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Updates from the Advisory Committee on Immunization Practices February Meeting

March 6, 2018 2 comments
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Photo Credit: James Gathany, Centers for Disease Control and Prevention

The Advisory Committee on Immunization Practices (ACIP) held its first meeting of 2018 on February 21st and 22nd.  The Committee consists of a panel of immunization experts that advise the Centers for Disease Control and Prevention (CDC).  Part of their charter is to continually evaluate new data and update or change vaccine recommendations as warranted. 

The agenda for the February 2018 meeting included presentations pertaining to several different diseases and vaccines, to include hepatitis, influenza, anthrax, HPV, pneumococcal, meningococcal and Japanese encephalitis.

A overview of the meeting is provided below, with details on presentations in the order they occurred: 

Hepatitis B

The committee voted unanimously to approve a non-preferential recommendation for a new Hepatitis B vaccine (Dynavax’s HEPISLAV-B™) to their list of recommended vaccines for adults 18 years and older against infections caused by all known subtypes of Hepatitis B.

This vote came following the presentation of data showing that the new two-dose vaccine generates a more rapid and higher antibody response than the standard 3 dose vaccine.

Hepatitis B is a viral disease of the liver that can become chronic and lead to cirrhosis, liver cancer and death. The hepatitis B virus is 50 to 100 times more infectious than HIV, and transmission is on the rise. In 2015, new cases of acute hepatitis B increased by more than 20 percent nationally and 850,000-2.2 million persons are estimated to be living with infection in the U.S.

Since there is no here is no cure for hepatitis B, vaccination is our best chance at preventing the disease. While about 90% of people are infected during infancy, in adults, hepatitis B is most often spread through contact with infected blood and through unprotected sex with an infected person. Some individuals who are especially susceptible include those who are immunosuppressed or living with diabetes. The CDC recommends vaccination for those at high risk for infection due to their jobs, lifestyle, living situations and travel to certain areas.

The Working Group summary suggested that this new vaccine option is likely to improve vaccine series completion and result in earlier protection, which is especially beneficial in persons with anticipated low adherence such as injection drug users.  Additionally, the improved immunogenicity in populations with typically poor vaccine response such as the elderly, diabetics and those on dialysis, is promising.  The ACIP will continue to review post-marketing surveillance studies and additional data to ensure safety and cost-effectiveness considerations.

Hepatitis A

The committee voted unanimously to pass three recommendations pertaining to Hepatitis A.

  • Hepatitis A vaccines should be administered for post-exposure prophylaxis for all persons 12 months of age or older.
  • Hepatitis A vaccine or immune globulin (IG) may be administered to persons 40 years of age or older, depending on the providers’ risk assessment.
  • Hepatitis A vaccine should be administered to infants age 6-11 months of age traveling outside the US when protection against hepatitis A is recommended. This recommendation takes into consideration the fact that infants under 12 months who will be traveling internationally will typically also need an MMR vaccine.  Since Hepatitis A immune globulin and MMR vaccine should not be administered simultaneously, these children should receive a single dose of HepA vaccine. It’s important to note that infants should then complete the full, 2 doses of MMR and HepA vaccines at 12 months of age as recommended.

Influenza

The Committee heard five presentations specific to influenza.

The first two were reports of current season data; one detailing flu surveillance, the other providing early influenza vaccine effectiveness data.

According to the update, the majority of circulating flu strains are similar to those contained in the 2017-2018 vaccine.  The only virus clearly showing antigenic drift was the B/Victoria lineage viruses which represents less than 1% of circulating viruses.  So far this season, influenza A (H3N2) has been dominant, with influenza B activity starting to increase more recently. Activity has been the highest we’ve seen since 2009, and while final severity can’t be determined until the end of the season, hospitalization rates and mortality could be similar to or exceed those send during the severe 2014-2015 season.

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Based on data from 4,562 children and adults with acute respiratory illness enrolled during November 2, 2017–February 3, 2018, at five study sites, the overall estimated effectiveness of the 2017–18 seasonal influenza vaccine for preventing medically attended, laboratory-confirmed influenza virus infection was 36%. The percentage differs by age group and by virus.  A detailed report can be found here.

The most notable news out of the Committee last week was the vote to restore the live attenuated influenza virus (LAIV) vaccine as an option for the 2018-19 season. LAIV is commonly known as the nasal spray flu vaccine or by its brand name, FluMist This renewed ACIP recommendation offers FluMist as one of several vaccine options for non-pregnant people who are 2-49 years of age during the 2018-2019 season, but does not indicate any preference for FluMist over injectable flu vaccines.

While FluMist has not been recommended for the past two flu seasons due to reduced effectiveness against the H1N1 flu strain in children, the Committee heard three presentations specific to LAIV vaccine efficacy in children prior to taking a vote on future recommendations for LAIV.  The first reported on the efficacy of Fluarix Quadrivalent in children 6-35 month of age. Another presented the results of a randomized trial of a new H1N1 LAIV strain in U.S. children. The third was a review LAIV in children 2-17 years of age.  

The possible root cause of the poor effectiveness of LAIV against H1N1 was discussed and poor replication of the H1N1 selected strain was thought to be the likely problem. A new strain selection process is now in place in cooperation with the Food & Drug Administration (FDA) and it suggested that the antibody responses of the latest reformulated version of the quadrivalent vaccine, which includes the new 2017-18 post-pandemic 2009 H1N1 LAIV strain (A/Slovenia), will perform significantly better than what was previously observed when the vaccine included the 2015-16 post-pandemic LAIV strain (A/Bolivia).  Immunogenicity and viral shedding data in small trials supported this notion, but no efficacy data is available at this time.

The Committee was therefore forced to a vote using only the science available to date. There was a lively discussion among members who expressed various concerns. While flu vaccine effectiveness is a serious issue, some committee members expressed concern that they may be holding FluMist to a higher standard than other influenza vaccines, yet all have efficacy challenges from year to year.  Other members were concerned with how the vaccine may perform in an H1N1 dominated season. Until the vaccine is used, further effectiveness assessments are performed, and a prominent H1N1 year occurs, a certain level of uncertainty will remain.

While members voted overwhelmingly (12-2) to reinstate LAIV on the immunization schedule, a second vote to give other flu vaccines a preferential recommendation over LAIV failed (11-3).  So, while the ACIP will not indicate a preference for any one type of flu vaccine over another, the public will ultimately determine whether there will be high uptake of this particular vaccine next season. Read more…

How One Teen is Engaging Her Peers to Help Eliminate HPV Related Cancers

February 27, 2018 1 comment

By Allyson Rosenblum

What if you could save a life or prevent someone from the devastation of cancer simply be providing them with information, would you do it?  What if it was someone you knew or cared about, would you do it then? 

IMG_3767 6.17.55 PMMy name is Allyson and I am a 17 year-old high school student living in Southern California. Earlier this year, I set out to do something that I hope will make a difference in the lives of others. I would like to encourage teenagers who care about their health and the health of future generations to join me.

What I’m asking is fairly simple. I am requesting high school and college students to pass along valuable information about HPV infection and prevention to those they know and care about.  

I have personally seen HPV and cancer devastate the lives and dreams of people I love. Beginning in October of last year, I witnessed my mother’s difficult battle with cancer every day as she endured three surgeries and eight months of chemotherapy. Two months later, my cousin informed me that she was diagnosed with cervical cancer resulting from an HPV infection she acquired as a teenager. At just 35 years old, she has now had to accept the fact she will never be able to have biological children of her own. Seeing all this pain and needless suffering has moved me to take action.

I decided to start a social media campaign on Facebook and Instagram, which I called “Two Shots To Beat Cancer.”

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My goal is to enlist high school and college students throughout the U.S. to help in passing along information about the importance of early HPV vaccination to other high school and college students using various social media platforms.

Let me emphasize that this campaign is not about teen sex.  Rather, it’s about prevention of HPV prior to sexual activity. If people can avoid acquiring the strains of the HPV virus that are linked to cancer, they will be less likely to suffer with an HPV related cancer later in life or pass the virus on to others.  This is why the CDC recommends the HPV vaccine to 11-12 year olds. However, if a child did not get vaccinated in their pre-teens, it’s not too late. The vaccine is recommended up to age 26 for women and age 21 for men.

Unfortunately, most people my age do not want to talk about health related issues. We’re often uncomfortable talking about such topics, especially with adults, and reticent to share private information about ourselves. As such, many of us remain unaware of the dangers and prevalence of HPV, and questions and concerns often go unaddressed. However, it is precisely the lack of education and informed knowledge that allows the HPV epidemic to persist. By sharing timely and credible information among peers, I hope to empower my generation to take responsibility for their health and to help encourage better health practices among our peers.

I started this campaign in January and through the power of social media have already been able to get 1807 high school and college students to join me in all 50 states. With an average of 600 followers per student, that gives us the potential of reaching 1,084,200 students and counting!  However, I’m not content with that. I believe we can do far better! In fact, if high school and college students were aware that there are 14 million new people acquiring HPV in the U.S. each year and over 50% of them are teens and young adults who are just becoming sexually active, than I believe they may see their important role in this mission.

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I would encourage any high school or college student who cares about their own health, or the health of future generations, to find out more by visiting my website at TwoShotsToBeatCancer.org and joining the Two Shots To Beat Cancer Facebook Page and following our Two Shots To Beat Cancer Instagram account.

By joining me in this worthwhile endeavor, we can be the generation that puts an end to HPV related cancers. By posting to social media and sending letters to politicians, newspapers and school board administrators, we can make a difference and help to stop the spread of HPV. It takes little time, costs no money and by encouraging students to engage in important and life-changing conversations, we can save lives and prevent needless suffering.

Resolve To Protect Your Family From Cancer

January 9, 2018 1 comment

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By Shaundra L. Hall, Southwest Regional Director, National Cervical Cancer Coalition (NCCC)

January is Cervical Health Awareness Month and if you’ve resolved to make healthier choices in 2018, then ensuring your loved ones are vaccinated against the deadly strains of human papillomavirus (HPV) should be on the top of the “resolutions to keep” list.

Cancer prevention is a gift of health for your child’s, and grandchildren’s, future.  But it’s only a gift if given early in life.

My journey with HPV began at the age of 17.

My very first Pap smear exam had an abnormal result. Over the next several years, I would have some normal and some abnormal Paps, and it was eventually determined that my cervical dysplasia required medical treatment to remove abnormal cell tissue that might become cancerous. I went on to have multiple procedures over the years – a LEEP/cold knife cone, cryosurgery – you name it, I had it.  So many painful treatments chipping away precious tissue from my cervix.

ShaundraHall2Years later, after my husband and I were married and bought our first house together, we started thinking about starting a family. When pregnancy didn’t happen as quickly as we had hoped, I made a visit to my gynecologist’s office. Back in to the stirrups I go, and with one look heard “Ohhhh…

My heart sank.

Until we had started trying for a family, I’d had four years of completely normal Pap tests and I felt confident that I was healthy enough to get pregnant.  I couldn’t have been more wrong.

During the course of about 10 months, some cancer switch turned on and I went from 4 years of a healthy cervix to invasive cervical cancer.  About fourteen days after my doctor’s appointment, I was in the hospital having a hysterectomy to save my life from a HPV related cancer.  Not only were my husband and I in our 20s trying to deal with the fact we would never have our own biological kids, but now we had the big “C” staring us in the face.  To say it was devastating is an understatement.

I wish I could say that I left all of that sadness from nearly 20 years ago behind me, but the reminders of my battle with HPV related cancer is with me every day. When I see my scar or when my legs, ankles and feet swell due to lymphedema from my missing abdominal lymph nodes, it’s clear that I can’t escape what the cancer has done to me. I think about it when I encourage my husband to keep each and every dental exam to ensure that he is not at risk for HPV related oropharyngeal or head and neck cancer.  My husband has been an amazing partner sticking with me through all of the intimacy challenges related to the physical modifications to my body, and I only wish we had the opportunity to be protected from HPV when we were younger. Read more…

New ACIP Recommendations for Meningococcal, Influenza and HPV Vaccines

March 10, 2015 3 comments
Photo Credit: James Gathany, Centers for Disease Control and Prevention

Photo Credit: James Gathany, Centers for Disease Control and Prevention

written by: Amy Pisani, MS, Executive Director, Every Child By Two

The Advisory Committee on Immunization Practices (ACIP) conducted an abbreviated meeting on February 26, 2015 due to the threat of a winter storm in the Atlanta, Georgia region.  The ACIP, which consists of 15 voting members who have expertise in vaccinology, immunology, healthcare and public health, makes recommendations to the Centers for Disease Control and Prevention (CDC) regarding vaccinations approved for use by the Food and Drug Administration (FDA).  The recommendations pertain to the timing and intervals of vaccines which are included on the childhood, adolescent and adult immunization schedules.   At this February meeting, the ACIP conducted three important votes which altered or created new recommendations for meningococcal vaccine, influenza vaccine and HPV vaccine.  

Meningococcal Serogroup B Vaccine

Two new vaccines to protect against meningococcal serogroup B, which has been spreading through college campuses in recent years, were recently approved by the FDA. The Trumenba vaccine is developed by Pfizer Pharmaceuticals and requires three doses and the Bexsero vaccine has been developed by Novartis Vaccines and Diagnostics requiring two doses.  The ACIP has previously recommended one dose of MCV4 vaccine at ages 11-12, and a booster at age 16 to protects against the A, C, W and Y strains of meningococcal bacteria   Nearly 80% of teens between the ages of 13 and 17 have received at least one dose of the MCV4 vaccine, which is fairly remarkable considering the fact that it is recommended, but not mandated for use within states nationwide.  However, because of the complicated nature of the virus, the new meningococcal serogroup B vaccine would require a separate series of shots, in addition to those recommended for MCV4 vaccine.

The serogroup B strain of meningococcal is considered the most common cause of meningococcal disease  among adolescents here in the U.S. with a fatality rate of 12 percent in 11-19 year olds and 17 percent in 20 year olds over the last 14 years.  While the number of meningococcal cases have declined since 1996, many advocates believe that the aggressive nature of this disease, which often kills or maims it’s victims within hours, necessitates a broad recommendation for the vaccine.  However, the ACIP discussion at the February meeting was limited to recommendations for those at high risk for serogroup B infection, with a follow up vote anticipated at the upcoming June meeting where the Committee will review data and make a determination on whether to recommend the vaccine for a broader population. Authors note-  added June 2015: At the June ACIP meeting the following recommendation was made “A serogroup B meningococcal (MenB) vaccine series may be administered to adolescents and young adults 16 through 23 years of age to provide short term protection against most strains of serogroup B meningococcal disease. The preferred age for MenB vaccination is 16 through 18 years of age.”

Several advocates traveled to the meeting to provide their testimonials.  These included parents of those lost to the disease as well as survivors who have suffered amputations and serious life-long health consequences of this invasive disease.  Dr. Mary Ferris, who helped lead efforts to contain the 2014 meningococcal outbreak at University of California’s Santa Barbara campus, provided compelling testimony regarding the impact of the outbreak on the university.  Ferris noted that four cases, one of which led to the amputation of a student, spread panic throughout the campus and the local community.  Students were banned from volunteering at the on-campus daycare and attempts were made by the local community to close the campus entirely.   Dr. Ferris urged the Committee to consider the broadest recommendation Read more…