2014 UPDATES FROM THE CDC’S ADVISORY COMMITTEE ON IMMUNIZATION PRACTICES (ACIP)

1. 2014 UPDATES FROM THE CDC’S ADVISORY COMMITTEE ON IMMUNIZATION PRACTICES (ACIP) William Schaffner, MD Professor of Preventive Medicine and Infectious Diseases Vanderbilt University School of Medicine Consultant, Communicable Disease Control Tennessee Department of Health

2. Conflict of Interest Merck: Member, Data Safety Monitoring Board Pfizer: Member, Data Safety Monitoring Board Sanofi-Pasteur: One lecture

3. Outline ACIP – what it is Tdap safety in pregnancy Influenza Pneumococcal HPV

4. 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

6. 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

7. 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

8. 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

9. IMMUNIZATION DURING PREGNANCY • Tdap during every pregnancy • Influenza

10. 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

11. 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

12. ACIP WAITING FOR • Indirect effect of vaccinating children with PCV13 • Results of CAPITA Trial – effect of PCV13 on community-acquired pneumonia (CAP)

13. 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

14. AUGUST, 2014 NEW RECOMMENDATION FOR PNEUMOCOCCAL VACCINATION ≥ 65 YEARS OF AGE No Vaccine before: PCV13 followed by PPSV23 6-12 months later Previously vaccinated with PPSV23 – give PCV13 1 year or longer

15. DIFFICULTIES • Educating providers • Medicare coverage • Keeping track of vaccinations

16. HUMAN PAPILLOMAVIRUS VACCINE(HPV) Adolescents (age 13-17 years) – 2013 USATN 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% ---

17. Disease is BAD  Vaccines are GOOD 

18. When meditating over a disease, I never think of finding a remedy for it, but, instead, a means of preventing it. Louis Pasteur