Shot of Prevention

By Christine Vara

I recall when AIDS was first making headlines 25 years ago.  There were so many misconceptions about the disease itself and how it was being spread that people were really frightened.  Nowadays, most people are educated about the ways in which the disease is transmitted and this has empowered people to take the steps necessary to protect themselves.  Education on AIDS prevention has therefore spared many people from pain, suffering and death.  

Unfortunately, the number of AIDS infected people in this world is still a staggering statistic and the global impact is frightening.  More than 2.7 million people worldwide are newly infected with H.I.V. every year.  According to an NY Times article written by Seth Berkley, president and CEO of the International AIDS Vaccine Initiative, and Alan Bernstein, executive director of the Global H.I.V. Vaccine Enterprise, the United Nations data shows that 5 million people are now receiving H.I.V. drugs in developing countries.  However, they represent just one-third of the number in need. For each person who receives treatment, 2.5 more are infected. While we in the US may not witness this devastating disease on a daily basis, 40% of the adult population in Swaziland, South Africa are already infected, resulting in an growing number of orphans among children.

So when will there be a vaccine that could effectively target this pandemic?  While many researchers have spent countless hours working on this, Mr. Berkley and Mr. Bernstein suggest that the search for an H.I.V. vaccine will only be accomplished through a global effort with more financial support.  Currently, there are only a handful of funders led by the U.S. government who pay for the bulk of H.I.V. vaccine research.  What is needed, they explain, is help from the private sector, whose expertise and resources could make the vaccine a reality, as well as a commitment by other nations to address this disease. 

USAID supports numerous HIV/AIDS projects in Uganda, including testing and counseling clinics.

While vaccine progress has been agonizingly slow, a recent trial on a preventative gel has proven that hope remains.  The vaginal gel, called a microbicide, consists of 1% tenofovir, which is an antiviral drug.  In the trial, African women inserted the gel before and after sexual relations from a plastic applicator to protect without their partner ever needing to be aware of the use of the gel.  Considering the cultural issues surrounding preventative measure in many areas of the world, this was a notable benefit of this type of AIDS prevention.    

The positive test results indicated that the gel provided women with at least a 39% chance of avoiding infection, while those using the gel faithfully experienced a 54% protection rate.  What’s even better is that there was an unexpected bonus that resulted from this gel as well.  Since tenofovir is an antiviral drug, it not only protected women from AIDS, but also offered a greater protection against genital herpes, which is also a viral infection. 

Interestingly, the NY Times published an article earlier this week Advance on AIDS Raises Questions as Well as Joy that pondered the many questions this research has raised.  For instance, is it safe enough to use daily?  Can it be used by pregnant women?  Could it be effectively used by men?  If more tenofovir went into the gel, would it be more effective?  The article goes on to discuss these and many other questions that could be explored in future trials.

The point here is that science is just that – scientific.  It can’t be rushed.  Research requires time and money and both are needed to determine results and evaluate the safety and effectiveness of various treatments.  One discovery often leads to more hope, and more questions.  Of course, in the interest of public health, we must accept the slow progress for the hope of lasting results. 

What are your thoughts on the fight against AIDS?  Are you encouraged by the scientific developments?  Let us know you thoughts by commenting below.

By Christine Vara

NBC News Chief Medical Editor, Dr. Nancy Snyderman, appeared this morning on NBC’s Today Show to discuss the current “comeback” of whooping cough.  As California is now facing the worse epidemic in 50 years, other states are also seeing an increase in infection and the numbers are expected to climb over the next few months.  Dr. Snyderman explains that we are witnessing a  tipping point that is contributing to the return of diseases like whooping cough and measles, and that can be attributed to a growing number of children who remain purposely unvaccinated.  Check out the video segment to hear Dr. Snyderman’s explanation of how individual’s are trumping the needs of the general populous by opting out of vaccinations.  She also explains how you can protect yourself, and the children in your life, by ensuring your family (adults and children alike) are keeping up with your vaccinations.

By Christine Vara

There are times when I feel so fortunate to live in this country.  Then there are days when I wonder what some Americans are thinking.  Yesterday, the vaccine related news gave me an equal sense of hope vs. despair. 

In Baltimore yesterday, there was a celebration announcing the city as one of six American cities that have been the most successful in improving childhood immunization rates.  Yet, in CA, news persisted regarding an epidemic of pertussis, the resulting death of the sixth infant this year as a result of this disease, and the concern that low vaccination rates in the state are a significant contributor to the epidemic.   

The hope came in reading an article in the Baltimore Sun, in which Dr. Beilenson details how the city of Baltimore went from a 60% immunization rate for school aged children in the mid-90’s, to an impressive 99.5% rate today.  Knowing the low immunization rates resulted from a lack of enforcement of state law by the school system, Dr. Beilenson, who was the health commissioner at the time, collaborated with the mayor and the Superintendent of Schools to enforce automatic exclusion of un-vaccinated students.  Support from the State’s Attorney pressured parents of kids who were not in school to also adhere to the school vaccine requirements.  These steps were combined with massive citywide immunization clinics, and their efforts proved successful. 

Within a matter of months, Baltimore’s school-age immunization rate jumped to 99.5 percent.  The gains, he claims, have been maintained by strong immunization programs, such as community-based centers and outreach vehicles.  With the current high immunization rates in Baltimore, public health officials no longer worry about the mini-epidemics of measles and mumps that had affected hundreds of Baltimore kids and families in years past.  The formula for success, according to Dr. Beilenson, was the determination of public health advocates who were able to effectively work with political leaders to influence immunization coverage.

In another example, organizations like the GAVI Alliance (Global Alliance for Vaccines and Immunisation), have also had a major influence on improving children’s health worldwide.  Their accomplishments are impressive.  In their first ten years, they have enabled 250 million children to be vaccinated, thereby averting an estimated 5 million early deaths.  This alliance is a successful strategic global partnership: a collaboration between private and public sectors.  Various governments, private sector philanthropists (such as the Bill & Melinda Gates Foundation), the financial community, vaccine manufacturers, research and technical institutes, organizations like the World Health Organization (WHO), the United Nations Children’s Fund (UNICEF) and the World Bank, all play a role in this alliance which helps to improve children’s health worldwide.  It is very promising to see the progress they have made and their successes should give us hope. 

But, like turning the pages of history, we continue to see despair.  There are still many children in various countries who are suffering, while recent headlines out of California continue to raise concerns over a pertussis outbreak here in the states.  Health officials expect this to be the worst epidemic of the contagious disease in the stateof CA  in 50 years.  The pertussis epidemic has already claimed the life of six infants this year, and nearly 1,500 whooping cough (pertussis) cases have been reported this year, which is  nearly five times the number of cases reported last year.  Health officials warned that low vaccination rates among U.S. adults (less than 6 percent nationally) and vaccine refusal from parents for their children, are contributing factors that are endangering the lives of infants too young to be immunized.

Although we live in a country where we have the money, the means and the education to know how to protect ourselves and our children, diseases it is obvious that diseases like pertussis continue to infect our population and claim the lives of infants.  The city of Baltimore and the GAVI Alliance are clear examples of how public health advocates can effectively work with political leaders to influence immunization coverage and protect children from vaccine preventable diseases.  Hopefully areas, like those in CA and other states, who are witnessing a rise in pertussis, can use these examples as a model to quickly address the issue with a boost in immunization rates. 

Listed below are a few recent articles that detail the CA pertussis epidemic.  Share this information to help us spread the word that adolescents and adults should be getting a Tdap booster and let us know what you are doing to get the word out by commenting below.    

 ”Whooping Cough Epidemic Hits California” WebMD  (July 21, 2010)http://children.webmd.com/vaccines/news/20100721/whooping-cough-epidemic-hits-california

“Infant dies of whooping cough, third confirmed death this year in L.A. County, sixth in state” Los Angeles Times (July 20, 2010)  http://latimesblogs.latimes.com/lanow/2010/07/infant-dies-of-whooping-cough-third-confirmed-death-this-year-in-la-county-sixth-in-state.html

 ”Marin Vaccine Fears May Be Linked to Illness Outbreak” NBC – Bay Area (July 20, 2010) http://www.nbcbayarea.com/news/health/Low-Vaccination-Rates-Linked-to-Whooping-Cough-Outbreak-jw-98875904.html

“California Whooping Cough Outbreak May Be Worst In 50 Years” U.S. News (MD) (July 20, 2010) http://health.usnews.com/health-news/managing-your-healthcare/articles/2010/07/20/health-highlights-july-20-2010.html

“Whooping cough epidemic grows; California, Monterey County officials urge vaccine for women, seniors” The Californian (July 20, 2010)http://www.thecalifornian.com/article/20100720/NEWS01/7200308/Whooping-cough-epidemic-grows-California-Monterey-County-officials-urge-vaccine-for-women-seniors

 ”Whooping Cough: Low Adult Vaccination Rates Makes Infants More Vulnerable” New America Media  (July 17, 2010)  http://newamericamedia.org/2010/07/whooping-cough-low-adult-vaccination-rates-makes-infants-more-vulnerable.php

 ”Coughing Up the Facts on Pertussis (Whooping Cough) – Dr. Glenn D. Braunstein” The Huffington Post (July 12, 2010)  http://www.huffingtonpost.com/glenn-d-braunstein-md/coughing-up-the-facts-on_b_642745.html

By Christine Vara

When I first started contributing to the Shot of Prevention blog, I couldn’t help but feel a bit of frustration.  It seemed whenever I read an article about vaccines, there was always some mention of autism.    It got to the point where I wondered if the word autism could ever be used in a sentence without it somehow being linked to vaccines.  Of course, I quickly became a student of history and science, while also an observer of the enormous amount of misinformation that is disseminated online in regards to a suggested link of autism and vaccines. 

The shining light came when I was fortunate enough to discover an organization called the Autism Science Foundation.   Recently, they launched the ”Autism Science Foundation Channel on YouTube“ which features interviews with top autism researchers, ASF grantees, autism book authors, and details the important new autism research being conducted today. 

By focusing on the science, this organization’s mission is to “support autism research by providing funding and other assistance to scientists and organizations conducting, facilitating, publicizing and disseminating autism research”.  Their efforts are critical in providing information about autism to the general public and their work helps to increase awareness of autism spectrum disorders and the needs of individuals and families affected by autism.

What’s important to note, is that their philosophy is based on three sound principles, as summarized below.

•  Autism is known to have a strong genetic component. Research must aim to discover the mechanisms of action that trigger autism, as well as safe, effective and novel treatments to enhance the quality of life for children and adults currently affected.
• Early diagnosis and early intervention are critical to helping people with autism reach their potential, but educational, vocational and support services must be applied across the lifespan.
• Vaccines save lives; they do not cause autism. Numerous studies have failed to show a causal link between vaccines and autism. Vaccine safety research should continue to be conducted by the public health system in order to ensure vaccine safety and maintain confidence in our national vaccine program, but further investment of limited autism research dollars is not warranted at this time.

It is comforting to know that there are autism advocates who recognize the fact that vaccines save lives.  I commend the Autism Science Foundation for standing firm on this principle.  I admire the work they are doing to advance autism research and encourage everyone to check out their new YouTube channel. 

Their premise continues to give me hope:  Communicating what we do know about what causes autism is often the best way to dispel myths about what doesn’t.   Do you agree?

By Christine Vara

I know this sounds pretty pathetic, but the sad reality is that some parents delay or avoid vaccinations because they simply don’t want to deal with their kids’ fear of pain, needles and shots.  I suspect that the same holds true in regards to some adults, and their yearly recommended flu vaccine.   Many patients would rather opt for a painless method than a needle in the arm.  Others avoid vaccinations, finding it a difficult and time consuming inconvenience to get to the doctor or clinic to have the shots administered. 

It can be painful and inconvenient for a flu shot to be administered in a doctor's office or clinic. (photo courtesy of the CDC's Public Health Image Library)

After reading a recent AP article Microneedles May Make Getting Flu Shots Easier, it occurred to me that there would probably be a market for a self administering vaccination patch like the one being developed by researchers collaborating at Georgia Tech and Emory University.

 The concept is pretty straight forward.  A Band Aid type patch, comprised of small microneedles, about three-hundredths of an inch in length – so small they tend to feel like sandpaper – is placed on the skin for 5 to 15 minutes to administer the correct amount of flu vaccine.  The little needles barely penetrate the skin before they dissolve and release their vaccine.  Since the needles then dissolve, there are no leftover sharp needles to be concerned about discarding.  Also, since there is no special training needed to administer the vaccine, people would be able to receive it in the mail or at the pharmacy and give it to themselves at home.

To me this sounds very promising.  According to lead researcher Mark Prausnitz, of the Georgia Institute of Technology Researchers, the patch has been tested on mice, but they are now seeking funds to begin tests in people with the hopes that the patch could be in use in approximately five years.  I think it will be interesting to see how modern science continues to improve immunization methods and how these less painful methods may in turn increase immunization rates.

What are your thoughts on this new development?  Do you believe more people would get their vaccinations if they could utilize this new method?  Let us know what you think by commenting below.

By Christine Vara

In light of the recent rise in pertussis in several states, it’s important that parents understand one basic fact about vaccines.  In a recent article in the Contra Costa Times, part of the CA Bay Area newsgroup, a mother questions why her 3 month old daughter had been diagnosed with pertussis, after she had received the pertussis vaccine just a month prior.

While this seems like a reasonable question, there is a reasonable answer.  It takes three!

As Dr. David Pepper states in his article, Healthy Outlook:  When a vaccine may be ineffective, “The reason this infant became ill, despite having been vaccinated, is that a first dose is just the start of becoming immune.  Usually all three shots in the series are needed for the best immunity and to prevent infection.  Immunity often requires a series of shots, such as in the DTaP vaccines, and the Hepatitis B vaccine that is given in three shots over six months.”

This is just another reason why it is important for children to stay up to date with their vaccinations.  A child’s immune response is one of many considerations when the recommended vaccination schedule is developed.  But to space out the vaccines even further simply delays the time in which the child will be better protected, which in turn increases the risk of disease. 

Adults are encouraged to consider Tdap booster shots as well, since immunity can decrease over time.  The concept of “cocooning” infants, by ensuring that the adults in their lives are immunized, can greatly reduce the risk of the children contracting disease during the time in which they are not completely immunized.