DEPARTMENT OF HEALTH AND HUMAN SERVICES 

CENTERS FOR DISEASE CONTROL AND PREVENTION

Advisory Committee on 

Immunization Practices (ACIP)

Summary Report

August 5, 2010 

Via Teleconference 

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Advisory Committee on Immunization Practices (ACIP) Summary Report August 5, 2010 

Table of Contents Page 

Acronyms 3 

Agenda 4 

Welcome and Introductions 5 

Influenza Vaccines

 Background on use of CSL Biotherapies Trivalent Inactivated Influenza Vaccine in Australia: 2010

 Influenza Work Group update: Vote on Use of CSL Trivalent Inactivated Influenza Vaccine in the United States: 2010-2011

 Open Discussion and Public Comment 

6-19 

Certification 19 

Participant Roster 20 

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Acronyms 

AAP American Academy of Pediatrics 

ACIP Advisory Committee on Immunization Practices 

ACOG American College of Obstetricians and Gynecologists 

AMA American Medical Association 

ANA American Nurses Association 

CDC Centers for Disease Control and Prevention 

CMS Centers for Medicare and Medicaid Services 

FDA Food and Drug Administration 

GSK GlaxoSmithKline 

IDSA Infectious Disease Society of America 

ISO Immunization Safety Office of CDC 

IVATS Influenza Vaccine Availability Tracking System 

LAIV Live Attenuated Influenza Vaccine 

MMWR Morbidity and Mortality Weekly Report 

MMRV Measles, Mumps, Rubella, Varicella 

TIV Trivalent Inactivated Vaccine 

UK United Kingdom 

US United States 

VFC Vaccines for Children Program 

VIS Vaccine Information Statements 

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Advisory Committee on Immunization Practices (ACIP) Summary Report August 5, 2010 

FINAL – August 4, 2010 

MEETING OF THE ADVISORY COMMITTEE ON IMMUNIZATION PRACTICES (ACIP)

Centers for Disease Control and Prevention 

1600 Clifton Road, NE, Atlanta, Georgia 30333 USA 

Thursday, August 5, 2010 

10:00 a.m. – 12:00 p.m. Eastern Daylight Time (U.S.) 

TELECONFERENCE – dial in information for ACIP Members & Presenters

 Dial in number: Toll-free number (within U.S. and Canada): 1-800-857-9623 

 Toll number: 1-773-756-4626 

 Passcode: 3908107 

AGENDA PURPOSE PRESIDER/PRESENTER(s) 

ITEM 

10:00 Welcome & introductions Dr. Carol Baker (Chair, ACIP) 

Dr. Larry Pickering(Executive 

Secretary, ACIP; CDC) 

10:05 Background on use of CSL trivalent 

inactivated influenza vaccine in 

Australia - 2010 

Information Dr. Tim Uyeki (CDC, National 

Center for Immunization and 

Respiratory Diseases, Influenza 

Division) 

10:15 Influenza Work Group update: vote 

on use of CSL trivalent inactivated 

influenza vaccine in the United 

States, 2010-2011 

Information 

Discussion 

Vote 

Dr. Wendy Keitel (ACIP, WG Chair) 

11:50 Public comment Dr. Carol Baker (Chair, ACIP) 

12:00 Adjourn Dr. Carol Baker (Chair, ACIP 

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Advisory Committee on Immunization Practices (ACIP) Summary Report August 5, 2010 

DEPARTMENT OF HEALTH AND HUMAN SERVICES

CENTERS FOR DISEASE CONTROL AND PREVENTION 

ADVISORY COMMITTEE ON IMMUNIZATION PRACTICES 

August 5, 2010

Teleconference 

Summary Report 

The Department of Health and Human Services (HHS), Centers for Disease Control and 

Prevention (CDC) convened an interim meeting of the Advisory Committee on Immunization 

Practices (ACIP) via teleconference on August 5, 2010. The following represents a summary of 

the proceedings. 

Welcome and Introductions 

Wendy Keitel, MD 

Chair, ACIP Influenza Work Group 

Baylor College of Medicine 

Dr. Larry Pickering 

Executive Secretary, ACIP / CDC 

Dr. Carol Baker 

Chair, ACIP 

Dr. Keitel officially called the interim ACIP meeting to order. 

Dr. Pickering welcomed those on the call to the interim meeting of the ACIP, and made 

administrative announcements. Slides presented during this meeting will be posted on the 

ACIP website within one week after the meeting. The meeting minutes will be available on the 

website within 90 days of the meeting. To ensure a quorum of voting members for this meeting, 

all ex officio members may be designated to vote as defined by the charter, which is posted on 

the ACIP website. With regard to disclosures, members who conduct clinical vaccine trials or 

serve on data safety monitoring boards may present to the committee on matters related to 

vaccines; however, they are prohibited from voting on issues related to those vaccines. 

Regarding other vaccines of the affected company, a member may participate in discussions 

with the proviso that he or she abstains on all votes related to the vaccines of that company. 

With regard to meeting structure, open telephone lines were made available to ACIP members, 

ex officio members, Influenza Work Group members, other CDC staff involved in influenza, and 

representatives from CSL and Merck during the period of presentation and discussion of data. 

Participants with open lines were asked to place their telephones on mute during the 

presentations. All others on this call had dial-in access to listen only. When requested by Dr. 

Keitel or Dr. Baker, this line would be opened by the operator for general discussion and then 

public comment. Those who intended to make public comments were asked to give their name, 

organization if applicable, and declare any conflicts of interest. Time for public comments was 

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Advisory Committee on Immunization Practices (ACIP) Summary Report August 5, 2010 

to be provided before the final vote. Given the time constraints, it was requested that each 

public comment be limited to two minutes. 

Dr. Pickering reiterated that depending upon how many voting members were on the 

teleconference when conflicts of interest were called for, it may be necessary for ex officio 

members to vote as well. 

Dr. Keitel the called for conflicts of interest, which were declared as follows: 

Member Conflicts 

Dr. Baker No conflicts 

Dr. Chilton No conflicts 

Dr. Cieslak No conflicts 

Ms. Ehresmann No conflicts 

Dr. Englund Receives research support from sanofi pasteur, Novartis, 

ADMA, and MedImmune. Dr. Pickering indicated that 

because other manufacturers may make influenza 

vaccines, Dr. Englund should not vote. 

Dr. Judson No conflicts 

Dr. Keitel Receives research support from Novartis. 

Dr. Meissner No conflicts 

Ms. Rosenbaum No conflicts 

Dr. Sawyer No conflicts 

Dr. Pickering noted that there was a quorum, and that there was a sufficient number of voting 

members on the call so the ex officio members would not be required to vote. 

Influenza Vaccine 

Background on CSL Biotherapies Seasonal 

Influenza Vaccine in Australian Children, 2010 

Tim Uyeki, MD, MPH, MPP 

Influenza Division 

National Center for Immunization and Respiratory Diseases 

Dr. Uyeki reported that on April 22, 2010, seasonal influenza vaccination of children under the 

age of 5 years was suspended in Western Australia due to reports of febrile seizures that had 

occurred and been reported during a mass vaccination campaign. Of note, this seasonal 

influenza vaccination campaign with the target population of 6 months through 4 years of age 

was also conducted during the 2008 and 2009 seasons in Western Australia among a similar 

number of children in the same target population, with approximately 50,000 estimated to have 

been vaccinated. Febrile seizures were not reported during 2008 or 2009. On April 23, 2010, 

vaccination of children age 5 years and under was suspended throughout Australia pending 

further investigations [Therapeutic Goods Administration, Australia, July 2, 2010]. 

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With regard to the findings of the investigation, vaccination of children age less than 5 years old 

with the 2010 trivalent inactivated vaccine (TIV) formulation produced by CSL Biotherapies 

(brand names Fluvax® or Fluvax® Junior) was associated with fever within 4 to 24 hours. A 

summary of the findings by the Therapeutic Goods Administration of Australia was released on 

July 2, 2010 indicating that in one cohort study, the risk of fever following Fluvax® vaccination 

was approximately 6.5 times higher than following a different TIV, Influvac®, made by Solvay / 

Abbott. Other studies indicated that the fever rate was approximately 8 to 10 times higher after 

receiving Fluvax® or Fluvax® Junior than Influvac® among children 6 months through less than 

3 years old. In children 3 and 4 years old, the fever rate was 10 to 20 times higher after 

Fluvax® or Fluvax® Junior compared to Influvac®. 

In terms of further data on fever, post-marketing surveillance reports in 2010 have indicated 

increased reports of fever in children age 5 years through 8 years following Fluvax® or Fluvax® 

Junior compared to the three previous seasons in Australia, although this is subject to reporting 

biases (e.g., lack of clarity about the vaccine coverage, influenza-stimulated reporting, et 

cetera). Nevertheless, there have been increased reports of fever in the 5 through 8 year old 

group following Fluvax® in 2010 compared to the three previous years. In addition, there are 

data from 2009 in which the CSL TIV was compared to another TIV in a clinical trial (both TIVs 

were the Northern Hemisphere formulation). This trial was conducted in the United States (US) 

and involved a 2-dose series for children aged 6 months through less than 8 years and 1 dose 

for children 9 through 18 years of age. The outcome for adverse events was fever occurring 

within 7 days of vaccination, which was found to be higher with CSL TIV (n = 229) versus the 

comparator (n = 228) for all age groups. In the group aged 6 months to less than 3 years, fever 

was 37% in CSL recipients versus 14% in the comparator. In children aged 3 to less than 5 

years, fever was reported 32% of the times in CSL recipients compared to 11% in the 

comparator. In children aged 5 to less than 9 years, 16% reported fever with CSL versus 9% 

with the comparator. Again, this was only with the first dose of the vaccine. There was really no 

difference with the second dose of either vaccine in terms of fever reported [Therapeutic Goods 

Administration, Australia, July 2, 2010]. 

Substantially higher rates of febrile seizures have been reported in 2010 following vaccination 

with either Fluvax® or Fluvax® Junior among children 6 months through 4 years of age. Febrile 

seizure onset occurred a mean of 7.2 hours following vaccination, with a range of 5.9 to 8.4 

hours. The overall rate of febrile seizures was estimated to be approximately 9 per 1,000 doses 

administered, which is roughly 9 times higher than the expected rate. In terms of the rates of 

febrile seizures for different age groups, for children aged 6 months through less than 3 years 

the rate was 7 to 10 per 1,000 doses administered. For children aged 3 years through less than 

5 years, the rates were 1.5 per 1,000 for Fluvax® to 15 per 1,000 for Fluvax® Junior. For other 

vaccines that have been used (including Influvac®) the rate was 0 per 1,000 doses in children 6 

months through less than 3 years of age and 3 years through less than 5 years. Compared to 

Influvac®, there was a substantially higher rate of febrile seizures with administration of Fluvax® 

or Fluvax® Junior [Therapeutic Goods Administration, Australia, July 2, 2010]. 

On April 26, 2010, the New Zealand Ministry of Health stopped the use of Fluvax® for ages less 

than 5 years also due to reports of febrile seizures. Prior to this stoppage, there were 9 cases 

of febrile seizures reported following Fluvax® in children aged less than 5 years. There was 

one case reported after vaccination with an unknown vaccine that was strongly suspected to be 

Fluvax®. A follow-up study revealed substantially increased febrile reactions in the 24 hours 

following Fluvax®, but this was not observed with Vaxigrip® manufactured by sanofi pasteur 

among more than 300 children aged less than 5 years. Another study revealed that no febrile 

seizures were reported in an estimated 5,000 to 7,000 children aged less than 5 years who had 

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received approximately 10,000 to 12,000 doses of Vaxigrip®. Similarly, no febrile seizures have 

been reported in New Zealand following administration of Influvac® [Memo, from Immunisation 

Manager, New Zealand Ministry of Health, April 26, 2010; Australian Technical Advisory Group 

on Immunisation, July 30, 2010]. 

No explanation has been identified to date for the observed increase in fever and febrile 

seizures in young children following administration of Fluvax® or Fluvax® Junior in 2010 in 

Australia or New Zealand. One limitation is that for persons aged 5 years and older, limited 

data are available on vaccination coverage with these or other TIVs. There was no increase in 

fever or febrile seizures noted with the monovalent 2009 H1N1 vaccination in Australia. On July 

30, 2010, Australia allowed seasonal influenza vaccination of children to resume in those aged 

6 months through 4 years using either Influvac® or Vaxigrip®, but not Fluvax® or Fluvax® 

Junior. Of note, the 2010-2011 Northern Hemisphere TIV strain composition is antigenically 

equivalent to what has been used in the 2010 Southern Hemisphere TIV in Australia and New 

Zealand [Therapeutic Goods Administration, Australia, July 2, 2010; Dept. of Health and Ageing, 

Australian Government, July 30, 2010]. 

In terms of the current policies on the use of CSL Biotherapies TIV, two countries in the 

Southern Hemisphere currently use CSL TIV (e.g., Australia and New Zealand). For Australia, 

Fluvax® and Fluvax® Junior are not recommended for use in children aged less than 5 years 

during 2010. In New Zealand, Fluvax® and Fluvax® Junior are not recommended for use in 

children aged less than 5 years during 2010. Three countries in the Northern Hemisphere use 

CSL Biotherapies TIV (e.g., Germany, the United Kingdom, and the US). The United Kingdom 

(UK) has recently published a recommendation regarding the use of Enzira®, which is 

distributed by Pfizer and CSL Biotherapies. The UK has recommended that these CSL 

vaccines not be used in children aged less than 5 years during the 2010-2011 influenza season 

[Dept. of Health and Ageing, Australian Government, July 30, 2010; Memo, from Immunisation 

Manager, New Zealand Ministry of Health, April 26, 2010; Letter from Director of Immunisation, 

Dept. of Health, U.K., July 28, 2010]. 

Afluria® is manufactured by CSL and is distributed by Merck in the US. This vaccine was 

approved in adults in 2007 by the Food and Drug Administration (FDA). In November 2009, it 

was approved by FDA for use in children 6 months and older. The 2010–2011 package insert 

for Afluria®, which was recently approved, includes additional information in Section 5: 

Warnings and Precautions, Section 6: Adverse Reactions, and Section 8: Use in Specific 

Populations. Basically, the additional language pertains to information about the experiences in 

Australia and New Zealand. Section 5.1: Fever and Febrile Seizures now reads as follows: 

Administration of CSL’s 2010 Southern Hemisphere influenza vaccine has been 

associated with increased post-marketing reports of fever and febrile seizures in children 

predominantly below the age of 5 years as compared to previous years [Afluria package 

insert, July 30, 2010] 

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Advisory Committee on Immunization Practices (ACIP) Summary Report August 5, 2010 

ACIP Influenza Work Group Update: Vote on Use of 

CSL Biotherapies Trivalent Inactivated Seasonal Influenza 

Vaccine (Afluria) for the 2010-2011 Influenza Season 

Wendy Keitel, MD 

Chair, ACIP Influenza Work Group 

Baylor College of Medicine 

Dr. Keitel thanked the members of the Work Group who have been devoted to this issue over 

the previous several months, as well as their colleagues at the FDA and CSL for their input into 

the Work Group’s deliberations. She also acknowledged the tragic and untimely death of their 

fellow Work Group member, Dr. Carol Friedman, and extended the Group’s condolences to her 

family, friends, and colleagues. 

As summarized by Dr. Uyeki, Dr. Keitel reiterated that a number of investigations have been 

performed to ascertain the etiology of the increased occurrence of febrile reactions associated 

with seizures in younger children. The vaccine is at its range for potency, and there is no 

evidence of endotoxin contamination. The vaccine passed the rabbit pyrogenicity assessment. 

There is no evidence of failure of complete inactivation of the virus, nor is there currently any 

evidence to suggest that there is incomplete disruption of whole viruses, which clearly has been 

associated with reactions and seizures in past influenza vaccines. There are currently a 

number of on-going investigations being used to evaluate the manufacturing processes and 

reagents related to the destruction of whole virions to determine what role they could possibly 

play; however, the cause of this increased reactogenicity remains unknown. The workgroup 

deliberated over a number of potential options. After extremely careful consideration, the 

majority opinion was that the following recommendation should be made: 

Afluria® should not be used in children aged 6 months through 8 years, except 

for children aged 5 years through 8 years old who are considered to be at high 

risk for influenza complications, if no other seasonal TIV is available. 

Other age-appropriate, licensed seasonal influenza vaccine formulations should 

be used for prevention of influenza in children aged 6 months through 8 years. 

Although this verbiage may require some word smithing if embraced byACIP, Dr. Keitel pointed 

out that this conclusion was predicated on the fact that there is a suggestion of increased 

reactogenicity in children aged 5 through 8 year olds; there is clearly an increased risk for febrile 

seizures in children under the age of 5 years; an increased fever response has been observed 

in prior CSL seasonal vaccines; and other options are available for prevention of influenza in the 

US. 

The following minority alternative option was favored by several Work Group members, 

including Drs. Keitel and Neuzil (who was not able to join the call), due to the simplicity of the 

messaging from a public health standpoint, and because other age-appropriate licensed 

seasonal influenza vaccination formulations could be used: 

Afluria should not be used in children aged 6 months through 8 years. 

Other age-appropriate, licensed seasonal influenza vaccine formulations should 

be used for prevention of influenza in children aged 6 months through 8 years. 

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Discussion Points 

Dr. Uyeki noted that Dr. Fiore thought there may be some grammatical confusion with the way 

the recommendation was worded. With that in mind, Dr. Fiore suggested the following wording: 

Afluria® is not recommended for children age 6 months through 8 years. 

Use of Afluria® can be considered if no other TIV is available for children aged 5 

years through 8 years with chronic medical complications because the risk for 

influenza complications is likely to outweigh the risk for febrile seizures in this 

group. 

Dr. Pickering noted that a recommendation could be approved, with word smithing generally 

permitted by the committee members afterward. This is a well-recognized practice that has 

been utilized in the past. 

Dr. Baker indicated that she would first invite discussion from ACIP members which would be 

followed by discussion from liaison members and a public comment session prior to the vote. 

Dr. Sawyer requested further information regarding the strange signal in the older age group of 

5 through 8 years of age on slide 4. The only information he saw during this presentation was a 

16% rate of fever compared to 9% rate, which he assumed was a subset of the sample of 229 

children. 

Dr. Keitel responded that the information on that slide referred to the 2009 CSL vaccine. 

Dr. Sawyer inquired as to what, in general, the strength of information was about fever in 

children aged 5 through 9 and whether there was a breakdown of rates of febrile seizures in that 

age group. While fever of any cause at that age group is rare, he wanted to be comfortable 

extending through age 8 in the US as opposed to what was done in Australia and New Zealand. 

Dr. Keitel responded that the work group understood based on spontaneous reporting, that 

there was a marked increase in the number of reports of adverse events. These were generally 

fever, but there was also a small increase in reports of “central nervous system abnormalities.” 

The caveat is that this may have been stimulated reporting albeit at a much higher frequency 

than in the three preceding years. With regard to febrile seizures, her understanding was there 

are anecdotal reports of febrile seizures among children in that age group, with at least one of 

these children having a history of past febrile seizures. 

Dr. Uyeki added that to clarify on slide 4, the 2009 data were from the clinical trial of the CSL 

TIV compared to a different TIV. In all three of those age groups, including 5 to less than 9 

years, there was a higher frequency of fever. However, that outcome was for fever. The study 

lacked sufficient power to find febrile seizures. In terms of the post-marketing surveillance, their 

understanding was that in the three seasons prior to 2010, there were approximately 10 to 20 

reports of fever in the 5 through 8 year old age group; whereas, in 2010, the rate was 

substantially higher. He deferred to CSL for the exact data, with the caveat that vaccine 

coverage in the 5 through 8 year old group is unknown. Also unknown is whether vaccine 

coverage was the same in 2010 as it was in the three previous seasons. The number of febrile 

convulsions and the rate is definitely lower, but in children 5 through 8 years, the rate is typically 

much lower. There were at least two reports for children aged 5 and one for a 9-year old who 

had febrile seizures following vaccination of Fluvax®. He believed both had a history of febrile 

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seizures. He requested that a representative from CSL further comment on the questions 

regarding fever and febrile seizures in this age group. 

Dr. Jane Leong (CSL) responded that they observed increased spontaneous reporting in the 

2010 Southern Hemisphere season. However, as Dr. Uyeki said, this was with a background of 

fairly significant media reporting so it is believed that reports were hyper-stimulated. 

Nevertheless, increases were observed in febrile reactions. Few febrile convulsions were 

observed because these typically do not occur in children older than 5. No febrile convulsions 

were observed at all in the 5 to 8 year old children. 

Dr. Sawyer inquired as to whether this information indicated that above age 8, even an 

anecdotal suggestion of fever was not observed, and whether that was how they came to the 

conclusion that the cutoff should be age 8. 

Dr. Jane Leong (CSL) replied that in the children older than 8 or 9 in Australia, the cutoff was 9 

years. While there were increased reports, the numbers were not as great as in the younger 

children. Therefore, increased reports were attributed to stimulated reporting. In the 8 to 9 year 

old group, the reports included fever, the majority was non-serious, and they were consistent 

with previous experience. 

To summarize, Dr. Baker said it seemed that in children over 5 through under 9 years of age, 

based on limited data, there was definitely more fever but no indication of more febrile 

convulsions. 

Dr. Meissner noted that if the CSL vaccine was not used in children under 36 months, that left 

just Sanofi Pasteur to provide vaccine to children age 6 through 35 months. This raised the 

issue regarding whether there would be adequate supply. 

Dr. Baker added that MedImmune’s live attenuated influenza vaccine (LAIV) can be used 

beginning at age 24 months. 

Dr. Uyeki responded, and Dr. Leong affirmed, that CSL made a decision not to distribute the 

0.25 mL product. They were not planning to distribute vaccine that would be eligible for 6 

months through less than 3 years of age. CDC understands that Sanofi Pasteur and 

MedImmune would be able to provide sufficient vaccine for the young, vulnerable age group. 

Dr. Santoli added that she thought the other manufacturers would be participating in this call 

and could speak for themselves with regard to vaccine supply. She reported that the total 

projected number was about 12.7 million doses. Given that CSL decided not to produce the 

0.25 mL doses for the US market, it was her understanding that more than half of the was in the 

0.5 cc syringe, and a smaller amount was in the multi-dose vials. That meant US would have 

about 6 million doses using half as a rough estimate. She requested that someone from CSL or 

Merck speak further about supply. 

Dr. Leong (CSL) responded that it was correct that CSL would not supply the 0.25 mL doses. 

They informed the ACIP Influenza Work Group that morning that they had made a decision not 

to supply the multi-dose vials. CLS continues to explore how this will impact the complete 

numbers in the end, and they will report back to ACIP with further information about this and the 

exact number of single dose syringes of 0.5 mL will be supplied. 

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Dr. Santoli added that with the total number of CSL doses completely removed, there were 

currently about 145 to 150 million doses across the other manufacturers. For comparison, the 

most that has been distributed in a single season was about 114 million doses. The current 

number of doses is significantly higher than that, even without adding in the CSL doses. 

However, that is a different question than what manufacturers actually have available to sell 

immediately. 

It remained unclear to Ms. Ehresmann whether the other manufacturers would be able to meet 

the demand for the younger age groups. In addition, she wondered whether contingency plans 

had been established for providers who ordered CSL exclusively for that age group to ensure 

that they have access to vaccine. 

Dr. Baker indicated that at least one manufacturer had shipped to the US Vaccines for Children 

(VFC) program, for which about 50% of children are eligible. It seems that the VFC supply 

might be a priority and might drive vaccine availability for that age group from the other 

manufacturers. 

Dr. Santoli reported that the VFC had received some doses, as had the private sector. The 

product is multi-dose vials and it is not the pediatric formula. 

Dr. Keitel clarified that based on what they had just heard, it did not appear that CSL had any 

plans to distribute a vaccine that could be used in a less than 36 month old child. There is no 

0.25 mL and there is no multi-dose vial from which to draw 0.25 mL. 

Dr. Ed Bresnitz (Merck) commented that the number of doses in the multi-dose vial, that are not 

going to be delivered now based on CSL’s decision, was about 5 million. They had said that 

approximately 12 million doses would be available prior to this decision, which left 

approximately 6 to 7 million doses of a single dose 0.5 cc that possibly could be available and is 

for ages 3 and up. Those numbers are not finalized, given that CSL and Merck must discuss 

this. 

Dr. Chilton pointed out that ACIP had discussed febrile seizures previously in the context of 

measles, mumps, rubella, varicella (MMRV) vaccine. He did not recall the frequency or 

incidence of febrile seizures following administration of MMRV, but ACIP made a somewhat 

different recommendation regarding that vaccine based on that frequency. 

Dr. Keitel responded that it was 1 out of 2500 MMR and 2 out of 2500 MMRV, which is about 25 

times more common. 

Dr. Karen Broder (Immunization Safety Office, CDC) clarified that for MMRV, 1 in 2500 was a 

rough estimate for the attributable risk of febrile seizures, meaning the additional febrile seizures 

experienced 5 to 12 days after vaccination with MMRV compared with the young children who 

received the MMR and varicella vaccines separately. If memory served her correctly, it was 

something on the order of about 8 febrile seizure events per 10,000 vaccinees for MMRV versus 

MMR + varicella vaccine. One of the issues was that the MMR and varicella vaccine option was 

available and at the time, the MMRV vaccine was not available. There was a lot of discussion 

about the risks and benefits of weighing the options for the MMRV and the varicella. Parents 

and providers were permitted to use the MMRV product for those young children provided that 

they clearly describe the risks and benefits. 

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Dr. Meissner noted that another question that arose in the MMRV discussion regarded the use 

of antipyretics. Obviously, it would not work so well for MMRV because the fever occurs more 

than a week after the vaccine. However, the influenza vaccine the seizures seemed to occur 

with a peak at 7 to 8 hours after the administration of vaccine. He wondered whether 

consideration had been given to prophylactic use of antipyretics post-immunization. 

Dr. Uyeki responded that there was brief discussion about this among the Work Group 

members, with the feeling that because there are plenty of alternative vaccines, this should not 

be considered as an option for recommendation. 

Ms. Ehresmann had concerns similar to Dr. Sawyer’s about what was driving the 5 through 8 

year old recommendation. While she understood what was described in terms of postmarketing surveillance, in the absence of febrile seizures, she did not feel that the evidence was 

compelling enough for her. In terms of the current recommendations, 9 and under is the age 

group for 2 doses of seasonal influenza vaccine. In 2009, 10 and under was added for H1N1. 

Now they had the potential to make a recommendation not to use a certain product for 8 years 

and under. She found this to be very confusing and without compelling evidence, it seemed that 

they should align more with Australia’s recommendation. 

Dr. Keitel clarified that it was under 9 years, namely age 5 through 8 years. In fact, that was a 

public health issue that it was consistent with the two doses, which is under 9. 

As a member of the Work Group, Dr. Englund reported that simplicity and straightforwardness 

were very important factors that the group considered when they wrote the proposed guidelines 

that were put forth for a vote. In terms of whether the Work Group had any concerns about the 

ages 5 through 8 group, it is quite clear that there is an increased risk of fever. The Work Group 

thought that since these vaccines would be used in pediatric practices, simplicity was a very 

important factor. Keeping it out of children in the less than 9 year old age group is a very 

important factor that equals the lack of good data. 

Speaking as a pediatrician, Dr. Baker noted that for this season, the recommendation was for 

children less than 9 years of age who have not previously been vaccinated to receive 2 doses. 

The work group was recommending, both for the hard data in the less than 5 year olds and for 

the fever data, be it not completely convincing, that children less than 9 years of age would not 

receive the CSL vaccine. In terms of simplicity for family practitioners and pediatricians, all they 

would have to think about is whether a child is less than 9 when thinking about which vaccine 

and how many doses are needed. The work group contemplated many programmatic 

considerations. 

Dr. Keitel responded that the simplest message would be the alternative option, which is not to 

use CLS vaccine in children under 9 years of age. The majority vote of the Work Group was to 

include the caveat about using the CSL vaccine in high risk children if no other vaccine was 

available, after weighing the risks and the benefits. 

Dr. Lett requested that Dr. Uyeki discuss the email exchanges he had with Dr. Stanley Gall 

regarding his concern about pregnant women. 

Dr. Uyeki responded that there does not appear to be any data to inform a recommendation 

about the use of this vaccine in pregnant women in the Southern Hemisphere. Vaccine 

coverage among pregnant women in Australia and New Zealand is not known, nor has CDC 

heard anything from its colleagues in Australia and New Zealand about reports of fever following 

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Advisory Committee on Immunization Practices (ACIP) Summary Report August 5, 2010 

seasonal influenza vaccination of pregnant women. While coverage in pregnant women with 

this vaccine is completely unknown, it is thought to be very low. The issues that have been 

raised for discussion with pregnant women are that, theoretically, if a pregnant woman has a 

post-vaccination febrile reaction, this could have implications for the health of the fetus. 

Theoretical concerns have been raised amongst a tremendous uncertainty about whether there 

is any fever signal in adults or even older adolescents of reproductive age. Dr. Gall is a liaison 

member for American College of Obstetricians and Gynecologists (ACOG) to the ACIP 

Influenza Work Group. He mentioned if there was post-vaccination fever, certainly that would 

have implications for the fetus. Again, there are no suitable data to inform this question. 

Dr. Baker added that based on Phase I controlled trials, pregnant women in general seem to 

have less febrile responses to vaccines than non-pregnant women receiving the same dose and 

the same vaccine. Pregnant women were studied in 2009 with respect to 2009 H1N1 vaccine, 

and using the results of the trial the year before for seasonal influenza. She wondered whether 

there were any data available from these larger studies on the rate of fever in pregnant versus 

non-pregnant women. 

Dr. Englund responded that she did not have data, but knew that for 2009 H1N1 vaccination, 

the rate of fever overall in adults and in pregnant women was very low. 

Dr. Keitel’s understanding was that there was almost no fever at all. 

Dr. Gorman confirmed that there were very few febrile reactions in adults. While they did not 

statistically test this, the “eyeball test” suggested that there was no difference between the rate 

in the general adult population and the rate in pregnant women. 

Dr. Keitel noted that CSL vaccine per se was not studied. 

Dr. Baker felt that in the absence of data suggesting concern, she thought they should stick to 

what was known. 

Ms. Rosenbaum inquired about the availability of alternative vaccines for children 5 through 8 

years of age, and what the level of concern was about other vaccines that could be used for this 

population. 

Dr. Santoli replied that the challenge was that there are a number of vaccines that can be used 

in multiple populations, and it is not clear who purchased what. The multi-dose vial from Sanofi 

Pasteur can be used in any age. CDC does not know which providers have purchased the 

Sanofi Pasteur multi-dose vials or for what age groups they intended to use this product. Other 

than knowing that the pediatric product is used in only one group, it is very difficult to talk about 

what product is available for children more than age 3 years because it is available for children 

over 3, but it is also available for older children and adults. 

Dr. Keitel reiterated that there is definitely live attenuated influenza vaccine (LAIV). Whether 

providers have ordered this product remains unknown, and it is indicated only for healthy 

children 2 years or age and older. LAIV is not currently indicated for asthmatics, who represent 

the largest risk group. She reminded everyone that the first option included a proviso that if no 

other vaccine is available and a child is high risk, the child may be vaccinated with CSL vaccine. 

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Dr. Baker noted that in general, if everything proceeded as planned this year, and certainly as 

occurred in previous years, Sanofi Pasteur has provided the largest number of doses, followed 

by GlaxoSmithKline (GSK) and Novartis. Hoping for the best and with nothing occurring before 

vaccines start being shipped, the vaccines currently available should supply a small proportion 

of children 5 through 8 years of age. However, there is the matter of who orders what product. 

Dr. Cieslak said he liked the Work Group’s recommendations, but like Ms. Ehresmann was 

concerned about pediatricians who had placed all of their orders with CSL in terms of the 

likelihood that they would be able to acquire vaccine from another source at this point. 

Drs. Baker and Pickering noted that as soon as the lines were opened to all parties on the 

teleconference, the manufacturers would be invited to comment further. 

Ms. Ehresmann requested that Dr. Santoli follow up with the manufacturers and that CDC 

coordinate with the American Academy of Pediatrics (AAP) in terms of whatever information 

they had been able to obtain. 

Dr. Santoli replied that CDC works with the National Influenza Vaccine Summit. There is a tool 

on the American Medical Association (AMA) website called the Influenza Vaccine Availability 

Tracking System (IVATS). Manufacturers and distributors submit information to IVATS that is 

updated on a weekly basis to let others know what is available for sale. The website address is: 

www.preventinfluenza.org/ivats 

Dr. Tan (AMA) added that the IVATS tool is available and will be up in 2010. Now that the 

manufacturers have all started shipping vaccines, AMA will be ramping up the system and 

planned to have it operational in the next week or so. This tool will allow anybody who visits the 

site to identify who is selling vaccine. 

Dr. Sawyer expressed his support of the majority opinion of the work group to allow flexibility in 

the 5 through 8 year old group with regard to product, given the shipment information just 

discussed. He reminded everyone that febrile seizures are extremely unusual in that age group, 

and that the data are fairly soft about fever in that age group. He stressed the importance of 

maintaining flexibility because of supply, though it may be at the expense of making the 

recommendation slightly more complex. 

Dr. Tan again raised the question regarding the alignment of the ACIP recommendation with the 

recommendations from the UK, Australia, and New Zealand, which actually specify below 5. 

Dr. Keitel replied that there is suggested evidence that there is an increased level of 

reactogenicity, the underlying cause of which is not known, and there are alternative vaccines 

available. Therefore, the Work Group felt that it would be prudent to limit use in this age group. 

Dr. Carolyn Bridges (CDC) added that these other countries do not have a universal pediatric 

influenza vaccine program. If they do target children, it is children less than age 5 years. One 

of the issues is that the denominator data for 5 through 8 year olds is unknown. Therefore, it is 

not clear what the risk actually is. Due to the fever signal for 5 through 8 year olds, and 

because the US pediatric vaccination program through age 18 years, the Work Group’s 

suggested recommendation and alternative do not align with the recommendation of the other 

countries. 

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Dr. Baker stressed that an important component of parent messaging would be to explain why 

the US recommendations differ from other countries. At this point, she requested that the lines 

be opened to liaison members, and invited any representatives from FDA to speak first. 

Dr. Baylor (FDA) indicated that FDA had been involved in discussions with the Work Group, and 

understands the rationale regarding the recommended options that were before the full ACIP, 

although they differ from the package insert. FDA understands the differences between its 

mandate and the ACIP’s, and has no objections to the recommended options. 

Dr. Hachey (DoD) noted that complex messaging had consistently been their “Achilles Heel” in 

attempts to increase immunization rates. After every influenza season, one of the common 

complaints has been complex messaging. Given that, he supported the alternative option of 

making things as simple as conceivably possible. 

Dr. Baker pointed out for anybody who had not be listening the entire time that people favoring 

the alternative option included the current ACIP Influenza Work Group Chair, Dr. Keitel, and the 

former Chair, Dr. Neuzil. 

Dr. Lewin (Novartis) reported that Novartis has begun shipping vaccine. They project to have 

approximately 40 million doses available over the season. Most of the doses have been 

allocated already, but they will work with CDC and the Influenza Summit to make additional 

doses available or to allocate supply. Influenza virion is indicated in individuals aged 4 years 

and above, so this product will cover only 4 through 8 year olds. 

While Dr. Brewer (ANA) appreciated the conversation and the decisions ACIP had to make, as 

a liaison she advocated for simpler messaging and trying to alleviate some of the burden on the 

providers of having to figure out the levels of complexity. 

Dr. Katz (IDSA) supported the simpler approach as one who frequently receives calls from 

practicing physicians. He stressed that the simpler the approach, the more effective it would be. 

He agreed that the complexity of the divided approach was a negative liability, and suggested 

sticking with the assets of everything up through age 8. 

Dr. Kathleen Coelingh (MedImmune) offered an update on vaccine availability of FluMist®. 

MedImmune committed to producing about 15 to 16 million doses of the intranasal vaccine that 

is approved for healthy children 24 months and older. Most of that vaccine has been allocated 

and they have begun shipping; however, she anticipated that they could probably make an extra 

2 million doses available if needed for the 2 to 3 year old age group. MedImmune will work with 

CDC or the Summit, to summarize the additional doses. She requested a contact to whom this 

information should be transmitted. 

Dr. Santoli replied that it would make the most sense to submit the information directly into the 

IVATS tool, given that this is the tool that CDC and AMA use together to communicate to the 

public. 

Dr. Tan (AMA) added that the AMA would be soliciting that tool. Once all of the information is 

in, they will make an announcement through the Summit so that people can visit the site to learn 

what vaccines are available. 

Dr. Cory Robertson (Sanofi Pasteur) reported that they too had begun shipping vaccine doses, 

and expect to deliver 70 million doses this season. With respect to the supply issue, Sanofi 

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Advisory Committee on Immunization Practices (ACIP) Summary Report August 5, 2010 

Pasteur has pediatric doses that are yet to be reserved. They are in the process of assessing 

their manufacturing capacity to determine whether they can meet the void left by CSL not being 

able to provide doses to the US market this season. The number of doses available for young 

children is being assessed. They will work with CDC and the Influenza Summit to make sure 

that information is available. 

Dr. Meissner explained that his major reservation with the alternative option was the issue of 

supply. ACIP has now recommended the vaccine for everyone, and it remained unclear 

whether there would be adequate supplies for children in the older age group if ACIP stated that 

the CSL vaccine should not be used for 6 months through 8 years. There could be some 

children in the 5 through 8 year old age group for whom a vaccine would not be available. 

Dr. Baker stressed that the answer remained unknown. Every year, different amounts of 

seasonal vaccine have been available. Last year, all pediatric age groups were recommended 

but all were not covered because they simply do not get their vaccines. This was not based on 

supply. While in part this had to do with supply and distribution in specific practices or locations, 

in general for the country, it has never been a problem and doses are always thrown away, 

which is very sad. Dr. Baker surveyed the largest practices in Houston, and no CSL vaccine 

has been ordered for children. 

Dr. Englund added that many pediatricians have no control over what vaccines are ordered or 

what is available. She thought the first option reflected the fact that for the 5 through 8 year old 

age group, there was a risk-benefit consideration. While it was a more complicated option, it 

appeared that very few sites were ordering the vaccine, and that the first option offered more 

leeway for the practicing physician despite being slightly more complicated. 

Ms. Ehresmann said that having heard from Sanofi Pasteur and Novartis, each of which 

indicated that they were considering the possibility of increasing the availability of vaccine in 

some of the key age groups, she was feeling more comfortable with the supply issue for 

providers who may have ordered CSL and with the more streamlined recommendation. 

Dr. Baker declared the line open for public comment. 

Luke Noll (FFF Enterprises) asked everyone to keep in mind that last year, the CSL product was 

only approved in individuals under the age of 18, so 2010 would mark the first full year that the 

product would have been approved for use in the under 18 age group, which may make a 

difference in supply. FFF Enterprises anticipates having vaccine available to cover the CSL 

orders that have received. 

Dr. Baker indicated that she would entertain a motion from an ACIP member. 

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Advisory Committee on Immunization Practices (ACIP) Summary Report August 5, 2010 

Motion: Use of CSL Trivalent Inactivated Influenza Vaccine in the US 

Dr. Sawyer made a motion to adopt the majority opinion, Option 1, that Afluria® should not be 

used in children aged 6 months through 8 years, except for children aged 5 years through 8 

years who are considered to be at high risk for influenza complications, if no other seasonal TIV 

is available. Dr. Meissner seconded the motion. 

The motion carried with 8 affirmative votes, 2 abstentions, and 1 negative vote. 

Dr. Baker thanked everyone for a wonderful discussion during this teleconference, as well as 

their diligence in doing their homework in terms of the background materials. 

Dr. Pickering noted that members of the press and / or others with questions could contact Mr. 

Tom Skinner. 

Kristine Sheedy (CDC) indicated that CDC would work as quickly as possible to finalize 

questions / answers, summarize this discussion, place information on the website by the end of 

the day. The goal would be to make this information prominent on www.cdc.gov/flu. She 

indicated that if the press reached an ACIP member who had the time and was willing, they 

were free to make comments on the teleconference and the vote. CDC will be doing the same, 

with Director Melinda Wharton handling the CDC inquiries. 

Dr. Pickering suggested that if members did not feel like commenting or did not have time, they 

could refer inquiries to Tom Skinner who would ensure that they were directed to the right 

person for a rapid answer. 

Dr. Keitel asked whether there were any issues related to the Vaccine Information Statements 

(VIS). 

Kris Sheedy responded that CDC staff would be discussing this further, with the hope that the 

VIS would be posted no later than early the next week. 

Dr. Pickering added that typically mention would not be made about a specific vaccine in the 

VIS. Part of CDC’s deliberations would address whether to include a specific statement about 

the CSL vaccine in the VIS. He also indicated that the draft Policy Note had been written and 

would be distributed to ACIP members for comments. It was making its way through the 

clearance process, and he requested an update on this from Dr. Uyeki. 

Dr. Uyeki reported that the Policy Note draft was going through clearance, with the expectation 

that there would be a publication in the Morbidity and Mortality Weekly Report (MMWR) the 

following week to summarize and report on the background and the ACIP recommendation. 

Dr. Tan inquired as to whether he could submit the slides from Dr. Uyeki’s presentation to the 

Summit. 

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o

 

 

 

 hereby certify that to the best of my knowledge, the foregoing Minutes of the October 21-22, 

2009 ACIP Meeting are accurate and c

Advisory Committee on Immunization Practices (ACIP) Summary Report August 5, 2010 

Dr. Pickering replied that this would be premature because there may be some final wording, 

and the slides must go though CDC clearance. Therefore, he requested that the slides be kept 

everything confidential until they were officially posted on the ACIP website. This will be on the 

fast track, so the final version will be posted as soon as possible. 

Dr. Tan requested clarification regarding whether the vote was public, and whether they could 

state that ACIP voted on the use of CSL vaccine. 

Dr. Pickering responded that the vote was public as are all ACIP votes. Because ACIP is an 

advisory committee, this vote will be submitted to Dr. Frieden for his approval and publication in 

the MMWR before it is finalized. While a statement could be made about the ACIP vote, the 

caveat was that it was not yet official CDC policy. 

With no further questions / comments raised or business posed, Dr. Baker officially adjourned 

the ACIP teleconference. 

I hereby certify that to the best of my 

knowledge, the foregoing Minutes of the 

August 5, 2010 ACIP Teleconference are 

accurate and complete: 

_____________________________ _________________________________ 

Date Dr. Carol J. Baker, Chair 

 Advisory Committee on 

 Immunization Practices (ACIP) 

 

 

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Advisory Committee on Immunization Practices (ACIP) Summary Report August 5, 2010 

Attendance Roster 

FTS CDC NCHSTP Conference Call 

 Leona Mitchell - Conference Leader 

Aug 5 2010 @ 09:00 AM CT 

Confirmation # 3462584 

Speakers: 

Carol Baker 

Norman Baylor 

Beth Bell 

Joe Bresee 

James Cheek 

Lance Chilton 

Paul Cieslak 

Ruben Donis 

Kris Ehresmann 

Janet Englund 

Anthony Fiore 

Demetria Gardner 

Bruce Gellin 

Richard Gorman 

Michael Greenberg 

Wayne Hachey 

Stephanie Henry-Wallace 

Frank Judson 

Wendy Keitel 

Chet Kitchen 

Susan Lett 

Gladys Lewellen 

Cody Meissner 

Sara Rosenbaum 

Cindy Ruff 

Jeanne Santoli 

Mark Sawyer 

Tom Skinner 

Frank Stefano 

LJ Tan 

Terry Tumpey 

Tim Uyeki 

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1 Jon Abramson Wake Forest University 

2 Bethany Anderson CDC 

3 Phyllis Arthur BIO 

4 Lynn Bahta MN Dept of Health 

5 Jack Balrymple Balrymple & Associates 

6 Allyn Bandell MedImmune 

7 Linda Bantell Central CT Health District 

8 Jennifer Bender Alembic Health 

9 Henry Bernastein AAP 

10 Gus Birkhead National Vaccine Advisory Committee 

11 Nichole Bobo National Association of School Nurses 

12 Mick Bolbuc CT DPH 

13 Michael Brady American Academy of Pediatrics 

14 Katie Brewer American Nurses Association 

15 Sheila Burke CSL 

16 Erin Burns CDC 

17 Stephanie Cadavillo Wintrop University Hospital 

18 William Callaghan CDC 

19 Doug Campos- Outcalt American Academy of Family Physicians

20 Cristi Carlton MI Dept of Community Health 

21 Heather Carman Cooney Waters 

22 Donna Cary Sanofi Pasteur 

23 Mike Chaney American Academy of Pediatrics 

24 Sharon Chin Merck 

25 David Cho US FDA 

26 Marcy Cleaver Merck 

27 Kathleen Coelingh MedImmune 

28 Nancy Cox CDC 

29 Stephen Dachowski Merck 

30 Dack Dalrymple Dalrymple & Associates 

31 Reetu Dandora Merck 

32 Christine Danka Presbyterian Senior Care 

33 Joy Dasgupta GlaxoSmithKline 

34 Kathleen Derr Worcester County Health Dept 

35 Stephen Dolak United States Navy 

36 Sara Duvall NY State Dept of Health 

37 Pam Eisele Merck 

38 Kimberly Elmore Premier Inc 

39 Alexis Elward HICPAC ACIP 

40 Geoffery Evans HRSA 

41 Mark Feinberg Merck 

42 Sandor Feldman MS State Dept of Health 

43 Angela Fhen HHS 

44 Bob Finn International Medical News Group 

45 Ashley Fishburn HIDA 

46 Laurel Fowler CDC 

47 Jen Frantz American Academy of Pediatrics 

48 Stanley Gall American College of Obstetricians 

49 Ann Gapper McKesson 

 

Advisory Committee on Immunization Practices (ACIP) Summary Report August 5, 2010 

First Name Last Name Company 

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Advisory Committee on Immunization Practices (ACIP) Summary Report August 5, 2010 

50 Diana Gaskins Retired 

51 Anita Geevarughese NY City Dept of Health 

52 Nancy Gemeinhart BJC Healthcare 

53 Joanne Geoegelis GlaxoSmithKline 

54 Jane Gidudu CDC 

55 Gino Girardi NIAD 

56 Kathleen Glassner Merck 

57 Sharon Greene Harvard Medical School 

58 Stan Grogg AOA 

59 Chris Ground FFF Enterprises 

60 Swati Gupta Merck 

61 Jacqueline Haas Coram 

62 Penina Haber CDC 

63 Stephen Hadler CDC 

64 Christine Hahn CSTE 

65 Neal Halsey Johns Hopkins University 

66 Erik Halstrom FFF 

67 Kimberly Harrington New Hampshire Hospital 

68 Janice Hashimoto Novarts Caccines 

69 Jamar Hawkins HHS 

70 Vincent Haynes Medimmune 

71 Greg Healy CSL Dehring 

72 Guillermo Herrera GSK 

73 Jan Hicks-Thomson WA State Dept of Health 

74 Malaika Hilliard CDC 

75 Jette Hogenmiller Truman Medical Center 

76 Wayne Hogrefe Focus Diagnostices 

77 Warner Hudson UCLA 

78 Mark Hummel Premier 

79 John Iskander CDC 

80 Liz Izaguirre TCPH 

81 Anna Jacobs OGC 

82 Robert Janssen DynaVax Technologies 

83 Will Jernigan Merck 

84 Rosemary Johann-Liang HRSA 

85 Barbara Jones Cabell Huntington Hospital 

86 Lynn Jones Wellpoint 

87 Doug Jordan CDC 

88 Steve Kalmeyer N/A 

89 Lori Kamimoto CDC 

90 Randy Katsoyannis CDC 

91 Samuel Katz Infectious Disease Society of America 

92 Harry Keyserling SHEA 

93 Alena Khromava Sanofi Pasteur 

94 Linda Kinsinger Veterans Health Admin 

95 Dmitry Kissin CDC 

96 Tom Kuchenberg HHS 

97 Caroline Lagoy CDC 

98 Nancy Lawler The Joint Commission 

Marie99 Michele Leger AAPA 

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Advisory Committee on Immunization Practices (ACIP) Summary Report August 5, 2010 

100 Terence Leopold Medimmune 

101 Zanie Leroy CDC 

102 Gladys Lewellen CDC 

103 Clement Lewin Novartis 

104 Paige Lewis CDC 

105 Patrick Liedtka Merck & Company 

106 Joanne Luedtke IBM 

107 Jan Markowitz Baltimore County Dept of Health 

108 Mary Marolla Alembic Health Communications 

109 Marie Mazur CSL 

110 Courtnay McFeters MI Dept of Community Health 

111 William McKinney University of Louisville 

112 Barbara McLean Baltimore County Health Dept 

113 Marco Melo HHS 

114 Toby Merlin CDC 

115 Kelly Moore TN Department of Health 

116 Riyadh Muhammad SC Dept of Health 

117 Flor Munos Baylor College of Medicine 

118 Oidda Musdrau CDC 

119 Mike Neal Olgelby Public Relations 

120 Mirjana Nesin NIH 

121 Luke Noll FFF Enterprises 

122 Elizabeth Parilla MN Dept of Health 

123 Kathy Parrish Merck 

124 Shital Patel Baylor College of Medicine 

125 Lindsay Paul Alembic Health 

126 Chandra Pendergraft CDC 

127 Georgia Perdue Eastern Shore Hospital Center 

128 Diane Peterson Immunization Action Coalition 

129 Rhonda Pikart NIH DMID 

130 Kristin Pope CDC 

131 Kumar Rallapalli Pfizer 

132 Lisa Randall Immunization Action Coalition 

133 Sonja Rasmussen CDC 

134 Marykate Reeves-Hoche Sanofi Pasteur 

135 Margaret Rennels GlaxoSmithKline 

136 Judith Richards Talbot County DPH 

137 Heather Richmond Medimmune 

138 Cory Robertson Pasteaur 

139 Bob Roos CidRap News 

140 Sara Rosenbaum George Washington University 

141 Mitchel Rothholz American Pharmacists Association 

142 Mary Rubin DVIC 

143 Cindy Ruff CMS 

144 Nicki Sabin Visiting Nurses Assoc 

145 Mark Sanyour Novartis 

146 William Schaffner Vanderbuilt University School of Medicine 

147 Robert Schechter CDPH 

148 Tim Schnaare GlaxoSmithKline 

149 Laura Scott Family Fighting Flu 

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150 Abbey Shefer 

151 Judith Shindman 

152 BJ Shoptaw

153 Barbara Slade 

154 Laura Smith

155 Stephen Smith 

156 ixie D Snider 

157 Sandra Snow 

158 Patsy Stinchfield 

159 Mike Stobbe 

160 Jeffery Stoddard 

161 Kathleen Stratton

162 Raymond Strikas

163 Leora Suprun 

164 Mark Thompson 

165 Ruth Thompson 

166 Stephanie Thompson 

167 Terri Thornton 

168 Lynn Trefren 

169 Vivienne Treharne 

170 Theadore Tsai 

171 William Tsang

172 Margaret Verrico 

173 Peter Vigliarolo 

174 Edward Wake 

175 Terethia Walker 

176 Jeremy Ward 

177 Theda Watson 

178 Robert Weibel 

179 Rick Welsh 

180 Mirian Wenworth 

181 Patricia Whitley-Williams

182 Meredith Whittaker 

183 Austin Wilder 

184 Cynthia Williams

185 Skip Wolfe 

186 Eileen Yamada 

187 Terry Yamauchi

188 Sandra Yarn 

189 Zhiping Ye

190 Janice Zalen 

191 Jane Zucker 

CDC 

Sanofi Pasteur 

Delmar VA Foundation 

CDC 

CDC 

Sanofi Pasteur 

CDC

AR Dept of Health 

NAPNAP 

Associated Press 

Novartis

IOM 

National Vaccine Program Office 

Merck 

Thompson Pharmacy Medical 

Baltimore County Dept of Health 

CDC 

IA State Health Dept 

Tri-County Health Department 

FL Department of Health 

Novartis 

Ruder Finn 

UPMC Medical Center 

Cooney Waters

NYC Dept of Health 

Exxon Mobil 

Ofstead & Associates 

St Vincents Hospital IN 

Vacine Injury Compensation Program 

SMQAI 

Merck 

University of Medicine & Dentistry of NJ-Robert Wood Johns 

Sommers County ARH 

CDC 

Lorenzo Health Clinic

CDC

CA Dept of Public Health 

AK Children's Hospital

GAAAP 

FDA

AHCA

NYC Dept of Health 

 

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