Developments in vaccines are coming quickly

There will be many new vaccines and new vaccine recommendations over the next three years or so, two of the top experts in the vaccine arena reported today at the AAP National Conference.

Leaders from AAP's Red Book (infectious disease) committee and the Centers for Disease Control and Prevention (CDC) noted that, for example:

• A recommendation for a second dose of Varivax (Merck) in children 12 months to 12 years old may be made within two years

• Two different vaccines for different strains of human papillomavirus that are associated with the highest risk of cervical cancer are due out, one this year and one next year. Although word of the coming vaccines only came to the attention of the national media recently, earlier studies had indicated excellent protection against cervical cancer with these vaccines.

The session on the fast-changing vaccine world was presented by Larry Pickering, MD, senior advisor to the director of the CDC's National Immunization Program, and Margaret Rennels, MD, professor of pediatrics at the University of Maryland and one of the AAP's experts on vaccine.

The bad news on this topic, Rennels said, is about a vaccine event that has not happened: Although there is work going forward, there is no dependable vaccine for avian influenza. Researchers fear that, at some point, that virus will mutate so that it is easily able to move from human to human.

Rennels said this scenario is "terrifying" because an influenza pandemic will happen, at some point. The question is: Will it be as bad as the one in 1918 that killed tens of millions worldwide. She also noted that, in a pandemic, priority may need to go to saving working-age adults to preserve the nation's economic framework.

In other developments, according to Rennels and Pickering:

• Last May, the FDA approved Boostrix, a GlaxoSmithKline product for booster protection against tetanus, diphtheria, and pertussis (Tdap), for single-dose use in people between 10 and 18 years old. Then, in June, the FDA approved Sanofi Pasteur's Tdap product, Adacel, for single-dose booster use in persons between 11 and 64 years.

• A three-dose vaccine regimen for infants 1 to 6 months old, to protect against rotavirus, has been developed by Merck. Licensing is expected next year.

• A recommendation for universal hepatitis A vaccine of children is expected in one or two years.

• Merck is developing a varicella zoster vaccine for adults.

Rennels and Pickering especially encouraged pediatricians to, first, look at the vaccine status section of the on-line edition of AAP's Red Book (http://aapredbook.aappublications.org) to find out what's in the pipeline and, second, to be prepared for public announcement of any developments in vaccine prevention of disease.

And what about the 2005-2006 influenza season? The AAP experts noted that, beginning October 24, the CDC may extend its recommendation for vaccination to everyone, not just those in one of the high-risk groups, if there is sufficient availability of vaccine from manufacturers.