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National Vaccine Advisory Committee Approves Recommendations to Improve HPV and Maternal Vaccine Efforts

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The National Vaccine Advisory Committee (NVAC) met last week in Washington, D.C. to deliberate recommendations aimed at continually improving our nation’s immunization system.

This federal advisory committee, which was authorized in 1987, provides vaccine and immunization policy recommendations to the U.S. Department of Health and Human Services (HHS).  The NVAC committee is made up of individuals with a wide variety of expertise including physicians, consumer organizations, state and local health agencies, vaccine researchers and manufacturers.

 

The NVAC is chartered to:

  • Study and recommend ways to encourage the availability of an adequate supply of safe and effective vaccination products in the States;
  • Recommend research priorities and other measures the Director of the National Vaccine Program should take to enhance the safety and efficacy of vaccines;
  • Advise the Director of the Program in implementation of sections 2102 and 2103 of the Public Health Service Act; and
  • Identify annually for the Director of the program the most important areas of government and non-government cooperation that should be considered in implementing sections 2102 and 2103 of the Public Health Service Act.

 

The NVAC has made recommendations on a wide variety of issues since its inception in 1987 at a time when vaccine supply, the improvement on existing vaccines, and vaccine resources and financing needs were the main focus of the committee’s time.  As issues arise which require further input to inform the full committee, NVAC forms subcommittees who, with tremendous support from the National Vaccine Program Office staff, deliberate the issue, conduct extensive research, and eventually develop draft recommendations.  The full committee reviews the report and votes to make recommendations on the issues at hand to the Assistant Secretary of Health.  These committees typically meet throughout the year on regular teleconferences; bringing in experts from a variety of health-related fields to inform their work.  A typical workgroup might meet for more than a year prior to developing a report and set of recommendations for full committee consideration.

The NVAC is one of several federal advisory committees who report, either directly or indirectly, to the Secretary of Health on issues related to vaccine development, approval and safety oversight.

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This valuable schematic, which was published in public health reports in larger format, includes each of the federal advisory committees along with the agency that supports their work.  Each of these committees provides liaison reports and input during the February, June and September meetings of the NVAC, along with several Ex Officio organizations.  This allows for better coordination of efforts at the national level on all matters related to the immunization system.

At the most recent NVAC meeting the HPV Working Group and the Maternal Immunization Working Group provided final recommendations for vote by the full NVAC.

The HPV working group was charged “to review the current state of HPV immunization, to understand the root cause(s) for the observed relatively low vaccine uptake (both initiation and series completion), and to identify existing best practices all with a goal of providing recommendations on how increase use of this vaccine in young adolescents.”   The committee was conducting their research at the same time as the President’s Cancer Panel (PCP), which was also preparing recommendations on a wide variety of cancer-related issues.  Recently the PCP report was released, with great focus on the importance of increasing HPV vaccination rates in order to reduce the number of cancers in women and men.  The NVAC HPV Working Group focused their recommendations in support of the PCP report and will continue to investigate the need for additional recommendations to the Assistant Secretary.

The NVAC approved the following recommendations in full, which will be posted in the near future for the public:

1. NVAC and the ASH should endorse the President’s Cancer Panel (PCP) report, Accelerating HPV Vaccine Uptake: Urgency for Action to Prevent Cancer, and adopt the recommendations outlined therein.

2. As written in the PCP report, NVAC should, “monitor the status of uptake and implementation of the recommendations.” This should be done by hearing an annual progress report from stakeholders identified in the PCP report.

3.  The working group will continue to work on a shortened schedule and will report back to NVAC on whether there are additional recommendations to me made.

The Maternal Immunization Working Group also made a series of significant recommendations aimed at fulfilling their charge “to review the current state of maternal immunizations and existing best practices.”  The working group was asked to first identify programmatic barriers to implementation of current recommendations regarding maternal immunization and make recommendations for overcoming these barriers. Efforts to identify barriers to and opportunities for developing vaccines for pregnant women should then be identified as well as ways to overcome these barriers and leveraging the opportunities.

In particular the working group made a series of recommendations aimed at:

1. Enhancing communication to address the safety and effectiveness of all currently recommended immunizations during pregnancy;

2. Maximizing obstetric provider recommendation and administration of recommended maternal immunizations;

3. Focusing efforts to improve financing for immunization services during pregnancy and postpartum;

4. Supporting efforts to increase the use of electronic health records (EHRs)and Immunization Information Systems (IISs) among obstetrical care providers; and

5. Recognizing and addressing current vaccine liability law barriers to optimize investigations and uptake of recommended and future vaccines during pregnancy

This committee’s work will be instrumental in forwarding the efforts to ensure the vaccination of pregnant women against whooping cough and influenza and build on policies and procedures necessary as potential new vaccines are recommended for the benefit of pregnant women and their newborns.  The recommendations, which are extensive, will be available to the public in the near future, at which time Every Child By Two will provide them to our readers.

The Vaccine Hesitancy Working Group will continue its research and prepare a draft report and recommendations to the full NVAC at the September 9 – 10 meeting.  To register for this public meeting please visit the National Vaccine Program Office website.  Note that all meetings are webcasted live to the public as well.  Stay tuned.

Victims Katie Couric Neglected To Mention In Her Discussion of HPV

December 5, 2013 232 comments

A few weeks ago I wrote about the fact that Katie Couric’s new daytime television show Katie was planning to air a segment about HPV vaccine.  After hearing the proposed line-up for the show it was clear that the HPV vaccine was not going to be portrayed favorably.  And as expected, the conversation has blown up all over the internet in the past 24 hours with many reporters and bloggers calling out Katie Couric and her producers for how poorly they’ve handled this important conversation.

Unfortunately, daytime television ratings are driven by emotion and controversy and Katie Couric’s producers know that.  So despite the overwhelming research available on the safety and efficacy of the HPV vaccine, that information was not adequately presented to the millions of viewers of her show.

But there was one other thing notably missing. 

It was the voices of those who have suffered with HPV related cancers.  And those family members who speak out on behalf of those lost to HPV related cancers.  

Since the Katie Couric neglected to include a single cervical cancer survivor, I’m encouraging anyone who has had a personal experience with an HPV related cancer to speak out and let others know just how terrifying it has been for you.  You may share your story in the comments below or send them to us at shotofprevention@gmail.com.  And I would like to encourage everyone to share your opinions of the episode with one of the show’s producers (Beth.Cochran@katiecouric.com).

Below are just a few of the HPV related stories that are featured on the Shot By Shot website.  They are all very compelling and emotional and I hope that someday they will get the kind of attention that the Katie show has given to those critical of the vaccine.

In this video, Heather Burcham shares her story of cervical cancer just two months before she died.  Her hope was to change just one person’s life by encouraging others to get the HPV vaccine.

This is an excellent video filmed at the national Cervical Cancer Coalition conference in Atlanta, GA, in January 2013 which highlights stories from cervical cancer survivors and family members of women who have died from the disease.  These personal stories highlight the devastating impact of cervical cancer and emphasizes the importance of prevention in the form of vaccines and regular screening–prevention that can save lives.

Read more…

Why Some Parents Are Refusing HPV Vaccine For Their Children

August 20, 2013 612 comments

Some of the data contained in this post has been updated.  For a more recent review of the prevalence of HPV infection and more current data on the safety and efficacy of the HPV vaccine, click here to read “Questioning Whether to Get Your Child The HPV Vaccine?  Read this“, published in January, 2016.  

This post is not the result of an official survey. Rather, it’s a collection of the most common explanations I’ve heard parents make when refusing HPV vaccine for their children, followed by points to consider.

REASON #1: My child is not/ will not/ should not be having sexual relations. So why would they need an HPV vaccine?

As a mother to five daughters I get it. Every parent wants to believe that their son or daughter will remain abstinent until marriage. And some may. But the reality is that some children, even as young as 12 and 13, are already involved in sexual relations and this reality is what has influenced the age at which the HPV vaccine is recommended.  Here is what the studies suggest:

The HPV vaccine is most effective when the complete three shot series is given long before any sexual activity begins, which is one reason the vaccine is recommended for boys and girls between the ages of 11 and 12. Additionally, the vaccine illicits a greater immune response and produces higher antibody to fight infection when given at this age, compared to receiving the vaccine at a later age.

Regardless of the when a child becomes sexually active, the HPV vaccine is important because the prevalence of HPV infection is staggering:

Some parents may be surprised to learn that sexual intercourse is not necessary for infection.  Oral-genital and hand-genital transmission of some genital HPV types is possible and has been reported.  Studies show that HPV was detected in 46% of females prior to first vaginal sex.  Based on this information, it’s possible that a person can become infected during their first sexual encounter. Even if someone remains abstinent until marriage, there’s no guarantee that the person they are marrying isn’t already infected.

Yet, some parents remain concerned that vaccinating a child for a sexually transmitted disease is like giving them permission to have sex. However, research indicates that HPV vaccination has had no notable difference in the markers of sexual activity, to include pregnancies, counseling on contraceptives, and testing and diagnosis of sexually transmitted infections. In other words, the vaccine does not appear to be changing sexual behaviors, only protecting those when they eventually engage in them.

The way I see it, most children by the age of 11 can understand that the HPV vaccine can protect them from various types of cancers, but not from pregnancy and STDs. It’s a simple matter of communication by which the parents can explain that the vaccine doesn’t equate to a free pass to have sex.  If a child chooses to refrain from sexual relations, I would venture to guess that it has more to do with their upbringing and strong moral character, than whether or not their parents choose to protect them with the HPV vaccine.

REASON #2: Won’t regular PAP smears detect any abnormalities and identify cervical cancer without the need for the vaccine? Read more…

HPV Vaccine is All About Cancer Prevention

January 24, 2013 91 comments

In recognition of Cervical Cancer Awareness Month, Dr. Lara Zibners* has contributed this guest post on the importance of HPV vaccination for both girls and boys.

DrZibnersLast year I went on a cycling weekend out in California with four other women, all of us doctors. We were there to celebrate my dear friend’s recovery from breast cancer. Of course there was the usual debauchery– feather boas included– that takes place when 5 middle-aged women have left their husbands in charge of the children. But there was still a sense of sobriety, knowing why we were all there and wishing that “chemo” and “reconstructive surgery” weren’t the frequent topics of conversation that they were. And with cancer on our minds, this group of five female physicians soon found ourselves talking about—what else?—genital warts.

The OB-Gyn in the group waxed poetically about how excited she was to immunize her patients against HPV—the human papillomavirus. It’s long been known that HPV is responsible for nearly all cases of cervical cancer in women. HPV is a nasty little virus that spreads from skin-to-skin, person-to-person. Often this occurs during sexual contact but can also be passed from mother to child. Many people infected with HPV don’t even realize it, meaning they continue to pass the infection to others. Hence the some 6 million people infected every year with HPV.  And while HPV causes unsightly genital warts, that’s not what bothers physicians about it. What bothers us is that HPV causes cancer. And cancer, to put it bluntly, sucks.

Good news is there’s a vaccine that can protect us from the most common strains of HPV that cause cancer. It is currently recommended that girls between the ages of 11 and 12 receive 3 doses of the vaccine. As of 2011, this was extended to include the routine vaccination of boys. Naturally this caused a stir, since HPV is usually blamed for causing cervical cancer. And a boy isn’t supposed to have a cervix. So what was this? An act of chivalry? A sort of “holding the door” open so cancer wouldn’t whack a girl in the head? Read more…

HPV Vaccination Still Not Where it Needs To Be

September 25, 2012 48 comments

This morning I was reminded of the importance of  human papillomavirus vaccination after reading an article that appeared yesterday in Ob.Gyn. News.  As the parent of five daughters, and the friend of several people who have had various health complications as a result of HPV, I’m disappointed that there is a safe and effective vaccine that is currently underutilized at this point in time.  Data released as part of the CDC’s National and State Vaccination Coverage Among Adolescents Aged 13–17 Years revealed that only 23% of 13-year-old girls in the U.S. had completed the recommended three-dose HPV series.  Additionally, as of 2011, only about 35% of all 13-17  year-old girls had completed the series.

If you are a parent that has yet to begin your child on the 3 dose HPV vaccination series, you may want to consider these tidbits of information that were included in the Ob.Gyn. News article:

  • Three-quarters of the general population become infected with HPV, and three-quarters of those infections occur at 15-24 years of age.
  • More than 50% of those who become infected with HPV do so within 2 years after becoming sexually active.
  • Studies show that more than 20% of males and females have already had vaginal sex by age 15.
  • One-third of all HPV-related cancers occur in men which is why the CDC recommended vaccination for 11-12 year old boys, as well as 11-12 year old girls.
  • Protecting boys will secondarily increase protection against cervical cancer in girls.

The article also discusses how vaccination can reduce the cost burden of this disease and references other interesting considerations regarding HPV and the vaccine to prevent it.  But what I found most interesting were the statistics that have come out of Australia, the first country to fund a HPV vaccination program for all females aged 12-26 years.

After the first two years of the Australian program, which began in July of 2007,  a national surveillance program had identified a 59% reduction in new diagnoses of genital warts among women in Australia.  There was also a 39% drop in new cases among heterosexual Australian males aged 12-26.  Even though they weren’t included in the vaccine program, the rate drop among men seems to suggest evidence of herd immunity, especially since they can be compared among the unchanged rates among men who have sex with other men.  In a subsequent report with updated data through mid-2011, Australian investigators credited “the dramatic decline and near disappearance” of genital warts in women and heterosexual men under age 21 year, to be a result of the national HPV vaccination program that had been initiated just four years prior.

This is just one example of what can be accomplished here in the United States if we work to improve HPV vaccination rates.  There are obviously some challenges we face, but when I think of my friend and fellow Shot@Life immunization champion, I’m committed to finding a way to educate parents and encourage vaccination.   Here is her story and her message to parents everywhere.

What do you feel are the biggest challenges we face in improving HPV vaccination rates?

Even the Unvaccinated are Protected by HPV Vaccine

July 10, 2012 71 comments

A new study published in Pediatrics is getting a lot of media attention today.  CBS News, HealthDay News, The Inquisitr and Examinir.com, are among the many news outlets that have been reporting about the human papillomavirus (HPV) vaccine.

The results of the study show that the HPV vaccine has been effective at reducing the number of infections that people are getting, while also protecting those people who haven’t been vaccinated.  The study abstract concludes that

“four years after licensing of the quadrivalent HPV vaccine, there was a substantial decrease in vaccine-type HPV prevalence and evidence of herd protection”.

The abstract specifically states that

“the prevalence rate for vaccine-type HPV decreased substantially from 31.7%–13.4% and the decrease in vaccine-type HPV not only occurred among vaccinated (31.8%–9.9%) but also among the unvaccinated (30.2%–15.4%)”.

Since vaccine critics often question the validity of “herd immunity”, it’s encouraging that this study was able to illustrate the reduction of disease, not only in the vaccinated population, but also among the unvaccinated.  The simple suggestion is that if we can protect a critical portion of the community from ever contracting these particular strains of HPV covered by the vaccine, than we can effectively reduce the overall transmission of these viruses and reduce the incidence of infection even among those who remain unvaccinated.  This is especially good news since the vaccine has had less than optimal uptake since it was first recommended to pre-teen girls several years ago.

In evaluating the disappointing vaccination rates, many believe that there have been a number of possible reasons. Read more…