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Protecting Myself and My Child against Vaccine-Preventable Diseases during Pregnancy

August 6, 2018 3 comments

By Erica DeWald, Director, Advocacy, Every Child By Two

Here at Every Child By Two, we practice what we preach. That’s why I got both a Tdap and influenza vaccine when pregnant with my first child (who is fully up-to-date on his childhood vaccines). Now that I’m expecting my second baby, I didn’t hesitate to get vaccinated again.

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Why do I choose to get vaccinated?

Vaccines during my pregnancy have the ability to protect not only me, but my child as well. Infections such as flu and whooping cough, also known as pertussis, are not just a threat to me. They can also be extremely dangerous, and even deadly, to newborns.

Why get vaccinated against whooping cough?

Whooping cough is a highly contagious respiratory disease that spreads easily from person-to-person through coughing and sneezing. Symptoms can be less severe in vaccinated people and older children and adults, so adolescents or adults may unknowingly pass the infection onto vulnerable infants.

In young children, the cough can be so severe that it can cause a child to gag, turn blue, vomit or pass out. A gasp for air after a coughing fit can sometimes produces a loud “whoop” sound, though it is not uncommon to have whooping cough without producing the “whoop” sound.  This intense coughing phase can last as long as 10 weeks.

Half of all children who get whooping cough under a year of age end up in the hospital. Some will suffer lifelong complications and one of every 100 will die.

Why get vaccinated against flu?

Changes in my immune, heart, and lung functions during pregnancy make me more likely to get ill and suffer severe complications from illnesses as compared to non-pregnant women. In fact, as a pregnant woman, I am five times more likely to suffer complications or death from flu compared to non-pregnant women.  Additionally, if I fall ill during pregnancy, I have a greater chance of hospitalization, spontaneous abortion or complications that can directly impact the health of my baby such as preterm labor and delivery, and low birth weight babies.

In children, the highest incidence of hospitalization due to influenza is among infants younger than 1 year, with those younger than 6 months at highest risk. On average, about 100 children die from flu each year in the U.S. and thousands more are hospitalized.

Getting vaccinated during pregnancy also provides my child with protection during his first weeks and months.

By getting my vaccines in pregnancy when recommended by the Centers for Disease Control and Prevention (CDC), the American College of Obstetricians and Gynecologists (ACOG), and the American College of Nurse Midwives (ACNM), I can lessen my child’s chances of contracting these diseases when he is most vulnerable (and before he receives his own vaccines):

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How do I know vaccines are safe for me and my child?

Experts carefully reviewed the safety data of the whooping cough vaccine before recommendation that women receive a Tdap vaccine during each pregnancy.  They concluded that the vaccine was safe for both pregnant women and their babies and there is a long list of published safety studies that can be reviewed here.

Additionally, science supports the safety of flu vaccination for pregnant women and their babies, and the flu shot has been safely administered to millions of pregnant women over many years.  While the scientific community will continue to gather data on this topic, various studies, such as those detailed below, already indicate that it is safe to administer the flu vaccine in pregnancy.

For now, I’m off to find a flu vaccine in order to give my child some protection against the disease before he’s born and flu season is in full swing!

Find more information on vaccines in pregnancy on these websites:

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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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Timely Flu News and Updates on Pediatric Deaths

February 7, 2014 1 comment

Over the last two decades, Every Child By Two has worked with partners at the grassroots and national levels to develop initiatives that help educate the public, healthcare workers and lawmakers about the importance and safety of immunizations.  As part of this mission, they continue their efforts to inform the public about the universal recommendations for influenza vaccination and the details of the current influenza season.

In a critical update from the CDC this week, Every Child By Two discovered that there have been 9 new pediatric deaths from influenza in the week ending in January 25th.

With a total of 37 pediatric deaths so far for the 2013-2014 flu season, the biggest tragedy is that 23 of the 37 children who died had a known vaccination status and they were eligible for vaccination; however, only 2 of the 23 children were fully vaccinated.

Furthermore, 6 of children who died were in the 0-5 month age group and ineligible for vaccination based on their age.  Ten of the children were between 6 and 23 months; five children were between 2 and 4 years old; ten children were between 5 and 11 years old; and six children were between 12 and 17 years old.

But no matter what the age or vaccination status, a pediatric flu death is a tragedy, especially if it could have been prevented with a simple vaccination.  

Read more…

Tragic Story of Pregnancy, Miscarriage and Two Lives Threatened by Flu

January 23, 2014 18 comments

Last night I read an article on the CNN Health pages that would haunt me in my sleep.  It was entitled Woman with flu miscarries, battles for her life.

A 'Love for Leslie' Facebook page keeps friends and family updated on Leslie Creekmore's condition.

A ‘Love for Leslie’ Facebook page keeps friends and family updated on Leslie Creekmore’s condition.

A young married couple, Chris and Leslie Creekmore, both shared symptoms of the flu earlier this month.  While Chris was able to recover, his wife Leslie, who was 20 weeks pregnant, was admitted to the hospital on January 11th.

In researching tips for a healthy pregnancy, the couple came across a recommendation to avoid the flu vaccine in the first trimester.  Since their OB-GYN agreed, stating that he was wary of giving flu shots during the first trimester, Leslie had planned to get vaccinated on January 13th when she went in for her 20-week ultrasound.  Instead, she succumbed to the flu and was put on a ventilator that day.

She has since been unconscious, suffering a miscarriage, a collapsed lung and a surgery to receive extracorporeal membrane oxygenation therapy which provides heart-lung bypass support and circulates blood through an artificial lung back to her body.

While Leslie continues to fight for her life, Chris is speaking out and spreading this message:

Vaccinate yourself against the flu.

As I read this tragic story, I couldn’t help but see the faces of all my friends and relatives who are expecting new babies in their lives.  Life is so fragile and I only wish that every expectant couple would be aware of the benefits of flu vaccine during pregnancy.

Dr. Rosanna Gray-Swain, an obstetrician-gynecologist at Barnes-Jewish Hospital where Leslie Creekmore is being cared for, explains that

“Pregnant women are five times more likely to end up in the ICU or have severe complications related to the flu than non-pregnant women who get infected with the flu.”

And while life-threatening developments like Leslie’s are generally rare, they are not unheard of.

Unfortunately, expectant couples like the Creekmores are often mislead by inaccurate information and outdated recommendations.  This is why we continue to emphasize the recommendation that have been made by the Centers for Disease Control and Prevention since 2004;  pregnant women should receive a flu vaccine as soon as it becomes available in order to protect themselves and their unborn child against serious complications from the flu. Read more…

2014 Flu Activity: Surprising or Not?

January 8, 2014 4 comments

After the past few weeks of holiday get-togethers and extended traveling, it’s no surprise that the flu has arrived in the U.S. with a vengeance.  Colorado, like many other states, is reporting an alarming increase in influenza infections with 448 flu-associated hospitalizations so far this year. In New York state, reports indicate that flu cases are up 119%, with a 126% surge in flu related hospitalizations.  Similar news reports can be seen all across the country, with as many as 25 states reporting high flu activity.

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As concerning as this is, it’s not all that surprising.  It is January after all.  And flu activity typically peaks in January or later.

But there have been a few surprises we’ve seen so far this season. 

First, a Texas health care system recently reported eight flu-related deaths in its Travis County hospitals during December.  The H1N1 strain appears to be the most prevalent strain there.  But that was not the surprise.  The surprise was seeing which patients the strain was impacting the most.  While the flu is typically most dangerous for people over 65 and kids under five, doctors in Travis County indicated that the early strain of H1N1 hitting so far this season was targeting a different age range.

 “Some of the sickest people we’re seeing with the flu are young and healthy people, 40- to 50-year-old people,” said Ross Tobleman, M.D., the medical director at the emergency department at Scott & White in Round Rock.  “For whatever reason, they just get really, really sick with this strain of the flu.”

Although flu vaccination rates have continued to climb in recent years, with last year’s flu vaccine uptake at about 56.6% for children through age 17 and 41.5% for adults, we don’t have enough data this season to determine which strain will be the most prevalent or dangerous, and which age group will suffer the most.

But there is one thing for sure.  There will be children who will die from the flu again this year.

So far there have been a total of six influenza-associated pediatric deaths reported for the 2013-2014 season.   And the death of a vaccinated 5-year-old boy, named Ronan, provided yet another surprise to some. Read more…

An Epidemic of Apathy Towards Seasonal Flu

December 13, 2010 22 comments

This article was originally printed as a guest post on BlogHer, Dec. 7, 2010, under the title, Why Everyone Should Get A Flu Shot, in honor of National Influenza Vaccination Week. 

By Christine Vara

Last year at this time, the H1N1 virus, also referred to as the “swine flu,” had us all rather panicked. People were anxious to get vaccinated against the flu then. But what about now?

My guess is that the media attention given to the H1N1 epidemic last year left a skeptical public uncertain about the impact of the flu, and the safety and effectiveness of flu shots in general.

Regrettably, H1N1 made itself personally known to my family last year when my own 9-year-old daughter, Marissa, received a positive diagnosis. Unfortunately, she contracted H1N1 before a vaccine became available. I’ll admit that my husband and I were very concerned.  In the back of our minds, we knew that she could easily become a tragic statistic, and the feeling was one of helplessness.

We did our best to quarantine her in order to keep the virus from spreading to our other four children. We tried to make her as comfortable as possible in her room, and gave her a walkie-talkie to call us with when she needed something. My husband even downloaded a week’s worth of Brady Bunch, Partridge Family and Happy Days reruns to keep her entertained. Her sisters slipped get well cards under her door and we served her meals on special trays that only my husband or I would handle and deliver.

After a week or so, my daughter recovered and resumed life as usual. It sure is interesting how a brief brush with an unpredictable disease can change your perspective. The unspoken fear that we faced last year has faded into a childhood memory for Marissa. Surprisingly, it appears that public memory has been short-lived as well — which troubles me as a mom of five active kids.

Due to the heightened concern from last year’sH1N1 outbreak, I would have guessed that more people would be inclined to get flu shots this year. Unfortunately, it appears that a significant portion of the public is more concerned about potential side effects of the vaccine than with the consequences of falling ill with influenza.

A survey of 1,500 adults, recently conducted by The Consumer Reports National Research Center, indicated that 30 percent of those surveyed will skip the flu shot this year, citing concerns about side effects, exaggerated epidemic messages, and a desire to build up their own immune systems.

Another recent Time article indicates that this sentiment is echoed among many parents. The National Foundation for Infectious Diseases (NFID) questioned more than 600 mothers of kids ages 6 to 18, and revealed that 80 percent of mothers said their attitude toward vaccination was not swayed by last year’s H1N1 scare and one-third were opting to forgo flu vaccination for their children, citing fear of side effects as their main concern.

What the public may fail to understand is that seasonal flu vaccines are extremely safe. Consider the fact that flu vaccines are administered year after year to a large percentage of the population. Because of this, they are some of the most widely used and well tested immunizations being administered today and their safety record is proven.

So what is all the worry about? Some minimal discomfort and minor side effects? 

Unfortunately, many of the common worries are actually based on unfounded myths.

To read the remainder of this post click here.  You will be redirected to the BlogHer website.  Feel free to submit your comments there, or include them here on Shot of Prevention. 

An H1N1 Scare – Gone, But Not Forgotten

October 21, 2010 65 comments

By Belinda Duvall

Fall is here again bringing crisp air, beautiful fall leaves, and family events. It is also the one year anniversary of my son, Luke, almost losing his life to influenza. This anniversary brings a new found concern to my family-the flu season. People rushed to get their flu vaccinations last year and were upset by the delay and shortage. I have come in contact with people who aren’t sure if they will even get their flu vaccination this year. I have heard many reasons-Don’t like shots”, “it’s not important”, “the flu is not around”, and “I have never gotten the flu before”. I am saddened and frustrated by people’s short memory. While this flu season may not be bringing the same attention, or the same frustrations and concerns as last, the dangers of the flu have not changed.

I will never forget the very long night we spent in our local hospital before Luke was ventilated and Med flighted to Arkansas Children’s Hospital. Luke asked me several times, while gasping and desperate to breathe, if there was anything we could have done differently that would have changed his situation. His question haunted me for days.   I felt I had failed as a mother and missed something.  Days later, with tears in my eyes, I mustered up the courage to ask a nurse his question to me.   Read more…