To Vaccinate Or Not: One Family’s Journey

9 02 2015

When I had my first child over a decade ago, the idea of not vaccinating was one I was wholly unfamiliar with. I followed all of the suggestions of the doctor in regards to care for my baby and didn’t question whether the guidelines I followed were best practice or not.

When my toddler had a reaction after her one-year shots, all of that came screeching to a halt.

Getting online to connect with other parents with similar concerns was a frightening experience. All of a sudden there was a ton of information about vaccinations and none of it felt terribly positive.

I stopped vaccinating. I was afraid more of the shots hurting my child than I was of the diseases the shots are designed to prevent. I didn’t vaccinate my other children at all when I had them and became a part of an online community that supported “natural health” and healing.

I spent many years never questioning this choice. There are so many things that really make vaccinations terrifying online—the idea of doing something that can injure or kill your child while trying to avoid minor diseases seemed simple and clear.

Slowly things started to change. The news started covering more outbreaks of diseases that were previously rare. Weighing out the odds of catching a disease vs. having a reaction seems very different when diseases are no longer mostly eradicated.

Information about the shady dealings of Wakefield about the tie between the MMR vaccine and autism came to light.

I changed where I was reading online at this point, as well. I really found the Red Wine and Applesauce blog to be a source of comforting and factual information.

I talked to other families that had previously not vaccinated and now were. My husband read with me and talked to other families. We talked to our pediatrician about why we had made our previous choices as well as why we were considering changing and listened.

Finally, we decided to try a single shot. We picked DTaP because of pertussis in the area, and vaccinated all the kids.

We then closely watched all of them for something terrible to happen. The hours and then days following that first shot were frightening—despite all that we had read about the low chances of side effects there was still years of seeing people blame vaccines for tons of injuries in children.

Nothing bad happened. Everyone ran a slight fever and then they were fine. The next time we went back we started to use the CDC’s catch-up schedule.

I do not regret catching the kids up on their shots. Talking to vaccine-hesitant people is productive and we can all work together to protect our kids—all of them.

 

The author chose to remain anonymous due to differences of opinion with members of her extended family.





Meningitis B Vaccine – Who Gets It?

19 01 2015

My whole life is on the Outlook calendar. Birthdays, meetings, to-do lists, reminders—when anything pops up, it goes on the calendar. Doesn’t matter if it’s four days or four years from now, it gets noted.

In a few months, my younger daughter will be 16. If you sat at my computer and clicked to that day, you’d find two things: 1) Bug’s birthday and, 2) Call to get mening booster for Bug. (Don’t tell her I called her Bug in this blog, but that is what you’d read in my calendar. It stands for Love Bug.)

Meningitis, or more accurately, meningococcal disease, is the real version of the monster under the bed. That’s how scared I am of this disease.

Love Bug - the early years.

Love Bug – the early years.

It’s not as common as flu, but when it strikes, it can kill or do horrendous damage to the body within hours of the first symptom appearing.

In the US, we have vaccines we use against several strains of the disease.

In the fall of 2014, the FDA approved a vaccine against serogroup B, a strain not found in our current vaccines. There’s at least one other vaccine against serogroup B that’s waiting for approval from the FDA, and I’m guessing that approval won’t be long in coming.

Because we haven’t had a vaccine against serogroup B, we’ve left our at-risk populations defenseless. When Princeton and Santa Barbara had their meningitis outbreaks in 2013, the culprit was serogroup B.

But, the good news is that the ACIP (Advisory Committee on Immunization Practices) will now take a look at the vaccine that protects against meningitis serogroup B and decide what recommendations it will make. The ACIP exists to make “recommendations on how to use vaccines to control diseases in the United States.”

It could be that the ACIP will decide to recommend that all young people ages 10 to 25 should be vaccinated. Or, they may recommend that the vaccine only be given in the event of an outbreak.

The CDC has a specific definition of outbreak when it comes to meningitis, and that is: An outbreak occurs when there are multiple cases in a community or institution over a short period of time. Specifically, an outbreak is defined as three or more cases of the same serogroup (“strain”) occurring within three months. Sometimes having just two cases in a school or college can meet the outbreak definition.

For a more precise definition, check out this Morbidity and Mortality Weekly Report (MMWR) on the Evaluation and Management of Suspected Outbreaks of Meningococcal Disease.

My personal feeling is that we’re a country that can afford to protect ourselves against vaccine-preventable diseases and we should take advantage of that fact. Why wait until an outbreak to start vaccinating? Let’s get the at-risk populations vaccinated and not worry about an outbreak.

I suspect that as discussions ensue, the cost of vaccinating pre-outbreak will be a major factor in determining what the official recommendations will be. After all, the federal government does have a budget. Maybe a few more zeroes in their budget compared to yours or mine, but still.

I know that other interests are clamoring for their share of the pot. Alzheimer’s research, foodborne illness, alcohol poisoning—everyone deserves some of the health and medical dollars available. As do those with other interests, such as agriculture, space exploration, or marine biology.

But still.

Preventing meningococcal disease has always made more sense to me than hoping treatment works and burying those for whom it does not.

I’d like to hear your thoughts on this. We will share them with ACIP members as they meet to discuss what recommendations to make for the new vaccines.

 

 

by Trish Parnell





EV-D68

7 10 2014

We were writing an update on EV-D68 when this email arrived from CDC. We think the points are important for parents to know, so we’re going to share this with you and will provide future updates as warranted.

As parents, we’re all concerned about this virus which isn’t really new, but has captured the nation’s attention. If you have questions, please ask them in the comments and we’ll get answers for you.

[This information is current as of 23 October, 2014 and has been slightly edited for length (believe it or not). The bold text includes the latest updates]:

The United States is currently experiencing a nationwide outbreak of enterovirus D68 (EV-D68) associated with severe respiratory illness.

From mid-August to October 23, 2014, CDC or state public health laboratories have confirmed a total of 973* people in 47 states and the District of Columbia with respiratory illness caused by EV-D68.** This indicates that at least one case has been detected in each of those states but does not indicate how widespread infections are in each state.

In the United States, people are more likely to get infected with enteroviruses in the summer and fall. We are currently in the middle of the enterovirus season. EV-D68 infections are likely to decline later in fall.

For the week of October 8-12, 34 states reported to CDC that EV-D68-like illness activity is low or declining; 8 still have elevated activity, and only 1 has increasing activity.

Many state health departments are currently investigating reported increases in cases of severe respiratory illness in children. This increase could be caused by many different viruses that are common during this time of year. EV-D68 appears to be the predominant type of enterovirus this year and is likely contributing to the increases in severe respiratory illnesses.

Due to increasing knowledge about the nationwide EV-D68 outbreak, there has been a very large increase in the number of specimens tested from patients with severe respiratory illness. Awareness of these initial results is also contributing to increased recognition of new cases.

CDC is prioritizing testing of specimens from children with severe respiratory illness. There are likely many children affected with milder forms of illness.

Of the more than 1,700 specimens tested by the CDC lab, about half have tested positive for EV-D68. About one third have tested positive for an enterovirus or rhinovirus other than EV-D68. Almost all of the CDC-confirmed cases this year of EV-D68 infection have been among children. Many of the children had asthma or a history of wheezing.

CDC has developed, and started using on October 14, a new, faster lab test for detecting EV-D68, allowing CDC to rapidly process in about seven to 10 days the more than 1,000 remaining specimens received since mid-September. As a result, the number of confirmed EV-D68 cases will likely increase substantially in the coming days. These increases will not reflect changes in real time or mean the situation is getting worse.

As a result, confirmed cases increased today and will likely continue to increase in coming days. This does not mean the situation is getting worse.

Faster testing will help to better show the trends of this outbreak since August and to monitor changes occurring in real time.

EV-D68 has been detected in specimens from eight*** patients who died and had samples submitted for testing.

CDC is reporting the test results to state health departments as we obtain them. State and local officials have the authority to determine the cause of death, the appropriate information to release, and the time to release it. CDC will defer to states to provide this information.

So far, state and local officials have reported that two of these deaths were caused by EV-D68.

CDC will post updated data to the website every Thursday.

CDC understands that Americans may be concerned about these severe respiratory illnesses and the new reports of neurological illness. Severe illness is always a concern to us, especially when infants and children are affected. We will share information as soon as we have it, and post updates on our website (http://www.cdc.gov/non-polio-enterovirus/outbreaks/EV-D68-outbreaks.html).

Clinicians should consider EV-D68 as a possible cause of severe respiratory illness, particularly in children, and report unusual increases in the number of patients with severe respiratory illness to their health department.

The general public can help protect themselves from respiratory illnesses by washing hands with soap and water, avoiding close contact with sick people, and disinfecting frequently touched surfaces. Anyone with respiratory illness should contact their doctor if they are having difficulty breathing, or if their symptoms are getting worse.

*Total confirmed case count includes results from State Public Health Laboratories that can do testing to determine type of enterovirus.
**The primary reason for current increases in cases is that a backlog of specimens is being processed from several states that are investigating clusters of people with severe respiratory illness. It can take a while to test specimens and obtain lab results because the testing is complex and slow, and can only be done by CDC and a small number of state public health laboratories. These increases will not necessarily reflect changes in real time, or mean that the situation is getting worse.
***Investigations are ongoing; CDC will review and update available data every Wednesday.

 

BACKGROUND

Enteroviruses are very common viruses; there are more than 100 types.

It is estimated that 10 to 15 million enterovirus infections occur in the United States each year. Tens of thousands of people are hospitalized each year for illnesses caused by enteroviruses.

Different enteroviruses can cause different illnesses, such as respiratory, febrile rash, and neurologic [e.g., aseptic meningitis (swelling of the tissue covering the brain and spinal cord) and encephalitis (swelling of the brain)].

In general, the spread of enteroviruses is often quite unpredictable. A mix of enteroviruses circulates every year, and different types of enteroviruses can be common in different years.

In the United States, people are more likely to get infected with enteroviruses in the summer and fall.

 

Enterovirus D68

EV-D68 was first recognized in California in 1962. Small numbers of EV-D68 have been reported regularly to CDC since 1987. However, this year the number of people with confirmed EV-D68 infections is much greater than that reported in previous years.

The strains of EV-D68 circulating this year are not new.

CDC, working with state health departments, has identified at least three separate strains of EV-D68 that are causing infections in the United States this year; the most prominent strain is related to the strains of EV-D68 that were detected in the United States in 2012 and 2013.

There is no evidence that unaccompanied children brought EV-D68 to the United States; we are not aware of any of these children testing positive for the virus.

It is common for multiple strains of the same enterovirus type to be co-circulating in the same year.

Respiratory illnesses can be caused by many different viruses and have similar symptoms. Not all respiratory illnesses occurring now are due to EV-D68.

EV-D68 has been previously referred to as human enterovirus 68 (or HEV-68) and human rhinovirus 87 (or HRV-87). They are all the same virus. The D stands for enterovirus species D.

 

SYMPTOMS

EV-D68 infections can cause mild to severe respiratory illness, or no symptoms at all.

Mild symptoms may include fever, runny nose, sneezing, cough, and body and muscle aches.

Severe symptoms may include wheezing and difficulty breathing.
Anyone with respiratory illness should contact their doctor if they are having difficulty breathing, or if their symptoms are getting worse.

Enteroviruses are known to be one of the causes of acute neurologic disease in children. They most commonly cause aseptic meningitis, less commonly encephalitis, and rarely, acute myelitis and paralysis.

CDC is aware of two published reports of children with neurologic illnesses confirmed as EV-D68 infection from cerebrospinal fluid (CSF) testing.

 

PEOPLE AT RISK

In general, infants, children, and teenagers are most likely to get infected with enteroviruses and become sick. That’s because they do not yet have immunity (protection) from previous exposures to these viruses. We believe this is also true for EV-D68. Adults can get infected with enteroviruses, but they are more likely to have no symptoms or mild symptoms.

Children with asthma may have a higher risk for severe respiratory illness caused by EV-D68 infection.

 

TRANSMISSION

Since EV-D68 causes respiratory illness, the virus can be found in an infected person’s respiratory secretions, such as saliva, nasal mucus, or sputum.

The virus likely spreads from person to person when an infected person coughs, sneezes, or touches a surface that is then touched by others.

Diagnosis

EV-D68 can only be diagnosed by doing specific lab tests on specimens from a person’s nose and throat.

Many hospitals and some doctor’s offices can test sick patients to see if they have enterovirus infection. However, most cannot do specific testing to determine the type of enterovirus, like EV-D68. CDC and some state health departments can do this sort of testing.

CDC recommends that clinicians only consider EV-D68 testing for patients with severe respiratory illness and when the cause is unclear.

 

TREATMENT

There is no specific treatment for people with respiratory illness caused by EV-D68 infection.

For mild respiratory illness, you can help relieve symptoms by taking over-the-counter medications for pain and fever. Aspirin should not be given to children.

Some people with severe respiratory illness caused by EV-D68 may need to be hospitalized and receive intensive supportive therapy.

There are no antiviral medications are currently available for people who become infected with EV-D68.

 

PREVENTION

You can help protect yourself from getting and spreading EV-D68 by following these steps:

  • Wash hands often with soap and water for 20 seconds
  • Avoid touching eyes, nose and mouth with unwashed hands
  • Avoid close contact such as kissing, hugging, and sharing cups or eating utensils with people who are sick, or when you are sick
  • Cover your coughs and sneezes with a tissue or shirt sleeve, not your hands
  • Clean and disinfect frequently touched surfaces, such as toys and doorknobs, especially if someone is sick
  • Stay home when you are sick
  • There are no vaccines for preventing EV-D68 infections.

Children with asthma are at risk for severe symptoms from EV-D68 and other respiratory illnesses. They should follow CDC’s guidance to maintain control of their illness during this time:

  • Discuss and update your asthma action plan with your primary care provider.
  • Take your prescribed asthma medications as directed, especially long term control medication(s).
  • Be sure to keep your reliever medication with you.
  • Get a flu vaccine when available.
  • If you develop new or worsening asthma symptoms, follow the steps of your asthma action plan. If your symptoms do not go away, call your doctor right away.
  • Parents should make sure the child’s caregiver and/or teacher is aware of his/her condition, and that they know how to help if the child experiences any symptoms related to asthma.

 

WHAT IS CDC DOING

CDC continues to collect information from states and assess the situation to better understand  EV-D68 and the illness caused by this virus and how widespread EV-D68 infections may be within states and the populations affected.

CDC is helping states with diagnostic and molecular typing for EV-D68.

We are working with state and local health departments and clinical and state laboratories to enhance their capacity to identify and investigate outbreaks, and perform diagnostic and molecular typing tests to improve detection of enteroviruses and enhance surveillance.

CDC has developed, and started using on October 14, a new, faster lab test for detecting EV-D68 in specimens from people in the United States with respiratory illness. CDC will provide protocols to state public health labs and explore options for providing test kits.

CDC’s new lab test is a “real-time” reverse transcription polymerase chain reaction, or rRT-PCR, and it identifies all strains of EV-D68 that we have been seeing this summer and fall. The new test has fewer and shorter steps than the test that CDC and some states were using previously during this EV-D68 outbreak. This will allow CDC to test and report results for new specimens within a few days of receiving them.

The previous test, which CDC used for about nine years,  is very sensitive and can be used to detect and identify almost all enteroviruses; however, it requires multiple, labor-intensive processing steps and cannot be easily scaled up to support testing of large numbers of specimens in real time that is needed for the current EV-D68 outbreak.

We are providing information to healthcare professionals, policymakers, general public, and partners in numerous formats, including Morbidity and Mortality Weekly Reports (MMWRs), health alerts, websites, social media, podcasts, infographics, and presentations.

CDC has obtained one complete genomic sequence and six partial genomic sequences from viruses, representing the three known strains of EV-D68 that are causing infection at this time.

Comparison of these sequences to sequences from previous years shows they are genetically related to strains of EV-D68 that were detected in previous years in the United States, Europe, and Asia.

CDC has submitted the sequences to GenBank to make them available to the scientific community for further testing and analysis.

 

GUIDANCE FOR CLINICIANS

Clinicians should:

  • consider EV-D68 as a possible cause of acute, unexplained severe respiratory illness, even if the patient does not have fever.
  • report suspected clusters of severe respiratory illness to local and state health departments. EV-D68 is not nationally notifiable, but state and local health departments may have additional guidance on reporting.
  • consider laboratory testing of respiratory specimens for enteroviruses when the cause of respiratory illness in severely ill patients is unclear.
  • consider testing to confirm the presence of EV-D68. State health departments can be approached for diagnostic and molecular typing for enteroviruses.
  • contact your state or local health department before sending specimens for diagnostic and molecular typing.
  • follow standard, contact, and droplet infection control measures

The antiviral drugs pleconaril, pocapavir, and vapendavir, have significant activity against a wide range of enteroviruses and rhinoviruses. CDC has tested these drugs for activity against currently circulating strains of enterovirus D68 (EV-D68), and none of them has activity against EV-D68 at clinically relevant concentrations.

 

SURVEILLANCE

U.S. healthcare professionals are not required to report known or suspected cases of EV-D68 infection to health departments because it is not a nationally notifiable disease in the United States. Also, CDC does not have a surveillance system that specifically collects information on EV-D68 infections.

No data is currently available regarding the overall burden of morbidity or mortality from EV-D68 in the United States. Any data CDC receives about EV-D68 infections or outbreaks are voluntarily provided by labs to CDC’s National Enterovirus Surveillance System (NESS). NESS collects limited data, focusing on circulating types of enteroviruses and parechoviruses.

For a large image and details of EV-D68-like illness activity in states, see http://www.cdc.gov/non-polio-enterovirus/outbreaks/EV-D68-activity.html.

MORE INFORMATION

CDC Enterovirus D68 in the United States, 2014 website: http://www.cdc.gov/non-polio-enterovirus/outbreaks/EV-D68-outbreaks.html

CDC Enterovirus D68 general website: http://www.cdc.gov/non-polio-enterovirus/about/EV-D68.html

CDC Enterovirus D68 for Health Care Professionals website: http://www.cdc.gov/non-polio-enterovirus/hcp/EV-D68-hcp.html

CDC Activity of Enterovirus D68-like Illness in States website: http://www.cdc.gov/non-polio-enterovirus/outbreaks/EV-D68-activity.html  

CDC What Parents Need to Know about Enterovirus D68 webpage: http://www.cdc.gov/features/evd68/

Enterovirus D68 in the United States: Epidemiology, Diagnosis & Treatment, COCA Call, September 16, 2014 (http://www.bt.cdc.gov/coca/calls/2014/callinfo_091614.asp)

Severe Respiratory Illness Associated with Enterovirus D68 – Multiple States, 2014, Health Alert Network, September 12, 2014 (http://emergency.cdc.gov/han/han00369.asp)

Severe Respiratory Illness Associated with Enterovirus D68 – Missouri and Illinois, 2014, MMWR, September 8, 2014 (http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6336a4.htm?s_cid=mm6336a4_w)

Clusters of Acute Respiratory Illness Associated with Human Enterovirus 68 — Asia, Europe, and United States, 2008–2010, MMWR, September 30, 2011 (http://www.cdc.gov/mmwR/preview/mmwrhtml/mm6038a1.htm)





Why We Talk About Immunizations

25 04 2014

There are so many ways to prevent infections, I sometimes wonder why we spend the vast majority of our time talking about immunizations.

Well, yesterday the CDC came out with data that are so astounding, all I could think when I listened was: That’s why!

The CDC looked back at children born between 1994 and 2013, and estimated that vaccination will prevent:

  • about 322 million illnesses
  • 21 million hospitalizations
  • and 732,000 deaths over the children’s lifetime

And, of less importance than a child’s life but good to know, the prevention of illnesses, hospitalizations, and deaths nets a savings of $295 billion in direct costs and $1.4 trillion in total societal costs. That ain’t hay, as my dad used to say.

I’m happily highlighting these numbers because it’s World Immunization Week, and because the Vaccines for Children (VFC) program celebrates its 20th anniversary this year. Thanks to the VFC, vaccines are provided at no cost to uninsured kids in our country.

20-year-infographicAbout 25 years ago, there was a big measles outbreak in the US. We saw approximately 55,000 cases of measles and more than 100 deaths. Come to find out, this outbreak was primarily due to uninsured children not being vaccinated.

Shortly after the outbreak, the VFC program was established with the hope that such an event would never be repeated.

We are currently seeing small outbreaks of measles cases in the US. Unlike 25 years ago, these outbreaks are primarily due to a small number of parents choosing not to vaccinate their children.

Measles was eliminated from the US in 2000, but not from the world. It’s estimated that 20 million people on this planet get measles each year, and 122,000 die from the disease. When unvaccinated individuals in this country travel to other countries, or interact with visitors from other lands, they are at risk for measles.

The symptoms of measles include the typical rash, fever, cough, runny nose, tiredness, red and watery eyes, and sometimes little white spots in the mouth. The symptoms stay for several days before gradually disappearing. However, complications are not uncommon. According to the CDC: About 30% of measles cases develop one or more complications, including:

  • Pneumonia, which is the complication that is most often the cause of death in young children.
  • Ear infections occur in about 1 in 10 measles cases and permanent loss of hearing can result.
  • Diarrhea is reported in about 8% of cases.

These complications are more common among children under 5 years of age and adults over 20 years old.

Even in previously healthy children, measles can be a serious illness requiring hospitalization. As many as 1 out of every 20 children with measles gets pneumonia, and about 1 child in every 1,000 who get measles will develop encephalitis. (This is an inflammation of the brain that can lead to convulsions, and can leave the child deaf or mentally retarded.) For every 1,000 children who get measles, 1 or 2 will die from it. Measles also can make a pregnant woman have a miscarriage, give birth prematurely, or have a low-birth-weight baby.

In developing countries, where malnutrition and vitamin A deficiency are common, measles has been known to kill as many as one out of four people. It is the leading cause of blindness among African children.

I look at these statistics and I think: Oh yes, this is the other reason we spend so much time talking about immunizations.

If I may appropriate and paraphrase something I heard the other day: Mom and dad, choosing not to vaccinate or to delay vaccination of your children is like choosing to put them in their car seats only on Thursdays when the sun is shining.

Don’t be a part of that small minority of parents who are afraid to proactively protect their children. Call your child’s healthcare provider today and make sure he or she is current on all immunizations.

Oh, and happy World Immunization Week.

 

by Trish Parnell

(Thanks to Liz Szabo for the thing I heard the other day.)





Baby Armor

6 03 2014

And now, a timely reminder from CDC:PSA-superbaby

It’s easy for parents to think of vaccine-preventable diseases like measles or whooping cough as issues of the past, but we know that most of these diseases still persist around the world.

Just last year a higher than normal number of measles cases were reported in the U.S., including an outbreak of 58 cases in New York City that was the largest reported outbreak of measles in the U.S. since 1996.

Making sure children get all of their vaccines is the most important thing parents can do to protect them from 14 serious childhood diseases before their second birthday. And CDC has created a series of print PSAs encouraging just that (including an adorable  super baby version).

CDC also has immunization schedules available for all ages and a handy scheduling tool that allows you to enter your child’s birth date and print out a custom copy of his or her personal immunization schedule.

As winter begins to fade and a new spring season starts creeping up, don’t forget to schedule your pediatrician’s visits and discuss vaccinations with your doctor. Let’s give our little super heroes the best protection we can.





Flu Then and Now

12 12 2013

The CDC came out with a lot of flu info today. Here’s a rundown on the highlights with a link to the rest at the end of the post:

CDC says that during last year’s flu season, 45 percent of the U.S. population aged 6 months and older was vaccinated against flu.

Influenza vaccination during 2012-2013 prevented 6.6 million illnesses, 3.2 million medical visits and 79,000 hospitalizations. Overall, this resulted in 17 percent fewer illnesses, medical visits, and hospitalizations than would have happened without flu vaccination.

The numbers are big, but the percentage is small. We need to increase the numbers of those vaccinated, and we need to come up with a more effective vaccine.

CDC estimates that during 2012-2013, there were 31.8 million flu-associated illnesses, 14.4 million medically attended illnesses, and 381,000 hospitalizations in the United States.

As for this year, CDC is recommending that those who have not yet been vaccinated do so. It takes about two weeks after vaccination for the body to develop immunity.

Most years, the flu season in the US peaks between January and March, which is reason enough to get immunized in December.

This year looks to be typical. Get vaccinated now and save yourself and your family the misery of infection.

The recommendation is that everyone six months of age and older get immunized against flu.

Visit the CDC Flu website for more info: http://www.cdc.gov/flu/





Meningitis Outbreaks This Holiday Season

25 11 2013

What’s going on with meningitis at Princeton and UC Santa Barbara?

Both universities are experiencing an outbreak of meningitis—specifically, serogroup B (that’s the genetic fingerprint of the particular strain of meningitis).

In the US, we don’t have an approved vaccine against this serogroup or strain, but we do have vaccines that fight other strains of meningitis, such as C and Y. Those vaccines are working great!

We’re seeing more serogroup B infection right now because there’s no vaccine available in the US to control transmission. And, we’re seeing an outbreak because that just happens sometimes, particularly when there’s no vaccine to prevent it.

As of 25 November, there have been seven cases identified at Princeton, with a probable eighth case not yet formally identified. Three cases have been identified so far at UC Santa Barbara.

Some of the cases have been serious, but to date there are no deaths. Dr. Amanda Cohn, a pediatrician and expert in meningitis with the CDC, talked about these outbreaks today in a teleconference.

She said that while health departments and healthcare providers should be aware of symptoms and think about meningitis should they see indications, it is safe for the college kids to come home for the holidays.

CDC is not expecting transmission in the home. It tends to occur with very close contact (“french” kissing, sharing a room and coughing all over a roommate). Generally, you might get either meningococcal meningitis or meningococcal septicemia from a meningococcal infection.

Symptoms of meningococcal meningitis as noted by CDC include:

  • Sudden onset of fever
  • Headache (severe)
  • Stiff neck (hurts to move it)

Other symptoms might include:

  • Nausea
  • Vomiting
  • Photophobia (increased sensitivity to light)
  • Altered mental status (confusion)

The symptoms of meningococcal meningitis can appear quickly or over several days. Typically they develop within 3-7 days after exposure. This infection can be serious with long-term consequences such as hearing loss or brain damage, and it is at times fatal.

Symptoms of meningococcal septicemia may include:

  • Fatigue
  • Vomiting
  • Cold hands and feet
  • Cold chills
  • Severe aches or pain in the muscles, joints, chest or abdomen (belly)
  • Rapid breathing
  • Diarrhea
  • In the later stages, a dark purple rash

These symptoms can come on in a matter of hours and the infection is very dangerous.

Prevention means washing your hands and covering your coughs and sneezes. Get up-to-date on your immunizations (no matter your age) and know that, if a healthcare provider suspects someone in the home may have an infection, those in close contact will receive antibiotics to prevent the spread of the disease. There are some manufacturers working on vaccines that include serogroup B for approval in the US, but they are not yet at the final stages of development on those vaccines.





What’s New With Flu?

26 09 2013

CDC released lots of data today on last year’s flu season. This will help to inform all of us as we look at the coming season and determine our health messaging targets.

Take a look . . .

Flu vaccination is the best protection available against influenza.  All persons 6 months and older should receive a flu vaccination every year to reduce the risk of illness, hospitalization, and even death.

The 2012-13 influenza season is a reminder of the unpredictability and severity of influenza.  The 2012-13 season began early, was moderately severe, and lasted longer than average.

More children than ever before received a seasonal flu vaccination during the 2012-13 season.

  • 45.0% of people in the United States 6 months and older were vaccinated during the 2012-13 season,  less than half of the U.S. population 6 months and older.
  • Among children, coverage was highest for children aged 6-23 months (76.9%) with large increases in vaccination for children 5-12 years old (4.4 percentage points higher for the 2012-13 season compared to the 2011-12 season) and teens 13-17 year old (8.8 percentage points higher for the 2012–13 season compared to the 2011–12 season).
  • Among adults, coverage was highest for adults aged 65 years and older (66.2%) and lowest among adults aged 18-49 years (31.1%).
  • Among children, coverage was highest among non-Hispanic Asian children (65.8%), Hispanic children (60.9%), non-Hispanic black children (56.7%), and non-Hispanic children of other or multiple races (58.5%). Coverage among non-Hispanic white children was lower at 53.8%.
  • Among adults, differences in coverage among racial/ethnic populations remain, with coverage among adult non-Hispanic blacks (35%) and Hispanics (34%) far lower than their non-Hispanic white counterparts (45%).

Coverage by Age:

Coverage for children 6 months through 17 years of age was 56.6% in the 2012-13 season, an increase of 5.1 percentage points from the 2011-12 season.  State-specific flu vaccination coverage for children 6 months through 17 years ranged from 44.0% to 81.6%.

  • Coverage for children decreased with age:
    • 76.9% for children 6-23 months
    • 65.8% for children 2-4 years
    • 58.6% for children 5-12 years
    • 42.5% for children 13-17 years

• Coverage increased in the 2012-13 season:

    • Children 5-12 years: an increase of 4.4 percentage points from the 2011-12 season
    • Children 13-17 years: an increase of 8.8 percentage points from the 2011–12 season
    • Changes in coverage were not significant for other age groups

Coverage for adults aged 18 years and older was 41.5% in the 2012-13 season, an increase of 2.7 percentage points from the 2011-12 season.  State-specific coverage ranged from 30.8% to 53.4%.

  • Coverage for adults increased with increasing age:
    • 31.1% for adults 18-49 years
    • 45.1% for adults 50-64 years
    • 66.2% for adults 65 years and older
  • Coverage increased in the 2012-13 season:
    • Adults 18-49 years: an increase of 2.5 percentage points from the 2011-12 season
    • Adults 50-64 years: an increase of 2.4 percentage points from the 2011–12 season
    • Adults 65 years and older: an increase of 1.3 percentage points from the 2011–12 season
  • Among adults 18-49 years of age with at least one high-risk medical condition (asthma, diabetes, or heart disease), coverage for the 2012-13 season was 39.8%, an increase of 3 percentage points from the 2011-12 season coverage estimate of 36.8%  State-specific coverage ranged from 17.9% to 58.8%.

Coverage by Sex:

Children (6 months-17 years)

  • There were no differences in coverage for male and female children.

Adults (18 years and older)

  • Coverage was higher for females (44.5%) than for males (38.3%).

Coverage by Race/Ethnicity:

Children (6 months-17 years)

Coverage for Asian children (65.8%) was significantly higher than all other racial/ethnic groups.

  • Coverage for non-Hispanic Asian children (65.8%), Hispanic children (60.9%), non-Hispanic black children (56.7%), and non-Hispanic children of other or multiple races (58.5%) was significantly higher than for non-Hispanic white children (53.8%).
  • Coverage for non-Hispanic American Indian/Alaska Native children (52.5%) was similar to that for non-Hispanic white children (53.8%).
  • There were significant increases in coverage from the 2011-12 season for non-Hispanic white children (6.2 percentage points), non-Hispanic Asian children (7.6 percentage points), and non-Hispanic children of other or multiple races (8.5 percentage points).
  • Coverage for non-Hispanic black, Hispanic, and non-Hispanic American Indian/Alaska Native children did not change from the 2011-12 season.

Adults (18 years and older)

Coverage among adults aged 18 years and older increased across all racial/ethnic groups except for American Indian/Alaska Native adults and adults of other or multiple races in which coverage did not change.

  • Among adults, coverage for non-Hispanic Asians (44.8%), non-Hispanic whites (44.6%), and non-Hispanic American Indians/Alaska Natives (41.1%) was higher than coverage for non-Hispanic adults of other or multiple races (38.0%), non-Hispanic blacks (35.6%), and Hispanics (33.8%).

There is an opportunity to raise awareness of the important benefits that can be gained by increased vaccination among children and adults.

  • Continued efforts are needed to ensure those at higher risk of flu complications (i.e. elderly, young children, and persons with chronic health conditions) are vaccinated each year.
  • Access to vaccination should be expanded in non-traditional settings such as pharmacies, workplaces, and schools.
  • Health care providers should make a strong recommendation for and offer of vaccination to their patients and improve their use of evidence-based practices such as vaccination programs in schools and WIC settings and client reminder/recall systems.
  • Immunization information systems, also known as registries, should be used at the point of care and at the population level to guide clinical and public health vaccination decisions.

Pregnant women and healthcare workers

During the period of October 2012-January 2013, 50.5% of pregnant women reported they received the influenza vaccination before or during their pregnancy.

Overall, 72.0% of health care workers reported having had a flu vaccine for the 2012-13 season, an increase from 66.9% vaccination coverage during the 2011-12 season.





Flu Season 2013 – 2014

5 09 2013

We’re getting ready for flu season!

We had our first National Influenza Vaccine Summit call today, and here’s what’s going on:

Scott Epperson from the CDC said that the summer in the US has been quiet for seasonal flu, as we’d expect. The 2013/2014 flu season officially begins at week 40, on 29 September, 2013.

The Southern Hemisphere is at the peak of their season. They seem to have a mix of strains, with no one strain particularly dominant or problematic. There’s a mix of severity among countries and the bottom line is, we can’t say (yet) what to expect in the Northern Hemisphere this coming season.

There will be quadrivalent flu vaccines available this season, but it sounds like there will not be enough doses for everyone. Many of us will continue to use trivalent, at least this year.

The ACIP flu vaccine recommendations should come out on 20 September in the MMWR.

That’s it for now!

 

By Trish Parnell





TB

15 06 2013

Tuberculosis is in the air, so to speak.  After U.S. health officials carefully tracked down TB Andy in Rome and told him not, repeat not, to travel by air, young TB Andy cheerfully boarded a plane, flew to Canada and drove across the border into the United States.

He says that he didn’t want to get stuck in a hospital in Rome, as he was convinced that he would die if he didn’t get to Denver for treatment.  Apparently fear of his own death did little to prevent TB Andy from exposing hundreds of people to his particularly dangerous form of TB.

In all fairness, he is currently claiming that he was told he was not infectious.

So, what’s the brouhaha and should everyone be this excited?

It seems the critical question would be: does TB Andy have latent or active TB?

Here’s some info from the CDC on TB:

Tuberculosis (TB) is a disease caused by bacteria called Mycobacterium tuberculosis. The bacteria usually attack the lungs. But, TB bacteria can attack any part of the body such as the kidney, spine, and brain. If not treated properly, TB disease can be fatal. TB disease was once the leading cause of death in the United States.

TB is spread through the air from one person to another. The bacteria are put into the air when a person with active TB disease of the lungs or throat coughs or sneezes or, sometimes, just talks. People nearby may breathe in these bacteria and become infected. However, not everyone infected with TB bacteria becomes sick. People who are not sick have what is called latent TB infection. People who have latent TB infection do not feel sick, do not have any symptoms, and cannot spread TB to others.

But, some people with latent TB infection go on to get TB disease. People with active TB disease can be treated and cured if they seek medical help. Even better, people with latent TB infection can take medicine so that they will not develop active TB disease.

Why is TB a problem today?

Starting in the 1940s, scientists discovered the first of several medicines now used to treat TB. As a result, TB slowly began to decrease in the United States. But in the 1970s and early 1980s, the country let its guard down and TB control efforts were neglected. As a result, between 1985 and 1992, the number of TB cases increased. However, with increased funding and attention to the TB problem, we have had a steady decline in the number of persons with TB since 1992. But TB is still a problem; more than 14,000 cases were reported in 2003 in the United States.

How is TB spread?

TB is spread through the air from one person to another. The bacteria are put into the air when a person with active TB disease of the lungs or throat coughs or sneezes. People nearby may breathe in these bacteria and become infected. When a person breathes in TB bacteria, the bacteria can settle in the lungs and begin to grow. From there, they can move through the blood to other parts of the body, such as the kidney, spine, and brain.

TB in the lungs or throat can be infectious. This means that the bacteria can be spread to other people. TB in other parts of the body, such as the kidney or spine, is usually not infectious.

People with active TB disease are most likely to spread it to people they spend time with every day. This includes family members, friends, and coworkers.

What is latent TB infection?

In most people who breathe in TB bacteria and become infected, the body is able to fight the bacteria to stop them from growing. The bacteria become inactive, but they remain alive in the body and can become active later. This is called latent TB infection. People with latent TB infection
• have no symptoms
• don’t feel sick
• can’t spread TB to others
• usually have a positive skin test reaction
• can develop active TB disease if they do not receive treatment for latent TB infection.

Many people who have latent TB infection never develop active TB disease. In these people, the TB bacteria remain inactive for a lifetime without causing disease. But in other people, especially people who have weak immune systems, the bacteria become active and cause TB disease.

What is active TB disease?

TB bacteria become active if the immune system can’t stop them from growing. The active bacteria begin to multiply in the body and cause active TB disease. The bacteria attack the body and destroy tissue. If this occurs in the lungs, the bacteria can actually create a hole in the lung. Some people develop active TB disease soon after becoming infected, before their immune system can fight the TB bacteria. Other people may get sick later, when their immune system becomes weak for another reason.

Babies and young children often have weak immune systems. People infected with HIV, the virus that causes AIDS, have very weak immune systems. Other people can have weak immune systems, too, especially people with any of these conditions:
• substance abuse
• diabetes mellitus
• silicosis
• cancer of the head or neck
• leukemia or Hodgkin’s disease
• severe kidney disease
• low body weight
• certain medical treatments (such as corticosteroid treatment or organ transplants)
• specialized treatment for rheumatoid arthritis or Crohn’s disease.

Symptoms of TB depend on where in the body the TB bacteria are growing. TB bacteria usually grow in the lungs. TB in the lungs may cause symptoms such as:
• a bad cough that lasts 3 weeks or longer
• pain in the chest
• coughing up blood or sputum (phlegm from deep inside the lungs).

Other symptoms of active TB disease are:
• weakness or fatigue
• weight loss
• no appetite
• chills
• fever
• sweating at night .

The Difference Between Latent TB Infection and Active TB Disease

A person with latent TB infection:
• Has no symptoms
• Does not feel sick
• Cannot spread TB to others
• Usually has a positive skin test or QuantiFERON-TB® Gold test
• Has a normal chest x-ray and sputum test

A person with active TB disease:
• Has symptoms that may include:
o a bad cough that lasts 3 weeks or longer
o pain in the chest
o coughing up blood or sputum
o weakness or fatigue
o weight loss
o no appetite
o chills
o fever
o sweating at night
• May spread TB to others
• Usually has a positive skin test or QuantiFERON-TB® Gold test
• May have an abnormal chest x-ray, or positive sputum smear or culture

What if I have a positive test for TB?

If you have a positive reaction to the TB skin test, your doctor or nurse may do other tests to see if you have active TB disease. These tests usually include a chest x-ray and a test of the phlegm you cough up. Because the TB bacteria may be found somewhere other than your lungs, your doctor or nurse may check your blood or urine, or do other tests. If you have active TB disease, you will need to take medicine to cure the disease.

What if I have been vaccinated with BCG?

BCG is a vaccine for TB. This vaccine is not widely used in the United States, but it is often given to infants and small children in other countries where TB is common. BCG vaccine does not always protect people from getting TB.

If you were vaccinated with BCG, you may have a positive reaction to a TB skin test. This reaction may be due to the BCG vaccine itself or due to infection with the TB bacteria. Your positive reaction probably means you have been infected with TB bacteria if:
• You recently spent time with a person who has active TB disease; or
• You are from an area of the world where active TB disease is very common (such as most countries in Latin America and the Caribbean, Africa, Asia, Eastern Europe, and Russia); or
• You spend time where TB disease is common (homeless shelters, migrant farm camps, drug-treatment centers, health care clinics, jails, prisons).

If I have latent TB infection, how can I keep from developing active TB disease?

Many people who have latent TB infection never develop active TB disease. But some people who have latent TB infection are more likely to develop active TB disease than others. These people are at high risk for active TB disease. They include:
• people with HIV infection
• people who became infected with TB bacteria in the last 2 years
• babies and young children
• people who inject illegal drugs
• people who are sick with other diseases that weaken the immune system
• elderly people
• people who were not treated correctly for TB in the past .

If you have latent TB infection (a positive TB skin test reaction or positive QFT) and you are in one of these high-risk groups, you need to take medicine to keep from developing active TB disease. This is called treatment for latent TB infection. There are several treatment options.You and your health care provider must decide which treatment is best for you.

The medicine usually taken for the treatment of latent TB infection is called isoniazid (INH). INH kills the TB bacteria that are in the body. If you take your medicine as instructed by your doctor or nurse, it can keep you from developing active TB disease. Children and people with HIV infection may need to take INH for a longer time.

Because there are less bacteria in a person with latent TB infection, treatment is much easier. Usually, only one drug is needed to treat latent TB infection. A person with active TB disease has a large amount of TB bacteria in the body. Several drugs are needed to treat active TB disease.

Sometimes people are given treatment for latent TB infection even if their skin test reaction is not positive. This is often done with infants, children, and HIV-infected people who have recently spent time with someone with active TB disease. This is because they are at very high risk of developing active TB disease soon after they become infected with TB bacteria.

It is important that you take all the pills as prescribed. If you start taking INH, you will need to see your doctor or nurse on a regular schedule. He or she will check on how you are doing. Some people have serious side effects from INH. If you have any of the following side effects, call your doctor or nurse right away:
• no appetite
• nausea
• vomiting
• yellowish skin or eyes
• fever for 3 or more days
• abdominal pain
• tingling in the fingers and toes.

Warning: Drinking alcoholic beverages (wine, beer, and liquor) while taking INH can be dangerous. Check with your doctor or nurse for more information.

People who have latent TB infection need to know the symptoms of active TB disease. If they develop symptoms of active TB disease, they should see a doctor right away.

How is active TB disease treated?

There is good news for people with active TB disease. It can almost always be cured with medicine. But the medicine must be taken as the doctor or nurse tells you.

If you have active TB disease, you will need to take several different medicines. This is because there are many bacteria to be killed. Taking several medicines will do a better job of killing all of the bacteria and preventing them from becoming resistant to the medicines.

If you have active TB disease of the lungs or throat, you are probably infectious. You need to stay home from work or school so that you don’t spread TB bacteria to other people. After taking your medicine for a few weeks, you will feel better and you may no longer be infectious to others. Your doctor or nurse will tell you when you can return to work or school or visit with friends.

Having active TB disease should not stop you from leading a normal life. When you are no longer infectious or feeling sick, you can do the same things you did before you had active TB disease. The medicine that you are taking should not affect your strength, sexual function, or ability to work. If you take your medicine as your doctor or nurse tells you, the medicine will kill all the TB bacteria. This will keep you from becoming sick again.

Why do I need to take TB medicine regularly?

TB bacteria die very slowly. It takes at least 6 months for the medicine to kill all the TB bacteria. You will probably start feeling well after only a few weeks of treatment. But beware! The TB bacteria are still alive in your body. You must continue to take your medicine until all the TB bacteria are dead, even though you may feel better and have no more symptoms of active TB disease.

If you don’t continue taking your medicine or you aren’t taking your medicine regularly, this can be very dangerous. The TB bacteria will grow again and you will remain sick for a longer time. The bacteria may also become resistant to the medicines you are taking. You may need new, different medicines to kill the TB bacteria if the old medicines no longer work. These new medicines must be taken for a longer time and usually have more serious side effects.

If you become infectious again, you could give TB bacteria to your family, friends, or anyone else who spends time with you. It is very important to take your medicine the way your doctor or nurse tells you.

How can I keep from spreading TB?

The most important way to keep from spreading TB is to take all your medicine, exactly as directed by your doctor or nurse.
You also need to keep all of your clinic appointments! Your doctor or nurse needs to see how you are doing. You may need another chest x-ray or a test of the phlegm you may cough up. These tests will show whether the medicine is working. They will also show whether you can still give TB bacteria to others. Be sure to tell the doctor about anything you think is wrong.

If you are sick enough with active TB disease to go to a hospital, you may be put in a special room. These rooms use air vents that keep TB bacteria from spreading to other rooms. People who work in these special rooms must wear a special face mask to protect themselves from TB bacteria. You must stay in the room so that you will not spread TB bacteria to other people. Ask a nurse for anything you need that is not in your room.

If you are infectious while you are at home, there are certain things you can do to protect yourself and others near you. Your doctor may tell you to follow these guidelines to protect yourself and others:
• The most important thing is to take your medicine.
• Always cover your mouth with a tissue when you cough, sneeze, or laugh. Put the tissue in a closed bag and throw it away.
• Do not go to work or school. Separate yourself from others and avoid close contact with anyone. Sleep in a bedroom away from other family members.
• Air out your room often to the outside of the building (if it is not too cold outside). TB spreads in small closed spaces where air doesn’t move. Put a fan in your window to blow out (exhaust) air that may be filled with TB bacteria. If you open other windows in the room, the fan also will pull in fresh air. This will reduce the chances that TB bacteria will stay in the room and infect someone who breathes the air.

Remember, TB is spread through the air. People cannot get infected with TB bacteria through handshakes, sitting on toilet seats, or sharing dishes and utensils with someone who has TB.

After you take medicine for about 2 or 3 weeks, you may no longer be able to spread TB bacteria to others. If your doctor or nurse agrees, you will be able to go back to your daily routine. Remember, you will get well only if you take your medicine exactly as your doctor or nurse tells you.

Think about people who may have spent time with you, such as family members, close friends, and coworkers. The local health department may need to test them for latent TB infection. TB is especially dangerous for children and people with HIV infection. If infected with TB bacteria, these people need medicine right away to keep from developing active TB disease.

What is multidrug-resistant TB (MDR TB)?

If you do not take your medicine as your doctor or nurse tells you, the TB bacteria may become resistant to a certain medicine. This means that the medicine can no longer kill the bacteria.

Drug resistance is more common in people who:
• have spent time with someone with drug-resistant active TB disease
• do not take their medicine regularly
• do not take all of their medicine as told by their doctor or nurse
• develop active TB disease again, after having taken TB medicine in the past
• come from areas where drug-resistant TB is common

Sometimes the bacteria become resistant to two or more of the most important medicines: INH and RIF. This is called multidrug-resistant TB, or MDR TB. This is a very serious problem. People with MDR TB disease must be treated with special medicines. These medicines are not as good as the usual medicines for TB and they may cause more side effects. Also, most people with MDR TB disease must see a TB expert who can closely observe their treatment to make sure it is working.

People who have spent time with someone sick with MDR TB disease can become infected with these multidrug-resistant bacteria. If they have a positive skin test reaction, they may be given medicine to keep them from developing MDR TB disease. This is very important for people who are at high risk of developing MDR TB disease, such as children and HIV-infected people.

What is extensively drug-resistant tuberculosis, or XDR TB?

XDR TB is a subtype of multiple-drug resistant tuberculosis.

People with XDR TB are resistant to first- and second-line drugs; their treatment options are limited and the disease often proves fatal, although cure is possible for up to 30 percent of cases.