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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…

Flu Vaccination is a Team Sport

November 10, 2017 Leave a comment
This week, as we wrap up the Centers for Disease Control and Prevention (CDC) Flu Blog-a-thon, we hear from Serese Marotta of Families Fighting Flu about how we all pay a role in flu prevention.

Most people know that the flu is a highly contagious, vaccine-preventable disease. What they don’t always realize is that flu prevention is a team sport.

It’s great when individuals get vaccinated. In fact, the Centers for Disease Control and Prevention (CDC) recommends annual flu vaccination for everyone six months and older.  But flu vaccination is not just about us as individuals. Healthy communities rely on cooperation and coordination of everyone – from family members to healthcare professionals. 

Flu is worth preventing.  

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  • According to the CDC, every year in the United States, the flu kills upwards of 56,000 people, which typically includes about 100 children. That’s more than all other vaccine-preventable diseases.
  • The CDC estimates that since 2010, hospitalizations due to flu ranged from approximately 140,000 to 710,000 cases per year, with hospitalizations of children five years of age and younger ranging from 7,000 to 26,000 cases per year.

Flu vaccination is critical to keeping our communities healthy. 

According to a recent study, the flu vaccine was found to prevent death in otherwise healthy children by as much as 65 percent. Also, it can reduce the risk of flu illness for the general population by up to 60 percent when the vaccine is well-matched to circulating strains.

The “community immunity” that is achieved when large numbers of a population vaccinate is particularly important. People in high-risk groups such as babies younger than 6 months old who are too young to receive a flu vaccination, people with compromised immune systems and pregnant women, are not only more susceptible to suffering with flu, but also more likely to suffer complications if they fall victim to flu.

We all play a role on the flu prevention team. 

Parents

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Children are often the “spreaders” of germs in their communities, which may explain why children have the highest rate of infection from flu. On average, children miss more than 38 million school days due to flu in the U.S., which can result in medical expenses and time off from work for parents. Young children are also at higher risk of developing serious complications from the flu, including hospitalization and death. Since parents are responsible for vaccinating themselves and their children against flu, they can be considered the “Captains” of our flu prevention team. 

 

Healthcare Professionals

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Research shows that a strong recommendation for annual flu vaccination from healthcare professionals is an important factor to improving vaccination rates. Most adults believe in the importance of vaccination, but sometimes need an annual reminder to actually do it. 

That’s why Families Fighting Flu has developed a new educational resource for healthcare professionals in collaboration with the National Association of Pediatric Nurse Practitioners and HealthyWomen. Through this collaboration entitled Do You Know the Flu?, we are arming healthcare professionals with the resources they need to effectively communicate the importance of flu vaccination to patients of all ages.

School Nurses and Teachers

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Studies have shown that high vaccination rates among school children (50 to 70%) can dramatically reduce the overall burden of disease in the entire community. Families Fighting Flu recognizes the role that school nurses and teachers play in educating school-aged children and their families. This is why we’ve developed our Keep Flu out of School program. By collaborating with the CDC, the National Foundation for Infectious Diseases, and the National Association of School Nurses, Families Fighting Flu has worked closely with a team of professionals to provide critical resources to school nurses and teachers to assist them with flu prevention efforts in their communities.

Co-Workers

Flu is not only a public health issue, but also an economic one. Flu costs the U.S. economy an estimated $10.4 billion every year. According to a recent survey released in October, roughly three out of five Americans (61%) who had the flu or flu-like symptoms admitted to leaving home while ill, which can put others at risk. It’s no doubt that many of us have experienced a sick co-worker at the office who should have stayed home, but instead is now exposing others to flu.

Teammates 

Teamwork is critical to the success of any sports team. Because team mates spend a great deal of time together, it’s not uncommon to hear about professional or collegiate sports teams that have all fallen victim to the flu during important play-off games. That’s why it’s important for athletes to get an annual flu vaccination in an effort to stay healthy and Stay in the Game™.

While we each make a personal decision about flu vaccination, it is our hope that people will recognize that a choice not to get a flu vaccine could have a profound impact on our own health, as well as the health of our families, classmates, coworkers and teammates.

While there is a “U” in flu, there is no “I” in “team”. 

Vaccinate Your Family and Families Fighting Flu are two members of the national team of flu vaccination advocates. Together, we encourage all individuals six months of age and older to get their annual flu vaccination stop that you can Stay in the Game™.

For more information, visit the Families Fighting Flu website at www.familiesfightingflu.org.

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.

Read more…

Global Pandemics are the Unseen Enemy in a Battle Without Borders

We live in world that is increasingly more connected.

17201073_755634207937920_5773479724868255787_nThe film Unseen Enemy, which will air on World Health Day, Friday, April 7th on CNN (10pm ET/7pm PT), explores this global connectivity and how it relates to the threat of emerging infectious diseases.  It extends beyond the role of global health leaders and calls upon individuals to take actions that can help improve the health of our communities and our world.

To set the stage, the film takes viewers on a journey across continents to explore large-scale disease outbreaks such as Ebola, influenza and Zika. It honors both patients and healthcare workers who have endured challenging circumstances, and often risked their lives, in the fight against infectious diseases. It also warns about emerging threats, where they may come from and what we should be doing to prepare.

In interviews with various researchers, the film provides a glimpse of the issues that global health leaders are working to solve.

How will we keep one step ahead in the fight against viruses and epidemics?  Where are the global hotspots where these diseases may emerge? How can healthcare workers, scientists, businesses, NGOs and governments work together to ensure that we are prepared for the next invisible threat? What are the possibilities that these threats will come in the form of viruses, laboratory mistakes or acts of bioterrorism?  

The film certainly emphasizes the need for global preparedness, but it also calls upon individual viewers to take action.  The power of the people exists in how we share valuable information, how we support key public health stakeholders around the world, and how we mobilize leaders to adequately prepare for emerging threats now, before it is too late.

It Takes All Of Us

Stopping an outbreak will require us all to work together, for the benefit of everyone.  Janet Tobias, who served as a director, producer and writer of the film, explains how working on Unseen Enemy provided her with a new perspective about our personal roles in public health. Read more…

Even With All Our Modern Medicine, I Watched My Sister Die From Flu

February 1, 2017 8 comments

By Michael Northrop, M.D.

 

lizaIn December, 2009 my sister Liza died of influenza.

She was previously healthy and only 49 years old.  She sought medical care early. She was cared for at a good hospital in a major city.  She had no other infections. And she was unvaccinated.

To say I was surprised is an understatement.  And yet, I’m a pediatric intensive care physician.

As a clinician, it’s easy for me to trace out the clinical course of Liza’s illness. The physiology of organ failure, mechanical ventilation and critical illness are familiar to me in the same way that your daily work is to you. It’s the human side that I still haven’t come to terms with. The part where you watch your sister die over the course of three long weeks while you stand helpless.  The part where you listen to a physician tell your family that they are out of options.  The part where you know that they are right and you realize that influenza is sometimes too much to handle, even with all our modern medicine.

That part is much harder to process.

Her symptoms started with fever, but progressed to vomiting after a few days. She went to the urgent care clinic twice over the course of a few days before ending up in the emergency department of the local hospital.  She had begun to experience difficulty breathing, and the emergency physician noted that the oxygen saturation in her blood was very low.  They put her on oxygen, and an x-ray revealed that both her lungs were filled with fluid. A condition that led to her being diagnosed with pneumonia.

You see, your lungs are supposed to have air in them. They should look like sponges. Pneumonia is just the term we physicians use to describe the situation when fluid, infection, and inflammation fill those little air spaces in the sponge.

Pneumonia can come from viruses or bacteria. If your pneumonia is caused by a bacteria, you can get antibiotics to kill the bacteria.  However, if your pneumonia is caused by a virus, like influenza, there is not much we can do but ride it out and wait for your own immune system to clear it.  The simple fact is that we just don’t have very good medications for viruses. Tamiflu can be prescribed and it might slow down the virus, but it doesn’t kill it or stop it.

So, they did the only thing they really could do, and started her on IV Tamiflu.  She was moved to the intensive care unit downtown, and within the next few hours she struggled to breathe and her oxygen saturations continued to fall. She had to be placed on a ventilator, and the hope was that her lungs would recover after a few days. After all, it was ‘just the flu’.

We never did get to speak with her again.  

Read more…

Make Sure Your College Student Has These Shots Before Returning To Campus

iStock_000078067721_Double.jpgTeens and young adults have a tendency to believe they’re completely invincible.  But their lifestyle – which often involves high levels of stress, inadequate amounts of sleep and close living quarters – can put them at an increased risk of certain infections such as flu, mumps, meningitis and HPV.  As students return to class after winter break, they’re  reunited with classmates, roommates, and professors who may have been exposed to infectious diseases during their travels to other states or other countries.

While it’s impossible to prevent every cough and sniffle, parents can help protect their kids by ensuring they’re up-to-date on all their recommended vaccines.

So what are all the vaccines that are recommended for teens and young adults?  

And wouldn’t they be required for school anyway?

Vaccine requirements vary by state and don’t necessarily include all the vaccines that the CDC recommends. Therefore, as winter break come to an end, parents should review their students’ immunization records and arrange for them to get any missing shots before they return to class.

Here are a few of the diseases that students should be protected against.

Influenza

Influenza is a dangerous viral infection that causes hundreds of thousands of hospitalizations and thousands of deaths each year in the U.S., even among health people of all ages.  For the best protection, the CDC recommends that everyone over the age of 6 months receive an annual influenza vaccine.

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Unfortunately, while flu vaccination rates are typically the highest among children, rates tend to drop among teens and young adults. If your college student hasn’t already received their annual flu vaccine it’s not too late.  Bring them to their healthcare provider or local pharmacy to get them protected before they return to campus. Although it can take up to two weeks to develop antibodies post-vaccination, flu season often extends well into Spring, so students will benefit from protection for many months to come.

Mumps

Mumps may not be considered “common” in the U.S. thanks to a 99% decrease in mumps cases once mumps vaccination began in 1967, but there have been several mumps outbreaks on college campuses in the past year, and approximately 4,258 cases across 46 states and DC in 2016.

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This shouldn’t come as much of a surprise when you consider that crowded environments, such a large classes and dormitory living can all contribute to the likelihood of outbreaks.  Also, since mumps is spread primarily through saliva, coughing and sneezing, teen behaviors such as kissing or sharing plates, utensils, cups, lipstick or cigarettes, are all factors that can increase the likelihood of transmission. Read more…

Amanda Peet Encourages Vaccines During Pregnancy to Protect Infants

March 7, 2015 2 comments
Photo Credit: FayesVision / WENN

Amanda and her husband welcomed their third child, Henry, back in December, 2014.  Photo Credit: FayesVision / WENN

Being a mom to Molly and Frankie is, without a doubt, the most rewarding role I’ve ever had.  As we prepared to welcome another baby into our home this fall, I was reminded of just how fragile and precious a newborn can be.

In recent interviews with Fox News and CNN, I shared my concerns over the growing number of unvaccinated children in the area where we live. It frightens me to think that my baby may possibly be exposed to a dangerous and life-threatening disease before he is old enough to be vaccinated himself. It seems unfair that while I do everything in my power to protect this delicate new life, others are making a choice that puts my child at serious risk.

I have real reason to worry. When my second daughter Molly was just 10 months old she contracted whooping cough (also known as pertussis). As any parent can relate, it’s scary when your child gets sick, but it’s especially upsetting when you realize that your child is part of the largest outbreak of whooping cough in over fifty years. As an advocate for Every Child By Two’s Vaccinate Your Baby initiative, I was all too aware of the fact that whooping cough can be deadly for infants, and yet here we were facing that terrible diagnosis. We were incredibly fortunate that Molly fully recovered, but I’ll admit that I was completely rattled by the experience.

Fortunately, since that time, scientists have been closely examining the possible causes for the large number of whooping cough cases over the past few years and have made recommendations aimed at curbing the outbreaks. Part of the problem is that the immunity against the disease is wearing off so that people throughout the U.S. are less immune to whooping cough. Therefore, it’s more important than ever for infants to receive all five recommended doses of the DTaP (diphtheria, tetanus and pertussis) vaccine, followed by the booster shot of the adult version of the pertussis vaccine (Tdap) at 11 or 12 years old.  It’s staggering to note that 83% of infants who are diagnosed with whooping cough got it from a family member, most often their own parents. Therefore, adults need to make sure they get a Tdap booster before a new baby arrives to protect themselves and to stop the spread of the disease to infants, who are most likely to become seriously ill from the disease.

Most important for newborns, the CDC’s Advisory Committee on Immunization Practices took a good hard look at the pertussis research and concluded that we can best protect newborns by ensuring that pregnant women receive an adult Tdap booster in their last trimester of each pregnancy. By getting vaccinated during pregnancy, not only was I protected, but antibodies were transferred to my baby through the placenta, providing my baby with protection against pertussis before he could start getting DTaP vaccine at two months of age. So I followed my doctor’s advice and not only received the Tdap vaccine during my last trimester, but I also got a flu shot.

Just as I have the ability to protect my newborn from pertussis, I also have the ability to protect him and other members of my family from influenza. I’ve learned that due to changes in a pregnant woman’s immune system, heart and lungs, I was more prone to serious complications from the flu such as pre-term labor and delivery, hospitalization and even death. And, since children can’t be vaccinated against the flu before six months of age, everyone in our family must do all we can to protect our baby boy.  With my child being born in the midst of flu season, I wanted to do everything I could to protect him from a disease that causes more than 20,000 children under the age of five to be hospitalized each year.  I find it upsetting to learn that with all the medical resources available to us here in the U.S., last year’s flu season claimed the lives of 109 precious children.

I’ll admit that as a parent I’m concerned about the threat of vaccine-preventable diseases, especially as a result of people choosing not to vaccinate. But I refuse to stand by and watch as others put my children’s health at risk. By getting the flu and pertussis vaccines during my pregnancy, I felt empowered that I could do something positive to protect my child. And you can too.

Talk to your doctor if you have questions about vaccines. In addition, encourage your friends and family to utilize the resources provided by reputable organizations, such as Every Child By Two and the American College of Obstetricians and Gynecologists.  And be sure to immunize yourself and your entire family.