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>> GOOD AFTERNOON.
I'D LIKE TO ACKNOWLEDGE HERE THE MEMBERS OF OUR ADULT
IMMUNIZATION WORK GROUP. I'D LIKE TO THANK THE COLLEAGUES
AND LEADER AND REPRESENTATIONS AND CONSULTANTS.
AND I DEFINITELY WANT TO MAKE SURE THAT WE THANK IN PARTICULAR
CAROLYN BRIDGES WHO AS MANY YOU YOU HEARD, WE HAD CERTAIN
PEOPLE WHO WERE TRYING TO KEEP US MOVING FORWARD AND I ALSO
WOULD LIKE TO THANK GENE SMITH AND EVERY ELSE WHO WAS HERE
HELPING US TO MOVE FORWARD. SO IF WE TALK ABOUT THE
ADOLESCENT -- SORRY, THE ADULT IMMUNE STAIGS SCHEDULE, VERY
MUCH LIKE THE CHILD IMMUNE STAIGS SCHEDULE, WE UPDATE THIS
ANNUALLY. AND IT IS ALSO TO REFLECT AND
SUM RIDES EXISTING ACIP POLICY. SO WE WON'T BE NECESSARILY
TALKING ABOUT ANY NEW POLICY. WE DO THIS THROUGH A SERIES OF
MINIMALLY MONTHLY MEETINGS OF WORK GROUP IN CONSULTATION WITH
VACCINE SUBJECT MATTER EXPERTS. AND THERE ARE SPECIFIC ISSUES
THAT OFTEN HAVE TO BE ADDRESSED. WE WILL UPDATE APPROVED POLICY
CHANGES UP UP THIS MEETING. IF THEY'RE PUBLISHED IN THE MMWR
PRIOR TO THE PUBLICATION OF OUR ADULT SCHEDULES, WHICH WE
ANTICIPATE TO BE EARLY 2014. WE ALSO WORK COLLABORATIVELY
WITH MANY OF OUR COLLEAGUE ORGANIZATIONS WHICH INCLUDE THE
AMERICAN COLLEGE OF PHYSICIANS, AMERICAN ACADEMY OF FAMILY
PHYSICIANS, AMERICAN COLLEGE OF GYNECOLOGY, AS WELL AS AMERICAN
COLLEGE OF NURSE MIDWIFES. AND SO THEY ACTUALLY APPROVE OUR
SCHEDULES. LIKE THE CHILDHOOD SCHEDULE,
WE'RE ACTUALLY GOING TO PRESENT THE WORK GROUP EVALUATIONS WITH
OUR SPECIFIC FOOTNOTE AND CHANGES AND THEN WE'LL FOLLOW
WITH A DISCUSSION AND VOTE. SO I'D THOUSAND LIEU TO CALL OUR
LE NOW LIKE TO CALL OUR LEAD DR.
BRIDGES. >> THANK YOU VERY MUCH.
I'M GOING TO BE SUMMARIZING THE CHANGES AND UPDATES FOR THIS
YEAR. I'LL START WITH THE FIGURE.
SO THE UPDATE TO THE FIGURE INCLUDE REALLY JUST TWO CHANGES.
ONE, SO THAT AS A REMINDER TO PROVIDERS FOR PATIENTS WHO NEED
BOTH, WE MOVED THE ORLANDO DER BARS.
AND BASED ON THE RECOMMENDATIONS VOTED ON MUCH EARLIER THIS YEAR,
WE ANTICIPATE PUBLICATION. WE IT ADD THE HIP VACCINE AS
WELL TO THE ADULT SCHEDULE. SO THE ACIP MEMBERS SHOULD HAVE
A COPY IN THEIR NOTEBOOKS OF THE SCHEDULE.
AND THE RED ARROWS JUST NOTE WHERE THESE CHANGES ARE IN THE
SCHEDULE THIS YEAR. SO AGAIN, THIS IS FIGURE ONE
WHICH IS GUY AIS BY AGE GROUP. AND FIGURE TWO IS BASED ON
HEALTH COMPLAIN. SO AGAIN CONSISTENT WITH THE
LANGUAGE ALREADY VOTED ON BY THE ACIP, WE DO NOTE FOR THE IMMUNE
COMPROMISING CONDITIONS COLUMN, THAT THE ONLY GROUPS FOR WHOM
THIS IS RECOMMENDED WHO HAS POTENTIAL TO RECEIVE HIPAA FOR
IT IS POST STEM CELL TRANSPLANTS BUT WE CHOSE NOT TO MAKE A
SEPARATE COLUMN GIVEN THAT THE REAL ESTATE ON THIS FIGURE IS
PRETTY SMALL. THERE ARE A FEW UPDATES TO THE
FOOTNOTES, AS WELL, WHICH I WILL GO OVER IN BRIEF.
AND THEN I HAVE AGAIN FOR THE ACIP MEMBERS A COPY THAT
PROVIDES THE EXACT WORDING OF THOSE CHANGES.
SO FOR INFLUENZA VACCINE, INFORMATION IS ADDED AND
ADDITIONAL LANGUAGE. IN THE FOOTNOTE, WE ATTEMPTED TO
AS MUCH AS POSSIBLE HARMONIZE THE LANGUAGE BETWEEN THE
PEDIATRIC AND ADULT SCHEDULE. AND THEN IN DOING SO, WHAT WE
REALIZED WAS THAT WHEN WE WENT FROM A PARAGRAPH VERSION OF THE
FOOTNOTE TO A BULLETIN VERSION OF THE FOOTNOTES TWO YEARS AGO
ON, WE INADVERTENTLY LEFT IT OFF.
IT WAS ALWAYS INCLUDED ON THE FIGURES TO GET IT EVERY TEN
YEAR, BUT IT GOT DROPPED FROM THE FOOTNOTE.
SO THE LANGUAGE IS NOW ALMOST IDENTICAL TO THE PEDIATRIC
FOOTNOTE AND WE APOLOGIZE FOR THAT ERROR.
AND THIS VACCINE CLARIFIES THAT PERSONS WHO HAVE ADULT IMMUNE
COMPROMISE CONDITION BORN IN THE U.S. BEFORE 1980 MAY NOT BE
IMMUNE TO VARICELLA. AND FOR THE HPV VACCINE,
HARMONIZED WITH THE PEDIATRIC SCHEDULE.
AND THERE HAVE BEEN QUESTIONS ABOUT THE INTERVALS BETWEEN
FIRST AND SECOND, SECOND AND THIRD AND FIRST AND THIRD DOSES.
SO THIS CLARIFIES. AND AGAIN TO POTENTIALLY
INCREASE AND NOT HAVE TO FURTHER DECREASE THE FOPT SIZE ON THE
FOOTNOTE, WE REMOVE SOME OF THE LANGUAGE ABOUT HEALTH CARE
PERSONNEL VACCINATION FOR THE VACCINES.
WE'RE NOT GETTING NEARLY AS MANY QUESTIONS ABOUT WHETHER HEALTH
CARE WORKERS CAN GET THEM OR NOT.
AND THE HEALTH CARE PERSONNEL IS THOETED WITH T ED
NOTED WITH THE COLOR OF THE FOOTNOTES AND LEGEND FOR THE
FIGURE. FOR PCB 13 AND PDS 23, AGAIN, WE
JUST CHANGED THE ORDER TO MAKE IT CLEAR THAT 13 SHOULD BE
ADMINISTERED FIRST. AND FOR THE MENINGOCOCCAL
VACCINE, THERE ARE A NUMBER OF SUGGESTIONS AGAIN ABOUT HOW TO
MAKE THIS FOOTNOTE CLEARER, ABOUT WHO NEEDS ONE DOSE VERSUS
POTENTIALLY MORE. AND THEN IT ALSO CLARIFIES THE
RECOMMENDATION THAT PERSONS WITH *** ARE NOT ROUTINELY
RECOMMENDED FOR THE MB C-4, BUT DOES CLARIFY IF THESE PERSONS DO
GET VACCINATED, THEY SHOULD BE GETTING TWO DOSES.
AND WE UPDATED THE LANGUAGE PER THE REP DAYG RECOMMENDATIONS.
CONTRA DECISION INDICATIONS TABLE, WE ADDED LANGUAGE ABOUT
PERSONS WITH EGG ALLERGY. SO SIMILAR TO THE PEDIATRIC
SCHEDULE, WOULD HE REVISE THE ADULT SCHEDULE BASED ON
DISCUSSIONS AT THIS MEETING TODAY.
WE'LL THEN BE SUBMITTING THE SCHEDULE FOR CDC CLEARANCE AS
WELL AS REVIEW BY OUR VACCINE SPECIFIC SMEs AND WORK GROUPS
THAT ARE ALSO IMPACTED. AND THEN WE WILL ALSO HAVE
REVIEW BY OUR COLLEAGUES, VARIOUS PROFESSIONAL
ORGANIZATIONS WHO ALSO LOOK AT THE SCHEDULE INCLUDING ACP,
AMERICAN COLLEGE OF OBSTETRICIANS, AMERICAN COLLEGE
OF NURSE MED WIVES. WE'LL BE SUBMITTING THE SCHEDULE
TO THEM AND ANNALS OF INTERNAL MEDICINE EARLY IN DECEMBER AND
WE ANTICIPATE PUBLICATION IN FEBRUARY.
I'M HAPPY TO GO OVER ANY OF THE INDIVIDUAL FOOTNOTES.
YOU HAVE THOSE IN YOUR PACKET. OR IF YOU HAVE QUESTIONS RIGHT
NOW, WE CAN TAKE THAT. DR. TEMTE, I'LL DEFER TO YOU.
>> ANY DISCUSSION OR QUESTIONS FOR DR. BRIDGES?
>> ON YOUR SLIDE ON VARICELLA IN THE FOOTNOTE, LOOKING AT THE
VERY FINE PRINT IN THE INITIAL SLIDES HERE, I JUST WONDER IF
THIS MAKES IT CONFUSING FOR PEOPLE.
BECAUSE IT GOES INTO EVIDENCE FOR IMMUNITY EXCEPT IF YOU'RE
IMMUNOCOMPROMISED THAT YOU MAY NOT BE.
AND AT THE SAME TIME IT'S CONTRAINDICATED TO VACCINATE.
I JUST WORRY THAT SETS UP KIND OF THE INTERNAL CONFLICT FOR
PEOPLE TRYING TO USE THIS FOR GUIDANCE.
>> THAT'S A GOOD POINT. WE ACTUALLY TALKED ABOUT DOING
THIS FOOTNOTE A COUPLE DIFFERENT WAYS.
ONE WOULD BE TO NOT DO IMMUNOCOMPROMISED PERSONS.
AND SECOND FOOTNOTE AMONG WHOM VACCINATION IS BEING CONSIDERED
INCLUDES ANY OF THE FOLLOWING. THAT WAS AN ALTERNATIVE AND WE
CAN CERTAINLY GO BACK TO THAT LANGUAGE IF IT'S CLEARER.
>> I DON'T KNOW IF IT'S JUST ME OR NOT, BUT THESE ARE THE TYPES
OF QUESTIONS I GUESS OCCASIONALLY.
AND JUST ANY CLARIIRRITY WOULD APPRECIATED.
>> THIS ISN'T A DIRECT QUESTION, BUT A COMMENT.
I THINK IT WOULD BE ON THE GRAPH THAT THERE IS A WHITE BOX FOR
PREGNANCY UNDER PCB 13 AS WELL AS UNDER HEB AND RECOGNIZING
THAT THIS TABLE DOES NOT REFLECT ANYTHING NEW AND THAT WE CAN'T
MAKE UP ANYTHING NEW, I WOULD REQUEST THAT AT A FUTURE MEETING
THERE BE A SPECIFIC CONVERSATION ABOUT THE SAFETY OF INACTIVATED
VACCINES FOR PREGNANCY. WHEN THERE IS A WHITE BOX, I
THINK THERE IS AN ASSUMPTION THAT IT IS UNSAFE.
SO WHEN I FIRST LOOKED AT IT, I THOUGHT IT MUST BE ON THE TABLE
BUT THAT'S NOT WHAT THE DATA SHOWS.
BUT I THINK THAT IT WOULD BE HELPFUL TO HAVE CLARITY ON THE
INACTIVATED VACCINES THAT WE'RE SUGGESTING TO BE USED IN
PREGNANT WOMEN AND BE VERY CLEAR THAT IF THERE IS A
RECOMMENDATION TO USE IT, THAT'S CLEAR.
AND IF THERE IS NO SAFETY DATA DON'T USE IT, THAT'S CLEAR.
BECAUSE THIS LEAVES PRACTITIONERS WITH HIGH RISK
WOMEN SORT OF NOT KNOWING. AND MY GUESS IS AS A
PRACTITIONER, I WOULD SAY I ASSUME IT'S UPDATED.
>> THAT WAS A WONDERFUL POINT. IS THAT SOMETHING WE CAN SEND TO
THE PNEUMOCOCCAL AND WORKING GROUPS JUST FOR CONSIDERATION?
AGAIN, BECAUSE WE WOULD LIKE TO HAVE MORE SPECIFIC GUIDANCE.
I THINK ALSO THAT REALLY PULLS THINGS INTO WHAT WE'D LIKE TO BE
DOING HERE IN CONJUNCTION WITH THE MATERNAL VACCINATION WARD.
SO APPRECIATE THAT COMMENT. >> WOULD IT BE USEFUL TO MAKE
THE WHITE BOX NO RECOMMENDATION NOT CONTRAINDICATED?
>> THE PROBLEM WITH THAT, THOUGH, IF YOU'RE TALKING ABOUT
PREGNANCY, HPV IS SPECIFIC DELAY YOUR HPV VACCINATION UP AFTER
PREGNANCY. SO THAT'S PRETTY CLEAR.NP AFTER
PREGNANCY. SO THAT'S PRETTY CLEAR.TIP AFTER
PREGNANCY. SO THAT'S PRETTY CLEAR.LP
AFTER PREGNANCY. SO THAT'S PRETTY CLEAR. AFTER
PREGNANCY. SO THAT'S PRETTY CLEAR.
MY UNDERSTANDING IS CERTAINLY FOR PCB, IF YOU HAVE SOMEONE WHO
IS HIGH RISK, YOU COULD GIVE IT DURING PREGNANCY.
>> THERE ARE SIX DIFFERENT WHITE BOXES, TWO ARE NOT APPLICABLE
BECAUSE THEY'RE MALE/FEMALE DISCOURTING.
ONE OF THEM IS NOT RECOMMENDED AND THE OTHER THREE COULD BE
LIKE JEFF SAID COULD BE NOT RECOMMENDED, NOT CONTRAINDICA
CONTRAINDICATED. SO YOU COULD HAVE DIFFERENT
ANSWERS FOR DIFFERENT WHITE BOXES.
>> AT THE RISK OF SAYING SOMETHING I SHOULDN'T SAY, I
THINK THAT THIS SCHEDULE IS CHALLENGING.
AND I THINK WE WANT IT TO BE EVERYTHING FOR EVERYONE.
BUT ONCE WE HAVE A LIST ON THE LEFT, THERE IS A DESIRE TO SORT
OF FIGURE OUT WHAT DO I NEED TO DO WITH THAT IN THIS PARTICULAR
POPULATION. ANOTHER WAY TO THINK ABOUT THE
SCHEDULE IS TO SAY IF YOU'RE CARING FOR A PERSON THIS A
COLUMN, WHAT ARE WE RECOMMENDED THAT YOU GIVE.
AND WE HAVE THIS DESIRE TO BE COMPREHENSIVE AND INCLUSIVE AND
COMMENT ON EVERYTHING ON THE LEFT, BUT THE REALITY IS THERE
ARE A COUPLE VACCINES THAT IS IMPORTANT PREGNANT WOMEN GET
BECAUSE THEY'RE PREGNANT. THERE ARE MANY VACCINES PEOPLE
WITH, YOU KNOW, DIABETES ARE RECOMMENDED TO GET.
AND SO IT MAY BE WE WANT TO P THROUGH WHAT DOES THE
PRACTITIONER ACTUALLY NEED TO POSITIVELY DO AS THE MAIN POINT
OF THE SCHEDULE OR IDEALLY WE HAVE ON THE INTERNET A DIFFERENT
SCHEDULE JUST FOR EACH OF THESE GROUPS WHERE THE REAL ESTATE
ISN'T GET SO PRECIOUS. SO FOR MY SENSE, IN PREGNANCY,
THERE ARE A COUPLE VACCINES WE'RE STRONGLY RECOMMENDING THAT
WE GIVE THE NUMBER OF ADULTS IN THE COUNTRY WHO REALLY NEED A
HEB VACCINE IS MINISCULE. BUT THERE ARE A LOT OF PREGNANT
WOMEN. SO I'D WANT TO MAKE SURE
PREGNANT WOMEN ARE GETTING THE KEY VACCINES THEY NEED TO GET.
THAT IS JUST MY COMMENT ON THE WHITE BOXES AND NOT HAVING THEM
DRIVE WHAT THE SCHEDULE IN TERMS OF POSITIVE PROMPT THAT IT'S
MEANT TO BE. >> IS IT POSSIBLE WE'RE GETTING
HUNG UP ON THE PHRASE NO RECOMMENDATION?
THERE WASN'T A VOTE AFFIRMATIVE RECOMMENDATION.
IT DOESN'T NECESSARILY MEAN THERE ISN'T GUIDANCE.
SO MAYBE THEY SHOULD GO TO THE FOOTNOTES OR THERE MAY BE OTHER
GUIDANCE. >> CAROL HAYES REPRESENTING THE
AMERICAN NURSES ASSOCIATION AND AMERICAN COLLEGE OF NURSE
MIDWIFES. AND MY EXPERIENCE IS CLINICALLY
WHEN VACCINATING PREGNANT WOMEN, I DON'T EVEN LOOK AT THIS.
I GO OVER LENGTHY SECTION WHERE YOU GO OVER EACH VACCINE AND WHY
IT'S NOT RECOMMENDED AND WHY IT'S CONTRAINDICATED.
SO I THINK THE WHITE AND PURPLE AND RED BOXES ARE THE ONLY ONES
THAT MATTER REALLY. WE MAKE IT CLEAR IF YOU'RE
GLANCING AT THIS, YOU KNOW WHAT YOU SHOULDN'T GIVE AND YOU KNOW
WHAT YOU SHOULD GIVE. AND YOU SHOULD GO TO THE REST OF
THE REAL ESTATE FOR THE WHILE BOX.
>> I HAVE SORT OF A PRACTICAL CONSIDERATION WHICH CAN BE DONE
ONLINE, WHICH IS IT SOUNDS LIKE THERE IS INFORMATION AND
GUIDANCE ON SOME OF THESE VACCINES.
WE CAN HOT LINK TO THOSE SECTIONS FOR PEOPLE WHO USE THE
INTERNET TO GET INFORMATION ABOUT THE VACCINE.
THAT MIGHT BE HELPFUL TO KNOW THAT THERE IS MORE INFORMATION
THAT YOU CAN SORT THROUGH WHEN MAKING DECISIONS ABOUT IT.
>> AND JUST SOME FEEDBACK TO DR. RILEY.
BACK WHEN I USED TO DO OBSTETRICS, I DIDN'T PAY
ATTENTION TO ALL THE ACIP. I PAID ATTENTION TO THE FLOW
SHEET FROM ACOG FOR MY GUIDANCE DURING PREGNANCY.
SO JUST A PLEA FOR THAT GUIDANCE THAT IS USED NOT ONLY BY YOUR
MEMBERS, BUT BY FAMILY DOCS TO BE PROACTIVE.
>> WE'RE GOING OFF OF THIS. ACOOG ISN'T COMING UP WITH THEIR
OWN FOINFORMATION. I'M NOT WORRIED ABOUT THE BOXES.
THERE IS NO WAY WE'RE PICKING IT IT UP AND LOOKING AT IT FOR A
SPECIFIC PREGNANCY. BUT FOR THOSE WHO DO GENERAL
DOCS WHO LOOK AT IT AND TELL PREGNANT WOMEN, OH, NO YOU CAN'T
HAVE THIS OR THAT AND THEN THE OB IS TRYING TO TALK THEM DOWN
OFF OF A LEDGE, I THINK WHERE THERE COULD BE CLARITY, THAT IS
HAPPIFUL. HELPFUL.
SO NOT A COMMENT ABOUT THIS PARTICULAR PICTURE, AS MUCH AS
IT WOULD BE VERY HELPFUL IF ACIP HAD A REALSO NOT A COMMENT ABOU
PARTICULAR PICTURE, AS MUCH AS IT WOULD BE VERY HELPFUL IF ACIP
HAD A REAL HELPFUL. SO NOT A COMMENT ABOUT THIS
PARTICULAR PICTURE, AS MUCH AS IT WOULD BE VERY HELPFUL IF ACIP
HAD A REALSO NOT A COMMENT ABOU PARTICULAR PICTURE, AS MUCH AS
IT WOULD BE VERY HELPFUL IF ACIP HAD A REAL HELPFUL.
SO NOT A COMMENT ABOUT THIS PARTICULAR PICTURE, AS MUCH AS
IT WOULD BE VERY HELPFUL IF ACIP HAD A REALHELPFUL.
SO NOT A COMMENT ABOUT THIS PARTICULAR PICTURE, AS MUCH AS
IT WOULD BE VERY HELPFUL IF ACIP HAD A REAL COMPREHENSIVE LOOK AT
ALL THE VK SEENS WE SHOULD BE GIVING TO PREGNANT WOMEN WITH
CLEAR SAFETY DATA. THERE IS THAT MUCH IN FLU AND
THIS MUCH IN HEB RECOGNIZING IT WILL BE SMALL, BUT IT JUST TAKES
AWAY THE ASSUMPTION THAT IF THERE IS NOTHING CLEARLY OUT
THERE, IT'S UNSAFE. >> BEING MY COMMENTS HAVE BEEN
MADE. >> MAYBE I'M NOT THE PROPOSE
PERSON ON THIS AND I KNOW CLINICIANS NEED READILY
AVAILABLE GUIDES AND IT WOULD BE GREAT IF EVERYTHING IS IN THE
SCHEDULE, BUT I ACTUALLY THINK CDC HAS A GREAT GUIDE TO
PREGNANCY AND BREAST FEEDING WOMEN AND I GIVE IT OUT ALL THE
TIME. AND IT'S GOT A WONDERFUL
DESCRIPTION OF WHICH VACCINES FDA RATINGS ARE AND AN
ACCOMPANYING CHART THAT YOU CAN PUT UP ON THE WALL THAT HAS THE
COLORS THAT I THINK YOU'RE ALLUDING TO AND A LITTLE MORE
DETAILED GUIDANCE. SO IT'S A GREAT RESOURCE.
>> DR. PICKERING. >> ONE IS A QUESTION, ONE A
SUGGESTION. THE QUESTION IS, CAROLYN, I
IMAGINE YOU'RE WORKING WITH THE THREE PROFESSIONAL SOCIETIES FOR
THE ADULT SCHEDULE, ALSO? >> THEY CERTAINLY GET THE
INFORMATION ABOUT THE CONTENTS INDICATION, YES.
>> AND I THINK THE LIAISONS OR MEMBERS OF THE COMMITTEE WHO ARE
IN THOSE ORGANIZATIONS CAN HELP, I'M SURE THEY WOULD BE WILLING
TO DO THAT. THE SECOND QUESTION IS I JUST
LOOKED AT THE CHILDHOOD SCHEDULE AND THREE PAMGS GES OF FOOTNOTED
ADULTS PROBABLY WILL BE EQUAL TO THAT.
ONE OF THE THINGS WE MIGHT CONSIDER FOR FUTURE IS THE
FOLLOW FOLLOW-UP ON WHAT RENEE SAID.
A LOT OF THINGS WE COULD LINK ELECTRONICALLY.
WHEN YOU MAKE ROUNDS, THEYjs-< USE THEIR iPADS AND S AND iPHON.
SO I THINK FOR NEXT YEAR, MAYBE WE CAN REALLY LOOK AT BOTH OF
THE SCHEDULES AND DETERMINE WHETHER A LOT OF THESE LINKS
SHOULD BE ADDED, AS WE GAIN MORE DATA IS FOR WHETHER OR NOT THESE
ARE USED MORE ELECTRONICALLY OR MORE HARD COPY FORMS.
>> I THINK AREA RERIN'S COMMENT IMPORTANT.
THE CONTRAINDICATIONS ARE CLEAR. BUT IF YOU LOOK AT THE TWO
YELLOWS, THAT'S WHAT WE'RE TRYING TO DO DURING PREGNANCY.
AND THE OTHER VACCINES, I MEAN, IT'S GOING TO REQUIRE DEEPER
INSIGHT, BUT I THINK AN OB/GYNA TO HELP AND WOULD LOVE TO
CORROBORATE. AND A POINT ABOUT MAKING
EVERYTHING WEB BASED, I FIND THIS VERY USEFUL TO HAVE THE
INFORMATION IN A PAPER FORMCAN LOOK AT.
THEY HAVE HACAN HAVE THEIR QUESTIONS ANSWERS.
SO PLEASE DON'T AT THAT TIME PA
TAKE THE PAPER AWAY FROM US. THIS IS VERY HELPFUL.
THANK YOU. >> WOULD IT ADDRESS THE CONCERNS
IF YOU HAD IN THE WHITE BOX NOT APPLICABLE, SAFE, BUT YOU
UNDERSTAND THAT IT'S SAFE, WHEREAS HPV AND FEMALE IS NOT
RECOMMENDED, SO YOU COULD EITHER HAVE VERY, VERY SMALL WORDS BUT
THEY MIGHT WORK. >> YESTERDAY WHEN WE WERE
DISCUSSING THE BOXES FOR PREGNANCY, ONE SUGGESTION WAS
THAT POTENTIALLY IT MIGHT BE HELPFUL TO HAVE A FUTURE SESSION
TO REVIEW THE SAFETY DATA ON INACTIVATED VACCINES IN
PREGNANCY. THAT MIGHT BE HELPFUL JUST
TRYING TO RESOLVE IT. >> I THINK IT WOULD BE PREMATURE
TO PUT ANYTHING IN THOSE BOXES AT THIS POINT IN TIME AND KEEP
THEM AS THEY EXIST NOW. AGAIN, I THINK AS THE POINT HAS
BEEN MADE THAT THE REAL BIG TARGET HERE IS INFLUENZA VACCINE
AND A TDAP DURING PREGNANCY AND ALSO AVOIDING THINGS THAT WE NOW
HAVE A HIGHER LIKELIHOOD OF DANGER AND SO ON.
AND THAT'S BORNE OUT HERE. WHEN WE START I THINK DEALING
WITH SOME OF THE NUANCES IN THE BOXES IN QUESTION, THOSE ARE
PEOPLE WHO ARE AT HIGH RISK FOR OTHER THINGS TO BEGIN WITH.
AND THEN IT REALLY BECOMES KIND OF A WAIN OF IF I HAVE A PERSON
WHO SHOULD BE GETTING ONE OF THOSE VACCINES BECAUSE OF OTHER
CONTRAINDICATIONS PREGNANT, IT REALLY IS BETWEEN
THE PHYSICIAN, THE PATIENT AND SO ON.
AND I DON'T THINK WE HAVE SUFFICIENT EVIDENCE ONE WAY OR
ANOTHER TO GIVE MUCH GUIDANCE. ESPECIALLY THROUGH THE CHART
HERE WITHOUT HAVING FURTHER DISCUSSION.
SO THAT'S MY LONG WINDED ANSWER. >> ONE OTHER POINT.
FOR THE HPV VACCINE FOOTNOTE, WE HAVE SAID FOR THE LAST SEVERAL
YEARS IF THE WOMAN IS FOUND TO BE PREGNANT AFTER INITIATING THE
SERIES, NO INTERVENTION IS NEEDED.
REMAINDER SHOULD BE DELAYED UP AFTER THE PREGNANCY.
SO WE WILL OFFER THAT CLARIFYING LANGUAGE.
>> OTHER COMMENTS, QUESTIONS? IF THERE IS SOMEONE WILLING TO
MAKE A -- PUT FORTH A MOTION FOR ADOPTION OF THE 2014 SCHEDULE?
OKAY. I HAVE AN AFFAIRMATION FROM
DR. BENNETT AND SECOND FROM DR. CURAN.
ANY FURTHER DISCUSSION? SEEING NONE, WE WILL START WITH
DR. BOHENI AND GO TO YOUR LEFT. >> GOOD.
I DON'T HAVE TO SHOW HOW IGNORANT
>> YES. >> YES.
>> JENKINS YES. >> RUBIN YES.
>> COYNE-BEASLEY YES. >> VAZQUEZ YES.
>> HARRISON YES. >> YES.
>> YES. >> BENNETT YES.
>> TEMTE YES. >> ERIN YES.
>> KEMP YES. >> YES.
>> YES. >> AN ANIMOUS APPROVAL OF THE
2014 ADULT SCHEDULE.