care-physician-payment-rule/. Accessed December 10, 2012.
Figure.
Pertussis incidence by state, 2011-2012.1
Figure.
Pertussis incidence by state, 2011-2012.1