Review of the latest immunization recommendations for the new year

Immunization Upodate

Jean-Venable “Kelly” R. Goode, PharmD, BCPS, FAPhA, FCCP

Immunization recommendations are made by medical and public health experts at ACIP who set the standard for the safe use of vaccines and related biologic products. ACIP uses an evidence-based method based on the Grading of Recommendations, Assessment, Development and Evaluation approach and the Evidence to Recommendations framework to review the type and quality of evidence. This framework includes the following domains: the public health problem, benefits and harms, values, acceptability, feasibility, resource use, and equity.

Pharmacists can expect new or updated recommendations after each ACIP meeting in February, June, and October. The new and updated recommendations are added to the Addendum section on the relevant immunization schedule, which enables timely implementation by health care providers. Last year, ACIP made new recommendations or updates for the following adult and child/adolescent vaccines: influenza, COVID-19, RSV, pneumococcal, haemophilus influenzae, meningococcal, and chikungunya.

Influenza vaccine: For the 2024–2025 season, several changes were made to the composition of the influenza vaccine. Since March 2020, there has not been any detection of influenza B/Yamagata viruses in global influenza surveillance. Therefore, FDA recommended the removal of the strain from the seasonal vaccine, changing the influenza vaccine from quadrivalent to trivalent. Additionally, an update was made to the influenza A(H3N2) component. ACIP continues to recommend the influenza vaccine for all persons aged ≥6 months who do not have contraindications. In October 2024, ACIP recommended that high-dose influenza vaccine (HD-IIV3) or adjuvanted influenza vaccine (aIIV3) are acceptable options, but without preference, for solid organ transplant recipients aged 18 through 64 years who are receiving immunosuppressive medication regimens.

COVID-19 vaccine: In August 2024, FDA approved and authorized updated COVID-19 vaccines including the KP.2 strain (Moderna and Pfizer) and the JN.1 strain (Novavax). Moderna and Pfizer COVID-19 vaccines are emergency use authorized for ages 6 months to 11 years and licensed for use in ages 12 years and older, and Novavax is emergency use authorized for ages 12 years and older. ACIP recommends an FDA-approved or authorized 2024–2025 COVID-19 vaccine for all persons aged 6 months or older.

ACIP recommended in October 2024, that all persons aged 65 years or older receive a second dose of 2024–2025 COVID-19 vaccine 6 months after the last dose of 2024–2025 COVID-19 vaccine with a minimum interval of 2 months between doses. If an unvaccinated adult 65 years or older receives a Novavax 2024–2025 COVID-19 vaccine, then two doses are recommended as the initial series and should be followed by a third dose of any age-appropriate 2024–2025 COVID-19 vaccine 6 months after the second dose with a minimum interval of 2 months between the second dose and the third dose.

Persons 6 months through 11 years who are moderately or severely immunocompromised and previously unvaccinated are recommended to receive an initial three-dose vaccination series of a 2024–2025 COVID-19 vaccine (Moderna or Pfizer-BioNTech) with all doses from the same manufacturer. Persons aged 12 years who are moderately or severely immunocompromised and previously unvaccinated are recommended to receive an initial three doses of a 2024–2025 COVID-19 vaccine (Moderna or Pfizer-BioNTech) from the same manufacturer or two doses of a 2024–2025 COVID-19 vaccine (Novavax). Moderately or severely immunocompromised persons who have completed an initial series and received at least one dose of a 2024–2025 COVID-19 vaccine should receive a second dose of age-appropriate 2024–2025 vaccine 6 months after the last recommended 2024–2025 COVID-19 vaccine dose with a minimum interval of 2 months between doses. These persons may also receive additional doses of the 2024–2025 COVID-19 vaccines (i.e., a total of  greater than or equal to 3 doses of the 2024–2025 COVID-19 vaccine) based on shared clinical decision-making.

RSV vaccine: ACIP recommends a single dose of any FDA-approved RSV vaccine (Adjuvanted RSVPreF3, Arexvy; Bivalent RSVpreF, Abrysvo; mRNA-1345, mRESVIA) for all adults aged 75 years and older and for adults aged 60 through 74 who are at increased risk for severe RSV disease. The following are considered risk factors for severe RSV disease:

• Chronic cardiovascular disease (e.g., heart failure, coronary artery disease, or congenital heart disease [excluding isolated hypertension]).
• Chronic lung or respiratory disease (e.g., COPD, emphysema, asthma, interstitial lung disease, or cystic fibrosis).
• End-stage renal disease or dependence on hemodialysis or other renal replacement therapy.
• Diabetes mellitus complicated by chronic kidney disease, neuropathy, retinopathy, or other end-organ damage, or requiring treatment with insulin or sodium-glucose cotransporter-2 inhibitor.
• Neurologic or neuromuscular conditions causing impaired airway clearance or respiratory muscle weakness (e.g., poststroke dysphagia, amyotrophic lateral sclerosis, or muscular dystrophy [excluding history of stroke without impaired airway clearance]).
• Chronic liver disease (e.g., cirrhosis).
• Chronic hematologic conditions (e.g., sickle cell disease or thalassemia).
• Severe obesity (BMI ≥40 kg/m2).
• Moderate or severe immune compromise.
• Residence in a nursing home.
• Other chronic medical conditions or risk factors that a health care provider determines would increase the risk for severe disease due to viral respiratory infection (e.g., frailty, situations in which health care providers have concern for presence of undiagnosed chronic medical conditions, or residence in a remote or rural community where transportation of patients with severe RSV disease for escalation of medical care is challenging).

Pharmacists may allow patients to self-attest to a risk factor for severe RSV disease; vaccination should never be denied for lack of medical documentation. Adults may be vaccinated at any time of the year, but vaccination will be most beneficial if administered in late summer or early fall before the RSV season. Adults who have received an RSV vaccine should not receive another RSV vaccine.

Pneumococcal vaccine: In October 2024, ACIP updated the pneumococcal vaccine recommendation for all adults aged 50 years or older who have not previously received a dose or whose previous vaccination history is unknown to receive a pneumococcal conjugate vaccine; either PCV20, PCV21 or PCV15. If PCV15 is administered, then a dose of pneumococcal polysaccharide vaccine (PPSV23) should be administered one year later. Recommendations for persons aged 19 to 49 years with certain underlying medical conditions or other risk factors were not changed. Pharmacists can use the PneumoRecs VaxAdvisor application to determine which pneumococcal vaccines are needed and when. It is available at www.cdc.gov/pneumococcal/hcp/vaccine-recommendations/app.html.

Haemophilus influenzae vaccine: ACIP recommends that Vaxelis (diphtheria and tetanus toxoids and acellular pertussis, inactivated poliovirus, Hib conjugate, and hepatitis B vaccine, DTaP-IPV-Hib-HepB) should be included with monovalent PRP-OMP in the preferential recommendation for American Indian and Alaska native (AI/AN) infants based on the Hib component. AI/AN infants are recommended to receive a primary Hib vaccination series consisting of either a monovalent PRP-OMP (2-dose series at ages 2 and 4 months) or DTaP-IPV-Hib-HepB (3-dose series at ages 2, 4, and 6 months). Any Hib vaccine may be used for the booster dose of Hib in AI/AN children, except the DTaP-IPV-Hib-HepB should not be used for the booster doses of Hib, DTaP, or IPV vaccines.

Meningococccal B vaccine: In August 2024, MenB-4c (Bexsero) received full FDA approval with a dosing schedule that aligns with MenB-FHbp (Trumemba). ACIP revised the meningococcal B recommendations to reflect the FDA labeling and to harmonize with the MenB-FHbp (Trumemba). ACIP recommends meningococcal B vaccine (MenB-4C or MenB-FHbp) be administered as a two-dose series at 0 and 6 months when given to healthy adolescents and young adults aged 16 to 23 years based on shared clinical decision-making for the prevention of serogroup B meningococcal disease. ACIP recommends meningococcal B vaccine (MenB-4C or MenB-FHbp) be administered as a three-dose series at 0, 1–2, and 6 months when given to persons aged ≥10 years at increased risk for serogroup B meningococcal disease (i.e., persons with anatomic or functional asplenia, complement component deficiencies, or complement inhibitor use; microbiologists routinely exposed to N. meningitidis isolates; and persons at increased risk during an outbreak). The same brand of meningococcal B vaccine should be used for all doses including booster doses.

Chikungunya vaccine: In February 2024, ACIP recommended chikungunya vaccine for travelers 18 years and older who are traveling to a country or territory where there is a chikungunya outbreak and for laboratory workers with potential for exposure to chikungunya virus. Chikungunya vaccine may be considered for the following persons traveling to a country or territory without an outbreak but with evidence of chikungunya virus transmission among humans within the last 5 years: age 65 years and older, particularly those with underlying conditions who are likely to have at least moderate exposure or persons staying for a cumulative period of 6 months or more.

Pharmacists can find these new recommendations and updates in the newly published schedules, “Recommended Child and Adolescent Immunization Schedule for ages 18 years and younger, United States 2025” and the “Recommended Adult Immunization Schedule for ages 19 years and older, United States 2025.” See the sidebar to the left for resources and visit www.cdc.gov/vaccines/hcp/imz-schedules/app.html for the schedules.

As the number and type of vaccines administered by pharmacists continues to increase, it is more important than ever that pharmacists and pharmacy technicians are aware and understand how to apply immunization recommendations in the care of patients across the lifespan.

Don’t forget to look for new immunization updates and recommendations in 2025 after ACIP meetings in February, June, and October. ■

Resources:

• Centers for Disease Control and Prevention. Evidence-based recommendations for ACIP. Atlanta, GA: CDC. Available at: www.cdc.gov/acip/evidence-based-recommendations/index.html#cdc_listing_res2-about-evidence-to-recommendation. Accessed December 30, 2024.
• Grohskopf LA, Ferdinands JM, Blanton LH, et al. Prevention and control of seasonal influenza with vaccines: Recommendations of the Advisory Committee on Immunization Practices—United States, 2024–2025 influenza season. MMWR Recomm Rep. 2024;73(5):1–25.
• Pangiotakopoulos L, Moulia DL, Godfrey M, et al. Use of COVID-19 vaccines for persons aged >6 months: Recommendations of the Advisory Committee on Immunization Practices—United States. 2024-2025. MMWR Morb Mortal Wkly Rep. 2024;73:819–824.
• Roper LE, Godfrey M, Link-Gelles R, et al. Use of additional doses of 2024-2025 COVID-19 vaccine for adults aged > 65 years and persons aged >6 months with moderate or severe compromise: Recommendations of the Advisory Committee on Immunization Practices—United States 2024. MMWR Morb Mortal Wkly Rep. 2024;73:1118-1123.
• Britton A, Roper LE, Kotton CN, et al. Use of respiratory syncytial virus vaccines in adults aged > 60 years: Updated Recommendations of the Advisory Committee on Immunization Practices—United States, 2024. MMWR Morb Mortal Wkly Rep. 2024;73:696–702.
• Centers for Disease Control and Prevention. Advisory Committee on Immunization Practices. Recommended adult immunization schedule for immunization schedules for adults aged 19 years and older—United States, 2025. Atlanta, GA: CDC. Available at: www.cdc.gov/vaccines/hcp/imz-schedules/adult-age.html). Accessed December 30, 2024.
• Collins JP, Loehr J, Chen WH, et al. Use of Haemophilus influenzae Type b-containing vaccines among American Indian and Alaska native infants: Updated recommendations of the Advisory Committee on Immunization Practices—United States, 2024. MMWR Morb Mortal Wkly Rep. 2024;73:799–802.
• Centers for Disease Control and Prevention. Advisory Committee on Immunization Practices (ACIP). Recommended immunization schedules for persons aged 0–18 years—United States, 2025. Atlanta, GA: CDC. Available at:  www.cdc.gov/vaccines/hcp/imz-schedules/child-adolescent-age.html. Accessed December 30, 2024.
• Centers for Disease Control and Prevention. ACIP Recommendations. Atlanta, GA: CDC. Available at: apha.us/ACIPRecommendations. Accessed December 30, 2024.