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Meningococcal Disease: How to Be Sure Your Teens Are Fully Protected

September 18, 2018 2 comments

Guest Post By Lynn Bozof, President, the National Meningitis Association

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This post was written by an extraordinary woman who passed away only days ago. Lynn spent the last phase of her life fighting to ensure that mothers, fathers, siblings and family members would never suffer the devastation of losing a child to a disease called meningitis. Many parents are now aware of this disease, and that is in large part due to the tireless advocacy and educational efforts of Lynn, and the many families who support the work of the National Meningitis Association.  The entire vaccine community will miss you dearly Lynn.  Every Child By Two  promises to remain steadfast in our shared goal to save others from this terrible disease.


 

 

As a parent, it’s no surprise that the busy lives of teenagers can leave little wiggle room between school schedules, homework, and numerous extra-curricular activities. It’s hard to believe we’re already only a few weeks away from Thanksgiving break. Those off days from school are the perfect time to check in with your child’s healthcare provider to make sure they’ve received all recommended vaccines to prevent against deadly diseases – including meningococcal disease.

In 1998, I lost my son Evan Bozof to meningococcal disease – commonly referred to as bacterial meningitis. Evan was a vibrant, healthy teenage athlete, but within a month my husband and I watched this terrible disease attack every part of Evan’s body and ultimately take his life. No one had ever told me that there was a vaccine available that might have prevented it.

Ever since then, I’ve made it my mission to spread awareness of bacterial meningitis and encourage parents to get their children vaccinated. As we head into the colder months, here is everything you should know about this disease and the vaccines available to prevent it.

 

What is Meningococcal Disease?

 

Meningococcal disease is a rare but potentially deadly bacterial infection involving the inflammation of the membranes (meninges) surrounding the brain and spinal cord. The disease strikes quickly and can lead to devastating complications if your teen has not been fully vaccinated.

Of those who contract meningococcal disease, 10 to 15 percent die from it. Among those who survive, as many as 20 percent live with permanent disabilities, such as brain damage, hearing loss, loss of kidney function or limb amputations. Vaccinations offer the best protection against meningococcal disease.

Symptoms and Progression: What is Important to Know

 

Meningococcal disease is often misdiagnosed, as early symptoms resemble those of other illnesses such as the flu. They may include sudden high fever, headache, nausea, vomiting and exhaustion, and can progress into sensitivity to light, abnormal skin color or rash, with the most extreme symptoms being confusion, delirium or loss of consciousness.

Symptoms of meningitis advance incredibly quickly. Within 24 hours, patients can go from being entirely healthy to near death.

 

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What You Should Know About Vaccination Options

 

There are two vaccines available to prevent against the five major strains of bacteria (A, C, W, Y and B)that cause meningococcal disease. The MenACWY vaccine protects against four strains, while the MenB vaccine protects against the fifth.

The Centers for Disease Control and Prevention (CDC) recommends the MenACWY vaccine to all adolescents at age 11-12, with a booster at age 16.

The MenB vaccine was recommended for permissive (aka Category B) use among those age 16-23 – with preferred vaccination between 16 and 18 – by the CDC in 2015. Older adolescents and young adults can decide, in collaboration with their doctors, whether they’d like to receive the MenB vaccine. Nearly MenACWYevery insurance plan covers the MenACWY and MenB vaccines, and adolescents without insurance can get vaccinated at little to no cost.

The NMA believes that all adolescents should be vaccinated against meningitis B, as it is the strain most commonly linked to outbreaks on college campuses. Vaccination is always the best method of meningitis prevention.

For a full list of those recommended by the CDC for meningococcal vaccination, please visit the CDC website.

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Why Teens Are Most at Risk

 

Meningitis is a rare disease, but once it strikes it can prove deadly within a matter of hours. Teens and young adults are the group most at risk because they often live in close quarters – like a dormitory – and tend to share beverages more often than adults or young children.

In the winter of 2016, three cases of meningitis occurred at the University of Santa Clara. The year before, the University of Oregon experienced a six-month meningitis outbreak that infected seven students and left one dead.

Increasingly, colleges have begun mandating that students receive the second dose of the MenACWY vaccine – as well as the MenB vaccine – prior to matriculation. The NMA fully supports these efforts and believes that the best path to meningococcal prevention is complete vaccination.

 

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About one in ten people carry meningococcal bacteria in their nose or throat without showing any signs or symptoms of the disease. These people can unknowingly transmit the bacteria to others.

 

Putting It into Perspective

 

It’s normal for kids and teens to think they’re invincible and not see the importance of getting vaccinated. Caitlin Brison was a high school senior when her doctor asked at her routine checkup if she wanted to receive the second meningitis vaccine. Not wanting another needle, Caitlin said no. That decision ultimately came back to haunt her.

In college, Caitlin contracted a severe case of bacterial meningitis that ultimately led to months of dialysis, as well as memory loss and physical therapy to re-learn how to walk. Several years later, she received a kidney transplant. Caitlin says she can still remember that day in the doctor’s office like it was yesterday. “My first question was ‘Do I have to have it?’’’ she says. “He said no, so then I said no, and that was a big, big mistake.”

Cases like Caitlin’s serve as a reminder to parents and adolescents to think about the big picture when it comes to vaccination. A small prick in the arm is nothing in comparison to kidney failure, loss of arms or legs, or any of the other debilitating after- effects that survivors of meningitis often must manage for the rest of their lives. Listening to survivors talk about their long and painful paths to recovery illustrates not only the horror of meningitis, but the importance of vaccines as prevention.

If I had known that there was a vaccine available to prevent against bacterial meningitis, my son might still be alive today. The NMA continues to advocate for the broadest possible vaccine recommendations from the CDC so that other families don’t have to experience the truly devastating impact of meningococcal disease.

 

Where Can I Find More Information?

 

Following are additional resources that provide more information about meningococcal disease and prevention methods, including vaccination:

 

 

 

 

Meningitis B and Your College Student: Preventing the Call

This important post is being published to highlight Preteens & Teens Week during National Immunization Awareness Month.  Please take the time to talk to your child’s healthcare provider to make sure he or she is up-to-date on all recommended vaccines. (A version of this post was originally published on Shot of Prevention on February 14, 2018.)

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Emily and the Stillman family after her high school graduation.

Emily was a 19-year-old college student when she called home complaining of a headache. Thirty-six hours later, she passed away due to serogroup B meningococcal disease (also known as meningitis B). Emily was able to donate six of her organs, together with bones and tissue, to save the lives of five others.

Emily’s mother, Alicia Stillman, who graduated from Arizona State University, returned to Arizona after founding The Emily Stillman Foundation to honor her late daughter’s life. She shared the story of how Emily contracted meningitis B and her family decision to donate Emily’s organs. She also explained the work she is doing to help educate others about the availability of serogroup B meningococcal vaccines (MenB) in the United States and to encourage organ donation. She spoke with Debbie McCune Davis, Director of The Arizona Partnership for Immunization (TAPI), who is leading the effort to increase awareness of the approved vaccine and who is working with the universities in Arizona to promote the Off to College education campaign.

Together these two women share a message of hope, as they work to save lives and prevent serogroup B meningococcal disease by educating parents, students, educators and medical professionals across Arizona and the nation.

Alicia: I always felt I was living a blessed life. I enjoyed motherhood. I had three beautiful children, a wonderful husband, and a successful career. I believed I was doing everything right to raise healthy, independent children, as I sent each one off to college.

My middle daughter Emily had a fabulous first year away at a small liberal arts college in Kalamazoo, Michigan. In 2013, she was well into the second semester of her sophomore year when she called home one evening, complaining of a headache. Thinking it was from lack of sleep, I advised her to take some ibuprofen, and to touch base with me in the morning. Little did I know that was to be the last time I would ever hear my Emily’s voice.

The call the next morning wouldn’t come from my Emily, but rather from the Dean of the college. She told me my daughter had been admitted to the hospital during the night with bacterial meningitis, that she was very sick, and I needed to get there as soon as possible. I remember insisting that this was not possible because even at that time, I knew she had received “the meningitis shot”.  In fact, I even remembered that before she left for college, she had received a meningitis booster. What I did not yet know at that time was that the vaccine she had received (MenACWY) only protected her against 4 of the 5 common serogroups of meningococcal disease. I had no idea that there was a strain (serogroup B) she was not protected against because a vaccine for that strain was not even available in the United States at that time.

Less than 36 hours later I said goodbye to my baby. My beautiful girl that I had promised to always protect and take care of was gone. As I said goodbye to her on that cold February morning, I told her that I would be ok…and that I would figure this out.  I would make sure this could not happen to other people.

Debbie: Stories like Alicia’s couldn’t be prevented in the U.S. when Emily Stillman was infected with meningitis B and lost her life to the disease, but they are today. In October of 2014 and January of 2015, the FDA approved licensing for two different vaccinations to protect against serogroup B meningococcal disease. Soon after that, the CDC’s Advisory Committee on Immunization Practices (ACIP) recommended that college students talk with their doctors about the meningitis B vaccine (MenB).

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Off to College TAPI’s campaign to educate college students and their parents about vaccinations needed before school.

In Arizona, our Board of Regents (the governing board of our state university system) took quick action to recommend all incoming freshmen get the vaccine.  There had been outbreaks in the PAC 12 schools and Arizona wanted to promote healthy campuses. We, at TAPI, worked with the universities, their medical directors and all of our professional medical organizations including osteopaths, pharmacists, nurses, and pediatricians to put forth a unified message and raise awareness.

Alicia: I live my promise to my Emily every single day with my work at The Emily Stillman Foundation. Before the vaccine was approved in the U.S., I discovered the vaccine was available in Canada. We took busloads of families across the Detroit/Windsor border into Canada to get the MenB vaccine. We met with the Food and Drug Administration (FDA) and many members of Congress to urge the fast tracking of the licensing process. I testified at the CDC and encouraged ACIP to grant a firm recommendation to protect our adolescents and young adults. I set up vaccination clinics locally to provide the vaccine before medical practices were willing to hear about it. I speak nationally, working with colleges, medical practices, and parents to raise awareness to this hideous disease, its symptoms, and the vaccinations now available to prevent it. I won’t stop until the MenB vaccine is on the required list, and is available to all people.  Only then will my promise to my Emily be fulfilled. 

Debbie: Today, we at TAPI are taking it a step further…we don’t want kids to wait until they’ve moved into their dorms to receive their vaccination. We are working with high schools, parents groups, physicians, athletic departments and more to promote Vaccinate Before You Graduate here in Arizona. We want this to become part of the college prep routine—take your college entrance exams, turn in your transcripts, apply for scholarships, choose your school, order your cap and gown and vaccinate.

As mothers and as experts – one from a heart-breaking loss, and one as a professional who works tirelessly to prevent disease – we urge you to enjoy these moments with your child.  However, as you are giving them that final send off, smoothing the bedding on their dorm bunk, stocking snacks and toiletries, telling them to study hard and have fun (but not too much fun), asking them to be safe, be sure to also give them the tools to stay healthy. Make sure they have their boosters, that they are up-to-date on all vaccination and be sure your health professional has given your child protection from all strains of meningitis, including meningitis B. If your child has already started that journey and is off to college, check with the student health services at their school for information about vaccine availability on campus. Do it for your child, do it for yourself and do it for Emily.

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Watch this video from the Meningitis B Action Project to learn more about MenB in 90 seconds

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Alicia Stillman lives in West Bloomfield, Michigan with her husband of 29 years, Michael. In addition to her angel daughter Emily, she has two live children – Karly, 25, and Zachary, 21. Alicia holds an MBA in Management Accounting, and is the Accounting Director for a multi-state law firm. She is the Co-Founder and Director of The Emily Stillman Foundation, founded in 2014 in memory of her late daughter Emily. The Foundation has a trifold mission to raise awareness for and encourage organ and tissue donation, to educate about meningococcal disease as well as all vaccine-preventable diseases, and to advocate globally for all health and wellness issues. Most recently, Alicia partnered with Patti Wukovits to co-found the Meningitis B Action Project. Alicia can be reached through the Foundation at emilystillmanfoundation@gmail.com.

McCune DavisDebbie McCune Davis has served as Director for The Arizona Partnership for Immunization, better known as TAPI, since February 1996. She was an elected member of the Arizona Legislature, serving from 1979 until 1994 and again from January 2003 until her retirement in January 2017, serving in both the House of Representatives and the Arizona State Senate. In her local community Debbie serves on numerous committees and task forces, working to improve the health status of women and children in Arizona. She has established a reputation for being a knowledgeable advocate for maternal and child health and childcare issues. In 2012 she was recognized for her advocacy by the Children’s Action Alliance in Phoenix and Every Child By Two in Washington, DC. Debbie also served on the Board of Directors of the American Immunization Registry Association and she volunteers her time as a member of the planning committee of the National Conference on Immunization and Health Coalitions. She is married to Glenn Davis and has a blended family of 5 children and 3 grandchildren. More information about TAPI may be found at www.whyimmunize.org.

Learn More

Vaccinate Your Family

National Meningitis Association

Meningococcal Vaccination for Preteens and Teens: Information for Parents (CDC)

CDC’s Recommended Immunization Schedule for Preteens and Teens (En español)

 

Remembering Nadja, another precious child lost to measles

July 11, 2018 4 comments

By Erica DeWald

Europe has been in the midst of a measles outbreak since 2016 which, so far, has resulted in 48 deaths.  Unfortunately, many people are at risk, including children who are not yet old enough to receive the vaccine and those with compromised immune systems.

One mother in Serbia has chosen to share the story of losing her young daughter, Nadja, in the hopes that it will encourage other parents to vaccinate their children against measles and other vaccine-preventable diseases.

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Nadja was diagnosed with an autoimmune condition when she was a year old. Her hypoparathyroidism, due to hypoglycaemia and hypocalcaemia, meant she could not keep her calcium levels high enough through simple oral therapy. She needed regular IV injections at her local hospital. The condition also made it harder for Nadja to fight infections and placed her among the high-risk group of people who cannot be vaccinated. She instead relied on those around her to protect her from vaccine-preventable diseases.

In January of this year, Nadja was admitted to the hospital but there was no room in the isolation unit. She ended up sharing a room for three days with another liNadja while hospitalizedttle boy. Her mother, Dragana, later learned the boy had been diagnosed with measles. Dragana recounted,

“At the moment, my world collapsed, I knew that she would get it, but again in the depths of the soul I hoped she will not.”

Three days later, measles caused Nadja to develop a high fever and she fell into a coma from which she never awoke. Despite multiple attempts and two resuscitations over the course of three months to stabilize Nadja, she died on April 4 from heart failure.

Measles is not just a threat in Europe. Here in the United States we are seeing increasing outbreaks of the disease. In the past week health officials have reported confirmed or suspected cases in Oregon and Washington as well as New Jersey. Since 2014, over 1,000 cases of measles have occurred in the U.S. placing communities at serious risk. That’s because it’s one of the most easily spread viruses we know of, and as many as 1 out of every 20 children with measles will get pneumonia, and about 1 child in every 1,000 who get measles will develop encephalitis. As a result, the disease still kills hundreds of thousands of children each year around the world.

Dragana has begun a Facebook page to remember her daughter and to warn others of the deadly consequences of measles. Please take a moment to follow her page and share it with your friends and families in remembrance of Nadja.

Have questions about the dangers of measles or what you can do to stop the spread of outbreaks?

 

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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With School Vaccine Exemptions on the Rise, What Can Be Done to Protect Our Students?

June 12, 2018 1 comment

Today, PloS Medicine published a study that examined the increase we are seeing across the country in philosophical exemptions to school vaccine requirements, also known as personal belief exemptions.

According to the authors, 12 of the 18 states that allow philosophical exemptions have seen an increase in parents choosing to exempt their children from one or more vaccines. As a result, several metropolitan areas are at risk of an outbreak of disease, such as measles, similar to the one we saw originate at Disneyland in Anaheim, California three years ago.

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The Washington Post notes that the study “characterized many rural counties, as well as urban areas, as ‘hotspots’ because their high exemption rates put them at risk for epidemics of measles, whooping cough and other pediatric infectious diseases.

Amy Pisani, Executive Director of Every Child By Two/Vaccinate Your Family, expressed concern about what is known as the “community protection threshold” by stating, 

“It’s alarming to see the rise in exemption rates across this country, putting communities at greater risk. Parents need to understand that timely vaccines are critical to protecting children’s health and should be at the top of the family’s to-do list.”

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While the study reveals some interesting data points, there’s little information as to why it appears that parents are increasingly claiming exemptions for their children.

In most states, the school vaccine exemptions tend to be elevated in a handful of communities, as opposed to a general rise in exemptions throughout the state.  It appears that more research needs to be done to better inform public health policymakers regarding the underlying reasons parents are exempting their children from school required vaccines.

In the meantime, some of the states with the highest levels of exemptions have passed legislation to make nonmedical exemptions more difficult to obtain. For example:

  • In Washington state, a law was passed that required parents to have their exemption form signed by a health care provider.
  • In Oregon, parents have the option of watching an online module on the dangers of not vaccinating or getting a form signed by a health care provider.

While both states saw an immediate and encouraging reduction in the number of exemptions claimed, it appears that these policies have not been effective over time and exemptions are once again on the rise.

Tightening laws and policies clearly does not keep those parents who are intent on seeking exemptions from obtaining them. But how about eliminating nonmedical exemptions?

After the 2014-2015 measles outbreak in California, the state legislature decided to eliminate all nonmedical exemptions. Again, one year after the law was passed exemption rates fell dramatically and, most importantly, vaccination rates rose well above community immunity thresholds, thus better protecting communities against disease outbreaks.

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But what will the future hold?  Will parents who have philosophical reasons to avoid vaccines for their children find ways to obtain medical exemptions?

Initial data suggests that may be the case. According to an article in JAMA, the California medical exemption rate reflected a three-fold increase following the introduction of the law, from 0.17% to 0.51%. According to the article’s authors,

“Some vaccine-hesitant parents may have successfully located physicians willing to exercise the broader discretion provided by SB 277 for granting [medical exemptions]…If true, this practice would be inconsistent with the recommendation from the American Academy of Pediatrics to reserve [medical exemptions] for children having contraindications.”

In the coming years, public health partners may have a better sense of whether eliminating nonmedical exemptions can sustainably increase vaccination rates and protect our communities against dangerous vaccine-preventable diseases. We will also be looking to additional studies to learn how many parents are choosing exemptions because they have true personal objections to vaccinations, or because they don’t view vaccination as a priority among their long back-to-school lists.

In the meantime, it’s important to help state legislators and the public understand what has been tried to-date and what are the most promising policy paths forward. 

Here are some ways that you can be informed and help to inform others:

  • Consider sharing Vaccinate Your Family’s fact sheet on the impacts of exemption legislation with your local lawmakers to remind them of their role in strengthening our defenses against vaccine-preventable disease.
  • Check out Vaccinate Your Family’s 2018 State of the ImmUnion report to learn more about federal policies that aim to protect our families and communities from dangerous diseases.
  • Help ensure children are better informed about how diseases develop and how vaccines work with the immune system by sharing specially designed science curricula from The Vaccine Maker’s Project with school nurses and science teachers at your local elementary, middle or high schools.
  • Find out more about the vaccination rates in your state and community by contacting your local schools, public health department or reviewing the latest CDC vaccination coverage reports.
  • Stay informed about the latest immunization news and research by following Vaccinate Your Family’s Facebook, Twitter and Instagram accounts, subscribing to this Shot of Prevention blog and sharing the information we discuss on these channels with your social contacts.

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Together we can work to ensure that students get the protections they deserve in their schools and communities.

What You Don’t Know About Hepatitis Can Hurt You

More than four million Americans are living with viral hepatitis, but most don’t know they’re infected.

HepABCs-cubeMany people can live with hepatitis for decades without feeling sick or exhibiting any symptoms.  But left untreated, there are three different types of viral hepatitis which can cause serious health problems, including liver damage, liver failure, liver cancer or even cirrhosis, a condition that causes permanent scarring of the liver.

In honor of Hepatitis Awareness Month, learn how the different types of viral hepatitis are spread, as well as how they can be prevented or treated. 

Hepatitis A

Hepatitis A can range in severity from a mild illness lasting a few weeks to a severe illness lasting several months.

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It is usually spread by contact with people who are infected or from contact with objects, food, water or drinks contaminated by the feces of an infected person, which can easily happen if someone doesn’t properly wash his or her hands after using the toilet. It’s important to know that not all people with hepatitis A have symptoms, but it’s more likely for adults to have symptoms than children. If symptoms develop, they usually appear two to six weeks after being infected and may include:

  • Fatigue
  • Nausea and vomiting
  • Loss of appetite
  • Fever
  • Dark urine
  • Gray-colored stools
  • Joint pain
  • Yellowing of the skin and eyes (jaundice)
  • Severe stomach pains and diarrhea (mainly in children)

The good news is that hepatitis A is easily prevented with a safe and effective vaccine. For the best protection, it is recommended that children receive two  doses of Hep A vaccine with the first dose being administered between 12 and 23 months of age, and a second dose administered 6 to 18 months after the first dose. Adults who have not been previously vaccinated, or who are at risk due to their work or travel. should also be vaccinated.  Since the introduction of the vaccine, cases of hepatitis A have plummeted across the country.  However, outbreaks still do occur. 

Currently, there are reported outbreaks in West Virginia, Kentucky and California in which hundreds of cases have been identified and several deaths have occurred. This is why all everyone should ensure they are protected against hepatitis A.

Hepatitis B

People who get infected with the hepatitis B virus, especially young children, can go on to develop a chronic or lifelong infection which can cause serious liver damage, liver failure, liver cancer or cirrhosis.

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Hepatitis B virus can be spread through contact with an infected person’s blood, semen, or other body fluids.  This may happen when someone has a cut or sore, when someone is bitten by another person (as in the case of children in daycare), through the sharing of a toothbrush or food has been chewed (like in the case of young children), from an infected mother to her baby during childbirth, through sexual contact, or by sharing needles, syringes, or other drug-injection equipment.

Not all people with hepatitis B have symptoms. However, if they occur, they usually appear about three months after infection and can range from mild to severe, including:

  • Dark urine
  • Fever
  • Joint, muscle and stomach pain
  • Loss of appetite
  • Nausea, diarrhea and vomiting
  • Fatigue
  • Yellowing of your skin and the whites of your eyes (jaundice)

The best way to prevent hepatitis B is by getting vaccinated. The vaccine is recommended for: 

  • All infants, starting with the first dose of hepatitis B vaccine within 24 hours of birth.  This shot acts as a safety net, reducing the risk of a child getting hepatitis B from moms or family members who may not know they are infected with the disease. Additional doses of the vaccine should be given between 1 and 2 months, and between 6 and 18 months of age.Newborns who become infected with hepatitis B virus have a 90% chance of developing chronic Hepatitis B, which can eventually lead to serious health problems, including liver damage, liver cancer, and even death. This is why the birth dose has been an extremely effective way of reducing the risk of chronic Hepatitis B infection. 
  • All children and adolescents younger than 19 years of age who have not been fully vaccinated against hepatitis B
  • Unvaccinated adults at risk for hepatitis, in addition to any adult who wants to be protected from hepatitis B.

Unfortunately, many people got infected before the hepatitis B vaccine was widely available. That’s why the CDC recommends that anyone born in areas where hepatitis B is common (such as Asia, the Pacific Islands or Africa), or whose parents were born in these regions, get tested for hepatitis B.

You can learn more about who may be at increased risk of hepatitis B here. Fortunately, treatments are available that can delay or reduce the risk of developing liver cancer.

Hepatitis C

FACT: People born from 1945 - 1965 are 5 times more likely to be infected with Hepatitis C. Learn more: //www.cdc.gov/KnowMoreHepatitis/

For some people, hepatitis C is a short-term illness, but for 70%–85% of people who become infected, it becomes a long-term, chronic infection which can cause serious liver damage and even liver cancer over time. Unfortunately, the majority of infected people are not aware of their infection because they are not clinically ill.

In the past, hepatitis C was spread through blood transfusions and organ transplants. However, widespread screening of the blood supply began in 1990 and the hepatitis C virus was virtually eliminated from the blood supply by 1992. Today, most people become infected with hepatitis C by sharing needles, syringes, or any other equipment to inject drugs. For reasons that are not entirely understood, people born from 1945 to 1965 are five times more likely to have hepatitis C than other age groups.

Unfortunately, there is currently no vaccine to prevent hepatitis C. However, once diagnosed, most people can be treated and cured in just 8 to 12 weeks, reducing liver cancer risk by 75%. This is why awareness and testing is so critical.


The CDC has developed an online Hepatitis Risk Assessment to help people find out if they should get tested or vaccinated for viral hepatitis.

ARE YOU AT RISK? Millions of Americans have VIRAL HEPATITIS. Most don't know it. Take this online assessment to see if you're at risk. //www.cdc.gov/hepatitis/riskassessment/

The assessment, which takes only five minutes, will provide personalized testing and vaccination recommendations for hepatitis A, hepatitis B, and/or hepatitis C.  Take it today and protect yourself from these viruses that can so easily go undetected.  

Five Important Reasons to Vaccinate Your Child

April 23, 2018 3 comments

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

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

 

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

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

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

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

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

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2.) Vaccines are safe and effective. 

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

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

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

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

 

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

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