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Some Things You Outgrow as an Adult. Vaccines Aren’t One of Them.

August 17, 2017 1 comment

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Did you know that vaccines are recommended for people of all ages?

Even if you were fully vaccinated as a child, the protection from some vaccines you received can wear off over time and you may need a booster. There also are specific vaccines that you may need as you get older based on your age, job, lifestyle, travel, or other health conditions.

Below are 5 reasons adults need vaccines:

 

1) Every year, thousands of adults in the U.S. suffer serious health problems, are hospitalized, or even die from preventable diseases.

Much of this could be avoided if more adults received their recommended vaccines. While most adults recognize the need for childhood vaccinations, many adults simply don’t realize that vaccines are recommended to protect against diseases like whooping cough, hepatitis A and B, pneumococcal disease, shingles and influenza.

The latest data from the Centers for Disease Control and Prevention (CDC) shows that vaccination rates for adults are extremely low (National Health Interview Survey, 2014).

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Higher vaccination rates could help avoid the many cases of vaccine preventable diseases that adults suffer with each year.  For example, in 2015 there were about 27,000 cases of invasive pneumococcal disease and 3,300 deaths among adults. In 2016, there were more than 15,000 cases of whooping cough reported to the CDC.  Additionally, there are about 1 million cases of shingles and millions of cases of influenza that occur each year in the U.S.

2) Certain health conditions can put adults at greater risk of complications if they do get sick. 

As we go through life we’re often diagnosed with certain health conditions that put us at increased risk for complications from diseases such as pneumonia and influenza.  This includes conditions such as heart disease, asthma, chronic obstructive pulmonary disease (COPD) and diabetes. Even if we feel we have those conditions under control, it is best to get vaccinated to prevent an illness that can complicate these conditions and cause severe illness, hospitalization or even death.

3)  Adults are more likely to contract certain diseases.

As we age, we also become more likely to suffer with diseases such as shingles or pneumococcal disease.  That is why adults 65 and older are recommended to receive one or more pneumococcal vaccines, and those 60 years and older should get a shingles vaccine.

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Even With All Our Modern Medicine, I Watched My Sister Die From Flu

February 1, 2017 6 comments

By Michael Northrop, M.D.

 

lizaIn December, 2009 my sister Liza died of influenza.

She was previously healthy and only 49 years old.  She sought medical care early. She was cared for at a good hospital in a major city.  She had no other infections. And she was unvaccinated.

To say I was surprised is an understatement.  And yet, I’m a pediatric intensive care physician.

As a clinician, it’s easy for me to trace out the clinical course of Liza’s illness. The physiology of organ failure, mechanical ventilation and critical illness are familiar to me in the same way that your daily work is to you. It’s the human side that I still haven’t come to terms with. The part where you watch your sister die over the course of three long weeks while you stand helpless.  The part where you listen to a physician tell your family that they are out of options.  The part where you know that they are right and you realize that influenza is sometimes too much to handle, even with all our modern medicine.

That part is much harder to process.

Her symptoms started with fever, but progressed to vomiting after a few days. She went to the urgent care clinic twice over the course of a few days before ending up in the emergency department of the local hospital.  She had begun to experience difficulty breathing, and the emergency physician noted that the oxygen saturation in her blood was very low.  They put her on oxygen, and an x-ray revealed that both her lungs were filled with fluid. A condition that led to her being diagnosed with pneumonia.

You see, your lungs are supposed to have air in them. They should look like sponges. Pneumonia is just the term we physicians use to describe the situation when fluid, infection, and inflammation fill those little air spaces in the sponge.

Pneumonia can come from viruses or bacteria. If your pneumonia is caused by a bacteria, you can get antibiotics to kill the bacteria.  However, if your pneumonia is caused by a virus, like influenza, there is not much we can do but ride it out and wait for your own immune system to clear it.  The simple fact is that we just don’t have very good medications for viruses. Tamiflu can be prescribed and it might slow down the virus, but it doesn’t kill it or stop it.

So, they did the only thing they really could do, and started her on IV Tamiflu.  She was moved to the intensive care unit downtown, and within the next few hours she struggled to breathe and her oxygen saturations continued to fall. She had to be placed on a ventilator, and the hope was that her lungs would recover after a few days. After all, it was ‘just the flu’.

We never did get to speak with her again.  

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October Updates from Advisory Committee on Immunization Practices

October 26, 2016 3 comments

10693.jpgLast week, the Advisory Committee on Immunization Practices (ACIP) held it’s third and final meeting of 2016.  The agenda included presentations pertaining to hepatitis B, pertussis, HPV, meningococcal, herpes zoster, pneumococcal and RSV vaccines, and surveillance updates on Zika and influenza viruses.

During the two-day meeting, the committee took nine votes on newly proposed vaccine recommendations that addressed vaccination timing, number of doses needed, and dosing intervals for hepatitis B, pertussis, HPV and meningococcal vaccines.  They also approved the child, adolescent and adult immunization schedules.

This post provides a recap of each agenda item in the order they occurred. 

Hepatitis B Vaccine

The recommended first dose of the three-series hepatitis B vaccine is often referred to as “birth dose” and is typically administered to infants in the hospital after birth.  At this meeting, the Hepatitis B Work Group asked that the Committee consider removal of the permissive language that appears at the end of the recommendation which allows for a delay of the birth dose until after hospital discharge.

When hepatitis B vaccine is administered within 24 hours of birth it can help prevent transmission of the hepatitis B virus from an infected mother to her child.  The intent of the birth dose is to provide an additional safety net to prevent transmission from HepB positive mothers that are not properly identified due to errors in maternal testing or reporting. In these instances, when the mother is not properly identified as HepB positive before birth, the HepB vaccine alone is 75% effective in preventing prenatal transmission, and 94% effective when used in conjunction with Hepatitis B immune globulin.

Since delaying hepatitis B vaccination can interfere with the prevention of Hepatitis B – especially in a child unknowingly born to a HepB positive mother – the HepB Work Group proposed that the reference to delaying vaccination be removed from the recommendation.  It had originally been added in 2005, but the data suggests that administering the birth dose in the hospital leads to timely completion of the series. The current birth dose coverage was stated to be 72.4% of children, which remains below the Healthy People 2020 goal of 84%.

The Committee voted to remove the permissive language as well as include new language to clarify that the first dose of vaccine should be administered within 24 hours of birth, which is more explicit than “before hospital discharge”.

The anticipated changes to the previous recommendation are indicated below, however the exact wording may differ once published by the CDC:

“For all medically stable infants weighing 2,000 grams or more at birth and born to HBsAg-negative mothers, the first dose of vaccine should be administered before hospital discharge within 24 hours of birth.  Only single antigen HepB vaccine should be used for the birth dose. On a case-by-case basis and only in rare circumstances, the first dose may be delayed until after hospital discharge for an infant who weighs 2,000 grams or more and whose mother is HBsAG-negative.

*It should be noted that for those infants with birth weight of less than 2,000 grams, the birth dose is not counted as part of the vaccine series.

There was some discussion concerning the removal of the option to delay vaccination and it was emphasized that having a clear recommendation from the ACIP is not a vaccine mandate.  Rather, practitioners, public health professionals and parents rely on the ACIP recommendations as expert guidance and best practice. The Hepatitis B “birth dose” has been a successful strategy to help eliminate hepatitis B virus transmission in the U.S., and the ACIP’s revised recommendations only emphasize the importance of vaccinating within the 24 hours timeframe that will help prevent further transmission.

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Other key updates to the hepatitis B vaccine recommendations included:

  • Providing examples of chronic liver disease, including recommending HepB vaccine for persons with HCV infection.
  • Post vaccination serologic testing for infants who’s mother’s HBsAg status remains  unknown indefinitely.
  • Testing HBsAg-positive pregnant women for HBV DNA.

For more information as to why babies need a Hepatitis B vaccine at birth, read these Shot of Prevention blog posts here

Pertussis Vaccine

The Committee reviewed the history of Tdap vaccination in pregnant women and reviewed studies that found that maternal Tdap vaccination to both safe and effective at preventing infant pertussis. Read more…

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

September 27, 2016 47 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.

Why? 

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,

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Preventing Shingles Today and the Promise of New Vaccines Tomorrow

September 22, 2016 1 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. 

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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.

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