O Canada! In tribute to Canada’s 153rd national anniversary, we are sharing select Canadian resources for immunization information and advocacy. Best wishes to all our vaccinating friends in Canada!

Expert committees:

Advocacy groups and resources:

• Immunize Canada
• Canadian Nurses Association (Association des infirmières et infirmiers du Canada)
• I Boost Immunity
• Canadian Cancer Society (on HPV)
• HPV Awareness (charity)

Government institutions: 

• Public Health Agency of Canada (PHAC), counterpart to CDC
• Health Products and Food Branch (HPFB), counterpart to FDA
• Health Canada, counterpart to HHS
• Provincial and Territorial Routine and Catch-up Vaccination Schedule for Infants and Children
• Provincial and Territorial Routine Vaccination Programs for Healthy, Previously Immunized Adults

These Canadian documents and resources are provided in both English and French.
   
 
 

For the first time, the Advisory Committee on Immunization Practices (ACIP) conducted a regular meeting virtually on June 24, 2020. Two votes were taken during the morning session of the meeting. The afternoon was devoted to discussions of COVID-19 epidemiology and prospects for SARS-CoV-2 vaccines and vaccination.  

Votes
 
New MenACWY Vaccine Added to VFC Program. ACIP voted unanimously to add MenACWY-TT vaccine (Sanofi Pasteur) as an option within the Vaccines For Children (VFC) program. This vaccine was licensed by the FDA in April 2020 for use in persons 2 years of age and older. No ACIP policy vote was needed, as the addition of MenQuadfi required no changes to the current meningococcal recommendations for dosing and scheduling. Trials are ongoing to seek eventual expansion of the age indication down to 6 weeks of age and to evaluate its use with varying pediatric immunization schedules in use throughout the world. MenQuadfi will become available in the U.S. in 2021.

Recommendations for 2020–21 Influenza Season. ACIP received multiple updates on the 2019–2020 influenza season. Preliminary results indicate an overall vaccine effectiveness (VE) rate of 39% against medically attenuated influenza. Although it would be desirable to see higher VE rates, it is important to remember this means that influenza-related outpatient visits and hospitalizations were reduced by almost 40%, which translates to millions of Americans.  
 
The committee unanimously approved inclusion of several updates to the influenza statement for the 2020–21 season. ACIP recommendations are not official until published in the MMWR.

• Vaccine composition—Three new vaccine strains will be incorporated for H1N1, H3N2, and B Victoria. The B Yamagata strain included in quadrivalent vaccine formulations remains unchanged from the 2019–2020 season.
• New quadrivalent vaccine formulations—Two recently licensed quadrivalent vaccines will be available for persons 65 years and older: Fluzone High-Dose Quadrivalent (Sanofi Pasteur) and Fluad Quadrivalent (Seqirus).  
• Contraindications/precautions table—The title of the table will be simplified to “Contraindications,” with the accompanying text providing more detail concerning which contraindications are printed in package inserts and which derive from ACIP recommendations.
• LAIV recommendations
  • Contraindications to the use of LAIV will be added for persons with cochlear implants, active CSF leaks, and anatomical or functional asplenia.
  • To prevent possible interference with LAIV replication, intervals between use of antivirals and LAIV will be clarified to address the use of long-acting, single-dose influenza antivirals.
• Egg allergy—Language will be updated to indicate that no special precautions are needed when using egg-free vaccines (RIV and ccIIV) in persons with severe egg allergy.

In anticipation of greatly increased demand for influenza vaccine and possible concurrent spread of SARS-Cov-2 in the upcoming season, CDC has purchased an additional 7.1 million doses of influenza vaccine to be made available for adults through state immunization programs in November or later in the influenza vaccination season.

COVID-19 Update
 
The remainder of the meeting was devoted to updates on COVID-19 disease and clinical epidemiology. The committee also reviewed information on various coronavirus vaccine candidates in development. In addition, ACIP heard from Matthew Hepburn, MD, Joint Product Lead for Operation Warp Speed (OWS), the federal effort to coordinate vaccine development and use in the U.S. Dr. Hepburn noted that OWS was established to take advantage of the best expertise available in the Department of Health and Human Services and Department of Defense. Three complementary teams have been established within OWS to coordinate pre-clinical and clinical research, vaccine manufacturing, and vaccine distribution and administration. The latter group will be headed by CDC’s Dr. Nancy Messonnier.

The ACIP COVID-19 work group presented and solicited feedback on its preliminary work on establishing priority groups to receive vaccine when it becomes available. The guiding principles for the work group’s efforts are: (1) safety is paramount; (2) vaccine clinical trials should be inclusive of populations most affected by the disease, e.g., older adults and selected racial and ethnic groups; (3) vaccine should be distributed in an equitable and efficient manner; and (4) flexibility must be allowed.
 
CDC also provided an overview of the recent precipitous drop in routine vaccination levels in the U.S. due to the pandemic response. The agency stressed that catch-up for childhood vaccination needs to be undertaken now, so that clinical capacity can be directed to back-to-school and influenza vaccination in the summer and fall. CDC has issued multiple resources to assist providers in this effort.

Vaccine Supply Update
 
In the meeting’s final presentation, CDC provided two updates on the nation’s current vaccine supply:

• Adult Hepatitis B—The adult and dialysis formulations of Merck’s adult hepatitis B vaccine (Recombivax HB) will be returning to the U.S. market the week of July 20. 
• Zostavax—Beginning July 1, 2020, Merck will no longer be selling Zostavax, zoster vaccine live. All remaining Zostavax supplies in the U.S. will expire no later than November 2020. 

All recommendations approved by ACIP are provisional until they are approved by the CDC director and published in MMWR. Presentation slides from the June meeting should be posted on the ACIP website in the next 4–6 weeks. In addition to the next regularly scheduled (virtual) ACIP session on October 28–29, the committee plans to conduct additional virtual public meetings to review SARS-CoV-2 vaccine developments. These meetings, which are tentatively set for August 12 and September 16, will be announced on the ACIP website.

Related Links

• ACIP Meeting Information
• FDA's MenQuadfi 
• MenACWY Campaign’s www.give2menacwy.org website
• IAC's Vaccines: Meningococcal ACWY (MenACWY) gateway page
• IAC's Handouts: Influenza gateway page
• MMWR: Effects of the COVID-19 Pandemic on Routine Pediatric Vaccine Ordering and Administration—United States, 2020 
• CDC's Interim Guidance for Immunization Services During the COVID-19 Pandemic gateway page
• CDC’s Resources for Encouraging Vaccinations During COVID-19 Pandemic gateway page
• IAC's Repository of Resources for Maintaining Immunization during the COVID-19 Pandemic with over 125 resources to assist in maintaining routine immunization rates during the COVID-19 pandemic
• AAP’s #callyourpediatrician campaign 
• MMWR: Coronavirus Disease 2019 Case Surveillance—United States, January 22–May 30, 2020 
• HHS's Fact Sheet: Explaining Operation Warp Speed 

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On June 23, Vaccinate Your Family released a special supplemental report, 2020 State of the ImmUnion: Special Supplement: COVID-19 Vaccination, to their earlier 2020 State of the ImmUnion: A Report on Vaccine-Preventable Diseases in the U.S.



In the supplement, they examine five steps Congress must take to strengthen the country’s vaccine infrastructure and three ways in which members of Congress can help their constituents understand the value of vaccines.

Related Links

• 2020 State of the ImmUnion: Special Supplement: COVID-19 Vaccination (10 pages; PDF)
• 2020 State of the ImmUnion: A Report on Vaccine-Preventable Diseases in the U.S. (25 pages; PDF)
• Vaccinate Your Family's State of the ImmUnion Report gateway page
• Vaccinate Your Family's website

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Vaccines For Children (VFC) program offers updated handout and article with information for parents and guardians who may not realize that free vaccines are available for their children 

Due to the COVID-19 pandemic, many children are no longer covered by private insurance. Parents may not be aware that these children are eligible for free vaccines through the Vaccines For Children (VFC) program. VFC is a federally funded program that provides vaccines at no cost to certain children 18 and younger who might not otherwise be vaccinated because of the inability to pay. 

This updated 1-page handout for parents of children ages 0–18 years is easy to share.



CDC has also updated its Vaccines For Children web page. Please consider sharing this information via your social media channels to help ensure that all children have a better chance of getting their recommended vaccines on schedule.

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