2014 UPDATES FROM THE CDC’S ADVISORY COMMITTEE

ON IMMUNIZATION PRACTICES (ACIP)

William Schaffner, MDProfessor of Preventive Medicine and Infectious Diseases

Vanderbilt University School of Medicine

Consultant, Communicable Disease ControlTennessee Department of Health

Conflict of Interest

Merck: Member, Data Safety Monitoring BoardPfizer: Member, Data Safety Monitoring BoardSanofi-Pasteur: One lecture

Outline

ACIP – what it is

Tdap safety in pregnancy

Influenza

Pneumococcal

HPV

Advisory Committee on Immunization Practices (ACIP)

15 Members: vaccinology, public health, academia 1 Lay person – represents the public

3 Meetings/yr Work Groups

Collaboration with professional societies

Publish recommendations on vaccine use 50+ years

ACIP also functions as the determining committee for Vaccines for Children program (VFC)Has authorization and appropriation function

Guides private medical insurance coverage for children, less reliably insurance for adults

Vaccines one of the great public health success stories of the 20th century – and more is expected of them in the 21st century

Vaccines save $3-$10 for every dollar spent on them

Among Children, vaccines have essentially eliminated healthcare disparities: income, race/ethnicity, rural/urban

Disparities in vaccine-preventable diseases and vaccine use still exist among adults

Safety of Tdap in Pregnancy

Oct, 2011: Unvaccinated pregnant women should receive a dose of Tdap

Oct, 2012: Tdap recommended during every pregnancy

Feb, 2014: Tdap during pregnancy was not associated with increased risk of birth outcomes

IMMUNIZATION DURING PREGNANCY

• Tdap during every pregnancy

• Influenza

Influenza

ACIP: Everyone ≥ 6 months of age

June, 2014: ACIP expressed a preference for live attenuated vaccine (LAIV) for children 2-8 years old when the vaccine is available

Immunization should not be delayed

PNEUMOCOCCAL VACCINE(S)FOR ADULTS ≥ 65 YEARS OLD

Pneumococcal polysaccharide vaccine (PPS 23)All ≥ 65 years of age

Pneumococcal conjugate vaccine (PCV13)Licensed for adults ≥ 50 late Dec, 2011

ACIP WAITING FOR

• Indirect effect of vaccinating children with PCV13

• Results of CAPITA Trial – effect of PCV13 on community-acquired pneumonia (CAP)

RESULTS

• Indirect effect substantial Nevertheless est. 5,000 (2,500-15,000) potentially preventable cases of CAP

• CAPITA 75% reduction in invasive pneumococcal disease

45% reduction in CAP

No Vaccine before: PCV13 followed by PPSV23 6-12 months later

Previously vaccinated with PPSV23 – give PCV13 1 year or longer

AUGUST, 2014 NEW RECOMMENDATION FOR

PNEUMOCOCCAL VACCINATION ≥ 65 YEARS OF AGE

DIFFICULTIES

• Educating providers

• Medicare coverage

• Keeping track of vaccinations

HUMAN PAPILLOMAVIRUS VACCINE(HPV)

Adolescents (age 13-17 years) – 2013

USA TN

Girls ≥ 1 dose 57% 49%≥ 2 doses 48% 40%≥ 3 doses 38% 36%

Boys ≥ 1 dose 35% 29%≥ 2 doses 24% 18%≥ 3 doses 14% ---

Disease is BAD

Vaccines are GOOD

When meditating over a

disease, I never think of

finding a remedy for it, but,

instead, a means of

preventing it.

Louis Pasteur