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Nurses, Teachers and Mothers All Influence Immunization Uptake

May 11, 2018 1 comment

This week is not only National Nurses Week, but it’s Teacher Appreciation Week and soon to be Mother’s Day.  As I sat down to acknowledge nurses, teachers and mothers, one person came to mind – Mary Beth Koslap-Petraco, DNP, PNP-BC, CPNP

32191415_810903039094009_6826616278065610752_nIf you ever get the chance to meet Dr. Koslap-Petraco, there are three things you will immediately recognize.

She is a leader among nurses.

She is incredibly passionate about immunization education. 

And she adores her family – especially her mother.

 

A few years ago, Dr. Koslap-Petraco shared the story of how her mother’s life was forever altered by polio.  In honor of her mother, Mildred Bliss Koslap, who recently passed away at the age of 98, I want to share her story once again.  The Koslap family story is a reminder of the role that mothers, nurses and teachers have in ensuring that people of all ages embrace immunization as a way to prevent debilitating diseases.

Dr. Koslap-Petraco begins the story by explaining that it was the summer of 1923, and her mother was only three years old:

“During that period in our history, it was common for families like mine to escape the heat of New York City and travel upstate to cooler weather.  That summer, the family chose to reside in a guest house in Utica, NY.  My mom arrived to Utica a fully-functioning and fun-loving child, but on a subsequent Sunday morning, she remembers not being able to get out of bed due to paralysis on the right side of her body.  She was able to scream out for help initially, but her voice consistently diminished throughout the day, only to disappear for a week.

Her father called for medical assistance, but during this time in Utica, people strictly followed what were known as Blue Laws—forbidding any type of work or major exertion to be made on Sunday.  With time, my grandfather was able to convince a kind-hearted Jewish doctor to come over.  He instantly recognized my mother’s condition as polio.  The periodic massages and other treatments that my mother had to undergo were hassle enough for a young child, but the emotional strain for her was even worse.

After a short time, her siblings were not allowed to play with her, for fear that they might come down with polio themselves.  And when my mother—born left-handed—entered school, she was constantly punished by the nuns who directed her to write using her right hand.  What they did not understand was that my mother had lost the ability to grasp objects with this hand as a result of her polio.  To this day she remains able to hold nothing more than a glass of water with her right hand.

To me, it’s important that I never lose sight of the experiences like this that my mother and her family had to endure that one hot summer in 1923.  What’s even more important is that I acknowledge the fact that polio is no longer a significant threat to the health of people in America.  Science and research have delivered so much to us, including the means to eliminate the threat of major preventable diseases like polio.”

polioMildred appears to have had a great life, raising three strong, successful and independent daughters and living to know not only five grandsons, but seven precious great-grandchildren. But that doesn’t mean she didn’t suffer throughout her life from her experience with polio at the age of three.  Her scars served as a constant reminder of the dangers of polio – a disease that greatly impacted her life, her parents’ lives, her siblings’ lives and even the lives of her children, grandchildren and great-grandchildren.

As a mother, I’m happy that my children will never have to suffer through the same experiences that Mildred did. I’m even grateful that my own parents chose to vaccinate me as a child and that they raised me to value the preventive power of vaccines.

I’m thankful to all the nurses who take the time to educate others about the benefits of vaccines, care for people who are suffering from vaccine preventable diseases, and bear the responsibility of administering vaccines.  I’m also encouraged by non-profit organizations like Nurses Who Vaccinate, which help to position nurses and other health care professionals as vocal vaccine advocates among their colleagues, patients, and the public.

And I’m grateful to all the teachers who do their part to educate people of all ages about the dangers of infectious diseases and how vaccines can help to boost our immune system.  I’m especially impressed with organizations like The Vaccine Makers Project which offers scientifically supported, historically accurate, and emotionally compelling content that teachers can use in the classroom to help excite young people about the power of vaccines.

While polio does still exist in the world, we are extremely close to eradicating it, thanks to the success of vaccines. However, as long as there are communities with polio vaccination rates that fall below the 80-86% level that is needed to prevent the spread of the disease, there is still a risk of a polio outbreak   As you take the time to thank mothers, nurses and teachers this week, be sure to also  learn more about polio and polio prevention on the Vaccinate Your Family website.  

 

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Rise in Vaccine Hesitancy Related to Pursuit of Purity: A Conversation with Professor Larson

This article was originally published in Horizon magazine by Gary Finnegan. It is being republished  to provide much needed perspective on the issues pertaining to vaccine hesitancy around the world.

 

The rise of alternative health practices and a quest for purity can partly explain the falling confidence in vaccines which is driving outbreaks of preventable diseases such as measles, according to Heidi Larson, professor of anthropology, risk and decision medicine at the UK’s London School of Hygiene & Tropical Medicine. She is working to understand the causes of vaccine hesitancy in order to devise ways of rebuilding trust.

Why would people opt out of recommended vaccines?

‘Most people have their recommended vaccines but many do not. In some cases, people are missing out on immunisation because they cannot access vaccines. But there is a growing and concerning trend that shows people with access and education are saying “no thanks”. This is a real challenge because it’s driven by belief and it’s difficult to change people’s minds when they have decided that they don’t want or need a vaccine.’

Our 2016 study in 67 countries found that Europe was the most sceptical region in the world.

Heidi Larson, London School of Hygiene & Tropical Medicine, UK 

What are the specific reasons people give when declining to immunise their child?

‘Sometimes there are concerns about vaccine ingredients, usually based on a misinterpretation of the science. There is misinformation circulating online about, for example, some compounds that contain metals. But there are also strong underlying beliefs linked to religion, philosophy and politics. In the US, some states allow philosophical exemptions from mandatory vaccination – although California repealed this opt-out option after a major measles outbreak in Disneyland.

‘One of the biggest lessons of our research is that you can never assume what’s in people’s mind nor assume that simply explaining science can change their opinion. People’s reasons for rejecting vaccines could stem from a bad experience at a healthcare facility, general distrust in the government, in medicine or in industry – it’s a real mix but you have to understand their reasons if you are to address concerns and prevent outbreaks of preventable disease.’

How is the decision to vaccinate political?

‘Vaccines are regulated, recommended and sometimes mandated by government or public authorities. In the US, researchers have looked at values-based vaccine rejection. Two major values can be seen: purity and liberty. For some, the idea of government influence over health is unacceptable.’

People need more support to maintain confidence in vaccines, says Dr Heidi Larson. Image credit - Jon Spaull

People need more support to maintain confidence in vaccines, says Dr Heidi Larson. Image credit – Jon Spaull

Do all countries and cultures share the same concerns about vaccines?

‘Ten years ago, the answer was no. We saw distinctions between the UK, where a (now withdrawn) 1998 research paper incorrectly linked the MMR (measles, mumps and rubella) vaccine and autism, and France, whose main vaccine concern was suspected – albeit unproven – links between Hepatitis B vaccines and multiple sclerosis. The UK public was generally not worried about Hepatitis B and the French public was unconcerned about MMR. Now, because information is shared rapidly online and online translation tools are freely available, rumours and myths spread more quickly.’

Does the public expect medicines and vaccines to carry zero risks?

‘Vaccines are different from medicines – they are preventative and given to healthy people. If you are sick, your attitude to intervention and risk is much different. In addition, vaccines are often recommended for people who are most vulnerable – children and pregnant women. Vaccination is, by its nature, somewhat invasive as most vaccines are given by injection, and this provokes an emotional reaction such as fear and anxiety. Indeed, one of the unhelpful trends we notice is that images of needles are commonly used in media coverage about vaccines – you rarely even see a person in the picture.’

Can information fix ‘fake news’?

‘We will always need public communication, but that alone will not fix things. I’m not a great believer in hitting rumours on the head by myth-busting or debunking falsehoods. We need to be more sophisticated and to build strong transnational networks to pick up rumours and misinformation early and surround them with accurate and positive information in support of vaccination.’

Through your Vaccine Confidence Index, you have surveyed opinion on vaccines in 67 countries. What did you find?

‘We came up with a systematic approach to measuring vaccine hesitancy through repeated global surveys. One of the reasons the issue of vaccine reluctance and refusal has not been addressed in any comprehensive way is that it was seen as complex and too fuzzy to measure. It was written off as “not fact” and perceived to be propagated by those who are ignorant, rather than recognising that, fact-or-not fact, these perceptions impact on vaccine uptake and risk disease outbreaks. Our 2016 study in 67 countries found that Europe was the most sceptical region in the world – France was the least positive about vaccines. Now we are planning to rerun the survey in Europe to see if recent devastating measles outbreaks – which have killed 50 people in Europe (since the beginning of 2016) – may have changed minds.’

There were 1,346 cases of measles in Europe in 2008 and 19,570 cases in 2017. Image credit - Horizon

There were 1,346 cases of measles in Europe in 2008 and 19,570 cases in 2017. Image credit – Horizon

How can this information be used to reduce preventable deaths?

‘First you need to understand what’s driving a decline in vaccination rates and only then can you come up with an appropriate response. The needed intervention will vary depending on whether the problem is vaccine supply or access to vaccines, inadequate awareness of disease risk, concern over vaccine safety risks, including ingredients, or general distrust in authority.’

How can people be persuaded that vaccines are safe and what role can research play?

‘Two of our biggest projects are EU-funded initiatives aimed at understanding drivers of vaccine confidence and developing interventions to build trust. One – EBODAC – focuses on trust building and community engagement around recruiting participants into Ebola vaccine trials in Africa, including investigating the evolution and impacts of negative rumours, such as those that led to the suspension of two Ebola vaccine trials in Ghana.

‘Another is the ADVANCE consortium where we are developing a consistent and coordinated approach to assessing vaccine benefits and risks, including more open and coordinated access to relevant data. For example, if a concern is raised about a particular vaccine, we need to be able to determine whether the rates of a reported adverse event are any different among those who are not vaccinated.’

What is the future of this field?

‘We need to do a better job in schools, helping children to understand essential concepts about how immune systems work to fight disease and how vaccines help build our body’s own protection against infection. Medical school curricula also need to focus more on vaccination, including how to engage with patients who have questions about vaccines.  Health authorities need more capacity to respond to vaccine confidence issues, not just by debunking myths, or just providing facts, but by understanding what is driving the concerns, where they are coming from and surrounding them with positive, informed people. The majority of people still believe in vaccines, but they need more support to sustain their confidence.’

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Five Important Reasons to Vaccinate Your Child

April 23, 2018 1 comment

Every parent wants to do what’s best for their children. However, when parents are bombarded by conflicting messages, it can be a struggle to try to determine what is best.  Every decision – from the type of car seat to purchase, to how to soothe a fussy child – elicits a variety of opinions.  But when it comes to protecting our children from dangerous and sometimes deadly diseases, parents should rely on evidence based information from trusted sources.  

In honor of National Infant Immunization Week 2018, we’ve outlined some of the top reasons experts give for immunizing for your child, along with trusted sources where parents can get more information:

 

1.) The diseases we can prevent through immunization are dangerous and sometimes deadly.  

The 14 different diseases that we can now prevent through vaccination had once injured or killed thousands of children in the U.S. each year. Today, we may hardly ever see these diseases, but the fact remains that these diseases still exist and can be extremely dangerous, especially to children.

Take polio as an example. Polio was once America’s most feared disease, causing death and paralysis across the country.  Thanks to vaccination, the U.S. has been polio-free since 1979.  But small pockets of polio still exist in Afghanistan and Pakistan, and the threat to your child may just be a plane ride away.  (Read Judith’s polio story.)

There are lots of other vaccine preventable diseases that we see more frequently here in the U.S., such as flu, measles and pertussis.  So far during the flu season, over 150 children have died from flu.  And in the past few years, we’ve seen a resurgence of measles.  Back in 2014, there was an outbreak involving 667 cases of measles in 27 states. Another large multi-state outbreak linked to an amusement park in California occured in 2015 involved 147 people. And more recently, an outbreak in MN resulted in the hospitalizations of a dozen children.

Learn more about the 14 different diseases we can prevent through vaccination with this interactive eBook which includes a description of each disease, its symptoms and an explanation of how the disease can be prevented through immunization. 

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2.) Vaccines are safe and effective. 

Vaccines today are the safest they’ve ever been. Of course, parents are bound to hear stories from people on the internet claiming that their children were injured by vaccines.  Since it is extremely difficult to validate these stories, parents should rely on evidence based information when making conclusions about the safety of vaccines.

It is important to acknowledge that vaccines do come with a risk of side effects. However, since vaccines are administered to almost every child in the U.S., they undergo an enormous amount of safety surveillance and scrutiny by scientists, doctors, and healthcare professionals.  The most common vaccine side effects are minor and include redness or swelling at the site of the shot, which is minimal compared to the pain, discomfort, and risk of injury and death from the diseases these vaccines prevent. Serious side effects following vaccination, such as severe allergic reaction, can happen, but are extremely rare.

Considering the dangers of the diseases we are trying to prevent, the benefits of vaccines far outweigh the minimal risk of side effects.

This video, as well as others available on our Vaccinate Your Family Facebook page, address some of the most common safety questions parents have about vaccines.  

 

3.) Childhood vaccines contribute to the community immunity that helps keep everyone free from disease.  

Some vaccines are not administered until a child is 2, 6 or 12 months of age.  Some vaccines even require multiple doses before a child receives optimal immunity.  Prior to being fully vaccinated, these infants remain vulnerable to diseases that can be particularly dangerous for infants.   Read more…

Shingles Vaccine is the Silver Lining of Turning 50

April 19, 2018 3 comments

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Turning fifty is a milestone most people would rather avoid.  

Not me.  

After watching both my 73-year-old mother and my 18-year-old daughter suffer with shingles, I would do almost anything to avoid it. And last year, when a new and more effective shingles vaccines was licensed by the FDA, and recommended by the Advisory Committee on Immunization Practices (ACIP) for people age 50 and older, I began looking forward to my 50th birthday.

You see, now that I’ve witnessed shingles up close and personal, I am eager to prevent it and I feel compelled to encourage everyone to as well.  And here’s why…

Vaccination is the Only Way to Prevent Shingles

You can’t avoid shingles by washing your hands or avoiding sick individuals.  The only means of prevention is through vaccination.

That’s because shingles isn’t your typical contagion. It’s a virus, but not the kind that is spread from person to person through coughing or sneezing. It’s actually a virus (the herpes zoster virus), that is caused by another virus, (the varicella-zoster virus, more commonly known as chickenpox).

Over the past two years I’ve watched as both my mother and my daughter have suffered with shingles, and I’ve learned a few things along the way.   

Shingles Pain Is Excruciating, Debilitating and Can Be Long Lasting

ShinglesImageThe rash then developed into fluid-filled blisters that would break open, ooze out and eventually crust over.  She had to be careful to keep the rash covered and wash her hands frequently since she didn’t want to infect my newborn niece who was living in the same home at the time. Since my niece had not yet received her varicella vaccine, she was not immune to the virus and would be at risk of developing chickenpox.  As a premature infant, that could have been extremely dangerous for her.   Read more…

What Your Dentist Should Be Telling You About Oral Cancer and HPV

April 6, 2018 2 comments

oral-cancer-monthI had my teeth cleaned yesterday, and while I was at the dentist I remembered that April is Oral Cancer Awareness Month. 

The dentist never mentioned it, but I knew just what she was doing when she put her gloves on and started rolling her fingers around the inside of my checks, under my tongue and on the outside of my neck and jaw.  She was doing what all oral health professionals should do – a thorough examination that could help with early detection of oropharyngeal cancers (also known as cancers of the throat and tongue) which are commonly caused by the human papillomavirus (HPV). 

As someone who has been diagnosed with two different cancers in the past, I no longer think “not me”.  Quite honestly, knowing how prevalent HPV is (it’s estimated that 80% of sexually active people will contract HPV at some point in their life) it’s probably more likely that I would be diagnosed with an HPV related cancer than many other types of cancer. Although most cases of HPV resolve without incident, the fact remains that approximately 14 million new cases of HPV occur in the U.S. each year, with at least 79 million people estimated to be currently infected and about 31,500 cases of HPV related cancers diagnosed in men and women each year in the U.S.. This includes cancers in the oropharynx, cervix, vagina, vulva, penis, and anus.  

While HPV can cause up to six different types of cancer, oral cancers are on the rise.  It’s estimated that HPV-associated oropharyngeal cancer affects about 16,400 people each year, and that by year 2020, it will become the most common HPV-related cancer in the US, surpassing cervical cancer.  

Here are a few other details to consider:

While I’m pleased that my dentist took the time to closely examine my neck, throat, mouth and tongue for any abnormalities, I’m disappointed that she didn’t take the opportunity to discuss the importance of HPV vaccination with me. 

Education of the public regarding the risk factors which lead to oral cancer, recognition of the early signs and symptoms, and the development of patient awareness, are primary responsibilities of the dental community.  

In 2017, the American Academy of Pediatric Dentistry (AAPD) issued a policy statement on HPV vaccination that encourages oral health care providers to educate patients and parents on the relationship of HPV to oral and oropharyngeal cancer and to counsel them regarding the HPV vaccination, in accordance with CDC recommendations. Currently, the CDC recommends two doses of HPV vaccination for girls and boys beginning at ages 11 or 12, but vaccination can be started at age 9 and can be administered through age 26 for females and age 21 for males.

Screen Shot 2018-04-06 at 10.36.56 AMWhile oral health professionals should be recommending HPV vaccination to all age-eligible patients, it would be prudent to also provide that information to patients who are parents. Although my dentist is not a pediatric dentist, my five children are also patients and we all get our regularly scheduled dental cleanings twice each year. 

At no point has anyone at this particular dental practice ever discussed oral cancer or HPV with me or any of my children, despite the fact that all five of my children are  considered “age-eligible”. (I know this because after my appointment yesterday, I asked my kids.)

Yesterday, my dentist failed to discuss HPV vaccination as a potential way to prevent oral and oropharyngeal cancers, which I consider to be a missed opportunity. However, during our collective twelve appointments each year for the past five years, it’s actually more like 60 enormous missed opportunities!

I get it.  Dentists may not be comfortable discussing vaccines. Or HPV.  But how comfortable can it be for them to have to tell their patients they may have oral cancer? How comfortable can it be for those patients who will end up having to suffer through an oral cancer that may have been preventable?

Fortunately, there are tests that can help detect HPV in women before they develop cervical cancer.  However, the same is not true for HPV-related head and neck cancers. These cancers typically develop in the throat at the base of the tongue, in the folds of the tonsils or the back of the throat, making them very difficult to detect. That is why regular dental exams can be vital. But prevention is always preferred to treatment, and HPV vaccination represents our best chance at prevention. 

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Since my dentist didn’t provide the information I feel all parents and patients deserve to know, I plan to bring them this action guide for Dental Health Providers, created by the National HPV Vaccination Roundtable when I return next week for my daughter’s visit. 

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According to the Oral Cancer Foundation, there are over 100,000 dentists in the U.S., each one seeing between 8 and 15 patients per day. If you include those patients who come to a practice and see someone other than the dentist, such as the hygienist, the number of patient visits is significantly higher. If they each did their part to educate their patients, imagine what a huge difference they could make in boosting HPV vaccination rates and reducing oral cancers.

Until we start seeing more dentist taking these types of actions,  please help spread the word about the association between HPV and oral cancers, during Oral Cancer Awareness Month and all throughout the year.

Below you will find additional resources regarding HPV vaccination and HPV-related head and neck cancers.  Here’s hoping that you never have to deal with an oral cancer diagnosis, like Jason Mendelsohn, Scott Vetter, Frank Summers and others.   


 

 


 

 


Other Resources:

Head and Neck Cancer Alliance

Oral Cancer Foundation

National HPV Vaccination Roundtable

Vaccinate Your Family Website: HPV Information

Research Article: Reduced Prevalence of Oral Human Papillomavirus (HPV) 4 Years after Bivalent HPV Vaccination in a Randomized Clinical Trial in Costa Rica

 

 

How Flu Strains are Selected for the Seasonal Flu Vaccine Each Year

March 14, 2018 5 comments
SereseMarotta_FamiliesFightingFlu-300x300by Serese Marotta, Chief Operating Officer of Families Fighting Flu 

 

The Centers for Disease Control and Prevention (CDC) recommends that everyone ages 6 months and older, with rare exception, get an annual flu vaccine. But did you ever wonder how the flu strains are selected for the seasonal vaccine every year?

A lot more goes into the decision than you might think!

Seasonal flu vaccines contain three (trivalent) or four (quadrivalent) flu strains. Because flu is a complex, dynamic virus that is constantly changing, there are more than 100 monitoring centers in over 100 countries located across the globe that monitor flu activity on a year-round basis to identify which flu strains are circulating.

These centers receive and test thousands of influenza virus samples from patients. They then send representative virus samples to five World Health Organization (WHO) Collaborating Centers for Reference and Research on Influenza, located in Atlanta, GA (i.e., the CDC); London, United Kingdom; Melbourne, Australia; Tokyo, Japan; and Beijing, China. The surveillance data gathered from these samples, along with other information, are used to make a recommendation on which flu strains should be included in the upcoming year’s seasonal flu vaccine.

Contrary to popular belief, the flu vaccine is not just based on last year’s flu viruses. Three general sources of information are considered in the selection of flu strains for the seasonal flu vaccine:

 

  • Surveillance data represents information gathered from the influenza monitoring centers that collect virus samples from patients. Experts use this information to determine which flu strains are circulating and where.
  • Laboratory data refers to antigenic characterization of the flu viruses in a laboratory, which simply means the identification of specific molecular structures on the influenza virus that are recognized by our immune systems and elicit an immune response. The antigen is the “invader” (i.e., in this case, the flu virus) that causes our immune systems to launch an attack through the formation of specific antibodies. Antibodies are what our bodies produce following flu vaccination so that it’s properly “armed and ready” to recognize and fight that specific flu virus if and when we’re exposed.
  • Genetic characterization of flu viruses may also be considered in the selection of vaccine strains. This refers to “mapping” of the genetic codes that make up each flu strain, which allows the experts to monitor changes in circulating flu viruses.
  • Data from clinical studies on vaccine effectiveness are also considered.

With this robust amount of data in hand,  the WHO then meets twice per year to make a recommendation for flu vaccine strains for the upcoming season: once in February to recommend flu strains for the Northern Hemisphere seasonal flu vaccine, and again in September to recommend flu strains for the Southern Hemisphere seasonal flu vaccine. But it doesn’t stop there! Each country then considers the WHO recommendation, reviews the available information, and makes their own decision on which flu strains to include in their country’s seasonal flu vaccine.

In the U.S., once the WHO makes their recommendation for flu strains for the upcoming year’s seasonal flu vaccine, an advisory committee from the U.S. Food and Drug Administration (FDA) meets in February or March to review the WHO’s recommendation and supporting information and vote on the final selection of flu strains. The role of the FDA is an important one, because once the flu strains are selected, the FDA produces materials in their laboratories that are critical for actually producing the flu vaccines. For instance, the FDA provides vaccine manufacturers with the seed viruses and the potency reagents needed to ensure that flu vaccines made by one manufacturer are similar to those made by another. The FDA also conducts quality control measures by ensuring that batches (referred to as “lots”) of flu vaccines released by the manufacturers meet appropriate standards and reflect the correct genetic composition.

Following the selection of flu strains for the seasonal vaccine and receipt of the appropriate materials and information from the FDA, private sector manufacturers begin the process of making the vaccines. All flu vaccines in the U.S. contain the same flu strains, i.e., the flu vaccine available in New York contains the same three or four flu strains as the vaccine that’s available in California. And it’s important to remember that all flu strains (influenza A or B) can be potentially dangerous, regardless of an individual’s health status, and are capable of causing serious illness, hospitalization, or even death.

Influenza is a vaccine-preventable disease that has the ability to affect all of us around the world, which is why it remains such a pressing global public health issue. Seasonal flu vaccines may not be perfect, but given the complexity of flu viruses and their ability to change and mutate frequently, the U.S. does have a solid, scientifically-based approach for flu vaccine development. While much research and development is being done for a universal flu vaccine, the possibility of this technological advancement is still many years off.  In the meantime, let’s not forget all the hard work and research that goes into helping to protect us with the currently available seasonal flu vaccines. And if you’re wondering “why bother” with a flu vaccine that may be substantially less than 100% effective, let’s remember that something is better than nothing, especially when it comes to your life or the life of a loved one.

More in-depth information on how flu strains are selected for the seasonal flu vaccine every year are available from the CDC and FDA


FFF logo_R copyAbout Families Fighting Flu:  Families Fighting Flu (FFF) is a national, nonprofit, 501(c)(3) volunteer-based advocacy organization dedicated to protecting the lives of children and families by helping to increase annual influenza vaccination rates, especially among children 6 months and older and their families.  Our members include families whose children have suffered serious medical complications or died from influenza, as well as healthcare practitioners and advocates committed to flu prevention.  In honor of our children, we work to increase awareness about the seriousness of influenza and to reduce the number of hospitalizations and deaths caused by the flu each year.

Updates from the Advisory Committee on Immunization Practices February Meeting

March 6, 2018 2 comments
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Photo Credit: James Gathany, Centers for Disease Control and Prevention

The Advisory Committee on Immunization Practices (ACIP) held its first meeting of 2018 on February 21st and 22nd.  The Committee consists of a panel of immunization experts that advise the Centers for Disease Control and Prevention (CDC).  Part of their charter is to continually evaluate new data and update or change vaccine recommendations as warranted. 

The agenda for the February 2018 meeting included presentations pertaining to several different diseases and vaccines, to include hepatitis, influenza, anthrax, HPV, pneumococcal, meningococcal and Japanese encephalitis.

A overview of the meeting is provided below, with details on presentations in the order they occurred: 

Hepatitis B

The committee voted unanimously to approve a non-preferential recommendation for a new Hepatitis B vaccine (Dynavax’s HEPISLAV-B™) to their list of recommended vaccines for adults 18 years and older against infections caused by all known subtypes of Hepatitis B.

This vote came following the presentation of data showing that the new two-dose vaccine generates a more rapid and higher antibody response than the standard 3 dose vaccine.

Hepatitis B is a viral disease of the liver that can become chronic and lead to cirrhosis, liver cancer and death. The hepatitis B virus is 50 to 100 times more infectious than HIV, and transmission is on the rise. In 2015, new cases of acute hepatitis B increased by more than 20 percent nationally and 850,000-2.2 million persons are estimated to be living with infection in the U.S.

Since there is no here is no cure for hepatitis B, vaccination is our best chance at preventing the disease. While about 90% of people are infected during infancy, in adults, hepatitis B is most often spread through contact with infected blood and through unprotected sex with an infected person. Some individuals who are especially susceptible include those who are immunosuppressed or living with diabetes. The CDC recommends vaccination for those at high risk for infection due to their jobs, lifestyle, living situations and travel to certain areas.

The Working Group summary suggested that this new vaccine option is likely to improve vaccine series completion and result in earlier protection, which is especially beneficial in persons with anticipated low adherence such as injection drug users.  Additionally, the improved immunogenicity in populations with typically poor vaccine response such as the elderly, diabetics and those on dialysis, is promising.  The ACIP will continue to review post-marketing surveillance studies and additional data to ensure safety and cost-effectiveness considerations.

Hepatitis A

The committee voted unanimously to pass three recommendations pertaining to Hepatitis A.

  • Hepatitis A vaccines should be administered for post-exposure prophylaxis for all persons 12 months of age or older.
  • Hepatitis A vaccine or immune globulin (IG) may be administered to persons 40 years of age or older, depending on the providers’ risk assessment.
  • Hepatitis A vaccine should be administered to infants age 6-11 months of age traveling outside the US when protection against hepatitis A is recommended. This recommendation takes into consideration the fact that infants under 12 months who will be traveling internationally will typically also need an MMR vaccine.  Since Hepatitis A immune globulin and MMR vaccine should not be administered simultaneously, these children should receive a single dose of HepA vaccine. It’s important to note that infants should then complete the full, 2 doses of MMR and HepA vaccines at 12 months of age as recommended.

Influenza

The Committee heard five presentations specific to influenza.

The first two were reports of current season data; one detailing flu surveillance, the other providing early influenza vaccine effectiveness data.

According to the update, the majority of circulating flu strains are similar to those contained in the 2017-2018 vaccine.  The only virus clearly showing antigenic drift was the B/Victoria lineage viruses which represents less than 1% of circulating viruses.  So far this season, influenza A (H3N2) has been dominant, with influenza B activity starting to increase more recently. Activity has been the highest we’ve seen since 2009, and while final severity can’t be determined until the end of the season, hospitalization rates and mortality could be similar to or exceed those send during the severe 2014-2015 season.

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Based on data from 4,562 children and adults with acute respiratory illness enrolled during November 2, 2017–February 3, 2018, at five study sites, the overall estimated effectiveness of the 2017–18 seasonal influenza vaccine for preventing medically attended, laboratory-confirmed influenza virus infection was 36%. The percentage differs by age group and by virus.  A detailed report can be found here.

The most notable news out of the Committee last week was the vote to restore the live attenuated influenza virus (LAIV) vaccine as an option for the 2018-19 season. LAIV is commonly known as the nasal spray flu vaccine or by its brand name, FluMist This renewed ACIP recommendation offers FluMist as one of several vaccine options for non-pregnant people who are 2-49 years of age during the 2018-2019 season, but does not indicate any preference for FluMist over injectable flu vaccines.

While FluMist has not been recommended for the past two flu seasons due to reduced effectiveness against the H1N1 flu strain in children, the Committee heard three presentations specific to LAIV vaccine efficacy in children prior to taking a vote on future recommendations for LAIV.  The first reported on the efficacy of Fluarix Quadrivalent in children 6-35 month of age. Another presented the results of a randomized trial of a new H1N1 LAIV strain in U.S. children. The third was a review LAIV in children 2-17 years of age.  

The possible root cause of the poor effectiveness of LAIV against H1N1 was discussed and poor replication of the H1N1 selected strain was thought to be the likely problem. A new strain selection process is now in place in cooperation with the Food & Drug Administration (FDA) and it suggested that the antibody responses of the latest reformulated version of the quadrivalent vaccine, which includes the new 2017-18 post-pandemic 2009 H1N1 LAIV strain (A/Slovenia), will perform significantly better than what was previously observed when the vaccine included the 2015-16 post-pandemic LAIV strain (A/Bolivia).  Immunogenicity and viral shedding data in small trials supported this notion, but no efficacy data is available at this time.

The Committee was therefore forced to a vote using only the science available to date. There was a lively discussion among members who expressed various concerns. While flu vaccine effectiveness is a serious issue, some committee members expressed concern that they may be holding FluMist to a higher standard than other influenza vaccines, yet all have efficacy challenges from year to year.  Other members were concerned with how the vaccine may perform in an H1N1 dominated season. Until the vaccine is used, further effectiveness assessments are performed, and a prominent H1N1 year occurs, a certain level of uncertainty will remain.

While members voted overwhelmingly (12-2) to reinstate LAIV on the immunization schedule, a second vote to give other flu vaccines a preferential recommendation over LAIV failed (11-3).  So, while the ACIP will not indicate a preference for any one type of flu vaccine over another, the public will ultimately determine whether there will be high uptake of this particular vaccine next season. Read more…