October 2007 NVAC Meeting Minutes
explaining that the Indian press, which has been even more reluctant about vaccinations, picked up this story, which is an important next step.
Dr. Humiston began the discussion by requesting global usage data for the Hib vaccine. Dr. Schuchat responded by stating that they have made great progress in terms of Hib vaccine usage. One study found that at the beginning of 2005, 19 of the 74 eligible countries were using the Hib vaccine; however, by the end of 2007, 53 countries had applied to use or started using the Hib vaccine. Dr. Feinberg reiterated Mr. Brandes’s point that many countries still do not have a full appreciation of the disease. Dr. Gordon wondered if more focus should be placed on surveillance rather than simple implementation of the vaccine. Dr. Schuchat responded by saying that the WHO believes implementation of the Hib vaccine should be global. She also commented that the WHO and the Gates Foundation are interested in broader surveillance for vaccine-preventable diseases to help sustain vaccination programs.
United States Department of Veteran’s Affairs (VA)—Dr. Ronald O. Valdiserri
Dr. Valdiserri began his update by explaining that the influenza vaccine was selected as one of the measures that the VA plans to use to report its performance to the public as part of the VA’s effort to meet the Presidential Executive Order on Quality and Transparency.
On October 19, the VA’s Medical Advisory Panel voted to add Zostavax to the VA National Formulary.
Dr. Valdiserri mentioned confusion surrounding the recommendations for Zostavax in HIV-infected patients. He said the Morbidity and Mortality Weekly Report (MMWR) stated that the vaccine is contraindicated for HIV-infected patients with CD4 cell counts less than 200. However, the document does not contraindicate or recommend the vaccine for HIV-infected patients with CD4 cell counts greater than 200.
The VA also added vaccinations to its list of agents that are followed as part of the pharmacovigilance program. He explained that this is a Web-based program available in every VA facility. He also explained that in 2008, the VA will pilot an active surveillance project that will monitor adverse reactions to the flu and pneumococcal vaccines. If the project is successful, it will be implemented nationwide.
Finally, the VA sent out a letter to all providers instructing them to offer the HPV vaccine to women 18 to 26 years of age.
Dr. Schuchat commented on Dr. Valdiserri’s question regarding use of Zostavax in HIV-infected patients. She explained that the Zostavax statement had not yet been published by CDC and apologized for the delay. Dr. Schuchat mentioned that this issue was going to be discussed at the upcoming ACIP meeting.
America’s Health Insurance Plans (AHIP)—Dr. Wayne Rawlins
Dr. Rawlins provided the following three updates:
America’s Health Insurance Plans (AHIP) are engaged with the Vaccine Evaluation Project around economic modeling for vaccine reimbursement;
They are informing members about the upcoming National Influenza Week; and