Spring 2017 Vaccine Advisory Committee Report

Reported by Mary Allison Koehnke, ND – Naturopathic representative to the Washington State Vaccine Advisory Committee

A. The Department of Health ultimately decides which vaccines should be required in schools. The VAC had made a recommendation that the DOH reviews the criteria and so the DOH will meet to do this in July. The current criteria are from 2006. In brief, the current criteria are as follows;

  1. A vaccine containing this antigen is recommended by the ACIP and included on its recommended childhood immunization schedule
  2. The antigen is effective as measured by immunogenicity and population based prevention
  3. The vaccine containing this antigen is as cost effective from a societal perspective as other vaccines used to prevent the diseases included in WAC 248-100-166
  4. Experience to date with the vaccine containing this antigen indicates that it is safe and has an acceptable level of side effects.\
  5. The vaccine containing this antigen prevents diseases with significant morbidity and/or mortality implications in at least some sub-set of the population
  6. Vaccinating the infant, child, or adolescent against this disease reduces the person-to-person transmission
  7. The vaccine is acceptable to the medical community and the public.
  8. The administrative burdens of delivery and tracing of vaccines containing this (these) antigen(s) are reasonable
  9. The burden of compliance for the vaccine containing this antigen is reasonable for the parent/caregiver.

There are more thorough explanations of each criterion available but not in digital format. If you’d like to read further keep an eye on the VAC website and they should be posted shortly.

B. The DOH is working to improve Medicaid reimbursement for vaccine administration (currently $5.61). No change in outcome as of our last meeting.

C. The Washington State Hospital Association presented on concerns regarding lack of mandatory vaccination for healthcare workers and hospital staff and the potential for life threatening disease burden on patients. Thirteen leading healthcare associations (AAFP, AAP, ACP, IDSA etc.) have provided position statements supporting mandatory influenza vaccination. Naturopathic associations did not provide a statement and so we were not represented in the report. The Washington State Hospital Association encourages us to use these position statements to develop and implement mandatory influenza vaccination polity in our healthcare institutions and clinics. Again, this document is not available digitally but please keep an eye out on the VAC website where materials are posted.

D. Mumps update; at our last meeting there had been 771 confirmed cases on mumps in Washington State. Two hundred eighty one of these were in King county. Sixty percent (60%) are in school aged children (5-19 years of age). Thirty four of the cases were at UW and 33 of those were connected to the Greek system. Many providers have had difficulty identifying mumps in vaccinated patients because the disease process is typically milder. The DOH reminds us to help our colleagues and patients understand that the mumps outbreak DOES NOT indicate that the MMR vaccination is not effective. To the contrary, this outbreak is further evidence of the need for community immunity. Please see a brief example below;

“Let’s say that an outbreak occurs among 1000 people and that 950 of these 1000 people have received two doses of the vaccine and 50 are unvaccinated (i.e. vaccine coverage is 95%). If there is 30% attack rate among people who haven’t been vaccinated, 15 unvaccinated people would get the disease. Among the 950 vaccinated people, the attack rate would be 3%, so 29 vaccinated people would get the disease. Therefore, of the 44 people who got sick during the outbreak, the majority (29 or 66%) would have been vaccinated. This doesn’t imply that the vaccine didn’t work. In fact, the people who hadn’t been vaccinated were 10 times more likely to get sick as those who had been vaccinated, its just that there were a lot fewer unvaccinated people at risk. Furthermore, if none of the 1000 people had been vaccinated, the outbreak would have resulted in 300 cases rather than only 44. In this scenario, we would say that the vaccine is 90% effective in preventing the disease after two doses, which is the same as saying that the attack rate in the unvaccinated group is 10 times higher than the attack rate among people who have received two doses of vaccine. The formula to calculate vaccine effectiveness is (attack rate in unvaccinated group minus attack rate in vaccinated group) divided by attack rate in unvaccinated group or (ARU-ARV)/ARU.”

I will be out on maternity leave for the next 12 weeks. If you have questions please feel free to email me at maryalison.koehnke@gmail.com, but I will likely be slow to return emails or phone calls.

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