ACIP Oct-2019 / Day 2

Liveblogging – these are my notes as I watch/listen to the livestream of the meeting, please understand there may be typos and these notes are not a transcription. You are encouraged to attend the meetings or view the meeting once it is posted. My opinions/editorial comments are in this color. 

Schedules proposed yesterday (adult and child/adolescent) were voted on.

Unfinished Business and Agency Updates from:                                                                              CDC, CMS, DoD, DVA, FDA, HRSA, IHS, NIH, OIDP

HRSA: updates on awards for (alleged) vaccine injuries. Why would this be necessary if vaccines are “safe and effective”? The only reason it isn’t bigger is because vaccine injury is not looked for or acknowledged. Our data is completely inadequate because of the willful refusal to do the kinds of gold standard studies (DB RCT using genuine placebos) that would provide far higher quality data. 

FDA: Nov 5th (8th) meeting about Chickungunya vac. Sep 24th approved Genyus (sp?) for smallpox or monkeypox for adults at risk.

DOD: yellow vaccine challenges better. Goal is to vaccinate at least 90% of service members against flu by Jan.

IHS: Efforts to improve vaccination of children in IHS.

DVA: 

Orthopox virus vaccine: 

Dengue Vaccine:

Introduction/Dr. Robert Atmar (ACIP, WG Chair) 

GRADE analysis for Dengvaxia/Dr. Gabriela Paz-Bailey (CDC/NCEZID): 

Review of Dengue incidence/prevalence.

Looked specifically at use of Dengue vaccine in 9-16yo in Puerto Rico.

Dengvaxia cost effectiveness in Puerto Rico / Dr. Alex Perkins (University of Notre Dame):  

 

Summary of work group discussion and next steps / Dr. Steve Waterman (CDC/NCEZID): 

During discussion one of the participants was horrified at the thought of going down the road of “shared decision making” with parents because the issue is so complicated. WOW! Incredible arrogance. 

General Best Practices: (postponed until Feb-2020 meeting due to time constraints)

Introduction / Dr. Paul Hunter (ACIP, WG Chair) 

Update on recent postings / Dr. Andrew Kroger (CDC/NCIRD) 

Rabies Vaccine

Introduction / Dr. Sharon Frey (ACIP, WG Chair) 

Background / Dr. Agam Rao (CDC/NCEZID) 

He acknowledged that antibody response is not necessarily predictive of protection even though it is presented that way routinely. Refreshing to hear that acknowledged. Antibody response is used as a proxy for protection. Science isn’t done by proxy – especially since it is possible to conduct DB RCT using genuine placebos to test level of effectiveness of vaccines. If we had been doing DB RCTs using genuine placebos all along we’d have data about effectiveness, we would have data about safety. The vaccine religious use epidemiologic studies to co-relate safety but denial correlation of risk when parents observe horrific changes following vaccination. 

Rabies PrEP schedule and serological monitoring by risk category in healthy nonpregnant persons and special populations / Dr. Jesse Blanton (CDC/NCEZID): 

Measles

National Measles overview / Dr. Paul Gastanaduy (CDC/NCIRD) 

Measles in New York State / Dr. Debra Blog (NY State Department of Health) 

Overview of outbreak

Measles in New York City / Dr. Jane Zucker

More detailed presentation of local data and response.

Questions following both Measles presentations:

(CDC/NCIRD)NMA Rep (sorry, did not get her name) posed question about vulnerability of African-American people group, she is hearing reports from pediatricians that many more are vaccine hesitant.

“We can’t force vaccination” – except you can by requiring vaccination for school, daycare, etc. (I think it was Dr. Blog who said this).

Sanchez asked about measles in <6month of age group and did they not receive maternal antibodies – speakers state they did not explicitly look at maternal antibody status, blamed unvac older siblings. This is a very astute question – since we are relying solely on measles vac antibody transfer (and also via breastfeeding if mom breastfeeds) is not as optimal, leaving <12month old babies more vulnerable. Achieving any kind of “herd immunity” via vaccination is expensive, mostly because of the need to continuously re-vac (whereas lifetime immunity is fairly reliably achieved subsequent to illness/recovery) – but we also do not have good, accurate data on safety of MMR since we do not have DB RCT studies using actual placebos, nor do we have studies comparing vac with unvac so doing any kind of risk/benefit analysis cannot really be done. We do not know how risky it is do have the illness vs receive the vaccine. We do not know if it is more beneficial to have the illness vs get the vaccine. Way too much missing information – these are questions that have not been answered. THIS IS WHY PEOPLE ARE VACCINE HESITANT. 

(didn’t get questioners name) – asked what percent were heartfelt religious exemption vs other reasons for vac hesitancy. Per Dr. Blog most of these were philosophical exemptions couched or posed in religious language.

Bernstein: does new state law apply to homeschool or private schools. Yes, to private schools, no to homeschools – though homeschooled students need to be vac’d if coming to school settings for testing or other reasons.

Vaccinate with confidence / Dr. Sarah Mbaeyi (CDC/NCIRD) 

Review of this program to increase vaccine uptake. Denial of missing information does not make the information any more missed.

Vaccine Supply Update / Dr. Jeanne Santoli (CDC, NCIRD): 

Hep B vac supply

Dr Fry asked why supplies are sometimes low (I think she was asking a general question not just about Hep B vac) – Santoli gave a non-specific answer due to information coming from private companies (considered confidential information).