Discover and read the best of Twitter Threads about #ACIP

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22. 6. proběhl další meeting imunizační komise #ACIP a tak jsem si řekl, že opět přinesu výstřižky. Jednotlivé prezentace se dají najít zde: cdc.gov/vaccines/acip/…
Introduction: cdc.gov/vaccines/acip/…
💉K 21. 7. podáno 339M dávek, >161M osob plně očkováno 💉Na programu: Debata k Guillain-Barré Syndrome (GBS)
#ACIP: Guillain-Barré Syndrome po vakcíně Janssen
💉Předběžně 100 hlášení, 95 závažných, 1 úmrtí
💉Nástup průměrně 13,8 dnů po očkování
🧐Zdá se, že do hlášení jsou uvedeny poměrně závažné případy a naopak mírné se buď nevyskytují nebo nejsou hlášeny?
Read 16 tweets
1. @CDCgov's vaccine advisors, #ACIP, are meeting today. I'll try to tweet, but also writing so tweets may be spotty.
Issues are: The suspected link between the J&J #Covid vaccine & Guillain Barre syndrome & whether immunocompromised people should get an additional dose of vax.
2. On the issue of whether immunocompromised people should get +1 dose of #Covid vax, don't expect a decision today. The emergency use authorizations that allow use of the vaccines specify how many doses can be given. Until @US_FDA changes that, #ACIP can't recommend more doses.
3. J&J presented #ACIP some new immunogenicity data for their 1 dose vaccine just now, with data by variant type. The T-cell responses are similar across all variants, the company shows. Persistent humoral and cellular immune responses, over 8 months.
Read 14 tweets
Reminder that today's #ACIP meeting will be covering Guillain-Barré syndrome + J&J Vaccine and also additional discussions on additional dosages for immunocompromised pts. My thread will be below this tweet, so please feel free to mute if you don't want me to flood your timeline!
Current update --> With Delta variant, we're seeing rise in cases with 57% of pop >= 12 fully vaxxed. Followed up with a recap of rare adverse events (AEs) along with a quick recap of what Guillain-Barre Syndrome (GBS). ImageImageImage
Warning has been added to the FDA's fact sheets for J&J due to higher reporting of GBS. No note of GBS on mRNA vaccines. Important to note that this is not the first vaccines to note increased risk of GBS. Of the 30 other prespecified outcomes, none have triggered safety signal ImageImageImage
Read 29 tweets
1. The impact of #Covid19 vaccines on the US epidemic. This graphic, from today's #ACIP meeting, speaks volumes.
I will try to tweet from the meeting, but it might be intermittent. First up: myocarditis & pericarditis in some people who've received mRNA vaccines.
2. #ACIP will also be discussing #Covid19 booster shots. Committee was just told it's not yet clear *if* boosters will be needed, but that it's important to plan for boosters if it becomes clear they are needed.
3. #ACIP hearing an explanation of traditional (ie not vaccine-related) myocarditis & pericarditis. The former is mostly seen in males & rates are higher in 15-18 yos than in younger children.
Read 22 tweets
Zítra má proběhnout meeting imunizační komise CDC #ACIP. Na agendě je spousta věcí, přičemž první den bude věnován #Covid očkování.
Záznam bude možné sledovat zde, plánuji střípky přidávat sem do vlákna: cdc.gov/vaccines/acip/…
#COVID19Vaccination ImageImage
Dle ACIP je roční incidence cca 0,8 případů na 100 000 dětí, 66% z toho jsou muži. U 15-18 letých byla v letech 2015-2016 incidence 1,8 na 100 000. Image
Read 38 tweets
1. ACIP votes to halt the pause on J&J vaccine as previously approved with special warning language in the EUA regarding clots in women <50.
2. Syndrome will now be referred to as TTS. Thrombosis with thrombocytopenia Syndrome. Unusual, rare and potentially dangerous cerebral venous sinus clot with low platelets
3. 10-15 cases per million doses in women average age 35. Severe headache most common presenting symptom. Detect and treat early with IVIG and non-heparin anti-coagulant. Median onset is 10 d following vaccine (5-24 days later). So don’t worry if your vaccine was > a month ago.
Read 11 tweets
A lot of praise for #ACIP's transparency

But de facto pausing for 7-10 days got the *substance* wrong, as @ashishkjha et al. observe

Understanding the expertise of ACIP members (deep but too narrow) can help understand why these decisions need diverse experts, not just MDs

1/6
For vaccine allocation, CDC/NIH called on @NASEM_Health committee: nationalacademies.org/our-work/a-fra…

Not just MDs but:
- health econ (@healthecon_dan)
- behavioral health (@abuttenheim)
- literally wrote the book on "nonmaleficence" (Jim Childress)
- tribal health (@echohawkd3)
et al

2/6
In contrast, every #ACIP voting member (exc 1 community member) is a MD/DO/RN. Couple w/a MPH. But no health econ. No ethicists. No behavioral sci. No tribal health experts.

Great group for indiv patient care & virology expertise

Not for managing trade-offs in a pandemic

3/6
Read 9 tweets
Some current Hematologic diagnostic & management dilemmas of Adenovirus #JNJ & #AstraZeneca #VITT:
1⃣VITT seems to behave like autoimmune (Type 2) HIT rather than non-immune (Type 1) HIT (more common).
(Greinacher et al, @JTHjournal, 2017)
1/
#MedTwitter #HemeTwitter #COVID19 Figure 3. Generation of the heparin‐induced thrombocytopen
2⃣High enough doses of heparin or LWMH can outcompete these PF4-polyanion complexes for binding sites & reduce platelet aggregation (similar to HIT).
➡️BUT, we can't yet tell where/if there's a consistent dose breakeven point at which aggregation⬇️
(Schultz et al, @NEJM, 2021)
2/ Note: High-dose/concentration Heparin in these assays is 100
➡️While many cases reported using LMWH (mostly low-dose Dalteparin), lab results were inconsistent on whether this sufficiently reduced/prevented platelet aggregation.

(Greinacher et al, @NEJM, 2021)
3/ Note: There was a discrepancy in LWMH reaction between the 4
Read 18 tweets
#JNJ Vaccine Cerebral Venous Sinus Thrombosis Surveillance🧵after @CDCgov #ACIP (for now ...):
1⃣Watch for symptoms like headache, aphasia, paresis, papilledema, seizure, mental status changes
2⃣High-risk groups *seem* to be young women (~20-50), 6-20 days after #JNJ vaccine

1/
3⃣True #CVST event rate is TBD (as is the true background rate)
4⃣PF4 IgG ELISA in all patients for screening (#publichealth reporting) & management (avoiding heparin if positive)
5⃣Consider IV steroids & IVIg for thrombocytopenia
#HemeTwitter
2/
6⃣Report any suspicious events to #VAERS vaers.hhs.gov/reportevent.ht…
7⃣Remember that these are RARE events and the proposed cause of #VITT remains theoretical. This pause is proof that the safety/surveillance system works!

3/
Read 6 tweets
The @CDCgov Advisory Committee on Immunization Practices (ACIP) emergency meeting on the #JNJ vaccine is ongoing. Currently, they're reviewing known data on 8 cases of thrombotic thrombocytopenia. Follow this thread for updates. 1/ #COVID19 #MedTwitter ustream.tv/channel/VWBXKB…
This was the initial @US_FDA announcement yesterday describing the #COVID19Vaccine #JNJ hold. In summary, 6 post-market cases of cerebral venous thrombosis reported as of yesterday (in ~6.8 million doses delivered) prior to the hold.
The awesome @acweyand excellently summarized the data known as of yesteday from the similar #AstraZenaca adenovirus vector vaccines and background on #CVST! #hemetwitter 3/
Read 20 tweets
An advisory committee to the CDC is meeting as we speak. You can watch here: #acip ustream.tv/channel/VWBXKB…
@InfectiousPS said she's gotten 80% of her staff vaccinated, with 10% waiting to see how others do. Dr. Tom Shimabakuru is speaking now about safety monitoring. Here's his presentation. #acip
cdc.gov/vaccines/acip/…
Who serves on the CDC vaccine advisory group? Here's the list: #ACIP cdc.gov/vaccines/acip/…
Read 27 tweets
IMPORTANT UPDATE: In advance of the upcoming #ACIP meeting, the @HIVinfo_NIH "Guidance for COVID-19 and People with HIV", recommends that #HIV be included as a high-risk medical condition for #COVID19 vaccine priority.
clinicalinfo.hiv.gov/en/guidelines/…
ACIP has already recommended that people with high-risk medical conditions be prioritized in phase 1c. However, HIV has been in the "may be at risk" category and therefore not necessarily prioritized; in fact, most states have not done so. In our analysis,
we found that only 12 states explicitly included HIV on their list of high-risk medical conditions (KS, MT, NE, NH, NM, NY, NC, PA, RI, TN, UT, VA). However,
kff.org/policy-watch/t….
Read 5 tweets
THREAD: From AstraZeneca Q&A with @CDCgov #ACIP on its #COVID19 vaccine: Further analysis suggests greater efficacy in low-dose/high-dose group is actually due to greater interval between doses, not the dosing itself.
“[W]e think that interval actually what is probably associated with the increased efficacy that we’re seeing for that low-dose standard-dose group just because many of those participants were in the longer interval group.” - Tonya Villafana, AstraZeneca
The perplexing claim of 90% efficiency for this dosing regime was one of several questions other experts had for Oxford University after the release of results from its trials of the vaccine.
buzzfeednews.com/article/petera…
Read 5 tweets
.@DrNancyM_CDC on #COVID19 vaccinations: It's the early stages of the complicated task but a task we're up for.
These are new vaccines & new platforms.
Storage/handling/administering slightly complicated.
covid.cdc.gov/covid-data-tra…
#STATPlusConversations #vaccines
#STATPlusConversations .@DrNancyM_CDC: Now that facilities/hospitals have experience with #COVID19 #vaccines & holidays over, expect pace of administration to go up massively in next couple of weeks.

#CDC
Read 27 tweets
Azar on @CBSThisMorning insisting it's important for him to get $MRNA #COVID19 vax today b/c he's a "leader."
Azar's wife tested positive & he's refusing to quarantine & he's been at photo ops/briefings.
Today, he'll be at #NIH, putting Fauci, @NIHDirector, others at risk
Leader?
Is it leadership to refuse to quarantine, claim you're an "essential worker" to get around that quarantine, hold photo ops putting others potentially at risk, not to mention stepping in front of health care workers at #NIH to get $MRNA #COVID19 vaccine?
1 month left Azar at #HHS
Would it have shown better leadership to follow #CDC's advice, #stayhome & #quarantine after being exposed to #COVID19 & wait your turn to get $MRNA vaccine rather than stepping in front of critical health care workers?

Azar claimed he gets the shot today b/c he's a "leader."
Read 77 tweets
Unlike the ultra-cold temperature of minus 80 degrees Celsius required for the $PFE $BNTX #COVID19 vaccine, the $MRNA product can be shipped and stored at the standard freezer temperature, making it easier to be transported to small and more rural areas, Gen. Gustave Perna noted.
As of midday Dec. 20, about 2.84 million doses of the Pfizer-BioNTech COVID-19 vaccine had been distributed and 556,208 doses had been administered, the U.S. Centers for Disease Control and Prevention reported.

$PFE $BNTX $MRNA #CDC #COVID19 #vaccines
Gen. Gus Perna said he was solely to blame for the miscommunication that led to last week's allocations of $PFE #COVID19 vaccine initially forecast to states to be significantly cut, while the company said it had millions of doses sitting in its warehouse waiting to be shipped.
Read 10 tweets
My public comment at #ACIP meeting today about Phase 1b & 1c #COVID19Vaccine focused on equity. A 🧵
Question isn’t whether to incorporate concerns for #healthequity but HOW.
First come first served worsens inequity. Bright line age cutoffs also can worsen inequity due to preexisting disparities in life expectancy.
Read 9 tweets
The @CDCgov ACIP move toward priortizing frontline workers is premised on "only slightly" more deaths compared to prioritizing by age &/or comorbidity. But that finding depends on the vaccine blocking transmission very efficiently, which we don't know.
In my opinion prioritizing by risk of death is the most robust strategy in the sense of being optimal or near-optimal whatever we find out about transmission blocking and the like. #ACIP
Notwithstanding misinterpretations and deliberate trolling from many the last few days, I have been saying for some time that in my view the most lifesaving strategy, and likely the one that will return us to functioning fastest, would be
Read 5 tweets
For those following #ACIP vaccine prioritization debate - proposal to have 75+ alongside frontline workers in phase 1B is interesting, and different from prior discussion. But there are still pitfalls with any age cutoff, whether 75 or 65, as I explained in a comment to ACIP /1
Down Syndrome deaths are disparately high and happen before 75. 54%, 61%, and 69% of Black, Hispanic, and AI/AN deaths (respectively) happen before 75. I haven't seen US data on income x age at death, but a similar gradient is plausible, and may help explain the race data. /2
So I continue to think #ACIP should encourage states & localities to look at overlapping risk factors like housing+age as LTCF priority did and @CDCDirector suggested, rather than using age cutoffs that sweep in ppl at very different risk & exclude some /3
Read 6 tweets
CDC’s #ACIP just now reiterates OWS projections for #covid19 vaccine supply:

By end of Dec: enough for 20M people
End of Jan: enough for 30M more people
End of Feb: enough for 50M more people

(2 doses each)

We know Dec supply will stretch into 1st wk of Jan for administration
CDC’s #ACIP has not yet voted, but recs for groups next in line for #covid19 vaccines are people 75+ and frontline essential workers, including:
Firefighters, police
Teachers, support staff, daycare
Food & agriculture
Manufacturing
Corrections
Postal, public transit
Grocery store Image
CDC #ACIP’s considerations for next groups + how many in each for #covid19 vaccine prioritization (vote this afternoon):
Phase1a: healthcare workers, nursing home residents (24M)
1b: Frontline essential workers, 75+ (49M)
1c: 65-74, high-risk, other essential workers (129M) Image
Read 6 tweets
The #ACIP meeting is starting. It looks like they have revised their 1b recommendation (still to be voted on) to be those 75+ and frontline essential workers.
cdc.gov/vaccines/acip/…
1c) rec will be those aged 65–74 years; those aged 16–64 years with high-risk medical conditions; and other essential workers.
Teachers are in ACIP's definition of frontline essential workers.
Read 39 tweets
Last (grumpy) thread about #ACIP vax prioritization before bed. Sure, there are some hard tradeoffs, though looking for overlapping risk should make it easier, & ACIP could have had better framing. But critics have been a real mess. Exhibit A, dishonest quoting (aka lying): 1/6
Redfield: need to"demonstrate that we as a Nation also prioritize the elderly (>70 yo) who reside in multi-generation households. Often our Hispanic, Black and Tribal Nations families care for their elderly in multigenerational households and they are also at significant risk."2/
Here, current @CDCDirector Redfield (hardly "Mr. Woke"), after endorsing long term care priority, is sensibly arguing for another multi-factor (age+housing risk) priority similar to LTCF, which would also address disparities for "Hispanic, Black, and Tribal Nations families" 3/6
Read 7 tweets
Thread on interconnected #bioethics problems in #COVID19 vaccine allocation: (1) the Stanford med center allocation debacle, (2) Rupert Murdoch, and (3) high-profile calls for age-only (“oldest first”) allocation policies. If you like (3), unfortunately you get (1) and (2). 1/7
People are right to be upset w/Stanford: see @CarolineYLChen excellent piece . But it’s not “algorithms”, it’s inputs. If your inputs are too simplistic (age-only, ignore exposure or medical risk), you get bad outcomes, e.g. no residents, senior WFH 1st 2/7
Same w/ Murdoch: . People are right to be upset. But age-only priority like the UK (start w/85+ or 90+), ends up prioritizing Murdoch over a 60 yo bus driver. Who lives to 90? We know the answer: more often, wealthier people. Need to consider other risk 3/7
Read 9 tweets
LIVE: A @cdcgov advisory committee is meeting right now to recommend who should get first covid-19 vaccines when they're available. Here are the work group members.
ustream.tv/channel/VWBXKB…
LIVE: A @CDCgov advisory committee will vote on recommendations for allocating the first covid-19 vaccines. Health care personnel and nursing home residents are getting top priority in the discussion.
LIVE: Nursing home residents make up less than 1% of the population but account for 40% of deaths. @cdcgov #acip
Read 10 tweets

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