Archive for July, 2013

Doctors fail to suggest recommended vaccines to teens

Sunday, July 21st, 2013 (last updated)

Seattle doctors are rarely talking to adolescent patients about recommended vaccines, a new study reports.

A team of researchers at the Seattle Children’s Research Institute reviewed health records for 1,628 patients ages 11 to 18 at the University of Washington’s Pediatric Care Center from November 2006 through June 2011. Doctors failed to suggest vaccines to patients in up to 85 percent of clinic visits.

Patients in this age range should be offered vaccines for tetanus, diphtheria and pertussis, human papillomavirus and meningococcal disease, according to the study’s lead author, Dr. Rachel Katzenellenbogen.

“Reducing these missed vaccination opportunities would improve young people’s health, including the risk for certain types of cancer and sexually transmitted infections,” she said.

Katzenellenbogen said more research is needed to explore why the percentage of missed opportunities is so high, but co-author Dr. Jeff Wright said part of the problem might be that adolescents tend to require less primary care compared to younger children. The study showed patients who had at least one preventive care visit, such as a yearly check-up, were less likely to have missed opportunities for some vaccinations.

“When they come in it’s often for a specific concern – an injury or illness,” Wright said. “That’s not always the best time to offer vaccines.”

Wright said there is also a higher rate of vaccine refusal in the Pacific Northwest compared to other parts of the country, especially when it comes to the HPV vaccine.

“Parents have a hard idea adjusting to the idea that their kids are going to grow to become adults and be sexually active,” Wright said. “Usually it takes a few conversations.”

Wright said many parents don’t understand the importance of preventing diseases like whooping cough or meningitis because they likely have never known anyone infected with the illnesses.

Adolescents are also likely to refuse vaccines because they are afraid of needles, Wright said.

“We use distraction techniques, numbing spray, hold hands, whatever it takes to get them through it,” he said.

Wright recommends clinics use computerized prompts through an electronic health record or even manual flags on a chart or record by nurses or medical assistants to indicate which vaccines a patient might need.

“Anytime a kid in this age group comes in for any reason we should think about [vaccines] – not just during checkups,” Wright said. “This may be the one chance to give them the opportunity to get vaccinated.”


Maternal Tdap vaccine increased pertussis antibodies in infants

Saturday, July 20th, 2013 (last updated)

Children whose mothers received the tetanus-diphtheria-acellular pertussis vaccine during pregnancy had higher pertussis antibody concentrations between birth and the first vaccine dose, according to recent study findings published in The Pediatric Infectious Disease Journal.

“The presence of these antibodies can potentially provide pertussis protection before [diphtheria and tetanus toxoids and acellular pertussis vaccine] can be given to the infant,” researchers wrote. “Exact correlations between antibody concentrations and protection are not known, but the increased antibody concentrations seen in the Tdap vaccine group would be expected to confer greater protection from pertussis.”

The cohort study included 16 infants whose mothers received the Tdap vaccine during pregnancy and 54 infants whose mothers did not receive the vaccine.

Researchers found that, at delivery, maternal and cord antibody concentrations to pertussis antigens were higher for the Tdap group (1.9- to 20.4-fold greater and 2.7- to 35.5-fold greater, respectively). Antibody concentrations remained increased for infants at first DTaP (3.2- to 22.8-fold greater).

Following the primary series, antibody concentrations to pertussis antigens were lower in the Tdap group (0.7- to 0.8-fold lower), except for fimbriae types 2 and 3 (1.5-fold greater). Antibody concentrations to pertussis before and after the booster dose were comparable (onefold to 1.2-fold higher than controls and 0.9- to onefold lower, respectively).

“Our study supports the recent recommendation for Tdap vaccination of all women during each pregnancy,” researchers wrote. “A larger controlled trial of prenatally vaccinated women is needed to confirm these findings. Maternal vaccination to provide passive immunity has been used with great success to reduce rates of other diseases. The use of maternal Tdap vaccination in pregnancy may increase protection of infants <6 months of age and decrease pertussis morbidity and mortality in this vulnerable population.”

Maternal Tdap vaccine increased pertussis antibodies in infants

Healio Pediatrics

Vaccination gaps led to rubella outbreaks in Japan and Poland

Friday, July 19th, 2013 (last updated)

Recent rubella outbreaks in Japan and Poland are the clearest evidence possible that herd immunity matters.

There are many reasons why people don’t get vaccinated for totally preventable diseases such as rubella. One major issue is anxieties around safety, such as in the case of the MMR (measles, mumps and rubella) combination vaccine in the UK. Faulty science published 15 years ago suggested a now debunked link between the vaccine and autism. Fear spread and vaccinations plummeted.

In 2013, the recent serious measles outbreak was fuelled by children who weren’t vaccinated a decade ago. The disease primarily affected teenagers but spread to infants who were too young to be vaccinated. There are now also concerns that outbreaks of mumps and rubella – the remaining “M” and “R” in MMR – could follow.

Outbreaks of vaccine preventable diseases can also happen, not because of individual or community refusals to vaccinate, but due to lack of access to a vaccine, because of supply or cost issues for example, or because of policy decisions as to who gets vaccines and who doesn’t.

Japan and Poland – uneven vaccination cover

Japan first introduced the rubella vaccine into its national immunisation programme in 1976 but it was only given to junior secondary school girls. In 1989, Japan introduced the MMR vaccine for all children aged one to six, but that left a 13-year gap where no boys were immunised.

Rubella vaccination is targeted at girls because although it only produces mild symptoms in sufferers, it can be catastrophic for unborn babies. If a pregnant woman catches the disease, it can spread to the fetus, causing miscarriage, stillbirth and congenital rubella syndrome, which can cause various severe birth defects.

But men still catch the disease and in Japan, where rubella cases have shot up to over 10,000 cases, about 77% of them are in young men aged between 20 and 40.

An additional issue with the MMR vaccine led to it being withdrawn in 1993 after an adverse event occurred related to the mumps part of the vaccine. In 2006, an MR (measles and rubella only) vaccine was introduced for children, leaving another coverage gap for both boys and girls for the years between 1993 and 2006. This time the government did a “catch-up” campaign to vaccinate those children who missed their vaccines during the time of the MMR vaccine suspension.

The value of this catch-up campaign is clear when you look at who contracted rubella in Japan’s outbreaks. Those boys who missed the rubella vaccine in the earlier “girls only” policy – now 20-39 year old men – were 68% of those who contracted rubella in the outbreak.

The introduction of the MR vaccine for all children, and the catch-up campaign for those who missed vaccination in the gap between MMR suspension and the introduction of the MR vaccine, paid off. Only 5.6% of the rubella cases were among children aged under 15 years old.

In Poland, since the start of the year to mid-June there were more than 26,000 cases of rubella. Similar to Japan, over 80% of the cases were among males aged between 15 and 29. And again this is the result of a policy decision to target 13-year-old girls when the rubella vaccine was introduced in Poland in 1989.

In 2004, the MMR combination vaccine was offered to both boys and girls in Poland (at 13-15 months old, with a second dose at 10-years-old) making coverage more gender neutral.

Future repercussions

Both the Japanese and Polish outbreaks are largely attributable to policy decisions made more than two decades ago.

Most of those who contracted rubella did not refuse, or rather their parents did not refuse, to take the vaccine – they were simply never offered it. Also in both of these outbreaks, the policy decision was to focus on immunising girls, not boys.

And Japan and Poland aren’t the first countries to pay the price of selective rubella vaccination policies. Romania had an outbreak of more than 20,000 rubella cases in 2011-2012 and Greece had large outbreaks in 1993 and 1999, all consequences of earlier vaccine policies.

The health threats posed by these historic decisions also stretch beyond the immediate countries affected.

In order to minimise the risk of importing rubella, as well as protecting individual health, the US Centers for Disease Control (CDC), for instance, recently issued an alert recommending that travellers to Japan or Poland ensure that their rubella vaccinations were up to date. Pregnant women were urged not to travel at all if they were unvaccinated.

While there are sometimes legitimate reasons to focus vaccine policies on those most immediately at risk, especially in times of limited vaccine supply or financial constraints, the value of vaccines depends on achieving a level of “herd immunity”.

In other words, if not enough of the “herd” or larger population get vaccinated, the virus continues to circulate and can infect anyone not vaccinated. And, as we’ve seen in Japan, Poland and elsewhere, the impact of these policies can hit years later.

Vaccination policies and programmes need to be designed to take a long-term view. And we need to stay vigilant to the risks of vaccination gaps before they become a crisis.

The Conversation (

Vaccinating children could provide protection for older adults

Thursday, July 18th, 2013 (last updated)

Researchers at Vanderbilt University recently found that infant vaccination against pneumococcal bacteria significantly reduced pneumonia hospitalizations in older adults, according to a study published this month in the New England Journal of Medicine.

In a study funded by the Centers for Disease Control and Prevention, researchers found that infant vaccination since 2000 reduced pneumonia hospitalization by more than 10 percent overall. The most significant drops in pneumonia hospitalization took place at the extreme ends of the age spectrum.

“Pneumonia is a leading cause of hospitalization in the United States,” Marie Griffin, the study’s first author, said. “The protective effect we saw in older adults, who do not receive the vaccine but benefit from vaccination of infants, is quite remarkable. It is one of the most dramatic examples of indirect protection or herd immunity we have seen in recent years.”

The study found that after introducing pneumococcal conjugate vaccine, or PCV7, among infants, children under the age of two experienced a 40 percent drop in pneumonia hospitalizations. The study also showed 70,000 fewer annual pneumonia hospitalizations in 2009 than there were in the year 2000 among adults aged 85 and older.

“Humans are the only reservoir for the pneumococcus,” Carlos Grijalva, the co-author of the study, said. “This group of bacteria can live in the nose and throat of healthy people, especially children. From young children, these bacteria may be transmitted to older age groups. Over time, the vaccine is causing a change in types of pneumococcus carried and transmitted nationwide. We are very fortunate to witness this in our time. These huge indirect effects on the adult population don’t happen very often.”

The researchers said they were optimistic that the newer vaccine that protects against 13 types of pneumococcus can keep providing direct and herd immunity effects moving forward.

“PCV13 may cause another large reduction in pneumonia hospitalizations; perhaps another 10 percent, we hope,” Griffin said. “It is important for people to know that adults are benefiting from our childhood vaccine program. These are adults who won’t be hospitalized, won’t be getting antibiotics, or complications of hospitalizations, and won’t be dying, since the risk of death is five percent to 12 percent when older adults are hospitalized with pneumonia. Vaccination of infants with pneumococcal conjugate vaccines results in a tremendous public health benefit.”

Vaccinating children could provide protection for older adults

Vaccine News Daily

inFact: Vaccine Ingredients

Wednesday, July 17th, 2013 (last updated)

inFact with Brian Dunning is the web video series that gives you the real facts behind popular myths, promoting high-quality information that helps people live better lives.

Antivaccine activists claim that vaccines contain all sorts of terrifying poisons. Is this true?


What are the reasons to vaccinate my baby?

Tuesday, July 16th, 2013 (last updated)

There are many reasons to vaccinate.

  • Serious Diseases Are Still Out There

Reducing and eliminating the diseases that vaccines prevent is one of the top achievements in the history of public health. But, because of this success, most young parents have never seen the devastating effects that diseases like polio, measles or whooping cough (pertussis) can have on a family or community. It’s easy to think of these as diseases that only existed in the past. But the truth is they still exist. Children in the United States can—and do—still get some of these diseases. In fact, when vaccination rates drop in a community, it’s not uncommon to have an outbreak.

For example, preliminary data for 2012 show that more than 41,000 cases of whooping cough were reported in the United States.  During this time, 18 deaths have been reported—the majority of these deaths were in children younger than 3 months of age. Learn about recent outbreaks of pertussis in the US.

  • Diseases Don’t Stop at the Border, and Many Can Spread Easily

You may have never seen a case of polio or diphtheria, but they still occur in other countries. All it takes is a plane ride for these diseases to arrive in your community.

  • Vaccines are the Safe, Proven Choice

The United States currently has the safest, most effective vaccine supply in its history. Before a vaccine is approved and given to children, it is tested extensively. Scientists and medical professionals carefully evaluate all the available information about the vaccine to determine its safety and effectiveness. As new information and science become available, vaccine recommendations are updated.

Although there may be some discomfort or tenderness at the injection site, this is minor compared to the serious complications that can result from the diseases these vaccines prevent. Serious side effects from vaccines are very rare.

Nearly all children can be safely vaccinated. There are some exceptions including children with allergies to something in a vaccine. Children with weakened immune systems due to an illness or a medical treatment, such as chemotherapy, also may not be able to safely receive some vaccines.

  • Children Need Protection Early

The Centers for Disease Control and Prevention (CDC) sets the U.S. childhood immunization schedule based on recommendations from the Advisory Committee on Immunization Practices (ACIP)—a group of medical and public health experts. This schedule also is approved by the American Academy of Pediatrics (AAP) and the American Academy of Family Physicians (AAFP). The recommended childhood immunization schedule is designed to protect infants and children early in life, when they are most vulnerable.

To be fully immunized, children need all doses of the vaccines according to the recommended schedule. Not receiving the full number of doses leaves a child vulnerable to catching serious diseases. Check with your child’s doctor to find out if your baby is due for any vaccinations. Or, you can use this online tool to enter your child’s current record and quickly see if any doses have been skipped or missed. It is important to your child’s health to be up-to-date on immunizations.

  • Vaccines Mean Fewer Missed Work Days and School Days

A child who gets a vaccine-preventable disease may have to miss school or day care for many days or weeks. Time lost from work to care for a sick child can cause a financial burden for the family. These diseases can also cause lasting disabilities that result in expensive medical bills and long-term care.

  • Vaccination Protects Your Family, Friends, and Community

Getting your child vaccinated helps protect others in your community—like your neighbor who has cancer and cannot get certain vaccines, or your best friend’s newborn baby who is too young to be fully vaccinated. When everyone in a community who can get vaccinated does get vaccinated, it helps to prevent the spread of disease and can slow or stop an outbreak. Choosing to protect your child with vaccines is also a choice to help protect your family, friends, and neighbors, too.

CDC (Centers for Disease Control and Prevention)

I’m vaccinated. Are you… ?

Monday, July 15th, 2013 (last updated)

I’m vaccinated. Are you… ?

VacciNewsNet (VNN)

Meningitis B: Beat it now

Sunday, July 14th, 2013 (last updated)

We know all too well the life-changing impact of meningitis B (MenB) and septicaemia. We have seen the devastating effects of this brutal disease which maims and kills thousands.

BUT we can stop this loss of life and life-changing impact if we can get the Government to quickly introduce the Meningitis B vaccine that has now been licensed. The last vaccine against a different type of meningitis was not introduced for over five years, resulting in deaths and disability that could have been prevented. Please help us make sure that does not happen this time.

Meningitis B: Beat it now

Make your voice heard and help save lives – support our Meningitis B: Beat it Now campaign to bring in the vaccine by 31 December 2013, the middle of the peak season for bacterial meningitis

Please download and print out this leaflet and take it out with you. It shows people why it’s so important to support our petition.

Meningitis B kills click here

Meningitis Trust

Flu vaccines aimed at younger populations could break annual transmission cycle

Saturday, July 13th, 2013 (last updated)

The huge value of vaccinating more children and young adults for influenza is being seriously underestimated, experts say in a new report, while conventional wisdom and historic vaccine programs have concentrated on the elderly and those at higher risk of death and serious complications.

A computer modeling analysis was just published in the journal Vaccine, in work supported by the National Institutes of Health. The study suggests that children in school and young adults at work do the vast majority of flu transmission. Programs that effectively increase vaccination in those groups would have the best payoff, the research concluded.

The key point: If you don’t catch the flu, you can’t die from it. Breaking the cycle of transmission benefits everyone from infants to the elderly, the researchers said. And at stake are thousands of lives and billions of dollars a year.

“In most cases, the available flu vaccine could be used more effectively and save more lives by increasing the number of vaccinated children and young adults,” said Jan Medlock, a co-author of the study and researcher with the Department of Biomedical Sciences in Oregon State University’s College of Veterinary Medicine.

“That approach could really limit the cycle of transmission, preventing a great deal of illness while also reducing the number of deaths among high risk groups,” he said. “Approaches similar to this were used in Japan several decades ago, and they accomplished just that. Our new analysis suggests we should reconsider our priorities for vaccination.”

In a perfect world and in accord with recommendations from the Centers for Disease Control and Prevention, researchers agree that almost everyone over the age of six months should get the flu vaccine, unless they were allergic to the shot or had other reasons not to take it. But in the United States, only about one-third of the population actually gets a flu vaccine each year. Historic efforts have been focused on people at higher risk of death and severe disease — often the elderly, and those with chronic illness, weakened immune systems, health care workers or others.

With existing patterns of vaccine usage, the problem is enormous. Seasonal influenza in the U.S. results each year in an average of 36,000 deaths, more than 200,000 hospitalizations, an $87 billion economic burden, and millions of hours of lost time at school and work — not to mention feeling sick and miserable.

The flu vaccine up until 2000 was only recommended for people over 65, Medlock said, and other age groups were added in the past decade as it became clear they also were at high risk of death or complications — children from age six months to five years, and adults over 50. Just recently, age was taken completely out of the equation.

“Clearly we would want people at high medical risk to get a flu vaccine as long as it is abundant,” Medlock said. “But what we’re losing in our current approach is the understanding that most flu is transmitted by children and young adults. They don’t as often die from it, but they are the ones who spread it to everyone else.”

The population and disease transmission modeling done in the new study outlines this, and concluded that a 25-100 percent reduction in deaths from flu or its complications could be achieved if current flu vaccine usage were shifted to much more heavily include children and young adults, as well as those at high risk.

One obstacle, experts say, is the historic reluctance to add even more vaccines to those already received and often mandated for school-age children.

“A simple program we could consider in our K-12 schools would be to have the school nurse, or other local professional, give every child an annual flu shot, with the parents being informed about it in advance and having the option to decline,” Medlock said.

“Vaccinating children could prevent a great deal of illness and save many lives at all ages, not just the children,” he said. “More aggressive educational campaigns to reach young adults would also be helpful.”

Collaborators on this research included scientists from Yale University and the University of Texas. It was supported by the National Institute of General Medical Sciences.

Science Daily

Rise in mumps cases linked to waning immunity given by MMR vaccine

Friday, July 12th, 2013 (last updated)

Public Health England says waning immunity may be contributing to transmission after 948 cases of mumps in first quarter of 2013.

Rise in mumps cases linked to waning immunity given by MMR vaccine

Public health officials are warning of a rise in cases of mumps due in part to waning immunity to the disease in those given the MMR vaccine.

There were 948 cases of mumps in the first quarter of the year, more than the 673 measles cases which prompted a national catch-up campaign to increase take-up of the MMR vaccine. Half of those who developed mumps in the first three months of this year had received at least one of the two jabs needed to give them the best chance of not falling ill.

Public Health England’s (PHE) official weekly update for professionals on infectious diseases stated in June that “some waning immunity may be contributing to transmission”.

Health experts are anxious that falling immunity to the mumps element of the MMR vaccine must not undermine the message that it still improves young people’s chances of not getting mumps – as well as protecting against measles and rubella.

Mary Ramsay, head of immunisation at PHE, said: “We think that in conditions of high exposure and close mixing [mumps] infection can spread even if vaccinated – but this makes it even more important for the unvaccinated to have the vaccine because herd immunity is not high, so individual protection relies on your own vaccination.”

She pointed to research, in which she was involved, on the 2004-5 mumps outbreak that suggested even one jab cut the risk of hospital treatment, painful swelling of the testicles for young men and meningitis.

National and local efforts to improve MMR coverage have been organised in recent years to make up for fall-off due to the now discredited link between MMR and autism. These included vaccination sessions at universities and colleges which were hit by big mumps outbreaks in 2004-5 – but there remains an estimated 1 million children and young people who have not had both jabs.

The MMR was phased in for children aged a year to 15 months from 1988, with a second dose added to the childhood vaccination programme at three years and four months in 1996. Before the MMR vaccine was introduced in 1988, there was no routine immunisation against mumps in the UK, and an immunisation campaign in 1994 to head off a measles epidemic used only a combined measles and rubella vaccine because there was not enough MMR.

Government advisers on vaccination have been monitoring the mumps part of the vaccine for some time. In January last year they noted that “a significant proportion” of infections were occurring in young people who had had jabs and that “it may be reasonable to assume that protection from infection falls to around 60% after 10-15-years.” A subcommittee of the Joint Committee on Vaccination and Immunisation looked at a number of options. But moving the second MMR dose from three-year-olds to an older age would leave young children unprotected against measles and rubella, they concluded, while a third dose of MMR during adolescence might not be cost-effective since the effectiveness of another jab for those already with immunity was uncertain.

There would also be “very little added protection” against measles and rubella and it might only shift the burden of the disease due to “waning vaccine-induced” immunity to older age groups. The advisers could not offer any advice on whether booster doses would work during outbreaks because evidence was so limited. The best solution was to reinforce current policy on encouraging families of un- or undervaccinated children to put that right.

Public Health England would like to see NHS advice on the MMR vaccine changed to reflect the issue of waning immunity to the mumps element of the vaccine.

The Guardian