[NP-Clinical] CDC Responds to NVIC's press release about the safety of the

GRETAOB at aol.com GRETAOB at aol.com
Mon Aug 20 23:55:55 PDT 2007


August 20, 2007
CDC RESPONDS TO NVIC'S PRESS RELEASE ABOUT THE SAFETY OF  
THE HPV VACCINE GARDASIL 

On August 17, CDC's Immunization Safety  Office, Office of 
the Chief Science Officer, posted a document on its  website 
titled "Fast facts that address statements made in a press  
release by the National Vaccine Information Center on 
8/15/07 regarding  Gardasil and Guillain-Barre Syndrome 
(GBS)." Gardasil is the trade name of  Merck's human 
papillomavirus (HPV) vaccine. 

CDC's Fast Facts gives  health professionals resources for 
answering patient questions that might  arise from the press 
release issued by the National Vaccine Information  Center 
(NVIC). NVIC is a non-governmental organization that 
frequently  criticizes the use of vaccines and vaccination 
efforts. In addition to  containing statements regarding 
Gardasil and GBS, NVIC's press release also  encouraged CDC 
to change its recommendations for HPV vaccination.   

CDC's Fast Facts document indicates there are no changes to 
any of  the existing HPV vaccination recommendations. The 
document is reprinted  below in its entirety. 

***********************

Fast facts that  address statements made in a press release by 
the National Vaccine  Information Center on 08/15/07 regarding 
Gardasil and Guillain-Barre  Syndrome (GBS). 

Fast facts: 

THE VACCINE ADVERSE EVENT REPORTING  SYSTEM (VAERS) is a national 
program that monitors the safety of vaccines  after they are 
licensed. VAERS is managed by the U.S. Centers for Disease  
Control and Prevention (CDC) and the U.S. Food and Drug 
Administration  (FDA). VAERS is designed to collect reports of 
potential adverse events  following immunization. VAERS reports 
can be submitted by anyone. When  evaluating data from VAERS, it 
is important to note that for any reported  event, no cause and 
effect relationship has been established. VAERS is  interested in 
all potential associations between vaccines and adverse  events. 
Therefore, VAERS collects data on any adverse event following  
vaccination, be it coincidental or truly caused by a vaccine. 
The report  of an adverse event to VAERS is not documentation 
that a vaccine caused the  event, nor is VAERS designed to 
calculate absolute or relative risks. Please  Note: VAERS defines 
"serious adverse events" by Code of Federal Regulations  as 
involving hospitalization, death, disability, life threatening  
illness, or certain other medically important conditions. Also, 
VAERS  data is continuously updated and the number of reports 
will vary from the  date of an analysis. 

VAERS REPORTS RELATED TO GARDASIL:
Since the  licensure of Gardasil, more than 7 million doses of 
vaccine have been  distributed. As of June 30, 2007, VAERS had 
received a total of 2,531  reports. Nearly 95% of the reports 
received to date have been classified as  non-serious. The number 
of serious adverse events reported is less then 6%  of the total 
number of reports received. In comparison, the overall average  
in VAERS for any serious adverse event ranges from 10%-15%; 
thus, the  percentage of serious reports for Gardasil are less 
than half of the overall  average. 

At this time the U.S. does not have a national registry for  
immunization and vaccination and therefore can not report the 
total  number of persons who have received Gardasil. 

CDC'S REVIEW OF VAERS  REPORTS CONCERNING GARDASIL AND GBS: 
As of June 30 2007, VAERS had received  13 reports concerning GBS 
after Gardasil. These 13 GBS reports are currently  undergoing 
expert review. Our efforts to date are below:  

*  Only 2 meet the case definition of GBS, occurred within six  
weeks after vaccination, and had received Gardasil alone. 

* Six of the  13 reports also involved simultaneous receipt of  
Menactra  vaccine. Current studies are underway to evaluate the  
small  increased risk of GBS, which might be associated with  
receipt  of Menactra vaccine. 

* Six of the 13 reports occurred after Gardasil was  given alone  
(without any other vaccine). 

* Thirteen  reports of GBS are within the numbers of reports that  
could be  expected to occur by chance alone after a  
vaccination.  

* As of June 30 2007, there have been seven deaths reported   
after Gardasil vaccine. These reports are currently being   
investigated. 

After a careful review of the GBS reports  received by VAERS, 
many appear to have insufficient clinical data. Because  GBS 
occurs at a rate of 1-2/100,000 person years during the second  
decade of life, it is likely that, some cases will occur after  
vaccination but will not be due to vaccination. A temporal 
association  does not confirm a causal association. In summary, 
the number of serious  adverse events has been relatively very 
rare, in the context of more than 7  million doses distributed 
across the U.S. 

Approximately 90% of the  reports received by the VAERS regarding 
Gardasil do not involve  co-administration of another vaccine. 
The recommendation of  co-administration is consistent with the 
General Recommendations of the  Advisory Committee on 
Immunization Practices (ACIP). 

Scientists  recognize the potential for syncope (fainting) after 
any medical procedure  involving a needle and therefore recommend 
a 15 minute waiting/observation  period after all vaccines. 
Syncope after vaccination is most common in  adolescent and young 
adults and has been reported after other vaccines.  About 50% of 
young adults experience at least one syncope episode at some  
point in their lives. 

In conclusion, there are no changes to any of  the existing HPV 
recommendations. 

ADDITIONAL RESOURCES AND LINKS:  
(1) Quadrivalent Human Papillomavirus Vaccine (HPV4): United 
States  Post-licensure Safety Update. Presented by John Iskander, 
MD, MPH,  Immunization Safety Office, Office of the Chief Science 
Officer, CDC.  
http://www.cdc.gov/vaccines/recs/acip/downloads/mtg-slides-jun07/35-hpv3-iskan
der.pdf

The  PDF can also be found at: 
http://www.cdc.gov/vaccines/recs/acip   

(2) The Advisory Committee on Immunization Practices (ACIP), 
Vaccine  for Children Program, Vaccine to Prevent Human 
Papillomavirus (HPV)  Infection. The link below is a PDF of the 
ACIP Resolution No. 6/06-2.   
http://www.cdc.gov/vaccines/programs/vfc/downloads/resolutions/0606hpv.pdf  

The PDF can also be found at:  
http://www.cdc.gov/vaccines/programs/vfc  

(3) CDC Questions and  Answers (Qs & As) Concerning the Safety 
and Efficacy of Gardasil, dated:  June 4, 2007. The link list is 
a PDF with the top 7 Qs &  As:
http://www.cdc.gov/vaccines/vpd-vac/hpv/downloads/vac-faqs-vacsafe-efficacy.pd
f   

Additional information and the PDF can also be found at:  
http://www.cdc.gov/vaccines/vpd-vac/hpv 

(4) Vaccine Testing and the  Approval Process: this link will 
describe vaccine development and testing  such as basic research, 
clinical studies, side effects and adverse reaction.  For 
additional information please visit:  
http://www.cdc.gov/vaccines/resdev/test-approve.htm  

(5) HPV  and HPV Vaccine: Information for Healthcare Providers. 
This PDF is a fact  sheet that provides an overview of HPV 
including information on Safety and  Efficacy. Additional 
information and the PDF can also be found at:  
http://www.cdc.gov/std/HPV  

(6) Quadrivalent HPV Vaccine:  Efficacy and Provisional 
Recommendations. Presented by Lauri Markowitz, MD,  National 
Centers for HIV, Viral Hepatitis, STD and TB Prevention, CDC:  
http://www.cdc.gov/vaccines/ed/ciinc/archived/hpv/downloads/3-HPV.ppt   

Additional information and the PDF can also be found at:  
http://www.cdc.gov/vaccines/ed/ciinc  

(7) Infectious Diseases  in Children: What's Hot in Pediatric ID. 
Article: Severe adverse events  associated with HPV vaccine are 
rare. August 2007, Volume 20. Number 8:  23-24. 

***********************

To access the fact sheet from the  CDC website, go to:  
http://www.cdc.gov/vaccines/vpd-vac/hpv/downloads/hpv-gardasil-gbs.pdf 



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