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Is This Season’s Flu More Severe Than Usual or Just Highly Active?

January 13, 2018 6 comments

At this point in the flu season people often wonder if all the media hype is part of an orchestrated effort to panic people about flu, or if it is really signaling serious concern.

While we’re seeing stories about emergency rooms in California turning away ambulances because of overcrowded with flu patients, or Alabama declaring a state of emergency due to the high number of flu cases, we’re left to wonder….is this year’s flu season more severe than usual or just highly active at the moment?

A recent CDC media briefing has helped clarify the following concerns regarding the latest flu activity in the U.S.: 

Right now, flu is widespread everywhere.  

One of the most notable differences between this season and others is in relation to the geographic spread of flu. This is the first time over the course of 13 years of surveillance data that the entire nation is experiencing widespread flu at the exact same time, as can be noted by the color of CDC’s flu surveillance map below.

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Activity is severe right now.

One of the ways the CDC tracks influenza activity is to record the number of lab confirmed cases of flu and hospitalizations by week. What they’ve noted is a very rapid increase in the number of people seeing their healthcare providers for flu diagnosis, along with a rapid rise in the numbers of people being hospitalized with lab confirmed flu. For instance, this week’s surveillance data indicates that there’s been 22.7 hospitalizations per 100,000 people in the U.S., which is up considerably from the 13.7 number recorded last week.

So far this season, influenza A (H3N2), has been the most prevalent strain in circulation. Unfortunately, historically it is often the strain linked to more severe illness, especially among children and older individuals above the age of 65. Interestingly enough, the current flu surveillance observations seem to be in line with two more previous H3N2 dominant seasons; the 2014-2015 and 2012-2013 seasons.

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Additinally the hospitalizations so far this season seem to be in line with other H3N2 predominant seasons, with the highest rates among those over the age of 65, those between 50-64, and children under 5 years of age.

Flu can cause mild disease in some, but severe disease and death in others.

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Sadly, this week there have been an additional 7 pediatric flu deaths, totalling 20 pediatric deaths so far this season.  While children are at great risk, there are plenty of reports of otherwise healthy adults who have been hospitalized or died from flu this season.

Peak season may have started early, but there are many more weeks to go.

Speaking to the media on behalf of the CDC on Friday, Dr.  Jernigan explained,

“If we look at the timing of the season, even if we have hit the top of the curve or the peak of the seasonal activity, it still means we have a lot more flu to go.”

He went on to suggest that there will likely be at least 11 to 13 more weeks of elevated influenza activity this season, before activity begins to subside. Even though it can take about two weeks for protection from vaccination to set in, Dr. Jernigan explained that we still have a lot of flu season to get through and that vaccination efforts should continue as long as influenza viruses are circulating.

While we are seeing a lot of H3N2 circulating now, we are also seeing H1N1 show up in states that have already had H3N2 activity. And we know that B viruses also tend to show up later in the season. Each of these strains are covered in the vaccine, so flu vaccination now can still help to prevent, or lessen the severity of flu throughout the remainder of the season.

Vaccination is our best defense.  

While flu vaccination is far from perfect, it remains our best defense. Not only can it help prevent flu, but it can also help lessen the severity of symptoms if a vaccinated person does end up getting infected.  This can reduce the chances of an individual being hospitalized or dying from flu.

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In fact, a recent study showed that influenza vaccination reduced the risk of flu-associated death by 65% among healthy children and by 51% among children with underlying high-risk medical conditions. Another study indicated that many older adults benefit from repeated flu vaccination. When getting vaccinated in both the current and previous seasons, the study found flu vaccination was 74% effective in preventing ICU admissions in older individuals and 70% effective in preventing deaths among older adults.

 

Manufacturers are reporting that they’ve shipped more than 151 million doses of flu vaccine this season, so there shouldn’t be a problem finding a flu vaccine in your area.  Simply refer to the flu vaccine finder for assistance.

We won’t know preliminary flu vaccine effectiveness until February.  

Read more…

Free Online Course Explains Cells, Immunity and Vaccines

January 4, 2018 1 comment
by Rich Greenaway, Director of Program Operations and Special Projects, Every Child By Two

Often times, the concerns people have about vaccines can be addressed through a better understanding of science.  It begins with a more comprehensive explanation of how the cells in our body work, how viruses can infect us, how our bodies fight off infections, and how vaccines help in that process.

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Fortunately, you don’t have to devote your life to being a doctor or scientist to benefit from an improved understanding of immunology.  While many people strive to better educate themselves on these topics, the challenge is in finding educational resources that are not only accessible to the general public, but are also scientifically accurate and comprehensible for non-scientists.

Now Dr. Jonathan M. Gershoni, a Professor of Molecular Immunology and Virology at Tel Aviv University, has stepped in to help.  

After spending thirty years investigating the immune response towards viruses such as HIV, HCV and SARS CoV, Dr. Gershoni is now offering a free course entitled, Viruses & How to Beat Them: Cells, Immunity, Vaccines.

 

Designed for the general public, the course is offered at no charge, but can also be taken for continuing education credits for a small fee ($49).  The online lectures are offered in English in a video format that is easy to understand. Additional learning materials and a glossary of terms are also available for each section.

The entire course consists of seven lessons which are then subdivided into six to ten sub-lessons, each concluding with a quiz.  Although the course became available in December, new participants can view any of the lectures at their own pace.  Lesson 7 may be of particular interest since it deals specifically with vaccines and how they work.  While the time one invests in this course may vary, it is expected that the course can be completed by committing two to three hours per week over an eight-week period.

At a time when immunization misinformation remains prevalent on the internet, and continues to interfere with the public’s ability to recognize the value of vaccines as a primary means of disease prevention, this class and others from reputable individuals and organizations, can further our mission to ensure that everyone is making well-informed decisions regarding vaccines.

Consider the comments Dr. Jonathan M. Gershoni has received from various experts on what they think about vaccines:

We encourage you to register for the course, share your thoughts about the course if you are taking it, and encourage others to further educate themselves about immunology and virology by signing up today.  Simply click here to get started.

Flu Vaccine Benefits Go Beyond Effectiveness of One Strain

December 11, 2017 2 comments
LJ TanGuest post by Litjen (LJ) Tan, MS, PhD; co-chair and co-founder of the National Adult and Influenza Immunization Summit.

 

There seems to be a lot of speculation recently about how effective the influenza (flu) vaccine will be at preventing cases of influenza this season.

We have heard suggestions that the vaccine may only be 10% effective against flu this year, that there may be mismatches in the vaccine compared to the influenza strains that are circulating, and thus, that the vaccine is not worth getting.

To address these concerns I will start with a basic explanation of flu and flu vaccines, and then discuss the factors that play into vaccine effectiveness.

First, let me say that influenza is a serious respiratory infection that is responsible for about 30% of all the respiratory infections during the winter season. When I say serious, I mean that flu can keep you down for a week or more, and you will feel completely miserable. Additionally, each year thousands of people of all ages die from flu in the U.S.; it can be very dangerous. So, that office colleague who said that he was out with the flu yesterday very likely did not have influenza. Not fully understanding the dangers of flu is why some people fail to see the value of flu prevention.  

Flu is caused by multiple strains of influenza viruses that circulate during the winter season; specifically, we have influenza type A (with the H3N2 and H1N1 strains) and influenza type B (there are two type B strains that can circulate and currently 90% appear to be the Yamagata lineage, but since it is still so early in the season and sample sizes are small, this data point may not be statistically significant). Because these strains of flu viruses can switch every season in terms of dominance, and can also mutate, manufacturers need to develop a new influenza vaccine every year and people need to be re-vaccinated each year.

To be clear, the vaccine development process is the same every year, it is just that the starting, or “seed”, vaccine virus that we immunize against has to be identified before it can be used to develop our country’s annual vaccines.

When that seed virus is identified, it is then amplified (or passaged) to develop more seed virus. Then that seed virus is further amplified to create the large quantities of vaccine virus that we ultimately need to prepare an adequate supply of vaccines to protect our population. That amplification of the seed virus, and the making of large amounts of vaccine virus, can occur in eggs, which is the more traditional way, or it can also occur in cell cultures. So there needs to be four seed viruses developed and amplified to create influenza vaccines – an H3N2 seed, an H1N1 seed, and the two B seed viruses.

So why do we keep hearing people say that this year’s flu vaccine may only be 10% effective? Where did that suggestion come from?

When we say that a flu vaccine is 10% effective, what we usually mean is that it was effective in preventing 10% of cases of influenza in those who were vaccinated. This 10% number that you may have heard is actually a data point from Australia, and it’s not against all strains of flu, but specifically against the H3N2 strain that dominated the southern hemisphere this past flu season. If you look at the Australian data for all influenza, the vaccine effectiveness goes up to 33%. Agreed, that’s not great for Australians (although, it’s still better than no protection), but is looking at the Australian data truly reflective of what might happen in the US?

It’s unlikely, and here’s why. Read more…

Vaccine Hesitancy Often Tied to Moral Foundations of Liberty and Purity

December 5, 2017 Leave a comment

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We often try to overcome vaccine hesitancy with education, hoping that the scientific evidence will be enough to change people’s minds.  The hope is that if we can just provide people with the facts about the dangers of diseases, and the benefits of vaccines, than they will be encouraged to vaccinate.  But research shows that it’s not that easy, and this may not even be the right approach.

Today, Washington Post reporter, Lena Sun, published an article that explains that vaccine hesitancy is not just an issue of education.  Recent behavioral research suggests that there is often a moral difference between people who accept vaccines and people who refuse them.  The point is that people don’t make decisions based solely on fact.  Rather, parents who are most reluctant to vaccinate appear to be strongly concerned with two powerful moral values that influence their attitudes and judgments: individual liberty and purity.

In this framework, liberty is associated with belief in personal responsibility, freedom, property rights and resistance to state involvement in citizens’ lives, while concerns about purity focus on boundaries and protection from contamination.

One new study out of Emory University, published recently in Nature Human Behaviour, used a social psychology theory known as Moral Foundations Theory to determine the underlying moral values most strongly associated with vaccine-hesitant parents. They assessed the parents’ level of vaccination hesitancy and explored how important different moral values were to them when deciding if something was right or wrong. Their findings correspond with the reasons many vaccine-hesitant parents give for delaying or refusing some vaccines.

Another group of researchers out of Loyola University in Chicago were able to validate these finding, but then went one step further.  They found that purity and liberty values also seem to influence the belief in false or misleading statements that often appear on websites that adamantly oppose vaccines.

In another study recently published in the Personality and Social Psychology Bulletin, researchers at the University of Amsterdam and University of Kent explored science skepticism as it relates to various issues such as climate change, vaccination and genetic modification in food.  They determined that “religiosity”, as well as concerns about moral purity, were also a common predictor of vaccine skepticism.

The insight that we get from this type of behavioral research can certainly help us better understand those who are vaccine hesitant.  If we can take the moral foundation concerns and incorporate them into our messaging, we may be able to persuade parents that vaccines do fulfill their desire to maintain both liberty and purity.

As an example, to address the purity concerns, one suggested intervention may be to explain that vaccinating is a way of  boosting a child’s natural defenses against disease and keeping the child “pure of infections”.  Whereas a liberty-oriented message might suggest that vaccines can help parents to take personal control of a child’s health so that they are free to live a happy and healthy life.

While such messaging has yet to be tested, these studies, and others like this, are critical to helping us develop more effective communication, and should be a consideration for all of us who engage with vaccine hesitant parents in the doctor’s office, on the internet or at the playground.

 

How One Man is Credited With Saving 8 Million Lives a Year  

November 17, 2017 Leave a comment

Saving 8 million lives a year may seem like a stretch, but not for Dr. Maurice Hilleman.

Hilleman_scope2Hailed as one of the world’s greatest scientists, Dr. Hilleman helped develop 9 of the 14 routinely recommended vaccines in the U.S. And in 1957, he was the first person to successfully predict an influenza pandemic when he read of an outbreak occurring in Hong Kong. This led him to develop a vaccine for the U.S. that likely saved hundreds of thousands of lives. His life spanned one of the most productive periods in vaccine innovation, and since Dr. Hilleman was right in the middle of it, his life story is truly inspiring.  Fortunately for science enthusiasts, it is now the focus of a new vaccine-related documentary, HILLEMAN: A Perilous Quest to Save the World’s Children.

Developed as part of the Vaccine Makers Project, produced by Medical History Pictures and sponsored by the Vaccine Education Center at Children’s Hospital of Philadelphia (CHOP), the film includes exclusive interviews with Dr. Hilleman and his peers, rare archival footage, and 3-D animations.

The film is meant to not only introduce Dr. Hilleman and his amazing accomplishments, but to also describe the incredible scientific discovery and effort required to create safe and effective vaccines.

Over the last several months, the film has been shown by institutions such as the Smithsonian’s National Museum of American History, the National Foundation for Infectious Diseases, and the Bill & Melinda Gates Foundation. HILLEMAN has also been featured at immunization coalition conferences and national professional meetings, including the American Academy of Pediatrics, National Association of School Nurses, National Science Teachers Association, and National Association of Biology Teachers.

To complement the film, the Vaccine Makers Project has developed comprehensive educational materials for elementary, middle, high school and college students. 

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Educators are encouraged to utilize this flexible curriculum in whole or part to support learning objectives related to infectious diseases, the immune system, and how humans fight disease through technologies such as vaccines.

The Vaccine Makers Project has also collaborated with Families Fighting Flu (FFF) to present an eight-minute excerpt of HILLEMAN: A Perilous Quest to Save the World’s Children to remind families of the importance of annual influenza vaccines. Families Fighting Flu has made the film a central component of its fall awareness efforts. According to Serese Marotta, Chief Operating Officer of Families Fighting Flu,

“Every year, we remind families of the importance of influenza vaccination, often with members of our organization sharing their own personal experiences. This year, we hope that by sharing the film clip along with our personal stories, even more families will be compelled to prioritize influenza vaccination for themselves.”

Visit the Vaccine Makers Project to view a list of upcoming film screenings, gain access to the free educational materials, or to make an inquiry about the project.

For more information about influenza, visit the Vaccine Education Center at Children’s Hospital of Philadelphia for an in-depth look at the flu vaccine and an influenza fact sheet.  And visit the Families Fighting Flu website to read stories of families who have been adversely affected by flu, view flu facts and download the Community Toolkit and other educational materials

In “The Pathological Optimist” Wakefield Profits From False Hope and a Disproved Autism-MMR Hypothesis

October 23, 2017 33 comments

This guest post has been written by Every Child By Two Board Member, Dr. Paul A. Offit, who is a professor of pediatrics and Director of the Vaccine Education Center at the Children’s Hospital of Philadelphia. 

The Pathological Optimist, which had its theatrical release on September 29, 2017, is a movie about Andrew Wakefield, the British doctor who claimed that the measles-mumps-rubella (MMR) vaccine caused autism.

Although much has been written about this man and his discredited hypothesis, one question remains unanswered. And it’s this question that makes Andrew Wakefield such an interesting character study.

Among scientists, Andrew Wakefield is unique.  He’s not unique because his explanation for why MMR caused autism was nonsensical. (MMR vaccine doesn’t overwhelm the immune system; measles vaccine virus doesn’t damage the intestine; and brain-damaging toxins don’t then enter the body and cause autism). And he’s not unique because 17 studies performed in seven countries on three continents showed that those who received MMR weren’t at greater risk of autism. (Four thousand studies are published in the scientific and medical literature every day; not surprisingly, false claims are published all the time). He’s not unique because the Lancet, the medical journal that published his original paper, retracted it when the editor learned that Wakefield had misrepresented biological and clinical data. (Researchers who falsify data are an occasional problem in science—a human endeavor). And he’s not unique because several of the families mentioned in his paper were in the midst of suing pharmaceutical companies, essentially laundering their legal claims through a medical journal. (Conflicts of interest occasionally confound medical research). Finally, he’s not unique because his misrepresentations and falsehoods caused him to lose his medical license. (Every year some doctors lose their license to practice medicine).

No. What makes Andrew Wakefield unique is that unlike many of the discredited, defrocked, and humiliated scientists who have preceded him, he continues to insist that he is right and that the rest of the world is wrong.

The question is: Why? In The Pathological Optimist, executive producer Miranda Bailey pulls back the curtain.

Between 2011 and 2016, Bailey, who is best known for her work in Swiss Army Man, The Diary of a Teenage Girl, and Norman, embedded herself in Andrew Wakefield’s life. Bailey is no novice. She’s spent a lot of time working around people who act for a living. She’s not easily fooled. And she’s not fooled here.

Throughout the movie, Andrew Wakefield’s grandiosity, his exaggerated sense of self-importance, his fantasies of brilliance, his sense of entitlement, his need for constant admiration, and his arrogance are on full display.

The Pathological Optimist follows Wakefield on what appears to be a cross-country, money-seeking tour targeting parents of children with autism. Wakefield isn’t raising money for research on autism’s causes or cures. And he isn’t raising money to promote better services or better educational tools for children with the disorder. Rather, he’s raising money for himself; specifically, to pay legal fees for his lawsuits against Brian Deer, the investigative journalist who had exposed Wakefield’s falsifications in the Lancet paper, and Fiona Godlee, the editor-in-chief of the British Medical Journal who had called Wakefield’s paper fraudulent and challenged the Lancet to retract it.

Wakefield is out to restore his reputation. And he’s taking advantage of vulnerable parents who believe in him to do it. For Andrew Wakefield, it’s all about Andrew Wakefield.

Read more…

Evaluating the Safety of Flu Vaccination in Pregnancy

September 18, 2017 2 comments

The decision to get a flu vaccination in pregnancy is one that should be based on a complete evaluation of the scientific evidence that is available.  Flu shots have been safely administered to millions of pregnant women over many years, so how should expectant parents respond to a recent study that implies a connection between multiple flu vaccinations and the incidence of miscarriage in early pregnancy?  

To properly evaluate the significance of the latest data, we must consider the findings of this one report alongside the abundance of other science-based information we have, such as: 

  1. Why the Advisory Committee on Immunization Practices (ACIP) currently recommends flu vaccination among pregnant women.
  2. Data from the numerous studies that support the safety of the ACIP’s current recommendation of flu vaccine for pregnant women.
  3. Details of the “case-control” study in question and an examination of the study methods, findings and limitations.

Why the ACIP recommends flu vaccination among pregnant women.  

Currently the CDC’s Advisory Committee on Immunization Practices (ACIP) recommends that pregnant women get a flu vaccine during any trimester of pregnancy to help protect them and their newborns from the dangers of influenza.  Due to changes in the immune system, heart and lungs during pregnancy, expectant women are more prone to severe illness from flu, which has been known to result in premature delivery, low birth weight babies, miscarriage, hospitalization or even death.

Flu vaccination in pregnancy doesn’t just help protect the expectant mother from influenza, it is also the most effective way to pass critical immunity on to the baby during pregnancy.  This passive immunity can then protect the infant child from the dangers of influenza in the time before they are old enough to receive their own flu vaccination at six months of age.

The ACIP recommendation for flu vaccination during pregnancy is supported by other organizations as well, to include The American College of Obstetricians and Gynecologists (ACOG) and the American College of Nurse-Midwives (ACNM).

The studies that support the safety of flu vaccination in pregnancy. 

The ACIP is a committee which consists of 15 voting members who have expertise in vaccinology, immunology, pediatrics, internal medicine, nursing, family medicine, virology, public health, infectious diseases, and preventive medicine.  The Committee meets in person three times a year and subcommittees meet regularly throughout the year via conference call to discuss vaccine research and scientific data related to vaccine effectiveness and safety.

The current ACIP recommendation for flu vaccination during pregnancy is based on a thorough review of the evidence compiled from numerous studies, which include the following:

    • A review of reports to the Vaccine Adverse Reporting System (VAERS), a national vaccine safety surveillance program run by CDC and the Food and Drug Administration (FDA), (Moro et al, 2011) which found no unusual or unexpected patterns of reporting for pregnancy complications or adverse fetal outcomes among pregnant women and flu shots.
    • A study using Vaccine Safety Datalink (VSD) data (Irving et al, 2013) which found no increased risk of miscarriage among pregnant women who received flu vaccines in the 2005-06 or 2006-07 flu seasons. (The VSD is a collaborative program that monitors the safety of vaccines and conducts studies about rare and serious adverse events following immunization.)
    • A large study using VSD data (Kharbanda et al, 2013) which found no increased risk for adverse obstetric events (like chorioamnionitis, pre-eclampsia, or gestational hypertension) for pregnant women who received the flu vaccine from 2002 to 2009 compared to pregnant woman who were not vaccinated.
    • A VSD study (Nordin et al, 2014) which compared pregnant women who received the flu shot with an equal number of pregnant women who did not receive the flu shot during the 2004-05 and 2008-09 flu seasons. The study found no differences between the two groups in the rates of premature delivery or small for gestational age infants.
    • A large August 2017 study using VSD data which found that the babies of women who received the flu shot during their first trimester had no increased risk of having children with major birth defects.

The examination of vaccine safety is an ongoing process.  Before being approved for administration, vaccines undergo rigorous testing by their manufacturers, the FDA, and the FDA’s Center for Biologics Evaluation and Research. Clinical trials are performed before the vaccine is made available to the public, to confirm the vaccine’s safety and efficacy. Even after the vaccine receives FDA-approval, post-licensure studies are conducted on an ongoing basis to continually monitor the vaccine’s safety and to detect and respond to any rare adverse events.

While the studies conducted to date have not signaled any safety concerns, the ACIP and the CDC are committed to the continuous evaluation of the safety of all vaccines, to include those recommended for pregnant women.

This has led to the “case-control” study of flu vaccination and possible miscarriage which was recently published in the journal Vaccine on September 12, 2017 and reported on by The Washington Post, the Associated Press, and various other media outlets.  The study showed that women in early pregnancy who received two consecutive annual vaccines during 2010-11 and 2011-12, both of which included a 2009 pandemic H1N1 (H1N1pdm09) component, had an increased risk of spontaneous abortion (miscarriage) in the 28 days after receiving the second vaccine.

Details of the recently published study of women who had miscarriage following flu vaccination. 

Read more…