October 2007 NVAC Meeting Minutes
Dr. Gellin explained that a lot of the work of NVPO is embodied in the work of the National Vaccine Advisory Committee and its various Subcommittees and Working Groups. The NVPO is also involved in the development of the new National Vaccine Plan.
The NVPO has spent a lot of time on pandemic flu issues, such as pandemic flu vaccine prioritization, which was an effort that was co-led by HHS and the Department of Homeland Security (DHS).
Dr. Gellin concluded his update by recommending that everyone be familiar with the Homeland Security Council’s pandemic flu implementation plan.
National Institutes of Health (NIH)—Dr. George Curlin
Dr. Curlin explained that NIH just awarded two contracts to look at the management of uncomplicated skin and soft tissue infection (SSTI) in an era of community-acquired MRSA. One goal of these contracts is to identify ways to treat routine community-acquired, antibiotic-sensitive staphylococcal infections with well-known antibiotics. Another goal of these contracts is to separate the treatment of uncomplicated staphylococcal infections from the treatment of methicillin-resistant staphylococcal infections, for which the more powerful antibiotics should be reserved.
Dr. Curlin explained that the issue of MRSA was embedded in the larger problem of the development of antibiotic resistance. He explained that inappropriate use of antibiotics was something that needed to be dealt with and explained that vaccines are important but not the major factor in combating MRSA.
There are currently two new Staphylococcus vaccines. The first vaccine is very much in the development stage and uses a genomic approach. The second vaccine uses a surface protein adhesion antigen approach and is now ready for clinical studies.
Dr. Curlin mentioned the existing Staphylococcus vaccine from Nabi Biopharmaceuticals that has gone through Phase III trials. The manufacturers chose to evaluate this vaccine in populations with high rates of Staphylococcus infections. The vaccine worked 10 weeks earlier than the study had called for, and since then, the manufacturer has added another antigen to the mix. However, Dr. Curlin mentioned that it is very difficult to evaluate staphylococcal vaccines. Dr. Curlin also mentioned the importance of immunotherapy in treating MRSA infections and explained that one particular type of immunotherapy was currently in the Phase III trials.
Dr. Schuchat mentioned that CDC, NIH, FDA, and USAID were going to meet in December to update the Public Health Action Plan on Antimicrobial Resistance with 70 external consultants. She explained that vaccines were only a very small part of this plan but that perhaps new action would be provided.
United States Agency for International Development (USAID)—Mr. Neal Brandes
Mr. Brandes began his update by discussing a journal article that was published in the July issue of the Pediatric Infectious Disease Journal on the effectiveness of the Hib conjugate vaccine in Bangladesh. He said that this study was a good example of how a small amount of money can be used quite well. This particular study reported that the vaccine was 90 percent effective in the population, 92 to 93 percent effective when administered in a facility, and 89 percent effective when administered in the community. The study was also shown to influence the government of Bangladesh to seriously consider purchasing the vaccine. Mr. Brandes explained that many countries are concerned about the cost of the vaccine and do not recognize the disease burden, which is why studies of this nature are needed. He continued by