RSV vaccine – Go Retire Psychiatrist

Reminder: CDC ACIP Meeting June 26-28 on Vaccines Including Covid-19 and RSV

Just a reminder about the upcoming CDC ACIP meeting on vaccines, including RSV and Covid-19.

CDC ACIP Meeting on the RSV Vaccine and Some Dad Jokes

We watched the section of the CDC ACIP meeting about RSV vaccines on February 29, 2024. There was a lot of discussion on the safety of the vaccine. It looks like it will still have a requirement that you have a shared clinical decision-making meeting with your physician. I think that still implies you’d need a prescription. However, there are only a handful of states which would require a prescription from your doctor. Iowa is one of them.

That made the comment by one of the committee participants thought provoking. I believe she got the RSV vaccine from a pharmacist, who asked no questions. There was no shared clinical decision-making discussion with that pharmacist.

But there was a discussion during the meeting with a pharmacist who was in the room. She made it clear that pharmacists had plenty of training (“20 hours” along with additional learning) and could handle the shared clinical decision-making piece with patients.

Sena and I have had all of our vaccines including the Covid-19 shots administered by pharmacy techs. I hardly know what the pharmacists look like because they are a blur, managing the drive-up window and all other customers. It’s clear that a large proportion of vaccines are available at most pharmacies and the techs give the shots. They are pleasant and happy to apply the Band-Aid.

You can’t even telephone the pharmacy and talk to a live person. Sometimes you’ll get a recording which replies to most of your questions with “Sorry, I didn’t get that. Did you say you want a vaccine or a cheeseburger with fries?” Scheduling vaccine appointments are generally done on line. Scheduling a visit with the pharmacist is probably not easier than scheduling one with your doctor, who might confuse you with “the colonoscopy” in room 5.

I’ve looked at the health care professional section on the CDC website pertaining to the age and medical conditions necessary to qualify for getting the RSV vaccine. I’m pretty sure I’m in the right age category, although I stopped keeping track after the evolution of asparagus. I don’t have any chronic medical conditions, unless you count dad jokes. I exercise, juggle, take only a multivitamin a day, meditate, and regularly leap tall buildings in a single bound. I’m pretty sure I don’t need the RSV vaccine, but what do I know? I’m a retired psychiatrist.

It looks like the risk of getting Guillain-Barre Syndrome (pronounced “GBS”) is not zero and may or may not be associated with the RSV vaccine. It’s pretty clear that 2 of the 3 major manufacturers of the vaccine who attended the meeting were pretty sensitive to any hints their product might have anything to do with GBS and might challenge you to a no holds barred thumb wrestling match if you say otherwise.

We think there’s a long way to go before everybody’s clear on who gets the RSV vaccine and when, and also where. But you can’t get it at the pharmacy drive up window.

CDC ACIP Meeting February 28-29, 2024 to Discuss Covid-19 and Other Vaccines

There are news stories about a pending CDC-ACIP meeting (February 28-29, 2024) which might include information about a CDC recommendation to possibly add a 3rd additional Covid-19 vaccine booster this spring.

The Covid-19 vaccine portion of the meeting is scheduled for February 28, 2024 at 8:30 AM EST. There will be a vote at 1:55 PM EST that day.

Interestingly, also on the agenda is a discussion about the RSV vaccine on February 29, 2024 at 8:30 AM EST. We wonder whether the committee will talk about the current requirement for a shared clinical-decision making discussion with a physician for getting the RSV vaccine.

CDC on How to Get Flu, Covid-19, and RSV Vaccines

The latest update on how to get the respiratory viruses vaccines is updated on the CDC website. Highlights:

“f you have insurance, these vaccines should be free to you in most cases.
Adults without health insurance or adults whose insurance doesn’t cover all COVID-19 vaccine costs can get an updated COVID-19 vaccine for free through the Bridge Access Program.
Most children can get recommended vaccines for free through their family’s insurance or the Vaccines for Children (VFC) Program.
How COVID-19 vaccines are being distributed changed in September 2023 when these products moved to the commercial market, but there is still plenty of vaccine supply.
Flu, COVID-19, and RSV vaccines may be given at the same visit.”

RSV Vaccine Prescription Necessary for Some States

Sena and I were wondering if you need a prescription to get the Respiratory Syncytial Virus (RSV) vaccine.

It turns out only four states require doctor prescription to get RSV vaccine: Iowa, Georgia, Missouri, and Utah. Washington D.C. is working on making the RSV vaccine available without a prescription.

The Iowa Pharmacy Association blog post about the issue makes it clear a prescription is needed to get the RSV vaccine.

What’s Up with Shared Clinical Decision Making for the RSV Vaccine?

There are probably some questions about the new Respiratory Syncitial Virus (RSV) vaccine. Because I’ve seen TV commercials about the new website RSVandMe, I checked on a few things the other day.

The RSVandMe website and the companion website are both produced by the RSV vaccine maker GlaxoSmithKline (GSK). As such, I consider them marketing commercials.

I checked the Centers for Disease Control (CDC) website and saw that the CDC Advisory Committee on Immunization Practices (ACIP) recommended approval of the RSV vaccine at their June Meeting (covered earlier on this blog):

Adults 60 years of age and older may receive a single dose of Respiratory Syncytial Virus (RSV) vaccine, using shared clinical decision-making.

The term “shared clinical decision-making” is clarified on the CDC webpage at this link.

The upshot of shared clinical decision-making is that it’s up to the provider (the list of providers include pharmacists). So far the list of recommended vaccines does not yet include RSV, so it probably needs updating. It looks like the ACIP MMWR recommendation page also needs updating.

What’s Up with Seasonal Vaccines This Fall?

I just read an interesting article in JAMA on this fall’s Covid-19 vaccine. Most of it is from the FDA meeting in June (Rubin R. This Fall’s COVID-19 Vaccines Will Target Omicron XBB Subvariants, but Who Needs Them Remains to Be Seen. JAMA. Published online July 05, 2023. doi:10.1001/jama.2023.10053).

One expert was quoted, indicating that there will be “…an elaborate discussion” at the CDC ACIP meeting about who should get the new monovalent XBB.1.5 vaccine. I don’t see that the meeting is scheduled yet.

There are some other interesting quotes to pass along:

“Back in March and the first half of April, XBB.1.5 represented more than 80% of circulating SARS-CoV-2 in the US, according to CDC estimates. Its dominance began to slip in late April, and as of late June, XBB.1.5 represented little more than a quarter of circulating SARS-CoV-2 variants. By then, though, XBB.1.5 and 9 other XBB subvariants together accounted for a total of 96% of circulating SARS-CoV-2 in the US. Fortunately, members of the XBB family of subvariants are antigenically similar to each other, so a vaccine against XBB.1.5 should protect against the rest of them as well, the WHO committee noted.”

“By the third quarter of 2022, an estimated 96.4% of approximately 143 000 blood donors in a nationwide, longitudinal cohort had SARS-CoV-2 antibodies from previous infection or vaccination or both, according to an analysis published in June in Morbidity and Mortality Weekly Report.

Or, as Sawyer told JAMA, “[t]he whole US has had this virus in one form or another.”

Because of the high prevalence of SARS-CoV-2 antibodies in the population, Paul Offit, MD, in an interview predicted “a focused recommendation by the CDC” regarding who should receive the XBB.1.5 vaccine.”

“Offit said he expects that the CDC will recommend the new monovalent XBB.1.5 vaccine for groups at the greatest risk for severe disease, reflected in continuing hospitalizations for COVID-19. Those groups likely would include people who are 75 years or older, people with severely compromised immune systems, and pregnant people, Offit said.”

“At least for people 60 years or older, the fall vaccine situation will be more complicated than it was a year earlier, Schaffner noted. That’s because at its regular monthly meeting in June, ACIP voted to recommend that this age group have the option of being vaccinated against respiratory syncytial virus (RSV) after consulting with their physician or pharmacist.”

That would mean that there would be 3 vaccines coming in the fall: RSV, Covid-19, and influenza. Sena and I have been doubtful about why a conversation with a physician would be necessary for the RSV vaccine. We don’t know whether that means you couldn’t get it without a physician’s order. There are also questions about coadministration of the RSV and Covid-19 vaccines.

Because the time is coming soon for seasonal vaccines, we’re hoping the questions will be answered soon.

Brief Remarks on CDC ACIP Vaccines Meeting This Week

My impressions of the first couple of days of the CDC ACIP meeting on vaccines will be brief. My wife and I were interested in learning more about the new Respiratory Syncytial Virus (RSV) vaccine. It sounds like the vaccine was upvoted with only a few no votes. Most committee members thought the vaccine was a good idea. It sounds like the decision to get the RSV vaccine should be in the context of a shared-decision making conversation with your doctor.

We didn’t get a chance to hear the presentation on the Polio vaccine. The slides were available and it looks like most people are vaccinated. The recommendation is that if you’re not already vaccinated or incompletely vaccinated, or you’re a health care worker likely to encounter patients with polio, a laboratory worker who might handle material with the polio virus in it, or traveling to regions where you might contract it, then the vaccine would be recommended.

Here is a link to the presentation slides.

Four Seasonal Vaccines for Older Adults?

There are a number of seasonal vaccines recommended for older adults in the U.S. They include vaccines for influenza, pneumonia, and the newest one is Respiratory Syncytial Virus (RSV).

I noticed that during the recent FDA meeting to decide on approval of another vaccine for the XBB variant of Covid-19, many experts objected to the use of the word “periodic” in the voting question.

Those objecting to it did so because of the implicit suggestion that Covid-19 is a seasonal virus. Not all experts agree on that. I gather it takes time to determine whether or not an infectious agent should be considered seasonal or not.

If the XBB variant of Covid-19, RSV, pneumonia, and influenza are all considered seasonal, then there are 4 vaccines for which older adults would be eligible.

The consensus among most experts is that you can take both influenza and Covid-19 vaccines at the same time. Most of us older adults also get the pnemococcal vaccine as well.

Will the RSV vaccine be added to the list? Should you get all 4 at the same time? Or should they be spaced out? Should you get the influenza and Covid-19 vaccines together and wait a week or two before getting the RSV and pneumococcal vaccines?

The increase in recommendations for vaccinations could be burdensome for those without health insurance. Vaccine uptake will probably continue to be a challenge.