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

Conflict of Interest Merck: Member, Data Safety Monitoring Board Pfizer: Member, Data Safety Monitoring Board Sanofi-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/yrWork 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 20 th century – and more is expected of them in the 21 st 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

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 CAPITA75% reduction in invasive pneumococcal disease 45% reduction in CAP

No Vaccine before: PCV13 followed by PPSV 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 years) – 2013 USA TN Girls≥ 1 dose57%49% ≥ 2 doses48%40% ≥ 3 doses38%36% Boys≥ 1 dose35%29% ≥ 2 doses24%18% ≥ 3 doses14% ---

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