GNN monthly update: August' 22

Dear all,

I hope everyone enjoyed a break over the summer/winter depending on where you are in the world.

COVID-19 vaccines

Novavax:

• On July 19, 2022, the ACIP made an interim recommendation for use of the Novavax vaccine in persons aged ≥18 years as a primary 2-dose series vaccination for the prevention of COVID-19, available here along with the GRADE and EtR tables.
• STIKO now recommends primary immunization with Nuvaxovid for children and adolescents aged 12-17 years.

Booster vaccination:

• STIKO recommends a further booster vaccination for people aged 60-69 and for people aged 5 and over who are at increased risk of contracting severe COVID-19. In addition to vaccination, the STIKO recommends pre-exposure prophylaxis with SARS-CoV-2 -neutralizing monoclonal antibodies to defined groups of people. More here.

ACIP is holding an online COVID-19 meeting on September 1^st. The meeting can be webcast. The full agenda is available here.

HPV:

• the JCVI issued a statement on a one-dose schedule for the routine HPV immunisation programme, available here. Of note, the first major review of a one-dose schedule took place in June 2020 and after a further review of the latest evidence on one-dose schedules in December 2021 the committee issued an interim statement for consultation on 10 February 2022.
• The CNAV (NITAG in Uruguay) agreed at its August meeting to recommend HPV vaccination for both women and men aged 11 to 26 years inclusive, in a two doses schedule ( 6 months apart). The vaccination should be universal and free without requirement or medical prescription. For Immunocompromised aged 9 to 26 years inclusive, the schedule is 3 doses given at 0, 2 and 6 months and a medical prescription is needed.

Monkeypox:

• NIAC (Irish NITAG) issued recommendations for the use of Monkeypox Modified Vaccinia Ankara Vaccines, Imvanex or Jynneos, by the intradermal route, available here.

SAGE:

1. SAGE recommends the Valneva vaccine for adults between 18 and 50 years, in a two-dose schedule with a spacing of 28 days.Due to limited data on the immunogenicity of this vaccine in persons aged 50 and above, the Valneva vaccine is not recommended for adults older than 50 years. The full recommendation is available here, along with the comprehensive background document here.  Of note, SAGE reviewed data from the UK COV-BOOST study, a study that was conducted independently from the manufacturer, and concluded that the Valneva vaccine should not be used as a heterologous booster post primary vaccination with a mRNA vaccine as immunogenicity was low. However, Valneva can be considered as a heterologous booster following primary vaccination with the AstraZeneca vaccine (ChAdOx1-S)
2. SAGE published a good practice statement on the use of a second booster doses for COVID-19 vaccines, available here. The statement speaks to the need for a second booster dose in the context of Omicron to restore VE. This guidance does not discuss future variants nor variant-updated vaccines. The rationale for a second booster is to restore protection in the most vulnerable populations. This includes protection from COVID-19 severe disease, and serious exacerbation of co-morbidities. Key recommendations from the good practice statement include:
3. It is acknowledged that the additional benefit from a second booster may more limited than the first booster.
4. To reduce the risk of severe disease, deaths and disruptions of health services, WHO recommends countries should consider a second booster dose for:
5. All older adults (age cut-off to be defined by countries);
6. All persons with moderate or severe immunocompromising conditions (effectively, the fifth dose);
7. Adults with comorbidities that put them at higher risk of disease;
8. Pregnant women;
9. Health workers.