How Are People in the U.S. Impacted By Polio Around the World?

October 18, 2016 1 comment

On October 24th, Rotary International will host the fourth annual World Polio Day event to raise awareness, funds and support to #EndPolioNow.

Since Rotary and its partners launched the Global Polio Eradication Initiative nearly 30 years ago, the incidence of polio has plummeted by more than 99.9 percent, from about 350,000 cases a year to 26 confirmed as of Sept. 19, 2016. Today, polio remains endemic in three countries – Afghanistan, Nigeria and Pakistan.


Until poliovirus transmission is interrupted in these countries, all countries remain at risk of importation of polio, especially vulnerable countries with weak public health and immunization services and travel or trade links to endemic countries. Without full funding and political commitment, this paralyzing disease could return to previously polio-free countries, putting children everywhere at risk.

Before we engage in the global discussion on polio eradication next week, we’ve asked Every Child By Two Board Member and infectious disease specialist, Paul A. Offit, MD, to elaborate on the “State of the ImmUnion” for polio here in the United States.  


This is what he had to say:

What is the most striking fact about polio that you wish people knew?

That once people are affected, there isn’t much you can do to make them better. The only real weapon against polio is the vaccine. Everything else—iron lungs, braces, hot packs, and occupational therapy—are far too little far too late.

How would you describe the current “State of the ImmUnion” for polio? Are there still cases of polio in the U.S.? Are enough people protected? How could people in the U.S. get polio?

Read more…

When Is the Best Time to Get a Flu Shot?

October 12, 2016 Leave a comment

Every year, some of the same questions and concerns about season influenza and flu vaccination make the rounds on social media.  So far this season, we’ve been hearing a lot of questions regarding the appropriate timing of a flu vaccination.  Some people have mistakenly been advised to delay vaccination until November. Experts agree the best time to get a flu shot is now and here’s why:

When is flu season? 

The CDC states,

“While seasonal influenza (flu) viruses can be detected year-round in the United States, flu viruses are most common during the fall and winter. The exact timing and duration of flu seasons can vary, but influenza activity often begins to increase in October. Most of the time flu activity peaks between December and March, although activity can last as late as May.”

When is the optimal time to get a flu vaccine? 

In recent years,  initial shipments of influenza vaccine have begun to arrive at some providers as early as July. Since this is well ahead of the typical onset of flu activity, many people have questioned when it is appropriate to start vaccinating for flu.

It makes sense that vaccination should occur before the onset of influenza activity.  However, since no one can predict when influenza viruses may start circulating in any particular area, the Advisory Committee on Immunization Practices (ACIP) recommends that everyone over the age of 6 months should be vaccinated by the end of October, when it’s most common for flu activity to begin.


This FluView images shows flu activity as late as May 31, 2016.

It’s important to understand that if can take up to 2 weeks from the date of vaccination for most people to generate vaccine induced immunity.  Additionally, children aged 6 months through 8 years, who have not been vaccinated in previous years, will require 2 doses of flu vaccine before they are optimally protected.  Therefore, they should receive their first dose as soon as possible after the vaccine becomes available, and the second dose at least 4 weeks later.

While vaccination by the end of October is recommended, the CDC is clear to state  that October is not a cut-off. Vaccination should continue as long as influenza activity persists because the duration of the season can vary.  For instance, a vaccine administered in December or later can still be beneficial since influenza activity can often last well into April or even May.

But wait….why are some people suggesting we wait to vaccinate?

Read more…

What You Should Know to Prepare for Flu This Season

September 29, 2016 Leave a comment

Earlier today, Tom Frieden, M.D., M.P.H., director of the CDC, joined leading medical and public health experts at the National Foundation of Infectious Diseases (NFID) News Conference to discuss the upcoming 2016-2017 flu season and vaccination coverage results from last season.

While flu season doesn’t “officially” begin until October 1st, Dr. Frieden reminded the public that the flu is unpredictable and there is no way to know when the virus will be circulating in your community.  This is why experts recommend getting yourself and your family members vaccinated now.

During his opening remarks, Dr. Frieden explained that the CDC has already tested 5,000 viruses and has begun to identify cases of flu across the U.S.  While it appears that this year’s vaccine will be a good match to the strains that were circulating at the end of last year, he explained that there’s no way to predict what type of flu season we will have in 2016-2017.  The best that we can do is to be get vaccinated.  flu

Dr. Frieden conceded that flu vaccination is not perfect. While we all wish it were better, he urged everyone over 6 months of age to get vaccinated since a flu vaccine can reduce a person’s risk of flu by at least 50%.  Flu vaccination also substantially reduces the risk of hospitalizations and other complications, while also reducing the risk of death.  In a bad year, the flu kills up to 49,000 Americans, 100 of which are infants and children.  Sadly, about 90% of the children who have lost their lives to flu were unvaccinated.

The most promising statement Dr. Frieden made in his opening remarks helped illustrate the enormous impact flu vaccination can have on our health and our communities. 

“If we could increase influenza vaccination coverage by just 5%, we would prevent 800,000 illnesses and almost 10,000 hospitalizations.”

Childhood Flu Vaccination According to the Numbers

Over the years, we’ve been making progress in increasing flu vaccination rates, however there is still plenty of room for improvement.

For example, Patricia Whitley-Williams, M.D., NFID Vice President and Division Chief and Professor of Pediatrics at Rutgers Robert Wood Johnson Medical School, stated that ten years ago only about 10-20% of children ages 6-23 months of age were vaccinated against flu. In contrast, last year about 75% of kids in that same age group were vaccinated for flu, exceeding our national public health goal.

Unfortunately, the goal has yet to be met in other age groups. Dr. Whitley-Williams explained that as kids get older, flu vaccination rates tend to decline, with only 47% of children 13-17 years being vaccinated last year.  This has had a direct impact on the 20,000 kids under the age of 5 who are hospitalized with flu related complications in this country every year.  While roughly 46% of people over the age of 6 months old were vaccinated last season, there were still 30 million kids that didn’t get a flu vaccine.

Vaccinating Healthcare Workers 

fight-flu-banner_585x338We are making progress among healthcare workers as well. The data indicates that 9 out of 10 healthcare workers were vaccinated last year, and there was also a slight increase in coverage among healthcare personnel working in long-term care settings such as nursing homes.  Yet, flu vaccination rates among adults age 50 and above decreased by  3% last year.

Importance of Flu Vaccine for Aging Adults 

Wilbur H. Chen, M.D., Associate Professor, University of Maryland School of Medicine concluded the news conference by address the concerns of a growing adult population.  The number of people age 60 and older will soon outnumber children 5 and under, and the concern is that this older demographic is often the hardest hit by flu.

Approximately 70-90% of influenza deaths occur among people 65 and older, and 50-75% of flu related hospitalizations occur in this age bracket as well.  While people are living longer, they can’t avoid the fact that our immunological peak appears to occur somewhere around age 45.  As a person ages, their immune system begins to decline resulting in higher rates of infection, more severe infections, and a lesser immune response when vaccinated.  At an age when flu vaccination is vitally important, only 63% of adults over 65 were vaccinated for flu last season.  Flu vaccination is an effective way to reduce illness and hospitalizations among this age group, while also helping to prevent other health complications such as heart attack and stroke.

Since pneumococcal and flu often go together, Dr. Chen suggested that older adults consider getting a pneumococcal vaccine in addition to their annual flu vaccine, if they haven’t already done so.  There are two different pneumococcal vaccines that are recommended to the public; the first is for everyone 65 and over, while the other is for those under age 65 with certain health conditions. While pneumococcal sends half a million people to the hospital each year, 4 out of 10 Americans over 65 still haven’t received a pneumococcal vaccine.

Importance of Flu Vaccination in Pregnancy

pregnant-women-vaccinated-by-flu-shotExperts continue to emphasize the benefits of flu vaccination among pregnant women.  Expectant woman are six times more likely to die from flu when pregnant, and contracting the flu during pregnancy can result in dangerous complications, to include pre-term labor.  Studies have shown that vaccinating pregnant woman can help protect the mother and her pregnancy while also transferring passive immunity on to their babies which can help protect them against flu for several months after they are born, while they are too young to be vaccinated themselves.  While flu vaccination coverage for pregnant women remained similar to previous season at 49.9%, this statitic measn that nearly half of all pregnant women and their babies are not protected from flu.

No Nasal Spray Flu Vaccine This Year

One of the biggest changes in the flu vaccine recommendations for the 2016-2017 season involves the elimination of the use of the nasal spray flu vaccine this year.   Read more…

Trivializing the Flu – It’s What Healthy Adults Tend To Do

September 27, 2016 45 comments

It’s not uncommon for healthy adults to skip their annual flu vaccine.  In fact, it’s estimated that only about 40% of adults receive an influenza vaccine each year – a preventive measure that the CDC recommends for everyone age 6 months of age and older, with rare exception.

While adults tend to understand that the flu can be dangerous and sometimes even deadly, they often don’t get vaccinated because they just don’t consider themselves at risk.


I imagine it’s because we’re living in a time when modern medicine is so advanced.  The average American just doesn’t consider it likely that a healthy adult could die from something so common as the flu? One would imagine that those at greatest risk of death from flu would be young children, the elderly or people who have underlying health conditions, right?

ceciliaheadshot-250x378While it is true that there are certain demographics of people who may be more likely to suffer severe consequences from flu, it does not mean that a healthy adult is not also at risk of hospitalization or death. As Michael Pulgini explains, the flu is “aggressive, sneaky, and potentially deadly” and “no one is invincible” just because you are young, strong, or healthy.

You see, Michael is one of those healthy adults who refused the flu shot last season, citing that he felt it wasn’t necessary and suspecting it might make him sick.  Michael ended up contracting the flu, but recovered after about five days of body aches, fever, runny nose and cough.

But what continues to haunt Michael today is the fact that his wife also fell victim to the flu – but sadly, she never recovered.  

Michael now lives with the horrifying memory of watching his beautiful wife Cecilia suffer and die from the very disease that he had previously trivialized.

After Michael had recovered, Cecilia started to show signs of illness, such as runny nose, body aches and pains, and a weird symptom that caused her upper lip to swell.  She made several visits to the doctor, and the last visit occurred about eight or nine days after her first symptoms appeared.  This time, she was complaining of shortness of breath.  The doctor gave her an injection to help open up her airways, but within 30 hours Cecilia was in terrible distress and her breathing was very rapid and shallow.  A chest x-ray at the hospital showed one lung was completely covered in puss and fluid from an infection.

cecilialipDoctors explained that the influenza virus continued to replicate, hitting Cecilia full force and completely overpowering her body’s ability to fight off the infection.

They also told Michael something he will never forget;

If she had been vaccinated against influenza, there was a 90% chance she wouldn’t be here [in the hospital] like this.”

Sadly, Cecilia was put into a medically induced coma.  They intubated her and put her on a ventilator since she was unable to breathe on her own. All the while, Michael believed in his heart that she would pull through because she was young and strong.

But Michael was wrong.  He explains,

Read more…

Preventing Shingles Today and the Promise of New Vaccines Tomorrow

September 22, 2016 Leave a comment

The timing could not have been worse.

It was the holiday season and many family members were traveling great distances to converge on “Mom’s House”.  To complicate matters even more, one family member was temporarily living with her mom as a result of being on bed rest for the duration of her high risk pregnancy.

Her mother, who was a fairly active woman in her mid-70 without any health problems, was complaining about back pain.  She believed she had strained a muscle but couldn’t seem to get relief.  When the rash appeared a few days later, it became clear that she had shingles.

It really shouldn’t have come as much of a surprise. 


About one of every three people in the U.S. will get shingles during their lifetime, and the risk increases with age. For immune compromised individuals, the risk of shingles increases by as much as 50 fold. In fact, every year in the U.S. approximately one million people are affected by shingles.  

If you’ve ever known someone who has suffered with this disease, you’ll know why you would want to prevent it. 

Shingles can cause severe and long-lasting pain.  While the shingles rash typically resolves in about a month for most people, the pain is very difficult to treat.  Other symptoms include fever, headache, chills, upset stomach, muscle weakness, skin infection, scarring.  Shingles can also develop in the eyes and cause vision loss.  Additionally, in about 10-18% of cases, patients will suffer with postherpetic neuralgia (PHN) which is a condition best described as a lingering, burning, stabbing, throbbing, or shooting pain that can last weeks, months or even years.

So with one mom down with shingles, her daughter grew concerned over the arrival of her new baby.  Would it be possible for her newborn to contract the virus?  

Fortunately, people don’t catch shingles from other people.  Rather, shingles (also called herpes zoster) is caused by a reawakening of the varicella zoster virus (VZV) that causes chickenpox. After contracting chickenpox, the virus lives in the nervous system for years – even decades – until something causing it to reawaken.  Sometimes it’s reawakened by a waking of the immune system from advancing age or immune-suppressive drugs used to treat cancers.  But what’s hardest to accept is that most cases of shingles occur among adults who are otherwise healthy.  Even having suffered with shingles doesn’t prevent someone from having it again.  In fact, a reoccurrence of shingles happens in about 6% of people.

In the case of the mother and pregnant daughter sharing a home, the possibility existed that the newborn baby, too young for varicella vaccine, could potentially be at risk of contracting chickenpox if she were to come into contact with the rash of the infected grandmother.  This is why the family was advised by their doctors to be extra diligent in washing hands after touching any of the open sores.

screen-shot-2016-09-22-at-3-21-06-pmWhile there are verified cases of shingles in people of all ages – even adolescents – the risk of shingles appears to peak in those age 65 and older (as seen in the chart at left).

So, while scientist have been observing an increase in the incidence of zoster since 1993, they attribute the rise in cases to an aging population as well as a population who is increasingly immune compromised.

To complicate matters further, experts explain that the epidemiology of zoster has been changing and it’s unclear exactly why.  The current vaccine, which we know to have poor efficacy in the high risk elderly, also does not provide long-lasting protection. However, it can reduce the risk of shingles by half (51%) and reduces the risk of prolonged pain at the rash site by 67%.

When shingles vaccine was first licensed in 2006, it was approved for use in people age 50 and over.  In fact, the research at that time determined that the shingles vaccine had a 70% efficacy  among people ages 50-59.  However, the efficacy was reduced when administered to older individuals, and protection continued to decline significantly at 5-10 years post vaccination.

So, when the Advisory Committee on Immunization Practices (ACIP) announced their adult vaccine recommendations in 2008, they recommended one dose of shingles vaccine be administered to adults at age 60 and older.  Their decision was based on the belief that vaccine administrations should be timed to achieve the greatest reduction in burden of disease and the related  complications.  Since there was insufficient evidence of long-term protection offered by the zoster vaccine, it was believed that vaccinating persons under 60 years of age may not help protect people when the incidence of herpes zoster and it’s complications were at their highest.

While it appears that there has been a downward trend in childhood cases of shingles since 2005, most likely as a result of increased varicella vaccination among children, current shingles vaccine uptake among adults 60 and over is lower than most other adult recommended vaccines at just 27.9%.  If uptake were greater it is suspected that we would be seeing fewer cases.

In looking ahead, we are hopeful that two new shingles vaccines will prove to be more effective.

Read more…

Physicians Can Help Influence Vaccine Opinions By Engaging Patients on Social Media

September 8, 2016 2 comments

posterDr. John Merrill-Steskal has spent 22 years as a Family Medicine Physician.  He believes that doctors can help promote healthy behaviors by becoming more engaged on social media. Throughout the past year, in an effort to help shape public perception on a variety of medical topics such as vaccines, Dr. Merrill-Steskal has begun hosting a monthly radio show,  blogging at Triple Espresso MD, and contributing guest posts on other blogs such as KevinMD.  We welcome his latest contribution:

Vaccine hesitancy: It’s time to go on offense

by John Merrill-Steskal, MD

The term “vaccine hesitancy” is a relatively recent term in medicine, a term used to describe patients who are worried about the safety, efficacy, or necessity of receiving immunizations. Vaccines are safe and have a proven track record of saving lives. As a result, doctors have been caught somewhat off guard by the notion that anyone would have second thoughts about the benefits of immunization.

Recommendations commonly publicized on how to respond to the vaccine hesitant patient are admirable, and have a calm, respectful tone.  For example, doctors are encouraged to engage patients and respond to their concerns, while giving a clear message to recommend vaccination. Since treating patients disrespectfully or with disdain will only serve to alienate them further, being respectful, calm, and clear in our communication is our best chance at tipping the scales in favor of vaccination

The problem with this approach, however, is that physicians are on the defensive before a discussion even begins. And as in sports, a good defense without an offense will not win the game. Because of where we talk to patients, doctors are at a critical disadvantage: the physical place in which physicians engage patients about vaccines is typically the exam room, and by the time patients have arrived to the clinic they may well have already formed their opinions about vaccines.

As a result, physicians are forced to respond and react to concerns, and must attempt to reclaim ground that has already been lost. In other words, because of the nature of where physicians physically interact with and engage patients, we are by default always on the defensive as we work to dispel myths and misinformation regarding vaccine safety or efficacy.

To make a true difference on vaccine hesitancy, I think doctors must engage patients where the dialog is happening in real time: in the world of social media.

Every day patients acquire information, discuss concerns, and formulate opinions within the realm of social media.  By the time a patient enters the exam room, their mind may already be made up about vaccines. While our discussions with individual patients in exam rooms will always be important, it is becoming equally important for physicians to enter the dialog where it is being created, before the patient arrives at the clinic. Physicians need to pay attention to what patients are talking about on social media, and need to be a part of that dialog.  If we don’t, we will always be on the defensive.

If we are to advance vaccination, physicians must leave the safety of the exam room and meet patients where their opinions are being created.  Start a blog, tweet an opinion grounded in science, or engage patients online; by having a stronger voice in social media, doctors have the opportunity to be more influential in shaping opinions before our patients have become “hesitant“.

It is time to go on the offensive, and is the only way we will win the game.


Dr. Merrill-Steskal is joined by a guest on his monthly radio show.


Dr. John Merrill-Steskal has recently been accepted to the 2016 American Academy of Family Physicians Vaccine Science Fellowship, an elite fellowship program which only accepts two providers per year.  We look forward to learning more about his work in the area of immunization education and we suggest readers also check out his other immunization related blog posts such as Past and Present: Rubella and Zika and Can the anti-vaccine movement be convinced with more positive messages?  

You can follow him on Twitter @MerrillSteskal.

Every Child By Two (host of the Shot of Prevention blog) welcomes guest blog posts on a variety of vaccine related issues.  The views and opinions expressed in these guest posts do not necessarily represent the views of the Every Child By Two organization.

Triumph Over Smallpox Reminds Us That Vaccines Help Prevent Disease Every Day

August 31, 2016 Comments off

Every Child By Two’s State of the ImmUnion campaign is honoring National Immunization Awareness Month (#NIAM16) with a Blog Relay highlighting the importance of vaccines across the lifespan and across the nation.

Parker.Heidi__vertical_0In this guest post, we hear from Heidi Parker, MA, Executive Director of Immunize Nevada.  She reminds us that promoting health and preventing disease is not just a cause to recognize during the month of August; instead, it is something we need to do each and every day.

By Heidi Parker, MA, Executive Director of Immunize Nevada

Dr. Donald A. Henderson passed away recently, with little media attention or fanfare. This is alarming, considering “saving millions of lives” was listed as one of his life accomplishments.

22Henderson1-obit-master768In case you’re wondering who he is, Dr. Henderson led the global effort to eradicate smallpox — a disease that, in the 20th century and before it was extinguished, was blamed for at least 300 million deaths. Clearly, his triumph over smallpox proved the power of vaccines.

During National Immunization Awareness Month, we are reminded that promoting health and preventing disease is not just a cause to recognize during the month of August; instead, it is something we need to do each and every day.

We must be relentless, much like Dr. Henderson was. Why? Because our news feeds continue to be filled with stories of vaccine-preventable diseases – a teen dies from meningococcal diseasea summer camp closes due to a whooping cough outbreakcollege campuses battle mumpsmeasles spreads at music festivalsan infant too young to be vaccinated dies from pertussis; the list goes on.

In the United States, vaccines have reduced — and in some cases, eliminated — many of the diseases that killed or severely disabled people just a few generations ago. My great-grandfather died during the 1918 Influenza Flu Pandemic, along with millions of others; but decades later, our family is protected from this deadly virus when we get our annual flu shot. By vaccinating children against rubella (German measles), the risk that pregnant women will pass this virus on to their fetus or newborn has been dramatically decreased, and birth defects associated with that virus are now rarely seen. Countless examples like these demonstrate, day after day, vaccines are one of public health’s greatest achievements.

Unfortunately, tens of thousands of Americans still suffer serious health problems, are hospitalized, and even die from vaccine-preventable diseases. Read more…