New Vaccine Recommendations from the Advisory Committee on Immunization Practices

Two new recommendations were issued on February 27, 2008, following a meeting of the Advisory Committee on Immunization Practices (ACIP). The CDC will formally distribute and publish the recommendations in MMWR Morb Mortal Wkly Rep. Clinicians will want to know about both recommendations now because they might affect vaccine orders during the coming months.

Recommendation 1: The CDC no longer favors the combination vaccine ProQuad (containing measles, mumps, rubella [MMR], and varicella) over two separate injections for MMR and varicella. The Kaiser Permanente Vaccine Study Center presented data to the ACIP that revealed that ProQuad was associated with twice the risk for seizures within 10 days of vaccination (9 per 10,000 children), compared with separate MMR and varicella vaccines (4 per 10,000). The reason for the different seizure rates is unclear, and, according to Merck & Co., which manufacturers both the combined and separate-component vaccines, the difference disappeared in a comparison of rates at 30 days.

Comment: The ACIP’s statement about the combination vaccine does not require an immediate change in practice but simply replaces the CDC’s previously stated preference for the combination vaccine. I prefer to use separate MMR and varicella vaccines in children with personal or family histories of febrile seizures. The overall risk for seizure after administration of the separate vaccines is lower than that with the combined vaccine, and warnings already are included in the information materials we give to parents before vaccination.

Recommendation 2: The CDC expanded recommendations for influenza vaccine to all children aged 6 months to 18 years (except children with serious egg allergies). The previous recommendation was for children aged 6 to 59 months. Although the recommendation will be implemented no later than the 2009–2010 flu season, physicians are encouraged to begin vaccinating children according to the new recommendation during the next influenza season. Data were presented at the ACIP meeting that underscore the need for two doses of flu vaccine in children who receive the vaccine for the first time: Among children aged 6 to 23 months, fully vaccinated children had 75% vaccine efficacy in preventing influenza-related hospitalization, and children who received only one dose did not receive statistically significant protection.

Comment: The recommendation to expand influenza vaccine has been controversial for many years largely because of logistical concerns about implementation, but, in my opinion, it is a great idea. More-widespread vaccination will lead to fewer missed days in school and fewer doctor visits. Experts hope that widespread coverage will reduce transmission to both infants and older adults. Talking to families about the expanded recommendation at routine visits might be helpful, because, by increasing awareness now, implementation will be easier in the years to come.