New Vaccine Recommendations from the Advisory Committee on Immunization Practices

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http://www.pkids.org/immunizenews/ March 21, 2008 New Vaccine Recommendations from the Advisory Committee on Immunization Practices Combination MMR-varicella vaccine is no longer favored over separate vaccines, and influenza vaccine is now recommended for all children aged 6 months to 18 years. Two new recommendations were issued on February 27, 2008, following a meeting of the Advisory Committee on Immunization Practices (ACIP). The CDC will formally distribute and publish the recommendations in MMWR Morb Mortal Wkly Rep. Clinicians will want to know about both recommendations now because they might affect vaccine orders during the coming months. Recommendation 1: The CDC no longer

favors the combination vaccine ProQuad (containing measles, mumps, rubella [MMR], and varicella) over two separate injections for MMR and varicella. The Kaiser Permanente Vaccine Study Center presented data to the ACIP that revealed that ProQuad was associated with twice the risk for seizures within 10 days of vaccination (9 per 10,000 children), compared with separate MMR and varicella vaccines (4 per 10,000). The reason for the different seizure rates is unclear, and, according to Merck & Co., which manufacturers both the combined and separate-component vaccines, the difference disappeared in a comparison of rates at 30 days. Comment: The ACIP’s statement about the combination vaccine does not require an immediate change in practice but simply replaces the CDC’s previously stated preference for the combination vaccine. I prefer to use separate MMR and varicella vaccines in children with personal or family histories of febrile seizures. The overall risk

for seizure after administration of the separate vaccines is lower than that with the combined vaccine, and warnings already are included in the information materials we give to parents before vaccination. Recommendation 2: The CDC expanded recommendations for influenza vaccine to all children aged 6 months to 18 years (except children with serious egg allergies). The previous recommendation was for children aged 6 to 59 months. Although the recommendation will be implemented no later than the 2009–2010 flu season, physicians are encouraged to begin vaccinating children according to the new recommendation during the next influenza season. Data were presented at the ACIP meeting that underscore the need for two doses of flu vaccine in children who receive the vaccine for the first time: Among children aged 6 to 23 months, fully vaccinated children had 75% vaccine efficacy in preventing influenza-related hospitalization, and children who received only one dose

did not receive statistically significant protection. Comment: The recommendation to expand influenza vaccine has been controversial for many years largely because of logistical concerns about implementation, but, in my opinion, it is a great idea. More-widespread vaccination will lead to fewer missed days in school and fewer doctor visits. Experts hope that widespread coverage will reduce transmission to both infants and older adults. Talking to families about the expanded recommendation at routine visits might be helpful, because, by increasing awareness now, implementation will be easier in the years to come. — Peggy Sue Weintrub, MDPublished in Journal Watch Pediatrics and Adolescent Medicine March 12, 2008Citation(s):Stobbe M. Kids vaccine linked to fever, seizures. Associated Press. Feb 28 , 2008. (http://tinyurl.com/2qdr2h)Centers for Disease Control and Prevention (CDC). CDC’s advisory committee recommends influenza

vaccination for children 6 months through 18 years of age [press release correction]. Feb 27 , 2008. (http://tinyurl.com/2ojlto) Tamiflu Label Updated with Neuropsychiatric Warning The revised label adds a warning about possible neuropsychiatric side effects. The FDA and Roche Laboratories have revised the product label for Tamiflu (oseltamivir phosphate) to include a warning about possible neuropsychiatric events. The updated label is based on recommendations from the agency’s Pediatric Advisory Committee meeting in November 2007. Postmarketing reports indicate that some patients with influenza who were receiving Tamiflu had delirium and abnormal behavior, leading to injury and even death. Most of the cases occurred in children and in

Japan.Although it’s not clear whether Tamiflu caused these events, the label cautions clinicians to monitor their patients for abnormal behavior when taking the drug. Adverse events should be reported through the FDA’s MedWatch site. Published in Journal Watch Pediatrics and Adolescent Medicine March 12, 2008Originally published in Physician’s First Watch March 5, 2008 Outbreak of Flu Shuts Schools in Hong Kong Boston Globe (03/13/08) Lee, Min — In an effort to prevent the spread of influenza, the Hong Kong government has closed all kindergartens and primary schools for two weeks. The students will start the Easter holiday early to help keep the disease from spreading. “We estimate this peak season of influenza will continue for a few weeks,”

said Hong Kong’s Health Secretary, York Chow. Also this week, Chow asked Yuen Kwok-yung, who helped investigate Hong Kong’s outbreak of severe acute respiratory syndrome several years ago, to lead a panel looking into the deaths of three children in the past week. The most recent death, of a seven-year-old boy on Tuesday, increased concerns because five of his classmates were also hospitalized. His cause of death has not yet been determined; however, officials believe that some of the other students had the flu, and that school was closed earlier this week. In the past week, health experts have confirmed six flu outbreaks at schools, hospitals, and a nursing home in Hong Kong. "there is more to the link about other shots"

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