CDC’s Advisory CDC’s Advisory Committee on Committee on Immunization Practices Immunization Practices (ACIP) (ACIP) How is Vaccine Policy Made? William Schaffner, MD William Schaffner, MD Professor and Chair, Department of Professor and Chair, Department of Preventive Medicine Preventive Medicine Professor of Medicine (Infectious Professor of Medicine (Infectious Diseases) Diseases) Vanderbilt University School of Vanderbilt University School of
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CDC’s Advisory Committee on Immunization Practices (ACIP) CDC’s Advisory Committee on Immunization Practices (ACIP) How is Vaccine Policy Made? William.
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CDC’s Advisory CDC’s Advisory Committee on Committee on
Professor and Chair, Department of Professor and Chair, Department of Preventive MedicinePreventive Medicine
Professor of Medicine (Infectious Diseases)Professor of Medicine (Infectious Diseases)
Vanderbilt University School of MedicineVanderbilt University School of Medicine
As there are persons who mend
torn garments, so there are
physicians who heal the sick; but
your duty is far nobler and one
befitting a just person – namely to
keep people in health.
Zenophon in Cryopaedia 400 BC
Food and Drug Food and Drug Administration (FDA)Administration (FDA)
Charged with licensing Charged with licensing pharmaceuticals and vaccines that pharmaceuticals and vaccines that are are safesafe and and effectiveeffective
AAdvisory dvisory CCommittee on ommittee on IImmunization mmunization PPracticesractices
((ACIPACIP))
Established in 1962 to guide Established in 1962 to guide vaccination practices in public vaccination practices in public health clinicshealth clinics
Advisory to Director, CDC Advisory to Director, CDC and Secretary, DHHS and Secretary, DHHS
AAdvisory dvisory CCommittee on ommittee on IImmunization mmunization PPracticesractices
((ACIPACIP))
Eliminate “two-tiered” approach to Eliminate “two-tiered” approach to immunization servicesimmunization services
Developed collaborations with Developed collaborations with professional societies – patients professional societies – patients seen in both public and private seen in both public and private venues are provided comparable venues are provided comparable immunization servicesimmunization services
American Academy of Pediatrics (AAP)American Academy of Pediatrics (AAP) American Academy of Family Physicians (AAFP)American Academy of Family Physicians (AAFP) American College of Obstetricians and American College of Obstetricians and
Gynecologists (ACOG)Gynecologists (ACOG)
American College of Physicians (ACP)American College of Physicians (ACP)
These organizations are key to distributing These organizations are key to distributing the the ACIPACIP recommendations to their members recommendations to their members
Infant and ChildhoodInfant and ChildhoodImmunization ScheduleImmunization Schedule
Recommended immunization schedule for persons aged 0 to 6 years – United States, 2012
For those who fall behind or start late, see the catch-up schedule
Note: These recommendations must be read with the footnotes that follow containing number of doses, intervals between doses, and other important
information.
Vaccines that might be indicated for adults based on medical and other indications
– United States 2012.
LinksLinks
http://www.cdc.gov/vaccines/schedules/index.html
http://www.cdc.gov/vaccines/vpd-vac/vpd-list.htm
Immunization Immunization Schedules:Schedules:
List of Vaccine-Preventable Diseases and List of Vaccine-Preventable Diseases and their vaccines:their vaccines:
ACIPACIP
MembersMembers
Ex-Officio MembersEx-Officio Members
Liaison RepresentativesLiaison Representatives
Organized and run by CDC staffOrganized and run by CDC staff
ACIPACIP
MembersMembers 15 voting members15 voting members
vaccinology, state and local public health, pediatrics, vaccinology, state and local public health, pediatrics, family medicine, internal medicine, infectious family medicine, internal medicine, infectious diseasesdiseases
one member must be a lay person representing the one member must be a lay person representing the publicpublic
4-year terms4-year terms
conflict of interest rules, public disclosure, voting conflict of interest rules, public disclosure, voting recrusalsrecrusals
Ex-OfficioEx-Officio Centers for Medicare and Medicaid Services Centers for Medicare and Medicaid Services
(CMS)(CMS) Department of Defense (DOD)Department of Defense (DOD) Department of Veterans Affairs (DVA)Department of Veterans Affairs (DVA) Food and Drug Administration (FDA)Food and Drug Administration (FDA) Health Resources and Services Health Resources and Services
Administration (HRSA)Administration (HRSA) Indian Health Service (IHS)Indian Health Service (IHS) National Institutes of Health (NIH)National Institutes of Health (NIH) National Vaccine Program Office (NVPO)National Vaccine Program Office (NVPO)
RecommendationsRecommendations Clinical and public health guidanceClinical and public health guidance Dual function: protect individual and Dual function: protect individual and
communitycommunity Strength of evidence ranking, GRADE Strength of evidence ranking, GRADE
1978 DHEW (CDC): Measles Elimination Program1978 DHEW (CDC): Measles Elimination Program Eliminate indigenous measles from USEliminate indigenous measles from US
1984-88 3,750 cases/year1984-88 3,750 cases/year 58% among vaccinated children58% among vaccinated children
Dilemma: Can public health goal of Dilemma: Can public health goal of measles elimination be achieved?measles elimination be achieved?
Note: Cases reduced by 99+%Note: Cases reduced by 99+% Measles control achievedMeasles control achieved Great clinical protectionGreat clinical protection
How tolerant are “we” of 3750 How tolerant are “we” of 3750 cases/year?cases/year?
If intolerant, what to do?If intolerant, what to do?
Dual Function: Protect Individual and Dual Function: Protect Individual and Community Community
1989 ACIP recommended 1989 ACIP recommended allall children children receive 2 doses of measles vaccinereceive 2 doses of measles vaccine
1993 Transmission of indigenous 1993 Transmission of indigenous measles interrupted in USmeasles interrupted in US
Although clinical result had been Although clinical result had been achieved, the public health achieved, the public health (community) goal required additional (community) goal required additional efforteffort
Dual Function: Protect Individual and Dual Function: Protect Individual and Community Community
Pneumococcal conjugate vaccine for adultsPneumococcal conjugate vaccine for adultsPCV13 for immunocompromised adults, etcPCV13 for immunocompromised adults, etc
PCV13 for normal adults – no recommendation yetPCV13 for normal adults – no recommendation yet
Hepatitis B vaccine for all persons with Hepatitis B vaccine for all persons with diabetes <60 years of age; clinician’s judgment diabetes <60 years of age; clinician’s judgment for >60for >60
ACIPACIP: Current Issues: Current Issues
New HCW without serologic New HCW without serologic confirmation of hepatitis B protectionconfirmation of hepatitis B protection
Use a third dose of MMR during a Use a third dose of MMR during a mumps outbreak?mumps outbreak?
Should nasal spray influenza vaccine Should nasal spray influenza vaccine be preferred for children?be preferred for children?
ACIPACIP
Use objective data and a transparent Use objective data and a transparent processprocess
Define what we know, what we don’t Define what we know, what we don’t know, and, then, what we will do nowknow, and, then, what we will do now
Be prepared to revise as new data Be prepared to revise as new data become availablebecome available
Beyond ACIPBeyond ACIP
Vaccine research & developmentVaccine research & development