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On Sept. 22, ACIP recommended maternal Respiratory Syncytial Virus (RSV) vaccine for pregnant people to prevent RSV lower respiratory tract infection (LRTI) in infants.
Now that there are two options that providers and their pregnant patients can choose between to protect young infants against RSV LRTI, it will be important for providers to discuss both options:
- The first option is to provide vaccine (Abrysvo) to the pregnant person before birth.
- The second option is to provide passive immunization (nirsevimab) to the infant after birth.
In either situation the timing of vaccination is an important consideration to provide the highest amount of protection to the infant during their first RSV season. Providers will need to discuss this with the pregnant person to determine which option best fits their situation. Pfizer’s RSVpreF vaccine, Abrysvo can be given to pregnant people who are at 32 through 36 weeks gestation of pregnancy during the months of September through January. This one-dose vaccine requires 14 days for the pregnant person to develop and transfer maternal antibodies to the infant. Protection in the infant lasts about 6 months. Protection can be influenced by the timing of vaccination and birth, especially if there are fewer than 14 days between vaccination and birth.
Earlier this summer, the Food and Drug Administration (FDA) approved, and CDC recommended, a monoclonal antibody, nirsevimab, for infants at birth through 8 months who will be or are already in their first RSV season. This passive immunization provides specific antibodies to protect against RSV LRTI (refer to the August Got Your Shots? News). These two products will be an either/or option. Except in rare circumstances, most infants younger than 8 months of age do not need nirsevimab if they were born 14 or more days after their mother got RSV vaccine. Guidance about which additional considerations need to be included will be coming soon.
The Minnesota Immunization Information Connection (MIIC) forecaster has been updated to include a schedule for the administration of infant RSV monoclonal antibody (Nirsevimab). MIIC will now recommend a dose of nirsevimab at birth up to 8 months of age. While there is also an Advisory Committee on Immunization Practices (ACIP) recommendation for infants 8 to 19 months old at higher risk of severe RSV disease to receive a dose of nirsevimab in their second RSV season, MIIC does not forecast for these populations. The MIIC forecaster will only take into account the first valid dose of monoclonal antibodies. Doses given beyond the first dose or after 8 months of age will not affect the forecaster. ACIP’s recommendation includes a seasonal component that is not currently reflected in MIIC.
The forecaster is a helpful tool, but we recommend you continue to use clinical judgement and the CDC: MMWR: Use of Nirsevimab for the Prevention of Respiratory Syncytial Virus Disease Among Infants and Young Children: Recommendations of the Advisory Committee on Immunization Practices — United States, 2023 to inform decisions for immunization.
Please join us for a four-part MIIC webinar series on Tuesdays starting Oct. 3. Registration is not required. For each session, staff will cover several aspects of MIIC and will include time for questions at the end. Sessions will be recorded and posted on MIIC User Guidance and Training Resources.
Continuing Education Units (CEUs) will be available to providers who participate in MIIC webinar sessions, either the live events or the recordings. To receive credit, participants will fill out a brief evaluation. Come with questions or submit your questions in advance to the MIIC helpdesk at health.miichelp@state.mn.us.
As of Jan. 1, 2024, MIIC regional coordinators will transition to being Immunization Quality Improvement for Providers (IQIP) consultants. Currently, MIIC regional coordinators focus on supporting and training primary care clinics and local public health departments in their use of MIIC. All questions and requests for MIIC service that used to go to MIIC regional coordinators should go to the MIIC Help Desk in the new year. MDH would like to thank all the local public health departments that served as regional entities over the last 20 years and looks forward to the new era of quality improvement focused work.
Meningococcal disease
Meningococcal disease, caused by the Neisseria meningitides bacteria, can cause severe illness, such as meningitis and sepsis, in otherwise healthy people. People at any age can be affected, but adolescents and young adults age 16 to 21 years have the highest rates of meningococcal disease. That is why all adolescents are recommended to get a dose of quadrivalent meningococcal conjugate vaccine (MenACWY) at age 11 to 12 years and then a booster at age 16 years.
Minnesota school requirements
Every year, schools are required to report the immunization or exemption status of students in kindergarten through 12th grade. Schools have been reporting on the first dose of MenACWY for seventh graders since September 2014. In the 2021-22 school year, schools began requiring 12th grade students to receive the MenACWY booster dose. While coverage rates have increased since the school requirements were implemented, there are still many adolescents who lack full protection.
In the 2022-23 school year, Minnesota schools reported that:
- 84.6% of seventh grade students had 1 dose of MenACWY vaccine.
- 74.0% of 12th grade students had received the booster dose.
Recommend the booster dose to all adolescents age 16 years and older
Protection after a single dose of MenACWY vaccine has been shown to wane after five years. Adolescents who only receive a single dose between 11 to 12 years of age may not be fully protected when they are most at risk for disease. Increasing booster dose coverage is vital for making sure adolescents and young adults are protected when they are at highest risk. Make a strong recommendation to all adolescents to receive the MenACWY vaccines, including the booster dose.
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