Vaccines: The Week in Review

1 March 2010
Center for Vaccine Ethics & Policy
http://centerforvaccineethicsandpolicy.wordpress.com/
A program of
- Center for Bioethics, University of Pennsylvania
http://www.bioethics.upenn.edu/
- The Wistar Institute Vaccine Center
http://www.wistar.org/vaccinecenter/default.html
- Children’s Hospital of Philadelphia, Vaccine Education Center
http://www.chop.edu/consumer/jsp/microsite/microsite.jsp

This weekly summary targets news and events in the global vaccines field gathered
from key governmental, NGO and company announcements, key journals and
events. This summary provides support for ongoing initiatives of the Center for
Vaccine Ethics & Policy, and is not intended to be exhaustive in its coverage.
Vaccines: The Week in Review is now also posted in a blog format at
http://centerforvaccineethicsandpolicy.wordpress.com/. Each item is treated as an individual
post on the blog, allowing for more effective retrospective searching. Given email
system conventions and formats, you may find this alternative more effective. This
blog also allows for RSS feeds, etc.
Comments and suggestions should be directed to David Curry, Editor and
Executive Director of the Center, at
david.r.curry@centerforvaccineethicsandpolicy.org.

The WHO Director-General issued a statement on 24 February 2010

following the seventh meeting of the Emergency Committee on 23
February 2010 in which the Committee's views on the determination
of the pandemic status were assessed:
“A detailed update was provided to the Committee on the global pandemic
situation. After asking additional questions and reviewing the evidence and
holding extensive discussion, the Committee was of the view that there was
mixed evidence showing declining or low pandemic activity in many
countries, but new community level transmission activity in West Africa.
Moreover, they expressed concern that the winter months of the Southern
Hemisphere had not yet started and there was uncertainty whether additional
generalized waves of activity might occur and the need to not undermine
preparations.
“The Committee advised that it was premature to conclude that all parts of
the world have experienced peak transmission of the H1N1 pandemic
influenza and that additional time and information was needed to provide
expert advice on the status of the pandemic. The Committee accordingly
suggested that the Committee be re-convened in a few weeks to review
intervening developments and related epidemiological information.
“Having considered these views, the current epidemiological evidence and
other relevant information, the Director-General determined that there had
been no change in the pandemic phase, and decided to continue to monitor
the situation and developments closely and to convene the Committee again
within the next several weeks.
 “The WHO Director-General asked the Committee for their views on
continuance of the three current temporary IHR recommendations issued for
the public health emergency of international concern. The consensus view of
the Committee was in favor of continuation but to update the second
recommendation by replacing "Intensify" with "Maintain" in recognition of the
increased pandemic surveillance already implemented by countries and the
need to maintain this activity. Having considered the views of the Emergency
Committee, and the ongoing pandemic situation, the Director-General
determined to continue the three temporary recommendations, as modified,
namely:
- countries should not close borders or restrict international traffic and trade;
- maintain surveillance of unusual flu-like illness & severe pneumonia;
- if ill, it is prudent to delay travel.
http://www.who.int/csr/disease/swineflu/7th_meeting_ihr/en/index.html

The WHO continues to issue weekly “updates” and briefing notes on the
H1N1 pandemic at: http://www.who.int/csr/disease/swineflu/en/index.html
Pandemic (H1N1) 2009 - update 89
Weekly update
26 February 2010
As of 21 February 2010, worldwide more than 213 countries and overseas
territories or communities have reported laboratory confirmed cases of
pandemic influenza H1N1 2009, including at least 16226 deaths...
Situation update:
In the temperate zone of the northern hemisphere, pandemic influenza
virus continues to be detected across many countries, however, overall
influenza activity continues to wane in most places. The most active areas of
transmission are currently in parts of south and southeast Asia and in limited
areas of east and southeastern Europe.
In Southeast Asia, pandemic influenza virus continued to circulate in areas,
however, the overall intensity of respiratory diseases activity remained low
and unchanged, except in a few countries.
More at: http://www.who.int/csr/don/2010_02_26/en/index.html

The U.S. Food and Drug Administration approved Prevnar 13, a

pneumococcal 13-valent conjugate vaccine for infants and young
children ages 6 weeks through 5 years. Prevnar 13 will be the successor
to Prevnar, the pneumococcal 7-valent conjugate vaccine licensed by the FDA
in 2000 to prevent invasive pneumococcal disease (IPD) and otitis media. The
new vaccine extends the protection to six additional types of the disease
causing bacteria. Prevnar 13 is approved for the prevention of invasive
disease caused by 13 different serotypes of the bacterium Streptococcus
pneumoniae. It also is approved for the prevention of otitis media caused by
the seven serotypes shared with Prevnar. The bacterium can cause infections
of the blood, middle ear, and the covering of the brain and spinal cord, as
well as pneumonia.
Karen Midthun, M.D., acting director of the FDA’s Center for Biologics
Evaluation and Research, said, “Although the rates of invasive pneumococcal
disease have declined dramatically, there are still children in the United
States who are suffering with this serious illness. The availability of Prevnar
13 will help prevent pneumococcal disease caused by the six additional
serotypes.”
The FDA said that safety was evaluated in 5,084 infants and young children
who received Prevnar 13, compared with 2,760 who received Prevnar, the
control vaccine. Common adverse reactions reported after administration of
Prevnar 13 were pain, redness and swelling at the injection site, irritability,
decreased appetite and fever. These reactions were similar to what has been
observed with Prevnar, which has a good safety record in the United States.
Post marketing studies will include continued monitoring for reduction in IPD
and otitis media, as well as continued evaluation of safety.
http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm201758
.htm

CDC’s Advisory Committee on Immunization Practices (ACIP) voted

on 24 February to expand the recommendation for annual influenza
vaccination to include all people aged 6 months and older. The
expanded recommendation is to take effect in the 2010 – 2011 influenza
season. The new recommendation “seeks to remove barriers to influenza
immunization and signals the importance of preventing influenza across the
entire population.” Prior to the action, ACIP recommendations for seasonal
influenza vaccination – which focused on vaccination of higher risk persons,
children 6 months through 18 years of age and close contacts of higher risk
persons – already applied to about 85 percent of the U.S. population.
CDC said that discussion at the ACIP meeting “focused on the value of
protecting all people 19 to 49 years of age, who have been hard hit by the
2009 H1N1 pandemic virus, which is likely to continue circulating into next
season and beyond. Another reason cited in favor of a universal
recommendation for vaccination is that many people in currently
recommended “higher risk” groups are unaware of their risk factor or that
they are recommended for vaccination. The ACIP discussion also recognized
the practicality and value of issuing a simple and clear message regarding
the importance of influenza vaccination in the hopes that this would remove
impediments to vaccination and expand coverage. Finally, new data collected
over the course of the 2009 H1N1 pandemic indicates that some people who
do not currently have a specific recommendation for vaccination may also be
at higher risk of serious flu-related complications, including those people who
are obese, post-partum women and people in certain racial/ethnic groups”
http://www.cdc.gov/media/pressrel/2010/r100224.htm

The Weekly Epidemiological Record (WER) for 26 February 2010,

vol. 85, 9 (pp 69–80) includes: Global tuberculosis control: key findings from
the December 2009 WHO report.
http://www.who.int/wer/2010/wer8509.pdf
Journal Watch
[Editor’s Note]
Vaccines: The Week in Review continues its weekly scanning of key journals
to identify and cite articles, commentary and editorials, books reviews and
other content supporting our focus on vaccine ethics and policy. Journal
Watch is not intended to be exhaustive, but indicative of themes and
issues the Center is actively tracking. We selectively provide full text of
some editorial and comment articles that are specifically relevant to our
work. Successful access to some of the links provided may require
subscription or other access arrangement unique to the publisher. Our initial
scan list includes the journals below. If you would like to suggest other titles,
please write to David Curry at
david.r.curry@centerforvaccineethicsandpolicy.org

JAMA
Vol. 303 No. 8, pp. 693-804, February 24, 2010
http://jama.ama-assn.org/current.dtl
[No relevant content]

Journal of Infectious Diseases

15 March 2010 Volume 201, Number 6
http://www.journals.uchicago.edu/toc/jid/current
[No relevant content]

The Lancet
Feb 27, 2010 Volume 375 Number 9716 Pages 697 - 776
http://www.thelancet.com/journals/lancet/issue/current
Comment
Time for fair trade in research data
Elizabeth Pisani, James Whitworth, Basia Zaba, Carla Abou-Zahr
Extract
Geneticists, astrophysicists, and molecular biologists routinely share research
data with colleagues and rivals alike. The reason is that scientists and their
funders know we will understand complex issues sooner if people build on
one another's work.1,2 Yet scientists in the complex area of public health
have been left behind in the data-sharing revolution.

The Lancet Infectious Disease

Mar 2010 Volume 10 Number 3 Pages 139 - 212
http://www.thelancet.com/journals/laninf/issue/current
Editorial
Gates Foundation's decade of vaccines
Original Text
The Lancet Infectious Diseases
 The GAVI Alliance celebrated the tenth anniversary of its foundation on Jan
29 this year. During its 10 years GAVI has overseen the delivery of vaccines
to around 250 million children in the world's poorest countries, a programme
that has probably averted around 5 million deaths.
To mark GAVI's birthday, the Bill and Melinda Gates Foundation announced
that it will commit US$10 billion over the next 10 years to a so-called decade
of vaccines—ie, research and development and delivery of vaccines to the
world's poorest. As an agency whose role is vaccine delivery, rather than
research and development, it is not clear how much of the Gates billions will
be coming to GAVI. However, GAVI is already the foundation's largest
grantee, having received $1·5 billion in its 10 year history.
Other major GAVI donors are national governments, of which 16 have
contributed to the alliance plus the European Commission. Countries that
have donated the most to GAVI's core funding include Canada, the
Netherlands, Norway, the UK, and the USA. Although the direct donation
made by Gates far outstrip those made by any national government, France
and the UK have committed billions of dollars to a funding mechanism called
the International Finance Facility for Immunisation and other governments
have promised substantial amounts to this scheme.
GAVI currently disburses around $1 billion per year among the 65 countries
in which it supports vaccination programmes. The alliance focuses its
activities on delivery of a childhood pentavalent vaccine that protects against
diphtheria, tetanus, pertussis, hepatitis B, and Haemophilus influenzae type
b. However, to roll out this vaccine to all 65 countries by 2015, plus achieve
its goal of adding pneumococcal and rotavirus vaccines to the immunisation
schedule, will require an additional $3 billion.
A lot more than just wishful thinking has gone into Gates' decision to
donate $10 billion. A model developed at the Johns Hopkins Bloomberg
School of Public Health (Baltimore, MD, USA), indicated that 90% vaccine
coverage—including the rotavirus and pneumococcal vaccines—would
prevent the deaths of 7·6 million children younger than 5 years between now
and 2020. Adding the malaria vaccine, which is undergoing clinical trials,
from 2014 could save an additional 1·1 million lives. The Gates Foundation
will certainly not be funding this expansion in vaccine coverage on its own,
but its financial commitment should act as an incentive for donor
governments to provide the additional funds to achieve 90% coverage with
childhood vaccines in developing countries within the next 10 years.
In addition to the diseases already mentioned, vaccination against measles
will likely be targeted for some of the Gates' billions. Progress in preventing
deaths from measles has been remarkable, with around 82% of those eligible
worldwide now receiving vaccine and the number of measles-related deaths
falling from around 750 000 in 2000 to 164 000 in 2008. GAVI does not
currently fund measles vaccination programmes; rather, another
international collaboration, the Measles Initiative, provides technical and
financial support for national vaccination programmes in developing
countries. Other areas that might benefit include the provision of
autodisposable syringes that cannot be reused, funding for new vaccines
against group A meningococcal meningitis and against tuberculosis, and
perhaps even a final push to eliminate polio.
 Although the life-saving benefits of vaccination are beyond question, no
immunisation programme is without an element of controversy. As pointed
out in Newsdesk, GAVI is optimistic about rolling out pneumococcal vaccine
on a large scale to developing countries, because it believes the cost of the
vaccine can be reduced by 90%; however, little research has been done on
the public health effect of widespread pneumococcal vaccine use in the
targeted countries—might there, for example, be replacement of the vaccine
pneumococcal serotypes with other serotypes, thus making the vaccine only
temporarily effective? Given the present influenza pandemic, some of the
Gates money could be spent on researching the effect of influenza in
developing countries and, if necessary, developing vaccines against influenza
that are cheap enough for widespread use in these countries.
These caveats are, of course, minor compared with the beneficial effect on
global health that the commitment made by the Gates Foundation is likely to
have. The foundation does need to set out a clear plan for how it intends to
disburse its money over the decade of vaccines. Nevertheless, many more
national governments than are currently backing global vaccine coverage
should be inspired to follow the lead taken by the foundation.
Reflection and Reaction
Vaccine safety: misinformed about the misinformed
Jonathan E Suk
Preview
Concern about the antivaccination movement is clearly warranted.1 It is also
correct that most concerns about vaccine safety can, in theory, be allayed by
logic and reason, and that the role of vaccines in improving public health
should never be understated. The accumulation of more evidence and clearer
communication about the differences between causation and correlation,
would also help.
Newsdesk
Polio eradication within 5 years now a real possibility
Kathryn Senior
Last year was a significant one for polio eradication. Real progress was made
simultaneously in northern Nigeria, on the Afghanistan–Pakistan border, and
in the remaining pockets in Bihar and Uttar Pradesh in India, cutting the
number of cases worldwide to 1597 (correct as of Feb 2, 2010). The new
bivalent oral polio vaccine (bOPV), which targets type 1 and type 3
polioviruses, was licensed in late 2009 and has been in use since December.
Starting in February, March, and April, 2010, multiple mass immunisations
are planned in all four remaining countries where polio is endemic, at the
start of a 3-year intensive effort to finally halt polio transmission worldwide.
Personal View
Reducing empiricism in malaria vaccine design
Vasee S Moorthy, Marie Paule Kieny
Preview
Gains in the control of malaria and the promising progress of a malaria
vaccine that is partly efficacious do not reduce the need for a high-efficacy
vaccine in the longer term. Evidence supports the feasibility of developing a
highly efficacious malaria vaccine. However, design of candidate malaria
vaccines remains empirical and is necessarily based on many unproven
assumptions because much of the knowledge needed to design vaccines and
to predict efficacy is not available. Data to inform key questions of vaccine
science might allow the design of vaccines to progress to a less empirical
stage, for example through availability of assay results associated with
vaccine efficacy.
Review
Tuberculosis and air travel: a systematic review and analysis of
policy
Ibrahim Abubakar
Preview
WHO international guidelines for the control of tuberculosis in relation to air
travel require—after a risk assessment—tracing of passengers who sat for
longer than 8 h in rows adjacent to people with pulmonary tuberculosis who
are smear positive or smear negative. A further recommendation is that all
commercial air travel should be prohibited until the person has two
consecutive negative sputum smears for drug-susceptible tuberculosis or two
consecutive cultures for multidrug-resistant tuberculosis.

Nature
Volume 463 Number 7284 pp999-1112 25 February 2010
http://www.nature.com/nature/journal/v463/n7284/
[No relevant content]

New England Journal of Medicine

Volume 362 — February 25, 2010 — Number 8
http://content.nejm.org/current.shtml
[No relevant content]

Pediatrics
February 2010 / VOLUME 125 / ISSUE 2
http://pediatrics.aappublications.org/current.shtml
[Reviewed earlier]

PLoS Medicine
(Accessed 1 March 2010)
http://medicine.plosjournals.org/perlserv/?request=browse&issn=1549-
1676&method=pubdate&search_fulltext=1&order=online_date&row_start=1
&limit=10&document_count=1533&ct=1&SESSID=aac96924d41874935d8e1
c2a2501181c#results
[No relevant content]

Science
26 February 2010 Vol 327, Issue 5969, Pages 1043-1162
http://www.sciencemag.org/current.dtl
News of the Week
Drug Safety: New Network to Track Drugs and Vaccines in Pregnancy
Jennifer Couzin-Frankel
Both doctors and patients are jittery about whether to continue or drop
potentially risky treatments during pregnancy. A new effort to bring risks into
focus is being launched this week with $12.5 million from two U.S. agencies.
It will start by examining asthma medications called short-acting beta
agonists, as well as flu vaccines and antivirals for influenza. Called VAMPSS
(the Vaccines and Medications in Pregnancy Surveillance System), the
program will be funded for 5 years by the Agency for Healthcare Research
and Quality and for 2 years by the Biomedical Advanced Research and
Development Authority and coordinated by the American Academy of Allergy,
Asthma, and Immunology. An advisory committee that includes members
from pediatric and obstetric groups, and the Centers for Disease Control and
Prevention, will guide VAMPSS's research.
Policy Forum
Intellectual Property: Fixing the Legal Framework for Pharmaceutical
Research
Sherry M. Knowles
The cost of drug research and development (R&D) has increased from $230
million per drug in the early 1980s to $1.2 billion today, with R&D currently
requiring about 10 to 15 years per drug (1–4). This investment of time and
money cannot be sustained without a legal system that provides sufficient
time to recoup the investment and to secure a reasonable return, as well as
the ability to make important business decisions that remain correct over a
long period of time. Pharmaceutical companies have historically relied on two
kinds of market protection: (i) the exclusive ownership of their own clinical
research and (ii) patents. However, the U.S. Hatch-Waxman Act (5), which is
designed to strike a balance between innovative pharmaceutical research
and access to generic drugs, is flawed. Further, U.S. courts sometimes
retroactively change standards for patent protection long after large R&D
efforts have been initiated, which increases the risk to defend and rely on
patent protection.
Chief Patent Counsel, GlaxoSmithKline, King of Prussia, PA 19406, USA.

Science Translational Medicine

17 February 2010 vol 2, issue 19
http://stm.sciencemag.org/content/2/19/19cm7.abstract
Research Articles
Vaccines
Long-Term Thermostabilization of Live Poxviral and Adenoviral
Vaccine Vectors at Supraphysiological Temperatures in
Carbohydrate Glass
Robert Alcock, Matthew G. Cottingham, Christine S. Rollier, Julie Furze,
Samodh D. De Costa, Marian Hanlon, Alexandra J. Spencer, Jared D.
Honeycutt, David H. Wyllie, Sarah C. Gilbert, Migena Bregu, and Adrian V. S.
Hill
17 February 2010:19ra12
Abstract [Bolding by Week in Review]
Live recombinant viral vectors based on adenoviruses and poxviruses are
among the most promising platforms for development of new vaccines
against diseases such as malaria, tuberculosis, and HIV-AIDS. Vaccines based
on live viruses must remain infectious to be effective, so therefore need
continuous refrigeration to maintain stability and viability, a requirement that
can be costly and difficult, especially in developing countries. The sugars
sucrose and trehalose are commonly used as stabilizing agents and
cryoprotectants for biological products. Here, we have exploited the ability of
these sugars to vitrify on desiccation to develop a thermostabilization
technique for live viral vaccine vectors. By slowly drying vaccines suspended
in solutions of these disaccharide stabilizers onto a filter-like support
membrane at ambient temperature, an ultrathin glass is deposited on the
fibers of the inert matrix. Immobilization of two recombinant vaccine vectors
—E1/E3-deleted human adenovirus type 5 and modified vaccinia virus Ankara
—in this glass on the membranes enabled complete recovery of viral
titer and immunogenicity after storage at up to 45°C for 6 months
and even longer with minimal losses. Furthermore, the membrane
carrying the stabilized vaccine can be incorporated into a holder
attached to a syringe for almost simultaneous reconstitution and
injection at point of use. The technology may potentially be
developed for the deployment of viral vector–based
biopharmaceuticals in resource-poor settings.

Vaccine
Volume 28, Issue 7, Pages 1661-1892 (17 February 2010)
http://www.sciencedirect.com/science/journal/0264410X
Conference Report
The second Geneva Consensus: Recommendations for novel live TB
vaccines
Pages 2259-2270
K.B. Walker, M.J. Brennan, M.M. Ho, J. Eskola, G. Thiry, J. Sadoff, R. Dobbelaer,
L. Grode, M.A. Liu, U. Fruth, P.H. Lambert
Abstract
Infection with Mycobacterium tuberculosis continues to be a major public
health burden in most developing parts of the world and efforts to develop
effective strategies for containing the disease remain a priority. It has long
been evident that effective mass vaccination programmes are a cost
effective and efficient approach to controlling communicable diseases in a
public health setting and tuberculosis (TB) continues to be a major target.
One approach with increasing acceptance is based upon on live
mycobacterial vaccines, either as recombinant BCG or rationally attenuated
M. tuberculosis, thus generating a new live TB vaccine.
The Geneva Consensus published in March 2005 set out the opinion on
priorities and requirements for developing live mycobacterial vaccines for
Phase I trials. In the intervening period much progress has been made in both
preclinical and clinical development of new TB vaccines and has provided the
impetus for organising the second Geneva Consensus (held at WHO
headquarters, April 2009) to discuss issues, including:
i. Explore the regulatory requirements for live TB vaccines to enter Phase I
trials, in particular those based on attenuated M. tuberculosis. Particular
attention was paid to the characterisation and safety package likely to be
required, including issues of attenuation, the presence of antibiotic resistance
markers in live vaccines and the nature of any attenuated vaccine
phenotype.
ii. To identify the general criteria for further clinical development from
Phase I through to Phase III.
iii. Obtain a perspective of the regulatory landscape of developing countries
where Phase II and III trials are to be held.
iv. Review manufacturing considerations for live TB vaccines and relevance
of the WHO and European Pharmacopeia guidelines and requirements for
BCG vaccine.
v. Consider requirements and associated issues related to the use of these
new vaccines within an existing BCG vaccination programme.
Cost-effectiveness of the CRM-based 7-valent pneumococcal
conjugated vaccine (PCV7) in Argentina
Pages 2302-2310
Norberto D. Giglio, Alejandro D. Cane, Paula Micone, Angela Gentile
Abstract
Due to the region's own conditions, universal vaccination with pneumococcal
conjugate heptavalent vaccine (PCV-7) in Latin American countries is still
controversial.
Objective
To compare projected economic costs and health benefits associated with
pneumococcal conjugate heptavalent vaccine as a routine immunization in
healthy children in Argentina.
Design
A decision analytic model of Markov simulated lifetime evolution of a birth
cohort (n 696,451) was developed and compared costs and health benefits of
pneumococcal disease in the presence and absence of vaccination.
Main outcome measures
Cost per life year (LY) gained, reduce in diseases burden and costs of
vaccination.
Results
From the society's perspective, the incremental cost per LY gained was US$
5599.42 and the purchase of the 4 doses of vaccine for the entire cohort with
a cost of US$ 26.5 dose requires an investment of US$ 73,823,806.00.
The model estimated that vaccination reduce the number of death by 159
cases of meningitis, 756 cases of bacteriemias 4594 cases of pneumonias
about 84,769 cases of otitis media and 20 meningitis sequelae.
The value of the cost per LY gained was considerably modified by the
variation in the cost of the vaccine dose, efficacy/effectiveness of the vaccine
for pneumonia the mortality from pneumonia and herd immunity.
Conclusions
Our analysis predicted that routine vaccination of healthy infants <2 years
could prevent an important number of pneumococcal infectious and reduce
related mortality and morbidity. This strategic could be highly cost-effective
in Argentina.
Meningococcal conjugate vaccination among adolescents aged 13–17
years, United States, 2007
Pages 2350-2355
Peng-jun Lu, Nidhi Jain, Amanda C. Cohn
Abstract
Background
An estimated 1000–2000 cases of invasive meningococcal diseases occur
annually in the United States. In 2005, a new quadrivalent meningococcal
conjugate vaccine (MCV4) was approved and, because of supply constraints,
was recommended for routine vaccination of some groups of adolescents. In
August 2007, vaccination recommendations were expanded for all
adolescents 11–18 years.
Methods
We analyzed data from the 2007 National Immunization Survey-Teen (NIS-
Teen), a nationally representative random digit dialed telephone survey.
Estimates of MCV4 coverage were assessed from provider-reported
vaccination histories. A multivariable logistic regression analysis and
predictive marginal model were performed to identify factors independently
associated with MCV4 vaccination.
Results
Provider-reported vaccination histories were available for 2947 adolescents
aged 13–17 years with a response rate of 55.9%. Overall, MCV4 coverage
was 32.4% (95% confidence interval (CI) = 30.2–34.7%) in 2007. Vaccination
coverage was similar among adolescents aged 13–14 years compared to
those aged 15–17 years (32.1% vs. 32.6%, respectively). Coverage was
30.6% for non-Hispanic whites, 35.9% for non-Hispanic blacks, and 36.1% for
Hispanics; however, these variations were not statistically significant.
Characteristics independently associated with a higher likelihood of MCV4
vaccination included having ≥2 physician contacts in the past year, having a
well child visit at age 11–12 years, and ever having a doctor recommendation
for meningitis vaccination of the adolescent.
Conclusions
In 2007, MCV4 coverage among 13–17 years old increased 20.7 percentage
points from 2006. Achieving high vaccination coverage among adolescents
will be challenging. Targeting adolescents with no health insurance and no
recent healthcare provider visits may be important to increase coverage.