More drugs pending addition to immunization roster

Much is expected to happen on the vaccine front in the next 1,000 days or so, two top vaccine experts told a session at the American Academy of Pediatrics (AAP) conference in Washington, D.C., in October.

In line with the impressive history of immunization in improving health, "the near future holds hope for the program to be raised to the next level, with the possible addition of conjugated meningococcal; Tdap; rotavirus; measles, mumps, rubella, and varicella (MMRV); and human papillomavirus vaccines to the childhood and adolescent immunization schedule." So said Larry Pickering, M.D., and Margaret Rennels, M.D. Pickering is senior advisor to the director of the Centers for Disease Control & Prevention's National Immunization Program. Rennels is professor of pediatrics at the University of Maryland. Both have been part of the AAP committee that developed Red Book recommendations on vaccinations for children and adolescents.

Among the vaccines likely to be added to the recommendations, according to experts, are:

The speakers also pointed to the news that two vaccines for different strains of human papillomavirus, which puts women at risk of cervical cancer and underlies other health problems, are due out in the not too distant future. Experts say several previous studies had indicated that the vaccines offer very good protection. They may be filed for licensure with the Food & Drug Administration at the end of this year or early next year. Then, said Pickering, FDA will have 10 months to make a decision; CDC and AAP will then make use recommendations. And there are studies in progress to determine whether these vaccines could interrupt ongoing disease at any point.

Several other vaccines are in various stages of FDA review:

Rennels acknowledged that even after vaccines are recommended by the AAP and CDC, "we know that there is enormous frustration in trying to get money into the budgets to pay for the vaccines. We know that it varies from state to state and from one third-party payer to another."

But some of the most important vaccine news is about what has not happened: There is no vaccine yet for the bird flu spreading from Asia. There has been a lot of attention to developing a vaccine for that H5N1 (bird flu) strain, noted the speakers, given the fears that if it can move easily from person to person, it could cause a pandemic. Trials have failed to come up with an effective vaccine, and, Rennels noted, the vaccine would still have to go through the normal stages for approval.

She went on to note that in a pandemic, prioritization for vaccination would depend on what age groups the virus is hitting and also on maintaining the social and economic infrastructure. She observed that the 1919 pandemic hit the adult age groups most critical to keeping society going. The Department of Health & Human Services has decided that we must prepare for the worst-case scenario and will soon finish a prioritization for vaccines and antivirals.