We live in world that is increasingly more connected.
The film Unseen Enemy, which will air on World Health Day, Friday, April 7th on CNN (10pm ET/7pm PT), explores this global connectivity and how it relates to the threat of emerging infectious diseases. It extends beyond the role of global health leaders and calls upon individuals to take actions that can help improve the health of our communities and our world.
To set the stage, the film takes viewers on a journey across continents to explore large-scale disease outbreaks such as Ebola, influenza and Zika. It honors both patients and healthcare workers who have endured challenging circumstances, and often risked their lives, in the fight against infectious diseases. It also warns about emerging threats, where they may come from and what we should be doing to prepare.
In interviews with various researchers, the film provides a glimpse of the issues that global health leaders are working to solve.
How will we keep one step ahead in the fight against viruses and epidemics? Where are the global hotspots where these diseases may emerge? How can healthcare workers, scientists, businesses, NGOs and governments work together to ensure that we are prepared for the next invisible threat? What are the possibilities that these threats will come in the form of viruses, laboratory mistakes or acts of bioterrorism?
The film certainly emphasizes the need for global preparedness, but it also calls upon individual viewers to take action. The power of the people exists in how we share valuable information, how we support key public health stakeholders around the world, and how we mobilize leaders to adequately prepare for emerging threats now, before it is too late.
It Takes All Of Us
Stopping an outbreak will require us all to work together, for the benefit of everyone. Janet Tobias, who served as a director, producer and writer of the film, explains how working on Unseen Enemy provided her with a new perspective about our personal roles in public health. Read more…
Last week, the Advisory Committee on Immunization Practices (ACIP) held it’s third and final meeting of 2016. The agenda included presentations pertaining to hepatitis B, pertussis, HPV, meningococcal, herpes zoster, pneumococcal and RSV vaccines, and surveillance updates on Zika and influenza viruses.
During the two-day meeting, the committee took nine votes on newly proposed vaccine recommendations that addressed vaccination timing, number of doses needed, and dosing intervals for hepatitis B, pertussis, HPV and meningococcal vaccines. They also approved the child, adolescent and adult immunization schedules.
This post provides a recap of each agenda item in the order they occurred.
Hepatitis B Vaccine
The recommended first dose of the three-series hepatitis B vaccine is often referred to as “birth dose” and is typically administered to infants in the hospital after birth. At this meeting, the Hepatitis B Work Group asked that the Committee consider removal of the permissive language that appears at the end of the recommendation which allows for a delay of the birth dose until after hospital discharge.
When hepatitis B vaccine is administered within 24 hours of birth it can help prevent transmission of the hepatitis B virus from an infected mother to her child. The intent of the birth dose is to provide an additional safety net to prevent transmission from HepB positive mothers that are not properly identified due to errors in maternal testing or reporting. In these instances, when the mother is not properly identified as HepB positive before birth, the HepB vaccine alone is 75% effective in preventing prenatal transmission, and 94% effective when used in conjunction with Hepatitis B immune globulin.
Since delaying hepatitis B vaccination can interfere with the prevention of Hepatitis B – especially in a child unknowingly born to a HepB positive mother – the HepB Work Group proposed that the reference to delaying vaccination be removed from the recommendation. It had originally been added in 2005, but the data suggests that administering the birth dose in the hospital leads to timely completion of the series. The current birth dose coverage was stated to be 72.4% of children, which remains below the Healthy People 2020 goal of 84%.
The Committee voted to remove the permissive language as well as include new language to clarify that the first dose of vaccine should be administered within 24 hours of birth, which is more explicit than “before hospital discharge”.
The anticipated changes to the previous recommendation are indicated below, however the exact wording may differ once published by the CDC:
“For all medically stable infants weighing 2,000 grams or more at birth and born to HBsAg-negative mothers, the first dose of vaccine should be administered
before hospital dischargewithin 24 hours of birth. Only single antigen HepB vaccine should be used for the birth dose. On a case-by-case basis and only in rare circumstances, the first dose may be delayed until after hospital discharge for an infant who weighs 2,000 grams or more and whose mother is HBsAG-negative”.
*It should be noted that for those infants with birth weight of less than 2,000 grams, the birth dose is not counted as part of the vaccine series.
There was some discussion concerning the removal of the option to delay vaccination and it was emphasized that having a clear recommendation from the ACIP is not a vaccine mandate. Rather, practitioners, public health professionals and parents rely on the ACIP recommendations as expert guidance and best practice. The Hepatitis B “birth dose” has been a successful strategy to help eliminate hepatitis B virus transmission in the U.S., and the ACIP’s revised recommendations only emphasize the importance of vaccinating within the 24 hours timeframe that will help prevent further transmission.
Other key updates to the hepatitis B vaccine recommendations included:
- Providing examples of chronic liver disease, including recommending HepB vaccine for persons with HCV infection.
- Post vaccination serologic testing for infants who’s mother’s HBsAg status remains unknown indefinitely.
- Testing HBsAg-positive pregnant women for HBV DNA.
For more information as to why babies need a Hepatitis B vaccine at birth, read these Shot of Prevention blog posts here.
The Committee reviewed the history of Tdap vaccination in pregnant women and reviewed studies that found that maternal Tdap vaccination to both safe and effective at preventing infant pertussis. Read more…