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IAC Express 2007
Issue number 657: April 16, 2007
Contents of this Issue
Select a title to jump to the article.
  1. AAP policy statement recommends that all children receive hepatitis A vaccination at age 1 year
  2. AAP policy statement recommends a two-dose varicella immunization strategy
  3. AAP voices concern that rising vaccine costs and inadequate payment procedures put children at risk
  4. Sabin Vaccine Institute awards Dr. Hilary Koprowski the 2007 Sabin Gold Medal
  5. April issue of CDC's Immunization Works electronic newsletter now available online
  6. ACIP meeting scheduled for June 27-28 in Atlanta; May 18 is deadline for non-U.S. citizens to register
  7. Proceedings of the AAP/AMA Immunization Congress now available online
  8. CDC reports on progress toward polio eradication in Pakistan and Afghanistan
  9. Biodefense Vaccines & Therapeutics conference planned for June 4-6 in Washington, DC
AAFP, American Academy of Family Physicians; AAP, American Academy of Pediatrics; ACIP, Advisory Committee on Immunization Practices; AMA, American Medical Association; CDC, Centers for Disease Control and Prevention; FDA, Food and Drug Administration; IAC, Immunization Action Coalition; MMWR, Morbidity and Mortality Weekly Report; NCIRD, National Center for Immunization and Respiratory Diseases; NIVS, National Influenza Vaccine Summit; VIS, Vaccine Information Statement; VPD, vaccine-preventable disease; WHO, World Health Organization.
Issue 657: April 16, 2007
1.  AAP policy statement recommends that all children receive hepatitis A vaccination at age 1 year


On April 9, the American Academy of Pediatrics (AAP) released a policy statement made by its Committee on Infectious Diseases. It is titled "Hepatitis A Vaccine Recommendations"; the abstract is reprinted below.

ABSTRACT. Since licensure in 1995 of hepatitis A vaccine, the Centers for Disease Control and Prevention (CDC) and the American Academy of Pediatrics (AAP) have been implementing an incremental hepatitis A immunization strategy in children. In 1996, children living in populations with the highest rates of disease were targeted for immunization, and in 1999, the program was expanded to immunization of children 2 years and older living in states and counties with rates of hepatitis A historically higher than the national average. The 1999 program has been successful; the current rate of hepatitis A is the lowest ever reported in the United States. Regional, ethnic, and racial differences in the incidence of hepatitis A have been eliminated. The incidence of hepatitis A in adults in immunizing states has decreased significantly, suggesting a strong herd immunity effect associated with immunization. In 2005 the U.S. Food and Drug Administration (FDA) changed the youngest approved age of administration of hepatitis A vaccine from 24 months to 12 months of age, which facilitated incorporation of the vaccine into the recommended childhood immunization schedule. As the next step in the implementation of the incremental vaccine immunization strategy, the AAP now recommends routine administration of an FDA-licensed hepatitis A vaccine to all children 12 to 23 months of age in all states according to a CDC-approved immunization schedule.

Available data suggest that hepatitis A vaccine can be coadministered with other childhood vaccines without decreasing immunogenicity. Hepatitis A vaccines have proven to be extremely safe. In prelicensure clinical trials of both Havrix (GlaxoSmithKline, Rixensart, Belgium) and Vaqta (Merck & Co., Inc., Whitehouse Station, NJ), adverse events were uncommon and mild when they occurred, with resolution typically in less than 1 day. Hepatitis A vaccine is contraindicated in people with a history of severe allergic reaction to a previous dose of hepatitis A vaccine or to a vaccine component. Because the hepatitis A vaccine is an inactivated product, no special precautions are needed for administration to people who are immunocompromised. No data exist about administration of hepatitis A vaccine to pregnant women, but because it is not a live vaccine, the risk to mother and fetus should be extremely low to nonexistent.

To access the complete policy statement, go to:

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2 AAP policy statement recommends a two-dose varicella immunization strategy


On April 9, the American Academy of Pediatrics (AAP) released a policy statement made by its Committee on Infectious Diseases. It is titled "Prevention of Varicella: Recommendations for Use of Varicella Vaccines in Children, Including a Recommendation for a Routine Two-Dose Varicella Immunization Schedule"; the abstract is reprinted below.

ABSTRACT. National varicella immunization coverage using the current 1-dose immunization strategy has increased among vaccine-eligible children 19 through 35 months of age from 27% to 88% by 2005. These high immunization rates have resulted in a 71% to 84% decrease in the reported number of varicella cases, an 88% decrease in varicella-related hospitalizations, a 59% decrease in varicella-related ambulatory care visits, and a 92% decrease in varicella-related deaths in 1- to 4-year-old children when compared with the prevaccine era. Despite this significant decrease, the number of reported cases of varicella has remained relatively constant during the past 5 to 6 years. Since vaccine effectiveness for prevention of disease of any severity has been 80% to 85%, a large number of cases of varicella continue to occur among people who already have received the vaccine (breakthrough varicella) and outbreaks of varicella have been reported among highly immunized populations of school children. The peak age-specific incidence has shifted from 3- to 6-year-old children in the prevaccine era to 9- to 11-year-old children in the postvaccine era for cases in both immunized and unimmunized children during these outbreaks. Outbreaks of varicella are likely to continue with the current 1-dose immunization strategy.

After administration of 2 doses of varicella vaccine in children, the immune response is markedly enhanced, with >99% of children achieving an antibody concentration (determined by glycoprotein enzyme-linked immunosorbent assay [gpELISA]) of >=5 U/mL (an approximate correlate of protection) and a marked increase in geometric mean antibody titers after the second vaccine dose. The estimated vaccine efficacy over a 10-year observation period of 2 doses for prevention of any varicella disease is 98% (compared with 94% for 1 dose), with 100% efficacy for prevention of severe disease. Recipients of 2 doses of varicella vaccine are 3.3-fold less likely to have breakthrough varicella, compared with those given 1 dose, during the first 10 years following immunization.

To achieve greater levels of immunity with fewer serosusceptible people, greater protection against breakthrough varicella disease, and reduction in the number of outbreaks occurring nationwide among school-aged populations, a 2-dose varicella immunization strategy is now recommended for children >=12 months of age.
  • Children 12 months through 12 years of age should receive two 0.5-mL doses of varicella vaccine administered subcutaneously, separated by at least 3 months; if the second dose inadvertently is administered between 28 days and 3 months after the first dose, the second dose does not need to be repeated. All children routinely should receive the first dose of varicella-containing vaccine at 12 to 15 months of age. The second dose of varicella-containing vaccine is recommended routinely when children are 4 to 6 years of age (i.e., before a child enters kindergarten or first grade) but can be administered at an earlier age.
  • People >=13 years of age without evidence of immunity, as defined in the Recommendations section of this statement, should receive two 0.5-mL doses of varicella-containing vaccine separated by at least 28 days.

Both a monovalent varicella vaccine (Varivax [Merck & Co. Inc., Whitehouse Station, NJ]) and a combination quadrivalent varicella-containing vaccine (ProQuad [Merck & Co. Inc.], or measles-mumps-rubella-varicella [MMRV]) are licensed by the Food and Drug Administration (FDA) for use in the United States. Monovalent varicella vaccine is approved for use in children 12 months of age and older (and, therefore, adolescents and adults as well), and MMRV is approved only for children 12 months through 12 years of age. Neither varicella-containing vaccine contains thimerosal or other preservatives. When all vaccine components are indicated, combination vaccines are preferred whenever possible to minimize the number of injections.

To access the complete policy statement, go to:

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3 AAP voices concern that rising vaccine costs and inadequate payment procedures put children at risk


On April 10, the American Academy of Pediatrics issued a press release titled "Pediatricians say rising vaccine costs are putting children at risk." It is reprinted below in its entirety.

The American Academy of Pediatrics (AAP) is alarmed that the soaring costs of vaccines combined with lower reimbursements from insurance companies will lead to the under-immunization of the nation's children and unnecessary outbreaks of preventable diseases.

"Childhood vaccines are among the greatest medical breakthroughs of the last century and are vital to growing up healthy," said AAP President Jay E. Berkelhamer, MD, FAAP. "However, the system for delivering vaccines is broken, and we're going to be in real trouble if it's not fixed soon."

Pediatricians spend tens of thousands of dollars and must frequently wait months before payment by payers (including Medicaid and private health plans). Often payments are below the cost of the vaccine. Gardasil, the new cervical cancer vaccine, costs physicians $360 for the recommended series of three doses per person. RotaTeq, the vaccine against diarrhea-causing rotavirus, costs $190 for the recommended three doses. Even the routine measles, mumps, and rubella (MMR) vaccine costs $86 for the recommended two doses. In addition to the cost of the vaccine, additional costs of ordering, storing, inventory control, insurance, and spoilage expenses need to be considered. However, payers are not recognizing these true costs. As a result, some pediatricians are unable to offer the newest vaccines.

About 85 percent of children in the U.S. are vaccinated at pediatricians' offices. Because the current system threatens to greatly reduce or even eliminate the physician provider role, the AAP is concerned that this will fragment care causing many children not to get the comprehensive and preventive health care they need.

Results from a national survey of pediatricians conducted by the AAP in 2006 indicated that less than half of pediatricians think vaccine reimbursement from private and public health insurance is adequate. Typically, pediatricians are among the lowest-paid physicians.

"Pediatricians are not looking to make huge profits off vaccines," said Jon R. Almquist, MD, FAAP, chair of the AAP Task Force on Immunization. "We're in pediatrics because we care about children—but we shouldn't be expected to subsidize the public health system and perform our jobs at a loss. We've carried this burden for long enough."

To access the press release, go to:

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4 Sabin Vaccine Institute awards Dr. Hilary Koprowski the 2007 Sabin Gold Medal


The Sabin Vaccine Institute (SVI) recently issued a press release announcing that Hilary Koprowski, MD, is the winner of the 2007 Sabin Gold Medal. The medal is awarded annually to recognize the extraordinary accomplishment of those who make vaccine discoveries or employ vaccines to combat vaccine-preventable diseases. A portion of the press release is reprinted below.

"Any serious discussion of the giants of 20th century biomedical research must include Hilary Koprowski as one of the most prominent," said Dr. H.R. Shepherd, SVI's Founding Chairman.

"The scope of his achievements is simply remarkable, ranging from polio to rabies and to monoclonal antibodies that are a key to effective cancer immunotherapy," noted Peter Hotez, MD, PhD, SVI's President.

Dr. Koprowski's ground-breaking work in polio and rabies greatly advanced vaccine research. In the late 1940s, his efforts resulted in production of the first oral polio vaccine that was used extensively to immunize people on four continents. In the 1970s, his passionate interest in rabies led him to develop a new tissue culture-based vaccine that is more effective and less painful than the traditional Pasteur technique.

He was a pioneer in the development of monoclonal antibodies, which are used to detect cancer antigens and in cancer immunotherapy. And he has successfully used plants to produce vaccines and antibodies. Dr. Koprowski and his associates developed the first functional monoclonal antibody against colorectal cancer antigen and rabies. The monoclonal antibody recognizing antigen of colorectal cancer is used throughout the world for diagnosis of pancreatic cancer by detection of the antigen in blood. . . .

To access the complete press release, go to:

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5 April issue of CDC's Immunization Works electronic newsletter now available online


The April issue of Immunization Works, a monthly email newsletter published by CDC, is available on NIP's website. The newsletter offers members of the immunization community non-proprietary information about current topics. CDC encourages its wide dissemination.

Some of the information in the April issue has already appeared in previous issues of IAC Express. Following is the text of two articles we have not covered.


ADD YOUR NIIW EVENT: If your organization is planning any National Infant Immunization Week (NIIW) Activities, CDC is interested in hearing from you. To add your event, please visit http://www.cdc.gov/nip/events/niiw/2007/activity_form.htm

2007 NCIRD ANNUAL REPORT: The 2007 annual report for CDC's new National Center for Immunization and Respiratory Diseases (NCIRD) is now available online. The report can be found at http://www.cdc.gov/nip/webutil/about/annual-rpts/ar2007/2007annual-rpt.htm

To access the complete April issue from the NIP website, go to:

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6 ACIP meeting scheduled for June 27-28 in Atlanta; May 18 is deadline for non-U.S. citizens to register

The Advisory Committee on Immunization Practices (ACIP) will hold its next meeting on June 27-28 at CDC's Clifton Road campus in Atlanta. The meeting is open to the general public.

To speed security clearance, ACIP attendees (participants and visitors) should register online. All non-U.S. citizens are required to register online AND complete the Access Request Form by May 18 for the June 27-28 meeting. Non-U.S. citizens will not be allowed to register on site.

To register online, go to:

To print the Access Request Form for non-U.S. citizens, go to:

For more information, go to: http://www.cdc.gov/nip/ACIP/dates.htm or contact Dee Gardner by phone at (404) 639-8836 or by email at DGardner@cdc.gov

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7 Proceedings of the AAP/AMA Immunization Congress now available online

The proceedings of the AAP/AMA Immunization Congress, which was held in Chicago on February 27-March 1, are now available online. To access them, go to:

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8 CDC reports on progress toward polio eradication in Pakistan and Afghanistan


CDC published "Progress Toward Poliomyelitis Eradication—Pakistan and Afghanistan, January 2006-February 2007" in the April 13 issue of MMWR. A summary made available to the press is reprinted below in its entirety.

The governments of Pakistan and Afghanistan are making special efforts to improve the polio eradication activities in the high polio transmission border area with compromised security. Successfully interrupting wild poliovirus in both these countries will depend upon continued support from the international partners, plus sustained commitment and coordination of both countries.

From January 2006 to February 2007, reported poliovirus cases increased in Pakistan and Afghanistan. However, the genetic diversity of the virus has decreased, indicating restriction in the transmission of poliovirus. The governments of both countries have high-level commitment and have coordinated cross-border polio activities, including two joint large-scale vaccination campaigns. Mobile populations have been targeted specifically for immunization, and vaccination posts have been increased along the border between the two countries. Successfully interrupting wild poliovirus transmission in both countries will require accessing and vaccinating children along the large, remote and increasingly security-compromised border between these two countries.

To access a web-text (HTML) version of the complete article, go to: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5614a5.htm

To access a ready-to-print (PDF) version of this issue of MMWR, go to: http://www.cdc.gov/mmwr/PDF/wk/mm5614.pdf

To receive a FREE electronic subscription to MMWR (which includes new ACIP statements), go to:

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9 Biodefense Vaccines & Therapeutics conference planned for June 4-6 in Washington, DC

The fifth annual Biodefense Vaccines & Therapeutics conference is scheduled for June 4-6 at the Almas Temple Club in Washington, DC. Conference attendees will include U.S. biodefense leaders; the program provides the most recent information on various government agencies' requirements for biodefense vaccines and therapeutics.

For conference information, go to:

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