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Advisory Committee on Immunization Practices June 2018 Meeting Update

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The Advisory Committee on Immunization Practices (ACIP) held their second of three annual meetings at the Centers for Disease Control and Prevention (CDC) in Atlanta, GA last week.  ECBT staff took advantage of the opportunity to view the meeting via webcast, and strongly encourage members of the public to take advantage of this technology in order to gain a better understanding of the deliberations that take place to ensure the ongoing safety and effectiveness of the vaccines licensed for use in the U.S.

The CDC sets the recommended immunization schedules for people of all ages in the U.S. based on recommendations from the ACIP. The ACIP establishes, updates and continually evaluates all the vaccine recommendations that are made in the United States for infants, adolescents and adults. These guidelines are considered the gold standard among healthcare providers. The ACIP consists of 15 voting members, 8 ex officio members and 30 non-voting representatives who participate voluntarily. In addition to the three meetings per year, which are open to the public, ACIP members serve on various work groups that are active throughout the year. Work groups review the latest studies on specific vaccines (including safety and efficacy reports), in order to provide recommendations to the larger committee.

Last week the ACIP voted on recommendations for influenza (flu) and anthrax vaccinations, and discussed HPV, mumps, shingles (herpes zoster), Japanese encephalitis, and pneumococcal vaccines. Votes and highlights from the discussions are detailed below.

 

Influenza (Flu) Vaccination Discussion and Vote

It will come as no surprise to our readers that the flu virus hit a brutal blow to people of all ages during the very severe 2017-18 flu season in the U.S., striking at nearly the same time nationwide.

 

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Influenza A (H3N2) was the predominant circulating strain and this year the effectiveness of the vaccine against this strain was approximately 24% (similar to the previous flu season). Effectiveness against the influenza A (H1N1) strain was 65% and 49% against the influenza B (Yamagata) strain.

 

 

 

Now the good news – vaccination reduced flu-related visits to healthcare providers (outpatient) by 40% among all people ages 6 months and older. Among adults, the vaccine reduced outpatient visits and hospitalizations by 22%.

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The ACIP listened to vaccine safety reports provided by representatives from the Food and Drug Administration (FDA), vaccine manufacturers, and the vaccine safety surveillance systems in the U.S. – the Vaccine Adverse Event Reporting System (VAERS) and Vaccine Safety Datalink (VSD) which is a collaboration between CDC and nine healthcare organizations that began in 1990 and analyzes up to 10 million immunization records per year to ensure ongoing safety.  After an extensive review of the safety of this season’s flu vaccines, the ACIP confirmed that there were no vaccine safety signals of concern including anaphylaxis, narcolepsy and Guillian-Barre Syndrome, each of which received increased scrutiny due to a number of news and anecdotal reports in recent years.

The ACIP approved the following influenza recommendations for the 2018-19 season:

Everyone 6 months of age and older should be vaccinated with any licensed, age-appropriate influenza vaccine (IIV, recombinant influenza vaccine [RIV], or LAIV), as indicated. No preference is given for any one vaccine over another. In its February meeting, the ACIP once again recommended LAIV (the nasal spray vaccine known as FluMist) for healthy, non-pregnant people 2 through 49 years old during the 2018-19 season. This recommendation was made after ACIP reviewed effectiveness data presented by the manufacturers of FluMist.

Of Note: The Redbook Committee of the American Academy of Pediatrics, who typically endorses the recommendations of the ACIP, have stated a preference for the flu shot (IIV or RIV) over the nasal spray vaccine (LAIV), recommending that pediatricians only give the nasal spray as a last resort. This decision by the AAP is not without controversy as it may lead to confusion among parents and their providers. ECBT Board Member Dr. Paul Offit recently created a Medscape video explaining why he agrees with the ACIP’s decision to recommend the use of FluMist in children based on the effectiveness data.

 

Pneumococcal Vaccination Discussion

Two pneumococcal vaccines are currently recommended for all adults over the age of 65 – one dose of pneumococcal conjugate vaccine (PCV13) with a booster dose of pneumococcal polysaccharide vaccine (PPSV). ACIP is re-examining whether PCV13 should be routinely recommended for otherwise healthy older adults. Some experts believe the childhood recommendations for routine vaccination with PCV13 is sufficiently lowering the disease burden in adults by reducing the circulation of the disease in communities. In data presented to the ACIP, however, it seems there are persistent disparities in the rate of pneumococcal disease and vaccine uptake  pneumoacip062018

among minority populations and those in poverty, which puts into question whether it would be wise to eliminate the vaccine recommendation for adults.  The ACIP will continue to deliberate the data and have continued discussions into 2019.

 

Anthrax Vaccination Discussion and Vote

The anthrax vaccine is currently approved for use by the FDA for 18-65 year olds, and is usually given to select populations of adults (i.e. military). As the Department of Health and Human Services (HHS) and CDC review their plans for responding to an anthrax “mass event”, they have asked ACIP to offer guidance on how best to use the vaccine in the event of emergency. Specifically, they asked ACIP whether the anthrax vaccine would be equally effective and safe if they had to administer the vaccine in fewer or smaller doses to ensure there was enough vaccine for everyone affected.  Also under consideration was the utilization of different types of needles to be used in the event of a needle shortage. The current vaccine is given subcutaneously, not intramuscularly, like typical vaccines. Intramuscular needles are therefore more readily available.

After reviewing the data, the ACIP agreed unanimously that reduced dosing would still save lives, as would offering the vaccine intramuscularly instead of subcutaneously. There was no data, however, on whether reduced doses given intramuscularly would be equally effective. The Committee also offered their recommendations on the duration of antimicrobial treatment following vaccination. There is a new intramuscular anthrax vaccine on the horizon which may help federal agencies better plan for a possible emergency situation.

The ACIP made the following recommendations:

The intramuscular route of administration may be used if the subcutaneous route presents clinical, operational, or logistical challenges that may delay or prevent effective vaccination.

  • Should there be an inadequate supply of anthrax vaccine available for Post Exposure Prophylaxis (PEP), either 2 full doses or 3 half doses of AVA may be used to expand vaccine coverage.
  • In immunocompetent individuals 18-65 years of age, antimicrobials given in conjunction with vaccine may be discontinued at 42 days after the first vaccine dose or 2 weeks after the last vaccine dose, whichever comes later.

 

Japanese Encephalitis Vaccination Discussion

The cell culture-derived Japanese encephalitis vaccine (JE-VC) is both safe and effective, but given how few U.S. travelers contract the disease, ACIP is re-evaluating their recommendations. They are in the midst of re-evaluating the cost effectiveness of the vaccine and whether their recommendations should be more targeted. ACIP will continue deliberations at a future meeting.

 

Mumps Vaccination Discussion

Mumps outbreaks continue to crop up throughout the nation. From late 2016 through 2017, there were 56 outbreaks, which included 3,914 cases, and in 2018, there have already been 30 outbreaks, including 1,415 cases. The ACIP previously recommended the use of a 3rd dose of mumps virus-containing vaccine (MMR) for people identified at increased risk during a mumps outbreak. img_0681.pngDuring the June, 2018 ACIP meeting, the CDC provided guidance for public health officials to assist them on the use of a 3rd dose of MMR vaccine during an outbreak, including identifying groups of people at risk for acquiring mumps during an outbreak; assessing transmission in the settings to determine if groups are at increased risk; and how to implement a 3rd dose recommendation.

 

Shingles (Herpes Zoster) Vaccination Discussion

In October 2017, ACIP made recommendations for a new recombinant zoster vaccine (RZV) called Shingrix. The vaccine is recommended for the prevention of shingles and related complications for adults 50 years of age and older. It is also recommended for adults 50 and older who previously received zoster vaccine live (ZVL), and it is preferred over ZVL for the prevention of shingles and related complications.

GSK, the manufacturer of Shingrix, reported to the Committee that it is increasing the number of doses available due to high demand and shipping delays.  They are also continuing to study the safety and effectiveness of the vaccine.  The CDC also continues to monitor shingles vaccine coverage and vaccine supply. As it does with all vaccines, the CDC is using U.S. safety surveillance systems – VAERS and VSD – to monitor the shingles vaccine (RZV). VAERS is a passive system that is not designed to determine if a vaccine caused a health problem, but does help to detect unusual or unexpected patterns of adverse events that might indicate a possible safety problem with a vaccine. The CDC reported that were 680 reports to VAERS between October 20, 2017 and April 27, 2018, and the majority concerned females. There were no unusual patterns or unexpected adverse events. 48 (7%) of reports involved co-administration with 1 or more other vaccines, and the most commonly reported side effects from RZV were injection site pain and pyrexia (fever).

The CDC also reported to ACIP about VSD monitoring of the shingles vaccine.  The staff of the  VSD conducted vaccine safety studies based on questions and concerns raised from the medical literature and reports to VAERS. As of May 31, 2018, 37,303 total doses of RZV were administered at the participating VSD sites. The VSD monitoring for RZV includes high priority short-term outcomes (GBS, anaphylaxis, and acute myocardial infarction); lower priority short-term outcomes for descriptive analysis (gout, local and systematic reactions); and longer-term outcomes (potential immune-mediated diseases). Evidence of safety and effectiveness of shingles vaccine in immunocompromised is currently being reviewed.

The CDC has created a number of resources for RZV. For providers, the CDC developed a report published in MMWR on vaccine administrative errors, a Continuing Medical Education program (CME) called “You Call the Shots”, a Medscape video, web pages, webinars/conferences and fact sheets. For the public, the CDC created a vaccine information statement (VIS) on the RZV, web pages and a fact sheet.

Human Papillomavirus (HPV) Vaccination Discussion

In October 2018, the FDA is expected to complete a review of scientific studies to determine whether 9-valent HPV vaccine (GARDASIL®9) is safe and effective for use in adults ages 27 to 45. The vaccine will continue to serve as a prophylactic to prevent new infections, and is not expected to prevent progression of the disease among those who already have a HPV infection. The ACIP is also simultaneously reviewing the evidence that has been sent to the FDA and will determine whether to recommend the vaccine if and when the FDA approves the vaccine for use among mid-aged adults. Factoring into the ACIP decision will be the fact that the overall population-level benefit will be lower among mid-aged adults than among younger populations. This is due to the fact that this

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population may have already been exposed to HPV and thus already have an infection, or have immunity against some strains of the disease. In addition they tend to have fewer new sex partners and have several other factors that will make the vaccine less beneficial (but not without merit) for this older group than for those ages 11-12, who can be vaccinated prior to exposure.

The ACIP’s HPV work group is also continuing to review data in consideration of “harmonizing” the schedule for males and females so that both populations would be recommended up to the age of 26 instead of up to age 21 for males and up to age 26 for females and will report back to the full ACIP at a future meeting.

ECBT will keep you informed on this and other deliberations of this important committee.  

Learn more about each of these vaccines and the diseases they prevent on the Vaccinate Your Family website and Facebook page.

 

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

March 14, 2018 6 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.

Scientists Travel to Remote Village in Search of Clues to Monkeypox Virus

November 4, 2017 Leave a comment

In this day of globalization, outbreaks of infectious diseases that begin in remote villages in far away countries can reach major cities on any continent in a matter of days.  To complicate matters, animal-borne infectious diseases that jump to humans are on the rise and there is still so much we don’t know about these diseases.

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“Understanding the virus and how it spreads during an outbreak is key to stopping it and protecting people from the deadly disease.” Lena H. Sun, The Washington Post

As an example, reports of monkeypox, a rare but fatal disease, have been on the rise since late last year. Monkeypox is a cousin to the deadly smallpox virus which initially infects people through contact with wild animals (though not necessarily monkeys) which is then spread from person to person. The disease produces a fever and a rash that often turns into painful lesions. Even though most people have never heard of monkeypox, the U.S. government has included it on their list of pathogens with the greatest potential to threaten human health.  

The concern with monkeypox is that there is still so much we don’t know about the disease. However, what we do know is that there is no cure and it is deadly in 1 out of 10 of its victims. 

So, while some parents in the U.S. have spent the year fighting for their right to exempt their children from school-required vaccines, human cases of monkeypox have been reported in Liberia, Sierra Leone, Congo Republic, the Central African Republic and, most recently, Nigeria.

But that doesn’t mean monkeypox isn’t a threat to the U.S.  In fact, according to the Washington Post, the U.S. “experienced a monkeypox outbreak in 2003 when an exotic pet dealer imported 800 animals from Africa, including giant pouched rats, dormice and rope squirrels”, some of which were believed to be infected with monkeypox. While the animals were in a facility in Illinois, some of them infected prairie dogs that were later sold as pets and 47 people in six Midwestern states were sickened.

As of January, the Congo Republic of Africa has been experiencing an outbreak of monkeypox that has since spread to at least 88 suspected cases throughout the country, with 6 documented deaths so far.  Out of concern for this outbreak, the Congolese government recently invited researchers from the Centers for Disease Control and Prevention (CDC) to their country to help track the disease and train local scientists.

As American scientists traveled deep into the Congo rain forest to a village at the epicenter of the outbreak, a Washington Post reporter and photographer had the rare opportunity to accompany them. Their amazing journey, and the fascinating work that the scientists did there, is featured in a special Washington Post story entitled CHASING A KILLER.

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The article chronicles the trip from Atlanta to the Congo Republic, and details the specific efforts made to sample the animal population and bring those samples back to Atlanta for analysis. Not only does the story unfold like a novel, but the photography captures the primitive conditions and the importance of this continuing work.

Hopefully, readers will appreciate the ongoing efforts that are being made to not only improve global health, but to protect our public health here in America.  

 

Raising Awareness of Viral Hepatitis on World Hepatitis Day

Viral hepatitis is a major health problem and one of the leading causes of death globally.  Approximately 1.34 million people die each year all around the world, and million others are infected, most of which do not even know.  Since hepatitis is not limited to one location or one group of people, everyone around the world needs to understand the disease burden and the steps they can take for prevention, testing and treatment.  

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The ABC’s of Hepatitis

Hepatitis” means “inflammation” of the liver and it can be caused by things such as bacterial and viral infections, toxins, certain drugs, some diseases, and heavy alcohol use. There are currently five hepatitis viruses that have been identified that specifically attack the liver and cause “viral hepatitis”. The most common types are A, B, and C, but there is also D and E.

All of the hepatitis viruses cause a new or “acute” infection, but only the hepatitis B and C viruses can result in a “chronic” infection that increases the risk of a person developing cirrhosis, liver failure or liver cancer.

Hepatitis A virus (HAV):

Hepatitis A virus can range in severity from a mild illness lasting a few weeks to a severe illness lasting several months. It is highly contagious and usually transmitted when the virus is taken in by mouth from contact with objects, food, or drinks that are contaminated by the feces (or stool) of an infected person.

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The best way to prevent an infection is by getting vaccinated with the 2-dose series of hepatitis which is routinely recommended for all children, travelers to certain countries, and persons at risk for the disease. Fortunately, the vaccine has helped reduce the incidence of hepatitis A, but there are still outbreaks in the U.S. every year. In 2014, there were an estimated 2,500 cases of acute hepatitis A infections in the United States. So far in 2017, there have been 275 cases in San Diego alone, resulting in 194 hospitalizations and 8 deaths.

Hepatitis B virus (HBV):

Hepatitis B virus can be transmitted through the body fluids of an infected person. This can happen through intimate contact, contact with the blood or open sore of an infected person, sharing needles, syringes, razors or toothbrushes, or from a mother to her baby at birth. Unlike hepatitis A, it is not routinely spread through food or water. However, it is possible to spread to babies when they receive pre-chewed food from an infected person.  Surprisingly, hepatitis B virus can survive outside the body for as long as 7 days. During that time, the virus can still cause infection if it enters the body of a person who is not infected.

Many people with chronic hepatitis B virus infection do not know they are infected since they do not feel or look sick. It is believed that 90% of people living with hepatitis B are unaware of their infection status. Unfortunately, this means they are often unknowingly spreading it to others.

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For some people, hepatitis B is an acute, or short-term, illness but for others, it can become a long-term, chronic infection. The younger a person is when infected, the greater their risk of developing chronic disease.  For example, approximately 90% of infected infants become chronically infected, compared with 2%–6% of adults. This is why the birth dose of hepatitis B vaccine is so critical in preventing chronic infections that can lead to serious health issues, like cirrhosis or liver cancer.  (To understand why babies need the vaccine at birth, see a guest post written by Carolyn Aldigé, President and Founder of the, Prevent Cancer Foundation here.)

In the U.S. an estimated 850,000-2.2 million persons have chronic hepatitis B. However, rates of acute hepatitis B in the U.S. have declined by approximately 82% since 1991, when the routine vaccination of children was implemented. Yet, in 2015, it was estimated that 257 million people are still living with hepatitis B infection worldwide.

Hepatitis C virus (HCV):

Read more…

Global Pandemics are the Unseen Enemy in a Battle Without Borders

We live in world that is increasingly more connected.

17201073_755634207937920_5773479724868255787_nThe film Unseen Enemy, which will air on World Health Day, Friday, April 7th on CNN (10pm ET/7pm PT), explores this global connectivity and how it relates to the threat of emerging infectious diseases.  It extends beyond the role of global health leaders and calls upon individuals to take actions that can help improve the health of our communities and our world.

To set the stage, the film takes viewers on a journey across continents to explore large-scale disease outbreaks such as Ebola, influenza and Zika. It honors both patients and healthcare workers who have endured challenging circumstances, and often risked their lives, in the fight against infectious diseases. It also warns about emerging threats, where they may come from and what we should be doing to prepare.

In interviews with various researchers, the film provides a glimpse of the issues that global health leaders are working to solve.

How will we keep one step ahead in the fight against viruses and epidemics?  Where are the global hotspots where these diseases may emerge? How can healthcare workers, scientists, businesses, NGOs and governments work together to ensure that we are prepared for the next invisible threat? What are the possibilities that these threats will come in the form of viruses, laboratory mistakes or acts of bioterrorism?  

The film certainly emphasizes the need for global preparedness, but it also calls upon individual viewers to take action.  The power of the people exists in how we share valuable information, how we support key public health stakeholders around the world, and how we mobilize leaders to adequately prepare for emerging threats now, before it is too late.

It Takes All Of Us

Stopping an outbreak will require us all to work together, for the benefit of everyone.  Janet Tobias, who served as a director, producer and writer of the film, explains how working on Unseen Enemy provided her with a new perspective about our personal roles in public health. Read more…

Measles Anywhere is a Result of Measles Everywhere

April 3, 2017 35 comments

Will we ever stop seeing cases of measles?

Last week, officials confirmed the first case of measles in Michigan this year. That may not sound significant.  It’s only one case in one state, but it’s actually one of 21 cases of measles reported across 7 different states so far this year.

17757243_10210140079997364_6840572758006483074_n-1Last week we also heard the World Health Organization warn of measles outbreaks across Europe.  This image, published in an article from The Sun in the UK, illustrates how widespread the outbreaks have been.  There are currently 14 countries seeing endemic transmission of measles, to include such countries as France, Germany, Italy, Poland, Romania, Switzerland and the Ukraine.  Maybe not the countries you were expecting.  And maybe some countries you plan to visit.

Although measles was declared eliminated in the U.S. in 2000, and even eliminated from all of the Americas in 2016, measles still kills an estimated 115,000 children per year all across the globe – that’s 314 measles related child deaths each day.  Clearly, measles remains a signifiant global health concern.

And it’s not just measles deaths we worry about.  Measles can be a serious illness requiring hospitalization. As many as 1 out of every 20 children with measles gets pneumonia, and about 1 child in every 1,000 who get measles will develop encephalitis – a swelling of the brain that can lead to convulsions, and can leave the child deaf or intellectually disabled.  For every 1,000 children who get measles, one or two will die from it.

When we consider the impact of measles worldwide, we begin to understand why every case is relevant and in someway related, and here’s why:Screen Shot 2017-04-02 at 6.56.10 PM

Measles is a highly contagious airborne disease.  

When one person has measles, 90 percent of the people they come into close contact with will become infected, if they are not already immune. The virus can linger in the air for up to two hours after an infected  person has coughed or sneezed.  If other people breathe the contaminated air or touch the infected surface, then touch their eyes, noses, or mouths, they can become infected.  This means you don’t even have to have contact with the contagious person to become infected. That is why one a case of measles can easily be spread to others.

Disease elimination is not the same as disease eradication. 

Measles elimination is defined as the absence of continuous disease transmission for 12 months or more in a specific geographic area.  Measles is no longer endemic in the United States, but that doesn’t mean we don’t still see measles cases.  The cases we see here begin with transmission elsewhere.  Sometimes cases originate with  U.S. citizens who unknowingly contract measles while traveling abroad and then became sick and spread the virus upon returning home.  Other times, travelers from other countries arrive in the U.S. while contagious.  In both instances, these individuals can spread measles to anyone they come in contact with who isn’t already immune.  In recent years, this has caused several widespread outbreaks of measles in the U.S.

There are still many people in this world who are not vaccinated against measles.

It’s estimated that in 2010 about 85% of the global population has received at least one dose of measles vaccine.  While that may sound good, it’s still not good enough to stop the spread of measles.  Because measles is extremely contagious, the immunity threshold – which is the percentage of individuals who need immunity in order to prevent a disease from spreading – is as high as 95%.  Sadly, as of 2014, only about 63% of countries have an immunization rate that is above 90% and even 90% isn’t good enough.   Read more…