Edward Nirenberg

@enirenberg.bsky.social

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Views my own, but you can borrow them if you feel so inclined. Anti-disease. Big Nerd Energy. “A homework person.” Fun at parties. Antibody hoarder. he/him

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People seem to be really bad at the distinction between: “everyone is entitled to their own opinion” and “everyone has the right to a massive audience for their opinion regardless of that opinion-holder’s expertise or what the relevant evidence base suggests about that opinion.”

Pardon me as I scream into a pillow about the fact that Johnson & Johnson slashed Janssen's vaccine R&D and abandoned their adult RSV vaccine even though that protected older adults from severe RSV for *3 seasons* with a single dose: www.sciencedirect.co...

This concludes the 3 days of ACIP meetings. You may now return to your regularly scheduled existential terror.

Okay so finally- the work group interpretations for maternal and infant RSV vaccination (and antibody use): www.cdc.gov/vaccines...

Okay now my favorite part: the data on the effectiveness of nirsevimab (a long-lasting RSV monoclonal antibody) in babies: www.cdc.gov/vaccines... It is FANTASTIC news.

Now we have safety in pregnancy: www.cdc.gov/vaccines... The big concern is that there were preterm births seen in the clinical trials for the Pfizer vaccine and for GSK's vaccine in pregnancy (GSK discontinued trials because of the severity). Analysis of Pfizer's data showed...

Now come the presentations on RSV vaccinations (and nirsevimab) for maternal and pediatric patients: www.cdc.gov/vaccines... Here are the current recommendations. CRITICALLY: GSK's vaccine cannot be used in pregnant individual. Neither vaccine can be given to infants.

ACIP is really concerned about how to implement age thresholds here for meningococcal vaccination. If protection wanes within 2 years, giving it at 16, before most are going to college, may be a mistake, let alone doing it earlier.

The Work Group will now present on their assessments of GSK's pentavalent meningococcal vaccine: www.cdc.gov/vaccines... The three vaccines caused similar reactogenicity, although unsolicited AEs slightly more common with pentavalent. No obvious safety issues are noted.

GSK notes that Bexsero has been used in the real world and has caused substantial drops in the incidence of invasive meningococcal disease due to serogroup B in Australia, in response to a concern from ACIP member Long about the durability of protection from MenB vaccine.

We now have a presentation from GSK about their meningococcal pentavalent vaccine covering serogroups ABCWY: www.cdc.gov/vaccines... We have one pentavalent meningococcal vaccine already from Pfizer. We do also have vaccines for ACWY and B separately.

Okay so- epidemiology of meningococcal disease update: www.cdc.gov/vaccines... Meningococcal disease is fortunately rare but causes an illness that is often catastrophic. It is among the only causes of epidemic meningitis but generally requires congregant settings for spread.

There is one more ACIP meeting today. Livestream: www.youtube.com/live... Agenda: www.cdc.gov/vaccines... This one is shorter, focusing on meningococcal disease and RSV vaccines in pregnancy and RSV antibodies for kids.

Advisory Committee on Immunization Practices (ACIP) Day 3 - YouTubewww.youtube.com CDC/ACIP FACA Committee Meeting

CDC Director Cohen has signed off on the updated COVID and flu vaccines: www.cdc.gov/media/re...

CDC Newsroomwww.cdc.gov Press releases, advisories, telebriefings, transcripts and archives.

Seeing some people advocate for getting vaccinated now against COVID-19 and then going to get the updated vaccines as soon as they come out in mid-August. ABSOLUTELY keep up to date but please note: for most people, this is *not* the best way to protect yourself. Let me explain:

Tomorrow ACIP will again meet at 08:30 EST. Votes from today's meeting need to be signed off on by CDC Director Cohen (I expect they will be shortly).

ACIP has voted to recommend the updated COVID-19 vaccine for everyone in the US aged 6 months and older 11-0-1 (ACIP member Maldonado has a conflict of interest and thus recused herself from the vote).

ACIP chair Talbott has voiced several times that she would like to see pneumococcal polysaccharide vaccine phased out from use because it is now superfluous by the use of conjugate vaccine. My only concern with that is PPSV has a role in evaluation of IEIs.

Merck (who makes PCV21), has an interesting suggestion: serotype 4 of pneumococcal tends to be clustered, which suggests that selective implementation of PCV20 in those clusters may be worthwhile while also lowering the age recommendation to 50 for PCV21.

ACIP members voice that pneumococcal vaccination is much easier in childhood, because when a newer iteration of vaccine emerges, the old one goes away. They hope that the adult vaccination schedule might emulate the childhood one in this regard.

My takeaway from this meeting is we should just get a PCV-100 vaccine, give it to everyone and call it a day.

Anyway, now we have the work group to tell us about the policy options for PCV21: www.cdc.gov/vaccines... Basically the work group agrees that adults as young as 50 could benefit from the vaccine, but adults as young as 19 likely won't.

My favorite part of this meeting is when ACIP chair was like "I don't get this result from your presentation" to the Tulane pneumococcal economics presenter, he tried to explain it, and then was like "I still don't get it but, thanks," verbalizing everything I was thinking.

Okay now we have another economics presentation on pneumococcal summarizing the work of 3 teams: www.cdc.gov/vaccines...

Okay now we have the presentations of pneumococcal. These recommendations, currently, are very complicated. I really hope they are simplified in this meeting; www.cdc.gov/vaccines... Part of the motivation here is the new PCV vaccine, a PCV-21 vaccine.

Alrighty we're back. Now we're looking at an update from the CDC influenza division covering... well, a lot: www.cdc.gov/vaccines...

CDC reinforces that raw milk has never been recommended because of the huge infectious disease risk it poses independent of its viability as a source of H5N1 influenza infection.

We now have the next item on the agenda which has to do with influenza (H5N1 and seasonal). First we have a presentation on H5N1: www.cdc.gov/vaccines... It's important to understand that H5N1 is not a new virus, but it is behaving in new ways.

During the implementation presentation, a comment was made that many clinicians are not raising the issue because they believe the patient will already reject it which ACIP member Loehr noted was not adequate as a reason to not counsel about vaccination.

There's now a small presentation on implementation: www.cdc.gov/vaccines... 2023-2024 vaccine coverage among children in the US overall is 14.4%. Coverage increased with income level and was higher among non-Hispanic white children than Hispanic and Black.