April 2025 ACIP Day 2: Meningococcal, RSV & Chikungunya Updates
On Day 2 of the April 2025 ACIP meeting, discussions centered around meningococcal, RSV, and chikungunya vaccines. Several updates and proposals are relevant for individuals with autoimmune or immune-compromising conditions, including those living with chronic illness, immunosuppressive treatment, or impaired antibody transfer during pregnancy.
Day 1 Summary:
Meningococcal Vaccine: Expanded Protection for High-Risk Groups
ACIP reviewed data on MenABCWY combination vaccines (Pfizer’s Penbraya and GSK’s Penmenvy). These pentavalent vaccines combine protection against serogroups A, B, C, W, and Y. The committee voted to recommend the use of Penmenvy only when both MenACWY and MenB vaccines are indicated at the same visit.
This applies to people with:
- Complement deficiencies or use of complement inhibitors
- Functional or anatomic asplenia
- HIV infection
- Certain autoimmune diseases associated with increased meningococcal risk
RSV in Adults: Ongoing Risk for Chronic and Immune Conditions
Multiple presentations addressed RSV hospitalization risk and vaccine effectiveness in adults under 60 who have chronic or immunocompromising conditions. Risk groups included:
- COPD, asthma, coronary artery disease, diabetes, obesity (BMI ≥40)
- Cancer patients, transplant recipients, and people on immunosuppressants
- Patients with renal, liver, or heart failure
CDC models showed that RSV hospitalization rates among adults aged 50–59 with ≥1 chronic or immune-related condition were up to 3.5 times higher than in the general population. Discussions are ongoing about whether to recommend RSV vaccination for high-risk adults under 60 formally.
Infants Born to Mothers With Immune Challenges: RSV Antibody Guidance
A new long-acting RSV monoclonal antibody (Clesrovimab) is under review as an alternative to Nirsevimab. If approved, either may be used in infants during their first RSV season.
Importantly, infants born to mothers with immune impairments (e.g., those with autoimmune diseases or HIV) may not receive enough protection via maternal vaccination. In these cases, direct antibody administration to the infant is recommended, even if the mother was vaccinated.
Chikungunya Vaccine: Guidance Includes Autoimmune-Adjacent Risks
ACIP reviewed updated guidance for two licensed chikungunya vaccines:
- Live attenuated vaccine (CHIK-LA) — approved in 2023
- Virus-like particle vaccine (CHIK-VLP/VIMKUNYA) — approved in 2025
Notably:
- Older adults (≥65) with underlying conditions may receive CHIK-VLP if traveling to high-risk areas. However, CHIK-LA is cautioned in this age group due to increased rates of adverse events, including rare hospitalizations for severe myalgia and atrial fibrillation.
- A reported serious adverse event occurred in a 58-year-old woman with fibromyalgia, raising questions about reactogenicity in individuals with chronic immune-related pain syndromes.
Watch the whole day 2 meeting here: