Tag Archives: Centers for Disease Control and Prevention

Can HPV Vaccination Be Simplified?

The human papillomavirus vaccine was recommended for routine use in 11-12 year old girls in 2007. But by 2010, the most recent year for which data are available, less than half had received one dose of the three-dose series and fewer than a third had received all three. The inconvenience of the need for three separate office visits along with the vaccine’s price – about $130 per Gardasil dose, as of July 2011 – have certainly contributed to the low uptake.

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Now, some parts of the world – including Mexico, Switzerland, and parts of Canada have moved to either a two-dose schedule, or a so-called “extended dose” schedule, in which the third dose is delayed until 5 years after the second one. (In the current U.S. three-dose schedule, doses two and three are given at 2 and 6 months, respectively, after dose one.)

“There has been emerging interest in HPV vaccine schedules with fewer than three doses, for a variety of reasons. These schedules could facilitate implementation, they may be more convenient for providers, parents, and vaccinees, and of course they would be cost-saving,” said Dr. Lauri Markowitz, of the Centers for Disease Control and Prevention, at a recent meeting of the CDC’s Advisory Committee on Immunization Practices.

No data on the efficacy of fewer than three doses have been published by either Merck or GlaxoSmithKline from their pivotal trials of Gardasil and Cervarix, respectively. But some other data are available for both vaccines. A nonrandomized study in Costa Rica that included more than 1,100 women who had received just one or two doses of Cervarix suggested that two doses or maybe even just one – could be as protective as three doses against infection at 4 years.

And in an as-yet unpublished study done in Canada, immune responses against both HPV 16 and 18 at 3 years were similar between two doses of Gardasil given at age 9-13 years and three doses given at age 16-26 years. But, there are limited efficacy data and no long-term data, Dr. Markowitz said.

Electron micrograph of human papillomavirus (HPV) / Courtesy of the National Cancer Institute

In an e-mail, Deb Wambold of Merck Vaccines said that, while the company does support studies of alternative dosing schedules for HPV vaccination including two-dose regimens, so far those studies are “interesting preliminary explorations in select subpopulations of vaccinees,” and “It is important to note that there are no data on the clinical efficacy or durability of effectiveness with two doses of either of the HPV vaccines, as we have for the recommended three-dose vaccination regimen.”

Dr. Joseph A. Bocchini Jr., who chairs the ACIP HPV vaccine working group, concurred. In an interview at the ACIP meeting, he noted that the long-term efficacy of two doses is “worth looking at,” as is the varying of three-dose schedules. “But, at this point, there are too few data to apply this to recommendations in the United States.”

More data from ongoing trials will be available in the next few years, Dr. Markowitz said.

-Miriam E. Tucker (@MiriamETucker on Twitter)

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Filed under Allergy and Immunology, Epidemiology, Family Medicine, IMNG, Infectious Diseases, Internal Medicine, Obstetrics and Gynecology, Oncology, Pediatrics, Primary care, Uncategorized

Antibiotic Smarts Week Is Here

Today the Centers for Disease Control and Prevention kicked off its third annual “Get Smart About Antibiotics Week”, a time to reflect on practical ways that clinicians and health consumers can reduce the rates of antibotic resistance.

One of the posters for this year's campaign. Image Courtesy CDC.

The campaign’s three main goal are to promote adherence to appropriate prescribing guidelines among providers, decrease demand for antibiotics for viral upper respiratory infections among healthy adults and parents of young children, and increase adherence to prescribed antibiotics for upper respiratory infections.

A wide variety of campaign-related free media are available for clinicians to use in their practices, from printable brochures about proper antibitoic use and one-page information sheets to posters and treatment guidelines for upper respiratory tract infections, one geared for adults and one for children. A number of related podcasts and videos geared to health consumers are also available.

The effort’s home page can be accessed here.  Happy campaigning!

— Doug Brunk (on Twitter@dougbrunk)

Image courtesy Centers for Disease Control and Prevention.

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Filed under Allergy and Immunology, Family Medicine, IMNG, Internal Medicine, Uncategorized

Why Pregnant Women Skip Flu Shots

Even though the Centers for Disease Control and Prevention identified pregnant women as one of the five initial target groups to receive the 2009 monovalent H1N1 influenza vaccine, many pregnant women report not knowing about the importance of vaccination.

Image via Flickr user USACE Europe District by Creative Commons License.

The finding comes from a cross-sectional study of 813 postpartum women at the University of Colorado Hospital conducted between November 2009 and May 2010. Barbra M. Fisher, a maternal-fetal medicine fellow at the University of Colorado, Denver, reported that 64% of women received the seasonal influenza vaccine during the study period and 54% received the novel H1N1 influenza vaccine.

Women who chose not to receive either vaccine cited the following reasons for opting out: not knowledgeable about the importance of vaccination (25%), concern for effects on fetal health (18%), concern for effects on maternal health (9%) and not knowing where to obtain vaccination (9%). In addition, 6% said that the vaccine was not available to them.

The findings, Dr. Fisher said, suggest that future vaccination campaigns “should focus on education of vaccine safety, enhance provider-patient education and communication –– targeting specific portions of the population –– and early availability of appropriate vaccines.”

— Doug Brunk (on Twitter @dougbrunk)
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Filed under Allergy and Immunology, Family Medicine, IMNG, Internal Medicine, Obstetrics and Gynecology