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Updates from June 2017 Meeting of the Advisory Committee on Immunization Practices

July 13, 2017 2 comments

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Recently, the Advisory Committee on Immunization Practices (ACIP) met to discuss several important developments concerning vaccines. As you may be aware, this impartial group of experts advises the U.S. Centers for Disease Control and Prevention (CDC) on all matters related to vaccine recommendations. In the coming years, the ability of the CDC and public health departments to implement the recommendations of this group may be under threat from proposed provisions within the health care reform bills and congressional budget cuts.

The activities of the ACIP are supported by staff at the CDC, which receives annual appropriations from the federal government to fulfill its duties.  This federal immunization funding is at risk of being drastically cut if the Prevention and Public Health Fund (PPHF) is eliminated. (Click here to see a breakdown of the impact of the elimination of the PPHF funds by state.) If Congress follows the recommendation of the President, funding will be reduced by another 14% beginning in Fiscal Year (FY) 2018.

The result is that CDC may no longer be able to fully support its immunization functions including:

  • ACIP staffing;
  • Vaccine purchase and supply management;
  • Vaccine safety monitoring;
  • Education initiatives;
  • Disease surveillance;
  • Outbreak response; and
  • Funding support for state, territory, and city immunization programs.

An example of the critical activities conducted by the CDC includes support for the ACIP.  This committee of experts from diverse fields such as vaccinology, immunology, pediatrics, internal medicine, nursing, family medicine, virology, public health, infectious diseases, and\preventive medicine meets three times a year to review and discuss vaccine research and scientific data related to vaccine effectiveness and safety, clinical trial results, outbreaks of vaccine-preventable disease or changes in vaccine supply.

There are 15 voting members, 8 ex officio members who represent other federal agencies with responsibility for immunization programs in the United States, and 30 non-voting representatives of liaison organizations that bring related immunization expertise. All members volunteer their time and come from many leading professional and public organizations such as the American Academy of Pediatrics, the National Foundation for Infectious Diseases, and the American Geriatrics Society. This is the only meeting to gather such a comprehensive group of experts whose aim it is to protect individual and public health.

The current health care reform discussions that are happening in Congress may have a direct impact on this Committee. Please continue to reach out to your Representatives and Senators to let them know the importance of keeping PPHF and CDC fully funded. (You can find your Members of Congress at http://whoismyrepresentative.com/ and some suggestive language to share here.) 

The value of the ACIP can not be overstated. During their most recent committee meeting in June, members discussed several important issues recapped in the summary below.

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Preventing Shingles Today and the Promise of New Vaccines Tomorrow

September 22, 2016 Leave a comment

The timing could not have been worse.

It was the holiday season and many family members were traveling great distances to converge on “Mom’s House”.  To complicate matters even more, one family member was temporarily living with her mom as a result of being on bed rest for the duration of her high risk pregnancy.

Her mother, who was a fairly active woman in her mid-70 without any health problems, was complaining about back pain.  She believed she had strained a muscle but couldn’t seem to get relief.  When the rash appeared a few days later, it became clear that she had shingles.

It really shouldn’t have come as much of a surprise. 

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About one of every three people in the U.S. will get shingles during their lifetime, and the risk increases with age. For immune compromised individuals, the risk of shingles increases by as much as 50 fold. In fact, every year in the U.S. approximately one million people are affected by shingles.  

If you’ve ever known someone who has suffered with this disease, you’ll know why you would want to prevent it. 

Shingles can cause severe and long-lasting pain.  While the shingles rash typically resolves in about a month for most people, the pain is very difficult to treat.  Other symptoms include fever, headache, chills, upset stomach, muscle weakness, skin infection, scarring.  Shingles can also develop in the eyes and cause vision loss.  Additionally, in about 10-18% of cases, patients will suffer with postherpetic neuralgia (PHN) which is a condition best described as a lingering, burning, stabbing, throbbing, or shooting pain that can last weeks, months or even years.

So with one mom down with shingles, her daughter grew concerned over the arrival of her new baby.  Would it be possible for her newborn to contract the virus?  

Fortunately, people don’t catch shingles from other people.  Rather, shingles (also called herpes zoster) is caused by a reawakening of the varicella zoster virus (VZV) that causes chickenpox. After contracting chickenpox, the virus lives in the nervous system for years – even decades – until something causing it to reawaken.  Sometimes it’s reawakened by a waking of the immune system from advancing age or immune-suppressive drugs used to treat cancers.  But what’s hardest to accept is that most cases of shingles occur among adults who are otherwise healthy.  Even having suffered with shingles doesn’t prevent someone from having it again.  In fact, a reoccurrence of shingles happens in about 6% of people.

In the case of the mother and pregnant daughter sharing a home, the possibility existed that the newborn baby, too young for varicella vaccine, could potentially be at risk of contracting chickenpox if she were to come into contact with the rash of the infected grandmother.  This is why the family was advised by their doctors to be extra diligent in washing hands after touching any of the open sores.

screen-shot-2016-09-22-at-3-21-06-pmWhile there are verified cases of shingles in people of all ages – even adolescents – the risk of shingles appears to peak in those age 65 and older (as seen in the chart at left).

So, while scientist have been observing an increase in the incidence of zoster since 1993, they attribute the rise in cases to an aging population as well as a population who is increasingly immune compromised.

To complicate matters further, experts explain that the epidemiology of zoster has been changing and it’s unclear exactly why.  The current vaccine, which we know to have poor efficacy in the high risk elderly, also does not provide long-lasting protection. However, it can reduce the risk of shingles by half (51%) and reduces the risk of prolonged pain at the rash site by 67%.

When shingles vaccine was first licensed in 2006, it was approved for use in people age 50 and over.  In fact, the research at that time determined that the shingles vaccine had a 70% efficacy  among people ages 50-59.  However, the efficacy was reduced when administered to older individuals, and protection continued to decline significantly at 5-10 years post vaccination.

So, when the Advisory Committee on Immunization Practices (ACIP) announced their adult vaccine recommendations in 2008, they recommended one dose of shingles vaccine be administered to adults at age 60 and older.  Their decision was based on the belief that vaccine administrations should be timed to achieve the greatest reduction in burden of disease and the related  complications.  Since there was insufficient evidence of long-term protection offered by the zoster vaccine, it was believed that vaccinating persons under 60 years of age may not help protect people when the incidence of herpes zoster and it’s complications were at their highest.

While it appears that there has been a downward trend in childhood cases of shingles since 2005, most likely as a result of increased varicella vaccination among children, current shingles vaccine uptake among adults 60 and over is lower than most other adult recommended vaccines at just 27.9%.  If uptake were greater it is suspected that we would be seeing fewer cases.

In looking ahead, we are hopeful that two new shingles vaccines will prove to be more effective.

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