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Advisory Committee Recommends Hepatitis A Vaccine for All Children


Pharmaceutical Executive

Pharmaceutical ExecutivePharmaceutical Executive-11-08-2005
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The success of a 1999 program to vaccinate children in high-risk areas against Hepatitis A prompted the Advisory Committee on Immunization Practices to recommend universal use. But the vaccine may face minor hurdles from insurance companies and states.

The Centers for Disease Control’s Advisory Committee for Immunization Practices recommends that all children get vaccinated against Hepatitis A.

    CDC does not have to follow the advisory committee’s recommendations, but it usually does, said spokesman Curtis Allen.

    The committee’s recommendation, issued October 17, expands a previous program, launched in 1999, which advised childhood vaccination against the disease in 17 high-risk Western states. That program was highly effective, according to an analysis by CDC scientists published in the July 13, 2005 issue of the Journal of the American Medical Association.

    According to the authors, between 1990 and 1997 the rate of infection in the 17 target states was 4 times higher than in the rest of the country. By 2003 the rate of Hepatitis A infection in these states was in line with the rates in other states, dropping from 21.1 cases per 100,000 in the 1990s to 2.5 cases per 100,000 people-a decline of 86 percent.

    In 1998 nearly 600,000 doses of the vaccine were distributed, the authors found. This climbed to more than 3 million in 2003.

    The results were achieved without the use of strict regulations. Of the 17 states where CDC recommended vaccination for all children, only 6 made vaccination a requirement for enrolling children in school and daycare, according to data updated in August by the Immunization Action Coalition. And of these, two mandated the vaccine only in selected counties.

    This is good news for vaccine advocates. “It’s a lot of work to get a mandate in place,”-because the decision is made by legislators rather than by a medical board- explained Deborah Wexler, director of the Immunization Action Coalition. But in most states, “the disease rates went down a lot without a mandate,” she said.

    The CDC authors credited some of this decrease to the “herd effect,” in which overall infection rates decrease as a result of lower person-to-person transmission through “modest levels of vaccination coverage.” The herd effect is also credited with reducing adult infections.

    The only potential issue is securing funding to protect children whose insurance plans will not cover the vaccine, Wexler said.

    “It’s going to take a while to put things in place so that the funds are secured,” said David Neumann, executive director of the National Partnership for Immunization.

    He also predicted resistance from some parents, because there are already so many recommended or required childhood vaccines.

    But Wexler disagreed.

    “This is not a vaccine that is going to be a problem for parents to accept,” she asserted.  Even if they have to pay for it out-of-pocket, she said.

Doctors are likely to include give the vaccine as a matter of routine in private practices, Allen said, because it is also recommended the American Academy of Family Physicians and the American Academy of Pediatrics.

    Allen said CDC would formally publish its recommendation in the Morbidity and Mortality Weekly Report within the next two months.

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