moderna myocarditis rate

"If you're focused on heart inflammation, the safer bet is to take the vaccine," said Mendel Singer at Case Western Reserve University in Ohio, who helped carry out the study. PMC According to the CDC, as of June 23, 2021, more than 177 million people had received at least one dose of a COVID-19 vaccine in the U.S. The Researching COVID to Enhance Recovery (RECOVER) Initiative is taking place at 80 centers across the country. stream Among all participants aged 16 to 24, myocarditis rates were 18.8 and 4.4 per 100,000 person-years for males and females, respectively. *** Data collection for race/ethnicity of myocarditis cases is ongoing. However, the balance of benefits and risks varied by age and sex because cases of myocarditis were primarily identified among males aged <30 years, and the risks of poor outcomes related to COVID-19 increase with age. https://www.sciencedirect.com/science/article/pii/S0735109718388430?via%3Dihubexternal icon** https://academic.oup.com/eurheartj/article/36/42/2921/2293375external icon Typically described as pain made worse by lying down, deep inspiration, or cough, and relieved by sitting up or leaning forward, although other types of chest pain might occur. As younger males get vaccinated, the reported rates have gone up,. OR, infants and children aged <12 years might instead have 2 of the following symptoms: troponin level above upper limit of normal (any type of troponin), Histopathologic confirmation of myocarditis, abnormal electrocardiogram (ECG or EKG) or rhythm monitoring findings consistent with myocarditis, abnormal cardiac function or wall motion abnormalities on echocardiogram, cMRI findings consistent with myocarditis, No other identifiable cause of the symptoms and findings. The risk of getting myocarditis from a COVID-19 vaccine is less than 1%. CDC continues to recommend that everyone ages 6 months and older get vaccinated for COVID-19. Among individuals older than 40 years of age, there were no more than 8 reports of myocarditis for any individual age after receiving either vaccine. Cookies used to track the effectiveness of CDC public health campaigns through clickthrough data. That means the vaccines protect heart health. A recent study classifying Long COVID into four types can help health care providers better target treatments for a patients specific symptoms. The review said they were all either elderly or had other health conditions. Vasudeva R, Bhatt P, Lilje C, et al. Information on v-safe is available at https://www.cdc.gov/vsafe. JEROME FLEG, M.D. The NHLBI supports and conducts research aimed at understanding risk factors for COVID-19, developing prevention and treatment strategies, and finding ways to hasten and enhance recovery. The https:// ensures that you are connecting to the Six awards are related to COVID-19related myocarditis. Mary Chamberland, Thomas Clark, Amanda Cohn, Frank DeStefano, Ruth Gallego, Alice Guh, Theresa Harrington, Fiona P. Havers, Lauri Hicks, Amelia Jazwa, Tara Johnson, Brian Kit, Paige Marquez, Sarah Mbaeyi, Elaine Miller, Hannah Rosenblum, Monica Parise, Kadam Patel, Pragati Prasad, David Shay, Jamila Shields, Christopher A. Taylor, Joshua Wong, CDC COVID-19 Response Team; Clinical Immunization Safety Assessment (CISA) Project; Vaccine Safety Datalink; Center for Biologics Evaluation and Research, Food and Drug Administration; Voting members of the Advisory Committee on Immunization Practices: Kevin A. Ault, University of Kansas Medical Center; Lynn Bahta, Minnesota Department of Health; Henry Bernstein, Zucker School of Medicine at Hofstra/Northwell Cohen Childrens Medical Center; Beth Bell, University of Washington, Seattle, Washington; Wilbur Chen, University of Maryland School of Medicine; Sharon E. Frey, Saint Louis University Medical School; Camille Kotton, Harvard Medical School; Sarah Long, Drexel University College of Medicine; Katherine A. Poehling, Wake Forest School of Medicine; Pablo J. Snchez, The Research Institute at Nationwide Childrens Hospital. Researchers also looked at rates per million doses and the rate was 35.6 cases per million for Moderna and 12.6 per million for Pfizer-;an almost threefold increase after Moderna shots vs.. scientist on Monday, every million doses of the Pfizer vaccine administered to 16- and 17-year-old boys would be expected to cause 73 cases of the . Myocarditis typically causes shortness of breath and chest pain. Centers for Disease Control and Prevention. The benefits (prevention of COVID-19 disease and associated hospitalizations, ICU admissions, and deaths) outweighed the risks (expected myocarditis cases after vaccination) in all populations for which vaccination has been recommended. A, For the BNT162b2 vaccine, there were 138 reported cases of myocarditis with known date for symptom onset and dose after 114246837 first vaccination doses and 888 reported cases after 95532396 second vaccination doses. Unfortunately, inflammation in the heart muscle can lead to serious complications, including heart failure, shock, or death. doi: 10.1001/jamanetworkopen.2022.53845. Exposures: No alternatives to mRNA COVID-19 vaccines for adolescents will be available for the foreseeable future, and vaccination of adolescents offers protection against COVID-19 that can be important for returning to educational, social, and extracurricular activities. endobj During the COVID-19 pandemic, Fleg turned his attention to the effects of SARS-CoV-2 infection on the heart, including myocarditis. Questions or messages regarding errors in formatting should be addressed to Patel, T., Kelleman, West, Z., M., Peter, A., Dove, M., Butto, A., & Oster, M. E. (2021). Myocarditis and Pericarditis After mRNA COVID-19 Vaccination, Centers for Disease Control and Prevention. doi: 10.1001/jamanetworkopen.2022.18505. Some groups have a higher risk of developing myocarditis from COVID-19. Figure 1.. Cases of Myocarditis After mRNA-Based, Figure 1.. Cases of Myocarditis After mRNA-Based COVID-19 Vaccination by Age at Onset of Myocarditis, Figure 2.. Cases of Myocarditis After mRNA-Based, Figure 2.. Cases of Myocarditis After mRNA-Based COVID-19 Vaccination by Time From Vaccination to Symptom, MeSH Researchers Identify Four Long COVID Categories. Myocarditis is a rare complication of COVID-19 vaccination. Approximately 96% of persons (784/813) were hospitalized and 87% (577/661) of these had resolution of presenting symptoms by hospital discharge. Symptoms typically include chest pain, dyspnea, or palpitations, although other symptoms might be present, especially in younger children (3). the rates per million doses were roughly 52 with the Pfizer shots and . Patients can usually return to their normal daily activities after their symptoms improve. 2022 Jun 11;399(10342):2191-2199. doi: 10.1016/S0140-6736(22)00791-7. Between 2001 and 2020, the Institute has funded 139 myocarditis studies at a cost of $43.6 million. Cordero, A., Cazorla, D., Escribano, D., Quintanilla, M. A., Lpez-Ayala, J. M., Berbel, P. P., & Bertomeu-Gonzlez, V. (2022). Comparison of COVID-19 Vaccine-Associated Myocarditis and Viral Myocarditis Pathology. When reported, the cases have especially been in adolescents and young adult males within several days after mRNA COVID-19 vaccination (Pfizer-BioNTech or Moderna). endorsement of these organizations or their programs by CDC or the U.S. A non-peer-reviewed retrospective paper, released as a pre-print, analyzed the rate of post-vaccination cardiac myocarditis in children aged 12-15 and 16-17 years who had received mRNA COVID . Myocarditis Cases After mRNA-Based COVID-19 Vaccination in the US. Paul Burton, M.D., Ph.D., shared that data has found that there have been 13.3 cases of myocarditis per 100,000 people who received the Moderna vaccine compared to 2.7 cases per 100,000 people. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). official website and that any information you provide is encrypted Were currently supporting two large studies looking at long-term effects of COVID-19, including myocarditis and other heart conditions. *** CDC is not responsible for the content In young people aged 12-17 years (boys and girls combined), the rate of myocarditis or myopericarditis in Denmark was 1 per 100 000 with BNT162b2 compared with 18.5 per 100 000 in Hong Kong,3 and roughly 7 per 100 000 in Israel (ages 16-19 years).2 In 12-39 year old males after the second dose of BNT162b2, the incidence of myocarditis or . The reports to the Vaccine Adverse Event Reporting System met the case definition of myocarditis (reported cases). Its important to remember that any vaccine can cause side effects. Because of uncertainty in the accuracy of myocarditis reporting, given that reviews are ongoing, and some cases might not have been reported yet, myocarditis reporting rates are presented as a range of values, calculated as 10% of the observed reporting rates. The benefit of vaccination against COVID-19 outweighs the potential risk of myocarditis and pericarditis. and transmitted securely. Expected vs. This risk should be considered in the context of the benefits of COVID-19 vaccination. Please enable it to take advantage of the complete set of features! CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website. 2021 Oct 1;6(10):1202-1206. doi: 10.1001/jamacardio.2021.2833. Age was not reported for 32 patients, and sex was not reported for 14 patients. The ACIP COVID-19 Vaccines Work Group, comprising experts in infectious diseases, vaccinology, vaccine safety, public health, and ethics, has held weekly meetings since April 2020 to review COVID-19 surveillance data, evidence for vaccine efficacy and safety, and implementation considerations for COVID-19 vaccination programs. endobj It is estimated there are around 2 more cases per 100,000 second vaccine doses in people under 40 who received Moderna original formulation than Pfizer original formulation. Descriptive study of reports of myocarditis to the Vaccine Adverse Event Reporting System (VAERS) that occurred after mRNA-based COVID-19 vaccine administration between December 2020 and August 2021 in 192 405 448 individuals older than 12 years of age in the US; data were processed by VAERS as of September 30, 2021. Moderna defended the use of its Covid vaccine, saying the protection it offers against severe disease, hospitalization and death outweighs the risk of myocarditis. 2 0 obj Of the nearly 21 million women, 7.2 million (34%) were younger than age 40, and a slightly increased risk of myocarditis was found among this younger age group after receiving a second dose of the Moderna COVID-19 vaccine: 7 estimated extra cases of myocarditis for every one million women vaccinated. Pediatrics 2011;127(Suppl 1):S4553. ** https://www.cdc.gov/mis/hcp/index.html, https://www.ahajournals.org/doi/10.1161/CIR.0000000000000239?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed#d3e785external icon. HHS Vulnerability Disclosure, Help Association Between Myocarditis and Mortality in COVID-19 Patients in a Large Registry. The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website. The y-axis range differs between panels A and B. Linking to a non-federal website does not constitute an endorsement by CDC or any of its employees of the sponsors or the information and products presented on the website. Follow-up is ongoing to identify and understand longer-term outcomes after myocarditis occurring after COVID-19 vaccination. Per million second doses of mRNA COVID-19 vaccine administered to males aged 1229 years, 11,000 COVID-19 cases, 560 hospitalizations, 138 ICU admissions, and six deaths due to COVID-19 could be prevented, compared with 3947 expected myocarditis cases after COVID-19 vaccination (Table 2). Gurdasani, D., Bhatt, S., Costello, A., Denaxas, S., Flaxman, S., Greenhalgh, T., Griffin, S., Hyde, Z., Katzourakis, A., McKee, M., Michie, S., Ratmann, O., Reicher, S., Scally, G., Tomlinson, C., Yates, C., Ziauddeen, H., & Pagel, C. (2021). Myocarditis was reported at a higher rate than expected among some people who received the Pfizer or Moderna vaccines, according to a July 2021 study. ; MIS-C Incidence Authorship Group. MMWR and Morbidity and Mortality Weekly Report are service marks of the U.S. Department of Health and Human Services. After reports of myocarditis and pericarditis in mRNA vaccine recipients, which predominantly occurred in young males after the second dose, an ACIP meeting was rapidly convened to review reported cases of myocarditis and pericarditis and discuss the benefits and risks of mRNA COVID-19 vaccination in the United States. . 23) cases per 100 000 person-days for the Pfizer-BioNTech Myocarditis has been linked with other vaccines, such as those that prevent influenza (flu), smallpox, and shingles.6. To describe reports of myocarditis and the reporting rates after mRNA-based COVID-19 vaccination in the US. CDC has provided guidance regarding evaluation and management of myocarditis after mRNA COVID-19 vaccine (https://www.cdc.gov/vaccines/covid-19/clinical-considerations/myocarditis.html), as well as considerations for a second vaccine dose in persons who develop myocarditis after a first dose (https://www.cdc.gov/vaccines/covid-19/info-by-product/clinical-considerations.html). (2022). Users are referred to the electronic PDF version (https://www.cdc.gov/mmwr) Among persons with reported myocarditis after mRNA vaccination, the median age was 26 years (range=1294 years), with median symptom onset interval of 3 days after vaccination (range=0179). If you have concerns about COVID-19 vaccination, talk with your healthcare provider or your childs doctor, nurse, or clinic. https://gis.cdc.gov/grasp/COVIDNet/COVID19_3.html. Even in this group, though, heart inflammation is seven or eight times more common after SARS-CoV-2 infection.10 And the data suggest that young adults with myocarditis possibly linked with COVID-19 vaccines recover quickly with supportive care.11. Shimabukuro TT, Nguyen M, Martin D, DeStefano F. Safety monitoring in the Vaccine Adverse Event Reporting System (VAERS). Among 1,194 reports for which patient age was known, 687 were among persons aged <30 years and 507 were among persons aged 30 years; of 1,212 with sex reported, 923 were male, and 289 were female. Among 1,094 patients with number of vaccine doses received reported, 76% occurred after receipt of dose 2 of mRNA vaccine; cases were reported after both Pfizer-BioNTech and Moderna vaccines. 3 0 obj Most of the cases have been reported after receiving a Pfizer-BioNTech or Moderna . This analysis did not include the potential benefit of preventing post-COVID-19 conditions, such as prolonged symptoms and MIS-C (6,7). Before Diagnosis and Management of Myocarditis in Children: A Scientific Statement from the American Heart Association. For Moderna's vaccine, rates of myocarditis or pericarditis overall were 23 cases per million first doses and 62.5 cases per million second doses. Members of the Advisory Committee on Immunization Practices COVID-19 Vaccines Safety Technical Work Group: Robert Hopkins, National Vaccine Advisory Committee; Kathryn Edwards, Vanderbilt University School of Medicine; Lisa Jackson, Kaiser Permanente Washington Health Research Institute; Jennifer Nelson: Kaiser Permanente Washington Health Research Institute; Laura Riley, American College of Obstetricians and Gynecologists; Patricia Whitley-Williams, National Medical Association; Tatiana Beresnev, National Institutes of Health; Karen Farizo, Food and Drug Administration; Hui Lee Wong, Food and Drug Administration; Judith Steinberg, U.S. Department of Health and Human Services; Matthew Clark, Indian Health Service; Mary Rubin, Health Resources & Services Administration; Fran Cunningham, Veterans Administration; Limone Collins, Department of Defense. FDA requires that vaccine providers report to VAERS vaccination administration errors, serious adverse events, cases of multisystem inflammatory syndrome, and cases of COVID-19 that result in hospitalization or death after administration of a COVID-19 vaccine under an EUA. For persons younger than 30 years of age, medical record reviews and clinician interviews were conducted to describe clinical presentation, diagnostic test results, treatment, and early outcomes. JAMA. Dr Soslow reported receiving personal fees from Esperare. Heart inflammation, or myocarditis, has been reported as a very rare side effect of COVID-19 vaccines. Montgomery J, Ryan M, Engler R, Hoffman D, McClenathan B, Collins L, Loran D, Hrncir D, Herring K, Platzer M, Adams N, Sanou A, Cooper LT Jr. JAMA Cardiol. A small number of myocarditis and pericarditis cases have been reported for booster doses. There were no cases. FOIA FLEG: Yes, but this is rare, and the symptoms are usually mild. Pillay J, Gaudet L, Wingert A, Bialy L, Mackie AS, Paterson DI, Hartling L. BMJ. COVID-19 Therapeutics: Use, Mechanism of Action, and Toxicity (Vaccines, Monoclonal Antibodies, and Immunotherapeutics). Accessed June 29, 2022, from. The rates of myocarditis were highest after the second vaccination dose in adolescent males aged 12 to 15 years (70.7 per million doses of the BNT162b2 vaccine), in adolescent males aged 16 to 17 years (105.9 per million doses of the BNT162b2 vaccine), and in young men aged 18 to 24 years (52.4 and 56.3 per million doses of the BNT162b2 vaccine and the mRNA-1273 vaccine, respectively). JAMA Netw Open. Would you like email updates of new search results? MMWR Morb Mortal Wkly Rep 2021;70:977982. Conflict of Interest Disclosures: Dr Creech reported receiving grants from the National Institutes of Health for the Moderna and Janssen clinical trials and receiving personal fees from Astellas and Horizon. Adenoviral Vector-Based Vaccine Platform for COVID-19: Current Status. The text reads: "Myocarditis is irreversible. Yes. A., Christakis, D. A., Cowell, L. G., Draper, C., Ghildayal, N., Harris, A. M., Kappelman, M. D., Ko, J. Y., Mayer, K. H., Nagavedu, K., Oster, M. E., Paranjape, A., Puro, J., Ritchey, M. D., Gundlapalli, A. V. (2022). The study shows a low but significant rate of myocarditis among vaccine recipients, at less than 1 per 100,000 recipients. You may have seen the recent reports linking rare cases. Cases have mostly occurred in adolescents and young adults under the age of 30 years and mostly in males. Within the Vaccine Adverse Event Reporting System (VAERS) (4), the national vaccine safety passive monitoring system, 1,226 reports of myocarditis after mRNA vaccination were received during December 29, 2020June 11, 2021. Chavda VP, Bezbaruah R, Valu D, Patel B, Kumar A, Prasad S, Kakoti BB, Kaushik A, Jesawadawala M. Vaccines (Basel). Informed by early reports, CDC prioritized rapid review of myocarditis in persons aged <30 years reported during May 1June 11, 2021; the 484 patient records in this subset were evaluated by physicians at CDC, and several reports were also reviewed with Clinical Immunization Safety Assessment Project investigators, including cardiologists. * Persons who lack the listed symptoms but who meet other criteria may be classified as subclinical myocarditis (probable or confirmed). Using the Dallas criteria (Aretz HT, Billingham ME, Edwards WD, et al. Comparisons of the risk of myopericarditis between COVID-19 patients and individuals receiving COVID-19 vaccines: a population-based study. FLEG: The CDC (Centers for Disease Control and Prevention) recommends COVID-19 vaccination for children as young as 6 months. Baggs J, Gee J, Lewis E, et al. They help us to know which pages are the most and least popular and see how visitors move around the site. Among 192 405 448 persons receiving a total of 354 100 845 mRNA-based COVID-19 vaccines during the study period, there were 1991 reports of myocarditis to VAERS and 1626 of these reports met the case definition of myocarditis. The CDC also needs to recommend . FLEG: Tens of thousands of people participated in the clinical trials for the COVID-19 vaccines. As of June 11, 2021, approximately 296 million doses of mRNA COVID-19 vaccines had been administered in the United States, with 52 million administered to persons aged 1229 years; of these, 30 million were first and 22 million were second doses. When reported, the cases have especially been in adolescents and young adult males within several days after mRNA COVID-19 vaccination (Pfizer-BioNTech or Moderna). Hromi-Jahjefendi A, Barh D, Uversky V, Aljabali AA, Tambuwala MM, Alzahrani KJ, Alzahrani FM, Alshammeri S, Lundstrom K. Vaccines (Basel). Broken down by age and sex, a second dose of the Moderna vaccine was associated with a higher rate of myocarditis or pericarditis compared with a second dose of the Pfizer/BioNTech vaccine among males ages 18 to 24 (adjusted rate ratio 6.6; 95% CI 3.3-13.2) and 25 to 39 (adjusted rate ratio 5.1; 95% CI 2.3-11.5), as well as females ages 18 to . Hamedi KR, Loftus G, Traylor L, Goodwin R, Arce S. Vaccines (Basel). Researchers added together cases after first and second doses to reach a total rate of 77 cases per million in this male age group triggered by vaccination, a sixth that seen after infection. Myocarditis linked with COVID-19 illness may also be more severe because these patients are usually older and have other health conditions that increase their risk of complications. In addition, CDC has updated patient education and communication materials reflecting this information for the Pfizer-BioNTech and Moderna****** COVID-19 vaccines; these are important to ensure that vaccine recipients, especially males aged 1229 years, are aware of increased risk for myocarditis and to seek care if they develop symptoms of myocarditis. Cases of myocarditis and pericarditis, although rare, have occurred more often in younger men (adolescents or young adults) and after the second dose, typically within a few days after . Dr Edwards reported receiving grants from the National Institutes of Health; receiving personal fees from BioNet, IBM, X-4 Pharma, Seqirus, Roche, Pfizer, Merck, Moderna, and Sanofi; and receiving compensation for being the associate editor of Clinical Infectious Diseases. (Jolygon/iStock via Getty Images) The risk of developing myocarditis - an inflammation of the heart muscle - following a booster dose of the Pfizer COVID-19 vaccine is low, according to new research from Israel. Key factors to consider are the current rates of COVID-19 infection, the childs overall health, and the parents assessment of risks. Your health care provider can provide more information thats specific to your situation. But the risk of myocarditis associated with the vaccine was lower than the risk associated with COVID-19 infection before or after vaccination - with one exception. According to the TGA, the current overall estimated rates for the entire population of myocarditis for Pfizer and Moderna are similar - 1.4 cases per 100,000 Pfizer doses versus 1.8 cases per 100,000 Moderna doses. The vaccine product-specific EUA fact sheet should be provided to all vaccine recipients and their caregivers before vaccination with any authorized COVID-19 vaccine. In a Danish study preceding Covid-19 of 753 autopsied sudden death cases, the cause of death was myocarditis in 42 (6%) cases corresponding to an SCD-myocarditis incidence of 0.16 (95%CI: 0.11-0.21) per 100 000 person-years, but males had significantly higher incidence rates of SCD-myocarditis compared to females with an incidence rate ratio of . myocarditis and pericarditis and the mRNA COVID-19 vaccines, made by Moderna and Pfizer-BioNTech, in some vaccine recipients. Kyt V, Sipil J, Rautava P. The effects of gender and age on occurrence of clinically suspected myocarditis in adulthood. Chou, O., Zhou, J., Lee, T., Kot, T., Lee, S., Wai, A., Wong, W. T., Zhang, Q., Cheng, S. H., Liu, T., Vassiliou, V. S., Cheung, B., & Tse, G. (2022). Suggested citation for this article: Gargano JW, Wallace M, Hadler SC, et al. Viruses. 2023 Feb 5;11(2):362. doi: 10.3390/vaccines11020362. <> Although numbers were too small to show rates in all subgroups by age, VSD data indicated increased risk of myocarditis in the 7 days after receipt of dose 1 or dose 2 of an mRNA COVID-19 vaccine compared with the risk 2242 days after the second dose, particularly among younger males after dose 2 (5). COVID-19 Vaccinations in the United States. Vaccine 2015;33:4398405. The U.S. Food and Drug Administration on Friday added a warning to patient and provider fact sheets for the Pfizer and Moderna Covid-19 vaccines to indicate a rare risk of heart inflammation. Myocarditis. Federal government websites often end in .gov or .mil. Of the 323 persons meeting CDCs case definitions, 309 (96%) were hospitalized. CDC twenty four seven. Members of the Advisory Committee on Immunization Practices COVID-19 Vaccines Work Group: Edward Belongia, Center for Clinical Epidemiology & Population Health, Marshfield Clinic Research Institute; Dayna Bowen Matthew, George Washington University Law School; Oliver Brooks, National Medical Association; Jillian Doss-Walker, Indian Health Service; Marci Drees, Society for Healthcare Epidemiology of America; Jeffrey Duchin, Infectious Diseases Society of America; Kathy Kinlaw, Center for Ethics, Emory University; Doran Fink, Food and Drug Administration; Sandra Fryhofer, American Medical Association; Jason M. Goldman, American College of Physicians; Michael Hogue, American Pharmacists Association; Denise Jamieson, American College of Obstetricians and Gynecologists; Jeffery Kelman, Centers for Medicare & Medicaid Services; David Kim, U.S. Department of Health and Human Services; Susan Lett, Council of State and Territorial Epidemiologists; Kendra McMillan, American Nurses Association; Kathleen Neuzil, Center for Vaccine Development and Global Health, University of Maryland School of Medicine; Sean OLeary, American Academy of Pediatrics; Christine Oshansky, Biomedical Advanced Research and Development Authority; Stanley Perlman, Department of Microbiology and Immunology, University of Iowa; Marcus Plescia, Association of State and Territorial Health Officials; Chris Roberts, National Institutes of Health; William Schaffner, National Foundation for Infectious Diseases; Kenneth Schmader, American Geriatrics Society; Bryan Schumacher, Department of Defense; Rob Schechter, Association of Immunization Managers; Jonathan Temte, American Academy of Family Physicians; Peter Szilagyi, University of California, Los Angeles; Matthew Tunis, National Advisory Committee on Immunization Secretariat, Public Health Agency of Canada; Thomas Weiser, Indian Health Service; Matt Zahn, National Association of County and City Health Officials; Rachel Zhang, Food and Drug Administration.

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