| IAC Express 2007 |
| Issue number 657: April 16, 2007 |
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Contents
of this Issue
Select a title to jump to the article. |
- AAP
policy statement recommends that all children receive
hepatitis A vaccination at age 1 year
- AAP
policy statement recommends a two-dose varicella
immunization strategy
- AAP
voices concern that rising vaccine costs and inadequate
payment procedures put children at risk
- Sabin
Vaccine Institute awards Dr. Hilary Koprowski the 2007
Sabin Gold Medal
- April
issue of CDC's Immunization Works electronic newsletter
now available online
- ACIP
meeting scheduled for June 27-28 in Atlanta; May 18 is
deadline for non-U.S. citizens to register
- Proceedings of the AAP/AMA Immunization Congress now
available online
- CDC
reports on progress toward polio eradication in Pakistan
and Afghanistan
- Biodefense Vaccines & Therapeutics conference planned for
June 4-6 in Washington, DC
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| Abbreviations |
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| AAFP, American Academy of Family Physicians; AAP,
American Academy of Pediatrics; ACIP, Advisory Committee on Immunization
Practices; AMA, American Medical Association; CDC, Centers for Disease
Control and Prevention; FDA, Food and Drug Administration; IAC, Immunization
Action Coalition; MMWR, Morbidity and Mortality Weekly Report; NCIRD,
National Center for Immunization and Respiratory Diseases; NIVS, National
Influenza Vaccine Summit; VIS, Vaccine Information Statement; VPD,
vaccine-preventable disease; WHO, World Health Organization. |
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| Issue 657: April 16, 2007 |
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| 1. |
AAP policy statement recommends that all children receive hepatitis A
vaccination at age 1 year
On April 9, the American Academy of Pediatrics (AAP)
released a policy statement made by its Committee on Infectious Diseases. It
is titled "Hepatitis A Vaccine Recommendations"; the abstract is reprinted
below.
ABSTRACT. Since licensure in 1995 of hepatitis A vaccine, the
Centers for Disease Control and Prevention (CDC) and the
American Academy of Pediatrics (AAP) have been implementing an
incremental hepatitis A immunization strategy in children. In
1996, children living in populations with the highest rates of
disease were targeted for immunization, and in 1999, the program
was expanded to immunization of children 2 years and older
living in states and counties with rates of hepatitis A
historically higher than the national average. The 1999 program
has been successful; the current rate of hepatitis A is the
lowest ever reported in the United States. Regional, ethnic, and
racial differences in the incidence of hepatitis A have been
eliminated. The incidence of hepatitis A in adults in immunizing
states has decreased significantly, suggesting a strong herd
immunity effect associated with immunization. In 2005 the U.S.
Food and Drug Administration (FDA) changed the youngest approved
age of administration of hepatitis A vaccine from 24 months to
12 months of age, which facilitated incorporation of the vaccine
into the recommended childhood immunization schedule. As the
next step in the implementation of the incremental vaccine
immunization strategy, the AAP now recommends routine
administration of an FDA-licensed hepatitis A vaccine to all
children 12 to 23 months of age in all states according to a
CDC-approved immunization schedule.
Available data suggest that hepatitis A vaccine can be
coadministered with other childhood vaccines without decreasing
immunogenicity. Hepatitis A vaccines have proven to be extremely
safe. In prelicensure clinical trials of both Havrix
(GlaxoSmithKline, Rixensart, Belgium) and Vaqta (Merck & Co.,
Inc., Whitehouse Station, NJ), adverse events were uncommon and
mild when they occurred, with resolution typically in less than
1 day. Hepatitis A vaccine is contraindicated in people with a
history of severe allergic reaction to a previous dose of
hepatitis A vaccine or to a vaccine component. Because the
hepatitis A vaccine is an inactivated product, no special
precautions are needed for administration to people who are
immunocompromised. No data exist about administration of
hepatitis A vaccine to pregnant women, but because it is not a
live vaccine, the risk to mother and fetus should be extremely
low to nonexistent.
To access the complete policy statement, go to:
http://www.cispimmunize.org/pro/pdf/HepatitisA-040907.pdf
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| 2. |
AAP policy statement recommends a two-dose varicella immunization strategy
On April 9, the American Academy of Pediatrics (AAP)
released a
policy statement made by its Committee on Infectious Diseases.
It is titled "Prevention of Varicella: Recommendations for Use
of Varicella Vaccines in Children, Including a Recommendation
for a Routine Two-Dose Varicella Immunization Schedule"; the
abstract is reprinted below.
ABSTRACT. National varicella immunization coverage using the
current 1-dose immunization strategy has increased among
vaccine-eligible children 19 through 35 months of age from 27%
to 88% by 2005. These high immunization rates have resulted in a
71% to 84% decrease in the reported number of varicella cases,
an 88% decrease in varicella-related hospitalizations, a 59%
decrease in varicella-related ambulatory care visits, and a 92%
decrease in varicella-related deaths in 1- to 4-year-old
children when compared with the prevaccine era. Despite this
significant decrease, the number of reported cases of varicella
has remained relatively constant during the past 5 to 6 years.
Since vaccine effectiveness for prevention of disease of any
severity has been 80% to 85%, a large number of cases of
varicella continue to occur among people who already have
received the vaccine (breakthrough varicella) and outbreaks of
varicella have been reported among highly immunized populations
of school children. The peak age-specific incidence has shifted
from 3- to 6-year-old children in the prevaccine era to 9- to
11-year-old children in the postvaccine era for cases in both
immunized and unimmunized children during these outbreaks.
Outbreaks of varicella are likely to continue with the current
1-dose immunization strategy.
After administration of 2 doses of varicella vaccine in
children, the immune response is markedly enhanced, with >99% of
children achieving an antibody concentration (determined by
glycoprotein enzyme-linked immunosorbent assay [gpELISA]) of >=5
U/mL (an approximate correlate of protection) and a marked
increase in geometric mean antibody titers after the second
vaccine dose. The estimated vaccine efficacy over a 10-year
observation period of 2 doses for prevention of any varicella
disease is 98% (compared with 94% for 1 dose), with 100%
efficacy for prevention of severe disease. Recipients of 2 doses
of varicella vaccine are 3.3-fold less likely to have
breakthrough varicella, compared with those given 1 dose, during
the first 10 years following immunization.
To achieve greater levels of immunity with fewer serosusceptible
people, greater protection against breakthrough varicella
disease, and reduction in the number of outbreaks occurring
nationwide among school-aged populations, a 2-dose varicella
immunization strategy is now recommended for children >=12
months of age.
- Children 12 months through 12 years of age should receive two
0.5-mL doses of varicella vaccine administered subcutaneously,
separated by at least 3 months; if the second dose
inadvertently is administered between 28 days and 3 months
after the first dose, the second dose does not need to be
repeated. All children routinely should receive the first dose
of varicella-containing vaccine at 12 to 15 months of age. The
second dose of varicella-containing vaccine is recommended
routinely when children are 4 to 6 years of age (i.e., before
a child enters kindergarten or first grade) but can be
administered at an earlier age.
- People >=13 years of age without evidence of immunity, as
defined in the Recommendations section of this statement,
should receive two 0.5-mL doses of varicella-containing
vaccine separated by at least 28 days.
Both a monovalent varicella vaccine (Varivax [Merck & Co. Inc.,
Whitehouse Station, NJ]) and a combination quadrivalent
varicella-containing vaccine (ProQuad [Merck & Co. Inc.], or
measles-mumps-rubella-varicella [MMRV]) are licensed by the Food
and Drug Administration (FDA) for use in the United States.
Monovalent varicella vaccine is approved for use in children 12
months of age and older (and, therefore, adolescents and adults
as well), and MMRV is approved only for children 12 months
through 12 years of age. Neither varicella-containing vaccine
contains thimerosal or other preservatives. When all vaccine
components are indicated, combination vaccines are preferred
whenever possible to minimize the number of injections.
To access the complete policy statement, go to:
http://www.cispimmunize.org/pro/pdf/Varicella-040907.pdf
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| 3. |
AAP voices concern that rising vaccine costs and inadequate payment
procedures put children at risk
On April 10, the American Academy of Pediatrics
issued a press
release titled "Pediatricians say rising vaccine costs are
putting children at risk." It is reprinted below in its
entirety.
The American Academy of Pediatrics (AAP) is alarmed that the
soaring costs of vaccines combined with lower reimbursements
from insurance companies will lead to the under-immunization of
the nation's children and unnecessary outbreaks of preventable
diseases.
"Childhood vaccines are among the greatest medical breakthroughs
of the last century and are vital to growing up healthy," said
AAP President Jay E. Berkelhamer, MD, FAAP. "However, the
system for delivering vaccines is broken, and we're going to be
in real trouble if it's not fixed soon."
Pediatricians spend tens of thousands of dollars and must
frequently wait months before payment by payers (including
Medicaid and private health plans). Often payments are below the
cost of the vaccine. Gardasil, the new cervical cancer vaccine,
costs physicians $360 for the recommended series of three doses
per person. RotaTeq, the vaccine against diarrhea-causing
rotavirus, costs $190 for the recommended three doses. Even the
routine measles, mumps, and rubella (MMR) vaccine costs $86 for
the recommended two doses. In addition to the cost of the
vaccine, additional costs of ordering, storing, inventory
control, insurance, and spoilage expenses need to be considered.
However, payers are not recognizing these true costs. As a
result, some pediatricians are unable to offer the newest
vaccines.
About 85 percent of children in the U.S. are vaccinated at
pediatricians' offices. Because the current system threatens to
greatly reduce or even eliminate the physician provider role,
the AAP is concerned that this will fragment care causing many
children not to get the comprehensive and preventive health care
they need.
Results from a national survey of pediatricians conducted by the
AAP in 2006 indicated that less than half of pediatricians think
vaccine reimbursement from private and public health insurance
is adequate. Typically, pediatricians are among the lowest-paid
physicians.
"Pediatricians are not looking to make huge profits off
vaccines," said Jon R. Almquist, MD, FAAP, chair of the AAP Task
Force on Immunization. "We're in pediatrics because we care
about children—but we shouldn't be expected to subsidize the
public health system and perform our jobs at a loss. We've
carried this burden for long enough."
To access the press release, go to:
http://www.aap.org/advocacy/releases/apr07vaccinecosts.htm
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| 4. |
Sabin Vaccine Institute awards Dr. Hilary Koprowski the 2007 Sabin Gold Medal
The Sabin Vaccine Institute (SVI) recently issued
a press
release announcing that Hilary Koprowski, MD, is the winner of
the 2007 Sabin Gold Medal. The medal is awarded annually to
recognize the extraordinary accomplishment of those who make
vaccine discoveries or employ vaccines to combat vaccine-preventable diseases. A portion of the press release is
reprinted below.
"Any serious discussion of the giants of 20th century biomedical
research must include Hilary Koprowski as one of the most
prominent," said Dr. H.R. Shepherd, SVI's Founding Chairman.
"The scope of his achievements is simply remarkable, ranging
from polio to rabies and to monoclonal antibodies that are a key
to effective cancer immunotherapy," noted Peter Hotez, MD, PhD,
SVI's President.
Dr. Koprowski's ground-breaking work in polio and rabies greatly
advanced vaccine research. In the late 1940s, his efforts
resulted in production of the first oral polio vaccine that was
used extensively to immunize people on four continents. In the
1970s, his passionate interest in rabies led him to develop a
new tissue culture-based vaccine that is more effective and less
painful than the traditional Pasteur technique.
He was a pioneer in the development of monoclonal antibodies,
which are used to detect cancer antigens and in cancer
immunotherapy. And he has successfully used plants to produce
vaccines and antibodies. Dr. Koprowski and his associates
developed the first functional monoclonal antibody against
colorectal cancer antigen and rabies. The monoclonal antibody
recognizing antigen of colorectal cancer is used throughout the
world for diagnosis of pancreatic cancer by detection of the
antigen in blood. . . .
To access the complete press release, go to:
http://www.sabin.org/news/article.html?aid=26
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| 5. |
April issue of CDC's Immunization Works electronic newsletter now available
online
The April issue of Immunization Works, a monthly
email
newsletter published by CDC, is available on NIP's website. The
newsletter offers members of the immunization community non-proprietary information about current topics. CDC encourages its
wide dissemination.
Some of the information in the April issue has already appeared
in previous issues of IAC Express. Following is the text of two
articles we have not covered.
MEETINGS, CONFERENCES & RESOURCES
ADD YOUR NIIW EVENT: If your organization is planning any
National Infant Immunization Week (NIIW) Activities, CDC is
interested in hearing from you. To add your event, please visit http://www.cdc.gov/nip/events/niiw/2007/activity_form.htm
2007 NCIRD ANNUAL REPORT: The 2007 annual report for CDC's new
National Center for Immunization and Respiratory Diseases
(NCIRD) is now available online. The report can be found at http://www.cdc.gov/nip/webutil/about/annual-rpts/ar2007/2007annual-rpt.htm
To access the complete April issue from the NIP website, go to:
http://www.cdc.gov/nip/news/newsltrs/imwrks/2007/200704.htm
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| 6. |
ACIP meeting scheduled for June 27-28 in Atlanta; May 18 is deadline for non-U.S.
citizens to register
The Advisory Committee on
Immunization Practices (ACIP) will
hold its next meeting on June 27-28 at CDC's Clifton Road campus
in Atlanta. The meeting is open to the general public.
To speed security clearance, ACIP attendees (participants and
visitors) should register online. All non-U.S. citizens are
required to register online AND complete the Access Request Form
by May 18 for the June 27-28 meeting. Non-U.S. citizens will not
be allowed to register on site.
To register online, go to:
http://www2.cdc.gov/nip/ACIP/juneRegistration.asp
To print the Access Request Form for non-U.S. citizens, go to:
http://www.cdc.gov/nip/ACIP/mtg_access_req_form.doc
For more information, go to: http://www.cdc.gov/nip/ACIP/dates.htm or contact Dee Gardner by
phone at (404) 639-8836 or by email at DGardner@cdc.gov
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| 7. |
Proceedings of the AAP/AMA Immunization Congress now available online
The proceedings of the AAP/AMA
Immunization Congress, which was held in Chicago on February 27-March 1, are
now available online. To access them, go to:
http://www.cispimmunize.org/immunizationcongress.htm
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| 8. |
CDC
reports on progress toward polio eradication in Pakistan and Afghanistan
CDC published "Progress Toward
Poliomyelitis Eradication—Pakistan and Afghanistan, January 2006-February 2007" in the
April 13 issue of MMWR. A summary made available to the press is
reprinted below in its entirety.
The governments of Pakistan and Afghanistan are making special
efforts to improve the polio eradication activities in the high
polio transmission border area with compromised security.
Successfully interrupting wild poliovirus in both these
countries will depend upon continued support from the
international partners, plus sustained commitment and
coordination of both countries.
From January 2006 to February 2007, reported poliovirus cases
increased in Pakistan and Afghanistan. However, the genetic
diversity of the virus has decreased, indicating restriction in
the transmission of poliovirus. The governments of both
countries have high-level commitment and have coordinated cross-border polio activities, including two joint large-scale
vaccination campaigns. Mobile populations have been targeted
specifically for immunization, and vaccination posts have been
increased along the border between the two countries.
Successfully interrupting wild poliovirus transmission in both
countries will require accessing and vaccinating children along
the large, remote and increasingly security-compromised border
between these two countries.
To access a web-text (HTML) version of the complete article, go
to: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5614a5.htm
To access a ready-to-print (PDF) version of this issue of MMWR,
go to: http://www.cdc.gov/mmwr/PDF/wk/mm5614.pdf
To receive a FREE electronic subscription to MMWR (which
includes new ACIP statements), go to:
http://www.cdc.gov/mmwr/mmwrsubscribe.html
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| 9. |
Biodefense Vaccines & Therapeutics conference planned for June 4-6 in
Washington, DC
The fifth annual Biodefense
Vaccines & Therapeutics conference
is scheduled for June 4-6 at the Almas Temple Club in
Washington, DC. Conference attendees will include U.S.
biodefense leaders; the program provides the most recent
information on various government agencies' requirements for
biodefense vaccines and therapeutics.
For conference information, go to:
http://www.infocastinc.com/biovac07.html
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