Tag Archives: Immunization

Have You Had Your Pertussis Vaccine?

As the North Pacific Pediatric Society’s annual meeting got underway recently, organizers invited Dr. Maxine Hayes of the Washington State Department of Health to the podium to deliver a special – and urgent – message.

Dr. Maxine Hayes (Sherry Boschert/IMNG Medical Media)

Her plea to pediatricians: Make sure that you, all of your staff, and your patients have been immunized against pertussis. Not only was the Society meeting during National Infant Immunization Week, but Washington State had just recorded its 1,000th case of pertussis in 2012, with 61% of cases in school-age children, she reported.

“It’s the worst we’ve seen in six decades,” Dr. Hayes said. “If infections continue at this rate, we’ll have more than 3,000 cases by the end of the year.”

Washington State had 1,008 reported cases of pertussis by April 21, 2012 – nearly 10 times more than the 110 cases reported during the same period in 2011, according to the U.S. Centers for Disease Control and Prevention. There are more pertussis cases in the state already for 2012 than there were in all of 2011 (965 cases) or all of 2010 (608 cases).

The Washington epidemic follows on the heals of a 2010 outbreak of 9,143 cases in California – the most in 63 years – that killed at least 10 infants.

My colleagues at IMNG Medical Media have been following the story, with multiple reports. The California epidemic probably was due to the waning immunity of the tetanus-diphtheria-acellular pertussis (Tdap) vaccine. Tdap vaccine is recommended for all health care workers.

And it’s not just for kids, health care workers, and medical office staff. If you’re a physician who treats adults, you should know that older adults need the Tdap vaccine too. Even pregnant women should be vaccinated.

When Dr. Michael E. Pichichero randomly asked 10 pediatricians if they’d had the Tdap vaccine, 8 of them said no, with some pretty weak excuses, if you ask me.

“I know that there are people in this room who have not had their Tdaps,” Dr. Hayes said with an accusing smile. “I also know that in busy practices, you have people in and out every day that have not had their Tdap. I’m calling on you to really get on it.” Make sure that your emergency rooms have Tdap in stock, too, she added.

“And if you’re not in Washington, don’t be smug about this, because you could be next,” Dr. Hayes said. Her public health colleagues in Oregon State are taking this so seriously that they’re planning to open pertussis booster clinics, she noted.

–Sherry Boschert (@sherryboschert on Twitter)

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Vaccine Advocate Chronicles the Opposition

Dr. Paul A. Offit‘s new book documents the history of his detractors.  The pediatric infectious disease specialist and vaccine researcher is a vocal vaccine advocate who has become a target for people who believe that vaccines cause autism and other ills in children. His new book, “Deadly Choices: How the Anti-Vaccine Movement Threatens us All,” follows his 2008 book, “Autism’s False Prophets: Bad Science, Risky Medicine, and the Search for a Cure” which focused specifically on the autism accusation.

The new book takes a broader historical view of the anti-vaccine movement, going back to the mid-1800’s in England, when some people actually expressed the fear that the bovine-derived smallpox vaccine would turn their children into cows. “If you look at the messaging and the style of those campaigns, it’s almost identical to today,” Dr. Offit told me in an interview, noting that he hopes the book will put the current anti-vaccine movement into perspective for physicians as well as lay readers.

Dr. Paul A. Offit / Photo by Miriam E. Tucker

According to the book, America’s modern-day anti-vaccine movement began on April 19, 1982, with the airing of “DPT: Vaccine Roulette,” a one-hour documentary on Washington, D.C.’s local NBC affiliate WRC-TV. It described children with a variety of mental and physical disabilities that their parents blamed on the diphtheria-tetanus-pertussis vaccine. The book also discusses today’s anti-vaccine crusaders, including celebrities such as Jenny McCarthy, Jim Carrey, and Bill Maher.

The book is intended to sound an alarm.“The problem with choosing not to vaccinate is not theoretical any more. I think we’re past the tipping point. We’ve had outbreaks of whooping cough, measles, and mumps and even bacterial meningitis that are preventable, because people are choosing not to vaccinate. They’re so scared that they’re more frightened of the vaccine than of the disease…I just think someone has to stand up for these children who are suffering and being hospitalized and dying,” he told me.

Dr. Offit is often attacked on the Internet by people who oppose vaccines, and once received a death threat by email. In June 2006, I was among the attendees at a meeting of the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices who had to navigate through a crowd of anti-vaccine protestors lining the sidewalk leading to the CDC’s main Atlanta campus. One protestor held a sign labeling Dr. Offit a terrorist. Another yelled at him through a megaphone, calling him the devil.

I asked if he’s worried about a similar reaction to the new book. “I don’t think it will evoke any more anger than I’ve already evoked,” he replied.

Miriam E. Tucker (@MiriamETucker on Twitter)

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A Difficult Vaccine Decision

In the 16 years that I’ve been covering the thrice-yearly meetings of the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices, I can’t recall a vaccine recommendation vote as close as the one last week on the meningococcal vaccine. The vote to add a booster dose for 16-year-olds passed by just 6 to 5, with 3 panel members abstaining.

In 2007, ACIP recommended the then-newly licensed conjugate meningococcal vaccine for all 11-12 year-olds. That age was chosen because other vaccines are also given then, as part of the so-called “adolescent platform.” The peak period of risk from Neisseria meningitidis is actually between the ages of 16 and 21 years and is particularly high for college freshman living in dorms, where the disease is easily spread. But, at the time of the recommendation, it was assumed that protection would last at least 10 years.

Credit: ©Sean Warren/iStockphoto.com

It has now become clear that immunity from the vaccine begins to wane after just 5 years. So, ACIP was obliged to revisit the issue. The panel was presented with three choices devised by a working group: Keep the 11-12 year status quo, move the vaccine out of the established adolescent visit to mid-adolescence, or keep it in place and add another dose later. The third choice won out, but barely.

Those who opposed cited cost — about $90/dose — as a primary reason. “I’m worried that we don’t have data that would support cost-effectiveness of a two-dose regimen,” said panel member Lance Chilton, one of the dissenters.

He told me he would have preferred moving the vaccine to mid-adolescence, without changing the 11-12 year visit for other vaccines. “Adding another platform is probably a good idea,” said Dr. Chilton, of the University of New Mexico, Albuquerque.

ACIP chair Dr. Carol Baker, who voted with the slight majority, said that the meningococcal vaccine decision illustrates the complexity of many of the decisions this committee faces. “Good people had varying opinions … one of the things the ACIP is charged to do is to grapple with these difficult decisions,” said Dr. Baker of Baylor College of Medicine, Houston.

I asked her about the role of vaccine cost in the decision. Her reply: “Things are not getting less expensive and that includes our new vaccines. It costs a lot of money to bring products to the market that will provide good health for our children, adolescents, and adults, and there are value judgments there. But, vaccines are one of the least expensive preventive health services we provide in this country.”

-Miriam E. Tucker (@MiriamETucker on Twitter)

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A Call for Timely Diagnosis of Pertussis

Image via Flickr user Pink Sherbet by Creative Commons License.

The pertussis outbreak in California shows no signs of slowing.

According to the California Department of Public Health, as of Sept. 7, 2010, there have been 3,834 confirmed, probable, and suspect cases of the illness reported in 2010, for a state rate of 9.8 cases per 100,000. That translates into a sevenfold increase in the number of reported cases during the same time period in 2009.

This marks the most cases reported since 1958, when Dwight D. Eisenhower was president. 

The situation is so shaky that, on Aug. 19, the state’s immunization branch chief, Dr. John Talarico, sent a letter to physicians and hospitals statewide, urging them to treat anyone under the age of 6 years who presents with trouble breathing as whooping cough until proven otherwise. To date, 8 infants have died from the disease. 

“A common theme among the infant deaths is that pertussis was not typically diagnosed until after multiple visits to outpatient clinics, emergency departments, or other health care facilities,” Dr. Talarico wrote. “In several cases, the infant’s symptoms at the time of examination were not highly suggestive of pertussis and the infants were treated only for nasal congestion or mild upper respiratory infection. By the time these infants developed severe respiratory distress, it was usually too late for any intervention to prevent their tragic deaths.” 

For a reminder of what whooping cough sounds like, give this file a listen.

— Doug Brunk (on Twitter@dougbrunk)

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H1N1 Flu Virus Goes “Post-Pandemic”

The pandemic caused by the 2009 H1N1 influenza virus is now post-pandemic, according to a statement issued today by WHO Director-General Dr. Margaret Chan.

We should consider ourselves lucky that the 2009 H1N1 virus remained relatively mild, despite its hostile takeover of other circulating flu viruses last fall. Now, according to data from the WHO, many countries where seasonal flu is occuring are reporting a mix of viruses. So, it sounds like the 2009 H1N1 is settling down to play happily in the mix with other circulating flu viruses, learning how to take turns with the likes of H1N3 and influenza B, which join 2009 H1N1 in the 2010-2011 seasonal flu vaccine. But hold on to your hand sanitizer—“Pandemics, like the viruses that cause them, are unpredictable,” Dr. Chan said in her statement. And she’s right: Think back to every horror movie you have ever seen, or any book where it seems like the villain must be dead.

courtesy of flickr user sdecoret (creative commons)

“No one could have survived that fall/ explosion /fire/gunshot wound/ decapitation/banishment to a parallel universe.”

Not until it’s time for the sequel.

The 2009 H1N1 pandemic was, in many ways, a trial run for how the government and the medical community can work together to provide information—and health care—to the public in an emergency. There is room for improvement, especially as social media evolves, but the regular media updates and availability of information online was at least a starting point for communicating this type of news effectively. And even though there has been some controversy over whether governments ordered too much of the H1N1 vaccine, one could argue that it is better to have too much than not enough. Imagine the panic if the H1N1 virus had been deadlier, and there was a vaccine shortage.That’s another potential positive side effect of the 2009 H1N1 pandemic—a revisiting of the vaccine-making process. Maybe we can look forward to quicker, more efficient vaccine production. Maybe not right away, but perhaps in time for H1N1 II: The Swine Flu Strikes Back. Coming Soon to a Germy Person Near You.

“Continued vigilance is extremely important,” Dr. Chan said in her statement. To that end, the WHO offers recommendations for the post-pandemic period on its website, and the CDC continues to provide the latest flu information.
—Heidi Splete (On Twitter @HSplete)
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