Here is the October update and this month is ending with the GNN webinar. We discussed the recent SAGE recommendations on monkeypox and COVID-19 variant-containing vaccines as well as the access and programmatic implications for future COVID-19 vaccination. The meeting presentations will be circulated separately but the recording is already available here. Feel free to share widely.
In Brazil, the NITAG recommends the vaccination against covid-19 of children between 6 months and 2 years old.
ATAGI (Australia) recommends that a booster dose of the Paediatric Pfizer COVID-19 vaccine (10mcg, ancestral strain) may be given to the following children aged 5 to 11 years who have completed a primary course of vaccination 3 or more months ago:
those who are severely immunocompromised
those who have a disability with significant or complex health needs
those who have complex and/or multiple health conditions that increase the risk of severe COVID-19
ATAGI does not recommend that a booster dose of COVID-19 vaccine be given to all children aged 5 to 11 years. There is insufficient evidence of severe disease in otherwise healthy children in this age group who have already received two primary doses of a COVID-19 vaccine. ATAGI continues to recommend that all children aged 5 to 11 years complete a primary vaccine course of 2 doses of COVID-19 vaccine, 8 weeks apart. A third primary dose from 2 months after dose 2 is recommended for those who are severely immunocompromised. More information here.
The Spanish NITAG issued Vaccination recommendations against COVID-19 for the fall in Spain, including a booster dose for people aged 60+, living in care homes and some health workers. Find out more here.
NACI updated the guidance on COVID-19 vaccine booster doses in Canada to reflect the authorization of the Pfizer-BioNTech Comirnaty BA.4/5 Bivalent (30 mcg) mRNA COVID-19 vaccine for use as a booster dose in people 12 years of age and older. This is the second bivalent Omicron-containing mRNACOVID-19 vaccine authorized for use in Canada. With regard to who is recommended to receive a 2022 fall booster dose, NACI continues to recommend that:
All individuals 65 years of age and older and individuals 12 years of age and older who are at increased risk of severe illness from COVID-19 should be offered a fall COVID-19 vaccine booster dose, regardless of the number of booster doses previously received. (Strong NACI Recommendation)
All other individuals 12 to 64 years of age may be offered a fall COVID19 vaccine booster dose, regardless of the number of booster doses previously received. (Discretionary NACI Recommendation)
With regard to the vaccine product offered for a 2022 fall booster dose, NACI now recommends that:
A bivalent Omicron-containing mRNA COVID-19 vaccine is the preferred vaccine product for booster doses.(Strong NACI Recommendation)
Individuals 12 years of age and older who are not able or willing to receive a bivalent Omicron-containing mRNA COVID-19 vaccine may be offered an original mRNA COVID-19 vaccine.
Uruguay: The NITAG recommends to administer modified Ankara virus vaccine (Jynneos™️) for pre-exposure vaccination: 0.5 mL subcutaneous dose with a 2-dose schedule, 28-day interval to laboratory personnel handling samples for MPX dg and for post-exposure vaccination: single dose (0.5 mL) subcutaneously to close contacts of confirmed cases older than 18 years (skin-to-skin) prioritizing those at risk of severe disease (immunocompromised), ideally within 4 days and up to 14 days if asymptomatic. In case the epidemiological scenario requires it, it is recommended to administer the fractionated vaccine (0.1 mL) intradermally, either as an initial scheme or for complementary doses. For cases outside the above-mentioned indications, a case-by-case analysis will be made and with consultation.
STIKO issued a statement on the possible intradermal application of the MVA vaccine (Jynneos/Imvanex) to protect against monkeypox, available here.
NACI (NITAG In Canada) is issuing recommendations on the use of pneumococcal vaccines in adults, including the use of 15-valent and 20-valent conjugate vaccines and Economic evidence supplementary appendix. This advance copy is available on request. This document is anticipated to be posted on the Government of Canada website in January 2023.
Meningococcal B vaccination:
In the Netherlands, the recommendations on Meningococcal B vaccination have been updated. The Committee recommends against including the MenB vaccine in the RVP for the time being. For young children in particular, the low number of cases combined with the adverse events and highly unfavourable cost-effectiveness ratio are the decisive factors in a decision not to vaccinate all young children against MenB for now. Find out more here.
SAGE ordinary meeting was held on October 3-6, 2022. All the presentations from the meeting are compiled here.
Currently, four bivalent variant-containing vaccines (developed by Pfizer-BioNTech and Moderna) have received authorisation from stringent regulatory authorities (SRAs) as boosters for individuals who have received their primary series vaccination. SAGE reviewed the available data on these variant-containing vaccines to form the Good Practice Statement
Available data indicates that Variant-containing COVID-19 vaccines modestly broaden and enhance protection against the Omicron subvariants compared to the monovalent ancestral boosters whilst maintaining protection against the pre-Omicron variants including the ancestral virus.
SAGE does not have data on whether variant-containing COVID-19 vaccines are more effective than existing WHO EUL COVID-19 vaccines. Countries should not delay the implementation of booster programmes for first or second doses in the hope of securing variant-containing vaccines.
WHO continues to recommend the use of all existing WHO EUL COVID-19 vaccines (including variant-containing vaccines) as boosters since they continue to protect those at highest risk from severe illness and death. Current data does not allow the issuance of any preferential recommendation; all boosters provide additional protection against infection and severe disease beyond the primary vaccination series.
The good practice statement includes information regarding heterologous booster. increasing evidence that boosters using different COVID-19 vaccine platform from that used for the primary series (heterologous boosting) may provide superior immunogenicity to receiving a homologous booster.
For countries considering heterologous boosters, WHO recommends the following:
countries implementing WHO EUL inactivated vaccines for initial doses may consider using WHO EUL vectored or mRNA vaccines for subsequent doses;
countries implementing WHO EUL vectored vaccines for initial doses may consider using WHO EUL mRNA vaccines for subsequent doses;
countries implementing WHO EUL mRNA vaccines for initial doses may consider using WHO EUL vectored vaccines for subsequent doses.
There is currently not enough data to compare the effectiveness of heterologous boosters with variant-containing boosters. SAGE has called for continued research into this topic.
LAST CALL FOR APPLICATION: The 23rd ADVAC will take place at Les Pensières, Annecy, France from 8 to 19 May 2023. The applications are open until November 15th. We highly encourage NITAG members to apply as this is a great learning and networking opportunity and are happy to support you in the application process. More on the ADVAC website: https://www.advac.org/
Best wishes to all.
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