From CDC: Zoster recommendations, measles outbreak, post-vaccine fainting, and more

Several items of note have been released by CDC in recent weeks, including:

• "Prevention of Herpes Zoster: Recommendations of the Advisory Committee on Immunization Practices" -- The publication making official the recommendations regarding the use of Merck's zoster vaccine, Zostavax. In short, routine vaccination of all persons age 60 and older is advised, except for those with specific contraindications.

• "Measles--United States, January 1-April 25, 2008" -- A report on the unexpectedly large number of measles cases confirmed in the U.S. in the early months of the 2008. Of the 64 cases, 63 occurred in people who were unvaccinated or were of undocumented vaccination status. The report notes that a large number of the cases occurred in children whose parents had received philosophical exemptions from vaccine requirements.

• "Syncope After Vaccination--United States, January 2005-July 2007" -- The arrival of newly recommended adolescent vaccines has led to an increase in fainting, particularly among 11-18 year old females, CDC reports. One fatality has been confirmed as a result of a head injury caused by a fainting-induced fall. The report reiterates a previous recommendation to observe patients for 15 minutes following vaccination to reduce the risk of falls and injuries caused by fainting.

• NCIRD Annual Report -- The 2008 annual report of the National Center for Immunization and Respiratory Diseases -- the administrative home of most of CDC's vaccination-related activities -- was released last month. Of interest to those interested in the breadth of CDC's immunization activities, it its own words.
  

Roundup: Exemption rates, Health-care workers, and Shingles

Some stories and perspectives in the news of late:

• "Parents claim religion to avoid vaccines for kids: Vaccination fears fuel increase in exemptions sought, AP finds" -- This AP story published late last week received significant attention in newspapers around the country. The key finding of their analysis is this: "From 2003 to 2007, religious exemptions for kindergartners increased, in some cases doubled or tripled, in 20 of the 28 states that allow only medical or religious exemptions, the AP found." The story includes reaction from Paul Offit, Barbara Loe Fisher, and others.

• "Inoculate thyself" -- This op-ed in the New York Times, written by an epidemiologist at the New York City Health Department, raises yet another alarm over low influenza vaccination rates among health care providers. The author argues that hospital accreditation and federal funding should be tied to improving staff vaccination rates, and until then, patients should refuse care from physicians and nurses who have not been vaccinated.

• "A vaccine as an option to keep shingles at bay" -- Also from the New York Times, this story from early October introduces readers to shingles, its treatment, and prevention options, namely, the potential benefits of Zostavax. The piece feels more like an informational article from WebMD than a story published in the nation's most respected newspaper, but a useful overview regardless.
  

Potential supply issues for varicella-containing vaccines

Late last month, the CDC's MMWR included a "Notice to Readers" titled "Supply of Vaccines Containing Varicella-Zoster Virus." What are those vaccines? Varivax (against chickenpox), Zostavax (against shingles), and Proquad (a combination of MMR and chickenpox). All are manufactured by Merck, and no other U.S. companies manufacture vaccines providing protection against VZV.

There's no shortage to report, only news from Merck that the yield produced from early stages of the vaccine manufacturing process are less than expected (the reasons for which are not yet known). In the meantime, the plan is to prioritize production of the chickenpox and shingles vaccines, creating the potential for a limited supply of the combination ProQuad by late 2007. Again, not a major issue, as children can receive the same protection by receiving MMR and Varivax separately.

However, this announcement does remind us of the potential fragility of the U.S. vaccine supply. In addition to varicella-containing vaccines, those against measles, mumps, rubella, HPV, and rotavirus, among others, are all produced by a single manufacturer in the U.S. While the economic reasons behind this single-supplier market have been discussed by many, minor hiccups such as this announcement raise the attention of those who worry that the system is not sufficiently insulated against the risk, however small, of major production problems affecting a recommended vaccine.

Shingles vaccine recommended for adults 60+

We'd be remiss not to mention the biggest development out of this week's ACIP meeting, namely, the recommendation that all adults age 60 and over receive a single dose of Merck's new shingles vaccine, Zostavax. Here's the CDC press release, the Merck press release, and an AP story (courtesy of the Washington Post).

Also useful is this site assembled by the NIP with numerous resources about the painful condition formally known as herpes zoster and the new vaccine against it. Zostavax was licensed by the FDA in May and is the latest in a series of new vaccines introduced by Merck during the past year, though it's safe to say that this news hasn't received a hundredth of the attention that went to Gardasil in June.

ACIP: June minutes and October agenda

The folks at the Immunization Action Coalition pointed out that the full minutes from the June 2006 meeting of the CDC Advisory Committee on Immunization Practices are now available here. The 96-page PDF is the next best thing to attending the meeting yourself, as it provides comprehensive coverage of everything that took place. In June, of course, the major news was the recommendation vote for Merck's HPV vaccine, Gardasil. For those interested in the data that informed the ACIP's recommendation, the report is invaluable.

Also on the ACIP website is a draft agenda for the group's next meeting, scheduled for October 25-26. The most notable item is a scheduled vote on a recommendation for Merck's shingles vaccine, Zostavax, for use in adults.