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Archive for the ‘Vaccines for PreTeens & Teens’ Category

Supercharge Your Kid’s Cancer Fighting Power

July 18, 2018 2 comments

Kids having fun with mumIt’s hard to believe how quickly the summer is rushing by. The July 4th holiday is in the rearview mirror and stores are already putting their summer clothes on clearance. So now is a good time to start thinking about what you need to do to prepare your kids to go back to school.

Are You the Parent of an 11- or 12-Year-Old? 6-reasons-listicle-05

Make sure your preteen gets the three vaccines that protect against whooping cough (Tdap), meningococcal disease (MenACWY) and HPV cancers (HPV).

We can reduce the risk of our children getting certain cancers later in life by helping them make healthy choices now, including eating a healthy diet, staying away from tobacco, wearing sunscreen and being physically active. We can also help prevent most HPV cancers with just two shots of the HPV vaccine.

HPV vaccination helps prevent six types of cancers caused by the human paillomavirus (HPV) in both men and women including cervical, vaginal, vulvar, anal, penis and throat cancers. Every year in the United States, HPV causes approximately 32,000 cancers in men and women, and HPV vaccination can prevent most of the cancers from ever developing.

HPV is a Common Virus that Infects Teens and AdultsHPV is a common virus

HPV is so common that most people will get the virus at some point in their lives. About 14 million people in the U.S., including teens, become infected with HPV each year. HPV is passed during intimate sexual contact. You can get HPV by having vaginal, anal or oral sex with a person who has the virus. And the virus can be passed even when an infected person has no signs or symptoms. Most HPV infections go away on their own without lasting health problems. However, there is no way to know which infections will turn into cancer. That is why it is important that all children get vaccinated against HPV.

Vaccines are for Prevention, Not Treatment

Since vaccines are for prevention, not treatment, they only work if given BEFORE coming in contact with a virus. That’s why you want to get your child vaccinated against HPV at 11 or 12 years old. In addition, scientific studies have shown that children have the best immune response to the vaccine at these ages. The HPV vaccine is given as a series of two shots, and the series should be completed by age 13.

HPV Vaccines Are Continuously Monitored for Safety

Like all vaccines recommended in the U.S., HPV vaccines are monitored on an ongoing basis to make sure they remain safe and effective. With approximately 100 million doses of HPV vaccine distributed so far in the U.S., data continues to show that HPV vaccines are safe, effective and give long-lasting protection.

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Make sure to ask your preteen’s health care provider about the HPV vaccine at his/her next appointment.

Commonly-Asked Questions

Are HPV vaccines safe?

Yes, numerous research studies have been conducted to make sure HPV vaccines are safe, both before and after the vaccines were licensed. Before the three HPV vaccines were licensed for use in the U.S. by the FDA, each went through years of testing in thousands of people through clinical trials. After being licensed, the CDC and FDA have continued to monitor the safety of the HPV vaccines through the three surveillance systems in the U.S.. Over 100 million doses of HPV vaccines have been distributed in the U.S. so far and HPV vaccines continue to have a good safety record.

Like any vaccine or medicine, HPV vaccines can cause side effects, but the most common side effects are mild. They include pain, redness or swelling in the arm where the shot was given; dizziness; fainting; nausea; and headache. The benefits of HPV vaccination far outweigh any potential risk of side effects.

Does the HPV vaccine contain dangerous ingredients?

No, the HPV vaccine does NOT contain harmful ingredients. While HPV vaccines, like some other vaccines, do contain a small amount of aluminum in order to boost the body’s immune response to the vaccine, it’s important to realize that people are actually exposed to aluminum every day. Aluminum is commonly found in numerous food and beverages, water, infant formula and even breast milk. Aluminum-containing vaccines have been used for decades and have been given to more than 1 billion people without problems. The quantities of aluminum present in vaccines are low and are regulated by the FDA’s Center for Biologics Evaluation and Research (CBER). Learn more about the use of aluminum and other ingredients in vaccines.

If I vaccinate my preteen now, won’t the vaccine wear off by the time he/she goes to college?

No, if you vaccinate your child at age 11 or 12, he or she should continue to be protected against HPV through college. Studies continue to monitor how long the vaccine protects against HPV infections, and protection has been shown to last at least 10 years with no signs of the protection weakening.

If I give my preteen the HPV vaccine, won’t it be like giving them permission to start having sex?

No, there have actually been scientific studies that have looked at this issue, and they show that there is no correlation between receiving the HPV vaccine and increased rates of, or earlier engagement in, sexual activity.

My child is not sexually active. Why should I vaccinate him/her against HPV now?

Preteens should receive all recommended doses of the HPV vaccine series long before they begin any type of sexual activity. Even if your child delays sexual activity until marriage, or only has one partner in the future, he or she could still be exposed to HPV if his/her partner has been exposed to HPV. Studies have shown that the HPV vaccine is most e­ffective in preventing the virus, and therefore HPV cancers, when given at age 11 or 12.

Can HPV vaccination cause infertility?

No, there is no evidence that HPV vaccination causes fertility or reproductive problems. In fact, getting HPV vaccine, which protects against cervical cancer, can help ensure a woman’s ability to get pregnant and have healthy babies. For example, a woman who develops cervical cancer later in life due to HPV infection may require serious treatments that could leave her unable to have children. It’s also possible that treatment for cervical pre-cancer could put a woman at risk for problems with her cervix, which could cause preterm delivery or other problems. HPV vaccination can help prevent these complications.

Learn more about HPV vaccination at vaccinateyourfamily.org

 

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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American Cancer Society Announces Goal to End HPV Cancers

June 8, 2018 2 comments

It has been 12 years since the FDA approved the first HPV vaccine. To mark the occasion, the American Cancer Society has launched a public health campaign with one very ambitious goal – to eliminate vaccine-preventable HPV cancers.  

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Since the HPV vaccine has been proven to be so highly effective, experts and organizations in the U.S. and around the world are talking about how the vaccine can be used to eliminate HPV cancers, starting with cervical cancer. As one of the most respected cancer organizations in the world, the American Cancer Society is uniquely positioned to lead the fight against all HPV related cancers.

How do they plan to achieve this goal?

By using their Mission: HPV Cancer Free Campaign to increase HPV vaccination rates for preteens to at least 80% by June 2026, the 20-year anniversary of the FDA’s approval of the first HPV vaccine.

Considering the number of adolescents who are receiving other recommended vaccines, like the meningococcal vaccine, this objective seems both reasonable and achievable.

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However, in order for the vaccine to prevent any of the six HPV related cancers, such as cancer of the cervix, vulva, vagina, penis, anus, head and neck (also called oropharyngeal cancer), children need to be vaccinated before potential exposure. By getting children vaccinated as recommended, at 11-12 years of age, parents can help ensure the vaccine is administered before sexual activity begins, and when studies show children to have the most optimal immune response to the vaccine.

While the HPV vaccine has been shown to be both safe and effective, the unfortunate reality is that only about 40% of boys and girls in the U.S. are fully protected with the recommended 2 or 3 doses of HPV vaccine.  This is unfortunate because we know that 9 out of 10 adults will have an HPV infection at some point in their lifetime.

6-reasons-listicle-04Many of these HPV infections may eventually clear up on their own. However, the fact remains that some infections will develop into dangerous cancers years, or even decades, after initial exposure. While doctors routinely screen for cervical cancer, there are no recommended cancer screening tests for the other 20,000 cases of cancers caused by HPV infections each year in the United States. Considering that there are often no early symptoms of these cancers, many of these cases will go undetected until they have progressed to a late and dangerous stage.

This is why HPV vaccination is so important.  Preventing cancer is always better than treating it. 

 

So how can you help the American Cancer Society in their goal to end HPV cancers?

 

Parents:

Educate yourself about HPV and make sure the children in your life are vaccinated. Read some of the most common myths about HPV vaccine here and help to dispel these myths by sharing accurate and evidence-based information about HPV and HPV vaccination with your friends and family.

Learn more about HPV and HPV vaccination, by reviewing the informative new resources that have been developed as part of the American Cancer Society’s Mission:HPV Cancer Free campaign, to include the following:

Also, hear the stories of HPV cancer survivors and the providers who have cared for them to consider why prevention is critical in our fight to end cancer.

Clinicians and Health Care Providers:

Your strong recommendation is the biggest predictor of whether your patients will receive timely HPV vaccination. To ensure you are prepared to make the most of your discussions with your patients and their parents, check out the library of provider resources available on the National HPV Roundtable website. There is even a special suite of Clinical Action Guides tailored to six different professional audiences, to include:

  • Physician/Physician Assistant/Nurse Practitioner Guide
  • Nurse & Medical Assistant Guide
  • Dental Health Professionals Guide
  • Large Health Systems Guide
  • Office Team Guide
  • Small Private Practices Guide

The goal of the Mission: HPV Cancer Free campaign may be to increase HPV vaccination, but the purpose behind the goal is our ultimate motivator. With the HPV vaccine, we have the power to prevent cancer, and that is something that deserves a chance.  By uniting in this endeavor, we can change lives, save lives and make HPV cancer history.  

 

 

 

 

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.  

What Your Dentist Should Be Telling You About Oral Cancer and HPV

April 6, 2018 2 comments

oral-cancer-monthI had my teeth cleaned yesterday, and while I was at the dentist I remembered that April is Oral Cancer Awareness Month. 

The dentist never mentioned it, but I knew just what she was doing when she put her gloves on and started rolling her fingers around the inside of my checks, under my tongue and on the outside of my neck and jaw.  She was doing what all oral health professionals should do – a thorough examination that could help with early detection of oropharyngeal cancers (also known as cancers of the throat and tongue) which are commonly caused by the human papillomavirus (HPV). 

As someone who has been diagnosed with two different cancers in the past, I no longer think “not me”.  Quite honestly, knowing how prevalent HPV is (it’s estimated that 80% of sexually active people will contract HPV at some point in their life) it’s probably more likely that I would be diagnosed with an HPV related cancer than many other types of cancer. Although most cases of HPV resolve without incident, the fact remains that approximately 14 million new cases of HPV occur in the U.S. each year, with at least 79 million people estimated to be currently infected and about 31,500 cases of HPV related cancers diagnosed in men and women each year in the U.S.. This includes cancers in the oropharynx, cervix, vagina, vulva, penis, and anus.  

While HPV can cause up to six different types of cancer, oral cancers are on the rise.  It’s estimated that HPV-associated oropharyngeal cancer affects about 16,400 people each year, and that by year 2020, it will become the most common HPV-related cancer in the US, surpassing cervical cancer.  

Here are a few other details to consider:

While I’m pleased that my dentist took the time to closely examine my neck, throat, mouth and tongue for any abnormalities, I’m disappointed that she didn’t take the opportunity to discuss the importance of HPV vaccination with me. 

Education of the public regarding the risk factors which lead to oral cancer, recognition of the early signs and symptoms, and the development of patient awareness, are primary responsibilities of the dental community.  

In 2017, the American Academy of Pediatric Dentistry (AAPD) issued a policy statement on HPV vaccination that encourages oral health care providers to educate patients and parents on the relationship of HPV to oral and oropharyngeal cancer and to counsel them regarding the HPV vaccination, in accordance with CDC recommendations. Currently, the CDC recommends two doses of HPV vaccination for girls and boys beginning at ages 11 or 12, but vaccination can be started at age 9 and can be administered through age 26 for females and age 21 for males.

Screen Shot 2018-04-06 at 10.36.56 AMWhile oral health professionals should be recommending HPV vaccination to all age-eligible patients, it would be prudent to also provide that information to patients who are parents. Although my dentist is not a pediatric dentist, my five children are also patients and we all get our regularly scheduled dental cleanings twice each year. 

At no point has anyone at this particular dental practice ever discussed oral cancer or HPV with me or any of my children, despite the fact that all five of my children are  considered “age-eligible”. (I know this because after my appointment yesterday, I asked my kids.)

Yesterday, my dentist failed to discuss HPV vaccination as a potential way to prevent oral and oropharyngeal cancers, which I consider to be a missed opportunity. However, during our collective twelve appointments each year for the past five years, it’s actually more like 60 enormous missed opportunities!

I get it.  Dentists may not be comfortable discussing vaccines. Or HPV.  But how comfortable can it be for them to have to tell their patients they may have oral cancer? How comfortable can it be for those patients who will end up having to suffer through an oral cancer that may have been preventable?

Fortunately, there are tests that can help detect HPV in women before they develop cervical cancer.  However, the same is not true for HPV-related head and neck cancers. These cancers typically develop in the throat at the base of the tongue, in the folds of the tonsils or the back of the throat, making them very difficult to detect. That is why regular dental exams can be vital. But prevention is always preferred to treatment, and HPV vaccination represents our best chance at prevention. 

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Since my dentist didn’t provide the information I feel all parents and patients deserve to know, I plan to bring them this action guide for Dental Health Providers, created by the National HPV Vaccination Roundtable when I return next week for my daughter’s visit. 

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According to the Oral Cancer Foundation, there are over 100,000 dentists in the U.S., each one seeing between 8 and 15 patients per day. If you include those patients who come to a practice and see someone other than the dentist, such as the hygienist, the number of patient visits is significantly higher. If they each did their part to educate their patients, imagine what a huge difference they could make in boosting HPV vaccination rates and reducing oral cancers.

Until we start seeing more dentist taking these types of actions,  please help spread the word about the association between HPV and oral cancers, during Oral Cancer Awareness Month and all throughout the year.

Below you will find additional resources regarding HPV vaccination and HPV-related head and neck cancers.  Here’s hoping that you never have to deal with an oral cancer diagnosis, like Jason Mendelsohn, Scott Vetter, Frank Summers and others.   


 

 


 

 


Other Resources:

Head and Neck Cancer Alliance

Oral Cancer Foundation

National HPV Vaccination Roundtable

Vaccinate Your Family Website: HPV Information

Research Article: Reduced Prevalence of Oral Human Papillomavirus (HPV) 4 Years after Bivalent HPV Vaccination in a Randomized Clinical Trial in Costa Rica

 

 

Updates from the Advisory Committee on Immunization Practices February Meeting

March 6, 2018 2 comments
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Photo Credit: James Gathany, Centers for Disease Control and Prevention

The Advisory Committee on Immunization Practices (ACIP) held its first meeting of 2018 on February 21st and 22nd.  The Committee consists of a panel of immunization experts that advise the Centers for Disease Control and Prevention (CDC).  Part of their charter is to continually evaluate new data and update or change vaccine recommendations as warranted. 

The agenda for the February 2018 meeting included presentations pertaining to several different diseases and vaccines, to include hepatitis, influenza, anthrax, HPV, pneumococcal, meningococcal and Japanese encephalitis.

A overview of the meeting is provided below, with details on presentations in the order they occurred: 

Hepatitis B

The committee voted unanimously to approve a non-preferential recommendation for a new Hepatitis B vaccine (Dynavax’s HEPISLAV-B™) to their list of recommended vaccines for adults 18 years and older against infections caused by all known subtypes of Hepatitis B.

This vote came following the presentation of data showing that the new two-dose vaccine generates a more rapid and higher antibody response than the standard 3 dose vaccine.

Hepatitis B is a viral disease of the liver that can become chronic and lead to cirrhosis, liver cancer and death. The hepatitis B virus is 50 to 100 times more infectious than HIV, and transmission is on the rise. In 2015, new cases of acute hepatitis B increased by more than 20 percent nationally and 850,000-2.2 million persons are estimated to be living with infection in the U.S.

Since there is no here is no cure for hepatitis B, vaccination is our best chance at preventing the disease. While about 90% of people are infected during infancy, in adults, hepatitis B is most often spread through contact with infected blood and through unprotected sex with an infected person. Some individuals who are especially susceptible include those who are immunosuppressed or living with diabetes. The CDC recommends vaccination for those at high risk for infection due to their jobs, lifestyle, living situations and travel to certain areas.

The Working Group summary suggested that this new vaccine option is likely to improve vaccine series completion and result in earlier protection, which is especially beneficial in persons with anticipated low adherence such as injection drug users.  Additionally, the improved immunogenicity in populations with typically poor vaccine response such as the elderly, diabetics and those on dialysis, is promising.  The ACIP will continue to review post-marketing surveillance studies and additional data to ensure safety and cost-effectiveness considerations.

Hepatitis A

The committee voted unanimously to pass three recommendations pertaining to Hepatitis A.

  • Hepatitis A vaccines should be administered for post-exposure prophylaxis for all persons 12 months of age or older.
  • Hepatitis A vaccine or immune globulin (IG) may be administered to persons 40 years of age or older, depending on the providers’ risk assessment.
  • Hepatitis A vaccine should be administered to infants age 6-11 months of age traveling outside the US when protection against hepatitis A is recommended. This recommendation takes into consideration the fact that infants under 12 months who will be traveling internationally will typically also need an MMR vaccine.  Since Hepatitis A immune globulin and MMR vaccine should not be administered simultaneously, these children should receive a single dose of HepA vaccine. It’s important to note that infants should then complete the full, 2 doses of MMR and HepA vaccines at 12 months of age as recommended.

Influenza

The Committee heard five presentations specific to influenza.

The first two were reports of current season data; one detailing flu surveillance, the other providing early influenza vaccine effectiveness data.

According to the update, the majority of circulating flu strains are similar to those contained in the 2017-2018 vaccine.  The only virus clearly showing antigenic drift was the B/Victoria lineage viruses which represents less than 1% of circulating viruses.  So far this season, influenza A (H3N2) has been dominant, with influenza B activity starting to increase more recently. Activity has been the highest we’ve seen since 2009, and while final severity can’t be determined until the end of the season, hospitalization rates and mortality could be similar to or exceed those send during the severe 2014-2015 season.

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Based on data from 4,562 children and adults with acute respiratory illness enrolled during November 2, 2017–February 3, 2018, at five study sites, the overall estimated effectiveness of the 2017–18 seasonal influenza vaccine for preventing medically attended, laboratory-confirmed influenza virus infection was 36%. The percentage differs by age group and by virus.  A detailed report can be found here.

The most notable news out of the Committee last week was the vote to restore the live attenuated influenza virus (LAIV) vaccine as an option for the 2018-19 season. LAIV is commonly known as the nasal spray flu vaccine or by its brand name, FluMist This renewed ACIP recommendation offers FluMist as one of several vaccine options for non-pregnant people who are 2-49 years of age during the 2018-2019 season, but does not indicate any preference for FluMist over injectable flu vaccines.

While FluMist has not been recommended for the past two flu seasons due to reduced effectiveness against the H1N1 flu strain in children, the Committee heard three presentations specific to LAIV vaccine efficacy in children prior to taking a vote on future recommendations for LAIV.  The first reported on the efficacy of Fluarix Quadrivalent in children 6-35 month of age. Another presented the results of a randomized trial of a new H1N1 LAIV strain in U.S. children. The third was a review LAIV in children 2-17 years of age.  

The possible root cause of the poor effectiveness of LAIV against H1N1 was discussed and poor replication of the H1N1 selected strain was thought to be the likely problem. A new strain selection process is now in place in cooperation with the Food & Drug Administration (FDA) and it suggested that the antibody responses of the latest reformulated version of the quadrivalent vaccine, which includes the new 2017-18 post-pandemic 2009 H1N1 LAIV strain (A/Slovenia), will perform significantly better than what was previously observed when the vaccine included the 2015-16 post-pandemic LAIV strain (A/Bolivia).  Immunogenicity and viral shedding data in small trials supported this notion, but no efficacy data is available at this time.

The Committee was therefore forced to a vote using only the science available to date. There was a lively discussion among members who expressed various concerns. While flu vaccine effectiveness is a serious issue, some committee members expressed concern that they may be holding FluMist to a higher standard than other influenza vaccines, yet all have efficacy challenges from year to year.  Other members were concerned with how the vaccine may perform in an H1N1 dominated season. Until the vaccine is used, further effectiveness assessments are performed, and a prominent H1N1 year occurs, a certain level of uncertainty will remain.

While members voted overwhelmingly (12-2) to reinstate LAIV on the immunization schedule, a second vote to give other flu vaccines a preferential recommendation over LAIV failed (11-3).  So, while the ACIP will not indicate a preference for any one type of flu vaccine over another, the public will ultimately determine whether there will be high uptake of this particular vaccine next season. Read more…

Meningitis B and Your College Student: Preventing the Call

February 14, 2018 1 comment

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. 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 Meningitis B vaccines 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 Arizona Universities 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.

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Emily and the Stillman family after her high school graduation.

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 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 weren’t preventable in the U.S. when Emily Stillman contracted and lost her life to Meningitis B, but they are today. In October of 2014 and January of 2015, the FDA approved licensing for two different vaccinations for Meningitis B. Soon after that, the Advisory Committee on Immunization Practices (ACIP) of the Center for Disease Control and Prevention (CDC) acknowledged that college age students should talk with their doctors about Meningitis B.

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.

Our Off to College flyer launched an awareness campaign for parents and college age students to make certain each has the benefit of protection from all strains of meningitis.

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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 FDA (Food and Drug Administration) 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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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_Davis_16 - Member Photo.jpgDebbie 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.