A 3D rendering of the respiratory syncytial virus. NIAID
The Advisory Committee on Immunization Practices voted to recommend that any adult RSV vaccine that is licensed by the Food and Drug Administration for use in high-risk adults ages 50 to 59 be recommended for use in that age group. If the recommendation is accepted by the Centers for Disease Control and Prevention — which the ACIP advises — insurance companies would be required to cover the cost of the vaccine for eligible individuals.
It’s unclear how quickly that could happen. The ACIP’s recommendations must be approved by the CDC director, and currently, the agency does not have a director. Susan Monres, who was serving as acting director until she was nominated for the position, has not yet gone through the Senate confirmation process.
A spokesman said CDC Chief of Staff Matthew Bazzelli will receive the committee’s six recommendations that emerged from Wednesday’s meeting.
Jeremy Fast, a Boston emergency room physician and public health expert who writes the weekly column Inside Medicine, reported last week that legal experts say that in the CDC director’s absence, Health Secretary Robert F. Kennedy Jr. could sign off on the committee’s recommendations.
In addition to the RSV vaccine vote, the committee also recommended the use of a new meningococcal vaccine from GSK, Bavarian Nordic’s chikungunya vaccine and voted to amend previous recommendations for another chikungunya vaccine made by Valneva.
If accepted by the CDC, the vote on the use of RSV vaccines in people in their 50s would initially apply to vaccines sold by GSK and Pfizer. Moderna is in the process of applying to the FDA to add people ages 50 to 59 to its RSV vaccine license, and the new policy — if approved — would cover them as well.
A cost-benefit analysis conducted by researchers at the CDC and the University of Michigan suggested that using these expensive vaccines in select members of this age group could result in cost savings. Specifically, it suggested that people who have had a lung transplant, or who have heart failure, chronic obstructive pulmonary disease, chronic kidney disease, or severe obesity, should be considered for RSV vaccination in their 50s.
About 30 percent of American adults ages 50 to 59 would be eligible, said CDC vaccine researcher Michael Melger.
The current CDC recommendation for use of these vaccines in older adults is that anyone 75 years of age or older should get the shot, and anyone 60 to 74 years of age who is at high risk of severe illness from RSV should get the shot. The ACIP has been slow to recommend broader use of the RSV vaccine for older adults due to some concerns.
Two vaccines — Pfizer and GSK products — appear to be associated with an increased risk of Guillain-Barré syndrome. (There have been no reports of GBS in people who received the Moderna vaccine.)
Another concern relates to the fact that it is not yet known how often these vaccines will need to be given, and whether getting a booster dose at a later date will provide a sufficient boost in protection. Data to date suggest that although booster doses do lead to a rise in antibodies, antibody levels do not return to the levels seen after the first shot with these vaccines.
The current recommendation for RSV vaccines is that they be a one-time shot, although it is widely expected that additional shots will be recommended at some point in the future.
The committee also voted to recommend the use of a new chikungunya vaccine, Vimconia, for travelers and scientists who work in laboratories with the chikungunya virus. The vaccine, made by Bavarian Nordic, is licensed for use in people 12 years of age and older.
Chikungunya infection, which is triggered by the bite of an infected mosquito, causes fever and muscle and joint pain that can be severe and, in some cases, long-lasting. Transmission has been recorded in about 120 countries worldwide, although the disease occurs in outbreaks that are unpredictable in their frequency.
The recommendation is that the vaccine can be used in people who are traveling to a country where there is an outbreak. The committee further recommended that the use of the vaccine could be considered for people who are traveling to a location where the risk of transmission is high if the person will be staying in that location for six months or more.
The committee had previously recommended the use of another chikungunya vaccine, made by Valneva. Earlier recommendations emphasized use in people 65 years of age and older, who are at increased risk of serious illness if infected with the virus.
But six reports of serious side effects in older adults after vaccination — five of which required hospitalization — prompted the committee to revise that recommendation on Wednesday. While it did not recommend against the use of Valneva in people 65 years of age and older, if the recommendation is accepted, caution would be exercised about the use of the vaccine in that age group.
The committee also recommended the use of GSK's pentavalent — one in five — vaccine for people aged 16 to 23 for whom a vaccine is recommended to protect against meningitis and for people aged 10 and older who are at increased risk of meningococcal disease due to underlying medical conditions.
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