World Hepatitis Summit 2015

9 09 2015

Imagine that you have a unicycle, and this unicycle is your favorite mode of transportation.

You have a handful of friends around the country who also own and ride unicycles, but where you live, you’re the only one-wheeler to be seen.

Now imagine you go to a meeting in a far off land that brings hundreds of people from 80+ countries together to discuss—unicycles.

It’s comforting and uplifting to be among your tribe, isn’t it!

That’s what happened to me when I attended the World Hepatitis Summit in Glasgow, Scotland, last week.

Granted, I’m always talking to parents about hepatitis. Many of our families have children living with a chronic, viral hepatitis infection. Some parents have lost their child to such an infection. Treatment, treatment side effects, prevention, testing—these are all frequent topics at PKIDs.

But, to be with so many people representing organizations around the world hard at work on issues surrounding hepatitis, well, that’s why it felt like a homecoming.

wha 1

Our hosts, the World Hepatitis Alliance (WHA) and the World Health Organization (WHO), did a bang-up job on this first summit. They and their partners, the Glasgow Caledonian University, Health Protection Scotland, and the Scottish government, made us feel welcome and provided a well-run meeting.

For five days, volunteers were everywhere, eager to help and always smiling. Seriously, they smiled the entire time. And word has it, most of them were out of bed by three o’clock each morning so they could be in place, ready to serve when we arrived.

Let me just say, there’s only one cranky person in all of Glasgow. He drives a white cab and hangs out at the SECC in front of the river Clyde. Every other Glaswegian treats you like a favorite cousin come to visit for a spell.

And the WHA members! A nurse from Wales and a physician from Egypt talked collaboration over lunch on Thursday, an attendee from Botswana gave funding tips to a few Americans as they all lounged around waiting for a passageway door to be unlocked, and the man from Pakistan impressed everyone with his sparkly evening attire at the Kelvingrove Art Gallery and Museum dinner.

Three vignettes from the thousands of interactions that happened at the World Hepatitis Summit this year. All of the members were eager and ready to band together in the fight against hepatitis.

wha 2

So what did we accomplish at this week-long event? We found out we’re not alone—that we’re actually part of a strong global network fighting to reduce and, one day, eliminate hepatitis B and C infections.

We found our voice, and by closing our many fists into one, we found that we are mighty.

Join WHA. You’re not alone!

 

by Trish Parnell





Hepatitis A, B, C, D, and E

28 07 2015

It’s World Hepatitis Day.

We want to use this day to remind moms and dads that hepatitis is around and some of it can be prevented by vaccination.

Hepatitis C is a bloodborne virus that attacks the liver. It is not vaccine-preventable. If babies are infected it’s usually from their hepatitis C+ mothers or, and this is unlikely these days, from a blood transfusion. It’s unlikely because the screening process of donated blood is pretty darn thorough. But, germs have slipped through that screening process.

Teens and young adults may become infected, primarily through sharing of needles, sex with an HCV+ person, or sharing personal items such as razors or toothbrushes that may be contaminated with HCV.

There are effective treatments that work on a good portion of hepatitis C-infected children. But not on all infected children. Work is ongoing in this area.

Hepatitis C is frequently a chronic infection, meaning that if treatment is not effective, you will be infected for your lifetime.

Hepatitis A is vaccine-preventable. Normally, it’s passed person-to-person through the fecal-oral route, which is when something you eat or drink has been contaminated with hepatitis A+ poop. If you haven’t been vaccinated, chances are you will become infected.

This virus makes you feel lousy and can, rarely, do serious damage to the body. It does not become a chronic infection. It infects you and then goes away, like a cold virus.

Hepatitis B is vaccine-preventable. It’s transmitted in a lot of ways—mom to newborn, sharing needles or personal items, sex with an infected person, even household (nonsexual) contact. If a mom is aware of her infection prior to giving birth, shots can be given to the baby within 12 hours of birth that are effective at stopping tranmission of the virus from mom to baby. However, when babies are infected, almost half of them in the US will become chronically infected. In developing countries, that figure shoots up to 90 percent.

Today, despite the vaccine, approximately 1,000 babies become chronically infected with hepatitis B each year in the US. Many of the moms-to-be who are infected are unaware of their infection. Every pregnant woman should be tested for hepatitis B so that action can be taken at birth to prevent infection of the newborn.

Hepatitis D is an odd virus. You have to be infected with hepatitis B before you can get hepatitis D. It’s vaccine-preventable in that, if you get immunized against hepatitis B, you won’t be able to get hepatitis D.

Hepatitis E is similar to hepatitis A in the way it is transmitted—the fecal-oral route. It’s rarely a chronic infection. For most people, they get it, get sick, and get over it. It can however be dangerous for pregnant women, with a 10% – 30% fatality rate for this group. It’s not often found in the US but can be easily picked up in some other parts of the world.

That’s about it for hepatitis in the US. To prevent a hepatitis infection (and lots of other infections), wash your hands throughout the day, put barriers between yourself and another person’s blood or body fluid, and use the available vaccines. The trick is to do these things with everyone. It’s impossible to tell who is infected with what, most of the time, so the safest course of action is to assume everyone is infected with something and then act accordingly.

Got any tips? Hope you share them will us in the comments.

By Trish Parnell

Image courtesy of Johns Hopkins





A Thoughtful Choice

17 04 2014

I remember lining up at school in the ‘60s to get vaccinated against smallpox and a few other diseases for which there were vaccines.

I also remember the years when my brothers and I took turns at getting measles, mumps and other diseases for which there were no vaccines.

In the end, we three were fortunate—no permanent harm from our maladies.

Fast-forward 30 years. My daughter was four months old when she was diagnosed with hepatitis B. She had not been vaccinated and subsequently developed a chronic infection.

It all sounds mundane when read as words on a screen. But in those early years, the heartache and anger I felt at having my daughter’s life so affected by something that was preventable . . . well, it was almost more than I could bear.

But again, we were fortunate. After years of infection, her body turned around and got control of the disease. Although we have bloodwork done every year to keep an eye on things, she has a good chance of living the rest of her life free of complications from this infection.

Over the years, I’ve met other parents whose children were affected by vaccine-preventable diseases. Some, like Kelly and Shannon, chose not to vaccinate their kids and ended up with horrible consequences. Kelly’s son Matthew was hospitalized for Hib and they came within a breath of losing him. Shannon did lose her daughter Abigale to pneumococcal disease, and almost lost her son. He recovered and was released from the hospital, at which time they had a funeral for their daughter.

Because of my job, I talk to and hear from many families with similar stories. Some children have died, some remain permanently affected, and some have managed to recover.

Also because of my job, I hear from parents who believe vaccines are not safe, and that natural infections are the safer choice. I understand and have experienced the emotions we as parents feel when something happens to our children. In a way, I was lucky. I knew exactly what caused my daughter’s problems. A simple test provided a definite diagnosis.

If we can’t identify the cause of our children’s pain or suffering, we feel like we can’t fix it and we can’t rest until we know the truth. When the cause can’t be found, we latch onto if onlys. What could we have done differently to keep our kids safe? If only we hadn’t taken her to grandpa’s when she didn’t feel good. If only we hadn’t vaccinated him on that particular day. If only. The problem is, the if onlys are guesses and no more reliable routes to the facts than playing Eenie Meenie Miney Mo.

The deeper I go into the world of infections and disease prevention, the more obvious it is to me that the only way to find the facts is to follow the science. Now granted, one study will pop up that refutes another, but I’ve learned that when multiple, replicable studies all reach the same conclusion, then I can safely say I’ve found the facts.

In our family, we vaccinate because for us, it is the thoughtful choice.

By Trish Parnell

Originally posted on Parents Who Protect





Sports and Infectious Diseases – Part 2 of 3

10 04 2013

bloodborneWhat risk does an athlete with a bloodborne pathogen pose?

The American Academy of Pediatrics tackled this difficult issue in December, 1999, with a policy statement on HIV and Other Bloodborne Viral Pathogens in the Athletic Setting.  In it, the Academy made clear, “Because of the low probability of transmission of their infection to other athletes, athletes infected with HIV, hepatitis B or hepatitis C should be allowed to participate in all sports.”

That participation, however, assumes all athletes and coaches will follow standard precautions to prevent and minimize exposure to bloodborne viruses.  The Academy tackled each infectious disease individually:

HIV: The risk of HIV infection via skin or mucous membrane exposure to blood or other infectious bodily fluids during sports participation is very low . . . such transmission appears to require, in addition to a portal of entry, prolonged exposure to large quantities of blood.  Transmission through intact skin has not been documented: no HIV infections occurred after 2,712 such exposures in 1 large prospective study.  Transmission of HIV in sports has not been documented.  One unsubstantiated report describes possible transmission during a collision between professional soccer players.

Hepatitis B: HBV [hepatitis B virus] is more easily transmitted via exposure to infected blood than is HIV . . . the risk of infection [is] greater if the blood [is] positive for HBV e antigen . . . transmission of infection by contamination of mucous membranes or broken skin with infected blood has been documented, but the magnitude of risk has not been quantified.

Although transmission of HBV is apparently rare in sports, 2 reports document such transmission.  An asymptomatic high school sumo wrestler who had a chronic infection transmitted HBV to other members of his team.  An epidemic of HBV infection occurred through unknown means among Swedish athletes participating in track finding (orienteering).  The epidemiologists concluded that the most likely route of infection was the use of water contaminated with infected blood to clean wounds caused by branches and thorns.

An effective way of preventing HBV transmission in the athletic setting is through immunization of athletes.  The American Academy of Pediatrics (AAP) recommends that all children and adolescents be immunized.  Clinicians and the staff of athletic programs should aggressively promote immunization.

Hepatitis C: Although the transmission risks of HCV infection are not completely understood, the risk of infection from percutaneous [through the skin] exposure to infected blood is estimated to be 10 times greater than that of HIV but lower than that of HBV.  Transmission via contamination of mucous membranes or broken skin also probably has a risk intermediate between that for blood infected with HIV and HBV.

“There is clearly no basis for excluding any student from sports if they are infected,” said Dr. Steven J. Anderson, who was chair of the Academy’s Committee on Sports Medicine and Fitness when it drafted the Academy’s policy, “and we should also try to protect the confidentiality of each athlete.”

Dr. Anderson, a pediatrics professor at the University of Washington and a team doctor for many high school athletic teams, ballet companies and the U.S. Olympic Diving Team, suggests students should have access to any sport, except boxing, which the Academy opposes for all youths because of its physical risks.

“I personally feel parents have no obligation to disclose the infectious status of their children to anyone,” said Dr. Anderson.  Strict compliance with standard precautions is critical for this open-embrace of all athletes, regardless of their infectious status.  Coaches and teachers must have a plan in place to handle blood spills, said Dr. Anderson, including latex [or non-permeable] gloves, occlusive dressings, appropriate sterilizing solutions, disposal bags and even a printed protocol for coaches, athletes and officials.

The following is an excerpt of a sample school policy, used by numerous public school districts and in compliance with ADA that addresses HIV infection:

“The privilege of participating in physical education classes, programs, competitive sports and recess is not conditional on a person’s HIV status.  School authorities will make reasonable accommodations to allow students living with HIV infection to participate in school-sponsored physical activities.

“All employees must consistently adhere to infection control guidelines in locker rooms and all play and athletic settings.  Rulebooks will reflect these guidelines.  First aid kits and standard precautions equipment must be on hand at every athletic event.

“All physical education teachers and athletic program staff will complete an approved first aid and injury prevention course that includes implementation of infection control guidelines.  Student orientation about safety on the playing field will include guidelines for avoiding HIV infection.”

In addition to the Academy, several sports and other health organizations have also weighed in on this issue.  According to the NCAA, National Football League (NFL) and World Health Organization, athletes with HIV should be permitted to participate in all competitive sports at all levels.

These organizations all endorse immunization against hepatitis B for all athletes.

The National Athletic Trainers’ Association (NATA) echoes Dr. Anderson’s suggestion that coaches, trainers, athletic directors, school officials and others take the lead in educating themselves, their teams, parents and their communities about the importance of effective disease prevention.

Trainers and coaches, they suggest, should provide the following information in age-appropriate terms to all participants before or during any competition :

  • The risk of transmission or infection during competition.
  • The risk of transmission or infection generally.
  • The availability of HIV testing (for teens and adults).
  • The availability of hepatitis B vaccination and testing (for parents, teens and adults).

“Athletic trainers who have educational program responsibility should extend educational efforts to include those, such as the athletes’ families and communities, who are directly or indirectly affected by the presence of bloodborne pathogens in athletic competitions,” the NATA stated in a position paper.

See PKIDs’ Infectious Disease Workshop for more information.

Photo courtesy of Lolie Smith





Hep B Clinical Trial

16 01 2013

When babies are infected with hepatitis B, chances are they’ll stay infected for life. It becomes a chronic condition.

Some live long lives and their deaths are unrelated to their hep B infection.

Others develop cancer or their liver gives out. And then there are those who have minor symptoms, such as jaundice or fatigue.

You never know what or when or if something’s going to happen.

There’s no wonder drug for this disease. The available treatments are anemic at best, and few get favorable results.

My daughter, who was infected as an infant, has lived with hep B for 13 years. We’ve waited a long time for drugs that might work for her stage of the disease.

Hope has just peeked over the horizon.

NIH is running a clinical trial through a few centers in the US and Canada on children whose hep B infection is at a certain stage.

They’re using a combination of entecavir and pegylated interferon. They’re not looking for a cure, but rather hoping to slow it down. Even the best results wouldn’t remove the hep b virus from the cells. It’s integrated now, and there’s no work being done that’s close to getting it out of the cells it’s infected.

But, if the stars align and results are better than expected, it could be that those who respond to this treatment can relax, knowing hep B needn’t remain on their worry list.

That’s what we want. We all want our kids to live long, happy, healthy lives.

We flew to San Francisco yesterday for blood work and to sign forms. Lots of forms. Dr. Phil Rosenthal is running the trial and Shannon Fleck, the clinical research coordinator at UCSF Benioff Children’s Hospital, is assisting. I’ve known Phil for nearly 20 years and was delighted to see how optimistic he is about this drug combo.

This first step is to determine if my daughter is eligible for participation in the study. Her lab results have to match the criteria set for the trial.

If she is eligible, we fly back down within 30 days and her name goes into a computer, which then spits back out her placement. She’ll either be in the control group (no treatment) or the treatment group.

If she’s in the control group and the study is proving successful, she’ll be allowed compassionate use of the drugs, but that won’t be for two or three years.

That’s where we are—not even past the first hurdle.

I know people who’ve been infected with hep B in their adult years and have died from the disease. And I know people who’ve had cancer or liver transplants, or both—all because of this infection.

There are lots of ways to become infected. The easiest way to prevent infection is to get vaccinated. You, your siblings, your parents, your kids . . . ask your healthcare provider about it.

You can’t fix this with an aspirin.

By Hep B Mom





Why Vaccinate? I Never Get Sick!

5 11 2012

No matter your age, if you’re sitting in a moving vehicle you’re required to wear a seatbelt or to be in a size-appropriate car seat.

Most states require that anyone riding a bicycle or a motorcycle wear a helmet. And again, it doesn’t matter what age you are.

Kids going to public schools are required to be immunized against several diseases for school entry. How many immunizations they’re required to get depends on the state they live in, and the school they attend.

I suppose I could think up a few public health scenarios that would require adults to be immunized against a particular disease. But as a rule, unless our jobs require it, we adults are exempt from this particular requirement.

There are lots of protections in place for kids, as there should be. For instance, if I don’t feed my daughters, or provide adequate shelter for them, they’ll be taken away from me and placed in a foster home, where they’ll get the care they need. We need that oversight in place, so that no kids fall through the cracks. The heartbreak is that there are still kids falling through the cracks, but we do know that the oversights in place keep that number from being astronomical.

Most adults don’t need that kind of micromanagement when it comes to their health. But, they do need information. Before I became involved with PKIDs, I wasn’t even aware that there were vaccines for adults, other than the flu vaccine.

Now I know.

I don’t have time to get sick. I get vaccinated for me. I also wash my hands, try to get enough sleep, make myself eat green vegetables, and generally do whatever I need to do to keep myself healthy. But because I’ve met and talked with so many families affected by preventable diseases and I know how awful those infections can be, one of my motivations for getting vaccinated is so that I don’t accidentally infect someone else.

For example, it’s the infected adults and teens around babies who infect them with whooping cough, and it’s the infected birth moms who infect their newborns with hepatitis B. Babies infected with whooping cough can end up hospitalized, or worse. And babies infected with hepatitis B usually stay infected for life. This can lead to liver cancer or transplantation—if they’re lucky.

If you’re one of those people who never gets sick and figures you don’t need to be vaccinated—well, who knows, you might be right. But not getting sick is not the same as not being infected. You can and do pass on those germs to little babies who haven’t gotten all of their vaccinations yet, and others whose immune systems are not robust, for one reason or another.

So, you know where I’m going with this. Take just a few minutes the next time you’re at the pharmacy or your doctor’s office and ask what vaccinations you need. Do it for you, but also do it for the vulnerable in your life.

By Trish Parnell





Infected Kids and Sports

23 07 2012

While soccer, softball and gymnastics are a joyful rite of passage for many young children, athletic events carry a risk for all children, given the increased chance for mishaps, accidents and blood spills.

For parents of children with viral infectious diseases, including hepatitis B, hepatitis C and HIV/AIDS, these games often present a number of stressful issues.

  • What if my child is hurt and another child is exposed to his or her blood?
  • Should I tell the coach about my child’s infectious disease if it will spur him or her to practice standard (universal) precautions?
  • What if the coach or athletic director doesn’t know or practice standard precautions?
  • Should I attend every game in case there is an accident?
  • Should my child even be playing this sport?

The American Academy of Pediatrics tackled this difficult issue in December, 1999, with a policy statement on HIV and Other BloodBorne Viral Pathogens in the Athletic Setting. (This policy was reaffirmed in 2008.) In it, the Academy made clear, “Because of the low probability of transmission of their infection to other athletes, athletes infected with HIV, hepatitis B or hepatitis C should be allowed to participate in all sports.”

That participation, however, assumes all athletes and coaches will follow standard precautions to prevent and minimize exposure to bloodborne viruses.

The Academy tackled each infectious disease individually.

HIV/AIDS: The risk of HIV infection through skin or mucous membrane exposure to infected blood or other infectious bodily fluids during sports events is very low. The Academy found the risk from damaged skin or mucous membrane exposure was one in 1,007 exposures or 0.1 percent.

Hepatitis B: While hepatitis B is more easily transmitted through exposure to infected blood than HIV, the Academy found only two documented sports transmission. A high school sumo wrestler with chronic hepatitis B was found to have transmitted the infection to a team member. Wrestling is the only sport that raised concern because herpes, impetigo and measles have been transmitted through skin-to-skin contact. However, there is no risk of bloodborne pathogens being contracted through wrestling, the Academy found.

An outbreak of hepatitis B occurred within an outdoor orienteering team in Sweden. Doctors believe the team members used a common cup of warm water to clean wounds caused by branches and thorns.

Hepatitis C: The risk of transmission is greater than for HIV but less than with hepatitis B. The Academy reported no documented cases of transmission in sports.

“There is clearly no basis for excluding any student from sports if they are infected,” said Dr. Steven J. Anderson, who was chair of the Academy’s Committee on Sports Medicine and Fitness when it drafted the Academy’s policy, “and we should also try to protect the confidentiality of each athlete.”

Dr. Anderson, a pediatrics professor at the University of Washington and a team doctor for many high school athletic teams, ballet companies and the U.S. Olympic Diving Team, suggests children should have access to any sport, except boxing, which the Academy opposes for all youths because of its physical risks.

Pediatricians can avoid reporting a student’s infection, the Academy noted, by making it clear on any participation forms that they support the Academy’s position that all students can participate in all sports and that pediatricians must respect an athlete’s right to confidentiality.

“I personally feel parents have no obligation to disclose the infectious status of their children to anyone,” said Dr. Anderson, “that includes their own physicians! While that may seem wrong, it is felt that if standard precautions are used for blood contact or contamination, the risk of contagion is adequately reduced.”

But strict compliance with standard precautions is critical for this open-embrace of all athletes, regardless of their infectious status. “As a parent, I would make sure that there is a plan in place to handle blood spills,” said Dr. Anderson, “including latex gloves, occlusive dressings, appropriate sterilizing solutions, disposal bags and event a printed protocol for coaches, athletes and officials.

“If standard precautions are not followed, I would recommend that the coaches or instructors are queried as to their familiarity with the precautions,” he added. “If they are not familiar with or following procedures, a higher up source needs to be consulted, such as a league office or school administrator.”

Parents should also contact the school or athletic league’s physician so he or she can also act as an advocate to ensure the coaches comply with the department or organization’s safety procedures.

But the Academy’s policy may not lessen the stress some parents feel when their very young children approach a soccer field for the first time. “When children are young, parents should educate their children about the dangers of blood contact,” said Dr. Anderson. “Despite the trauma that can accompany free play, I don’t hear of too many cases where two or more bleeding children mix their blood. I would also hope that an adult would be present when children are playing and would be consulted if there were an injury.”

Dr. Anderson feels it is not necessary to disclose a child’s infectious status to a coach. “Given the low risk of infecting other children, and the high risk of being shunned or ostracized. However, I think a responsible parent would be adamant about standard precautions being in place and followed. I supposed an astute coach might make inferences if a particular parent was a zealot about blood contamination. I would read that as a message that their child was infected and that they wanted their child to participate without creating a risk for others.”

Even when a child has an HIV infection, disclosure is not a requirement, explained Dr. Anderson, stating his personal opinion. “However, if a coach is educated about the risks, the necessary precautions and can be trusted to maintain confidentiality, disclosure may be appropriate. Unfortunately, most youth sports coaches are parent volunteers, non-professionals and are unlikely to have a long-term relationship with the athlete. In such cases, I recommend that standard precautions be followed.”

Dr. Anderson contends active contact sports, such as football, are also not off limits to athletes with infectious viral hepatitis. “However, students with infectious hepatitis A (spread through close physical contact with contaminated food, water or skin) or with liver or spleen enlargement should be restricted from contact or collision sports until the liver or spleen has returned to normal size,” he added, “and the person is no longer contagious.”

One mother whose son has hepatitis B commented, “I used to worry about my son infecting other children, but eventually I decided to make sports decisions based on what my kids risked catching from others.”

This post originates from PKIDs’ website.

Image courtesy of Rugby Pioneers





A Mother’s Legacy

25 06 2012

I would like to tell you about my mother and all mothers like her who suffered through the loss of a child from an infectious disease. Raising a family in the hills of Kentucky, where most people were too poor to pay for the little, if any, medical help available, my mother struggled to keep her family healthy.

When one of her babies became seriously ill, my mother and her parents did everything they could to try and help her. Despite their efforts, my mother watched her child, Patsy Lynn, die from whooping cough. While making arrangements for Patsy’s funeral my mother learned that another one of her children was gravely ill. Both children were buried on the same day, in the same casket, in the same grave next to my mother’s church.

After the death of two children, my family was able to relocate to the Cincinnati area where medical attention was more readily available. We all had our vaccines as my mother was determined not to lose another child to unseen viruses and she insisted on washing and boiling everything that we touched.

I lived through the effect the loss had upon my mother’s life. The fear of disease was so real then, but many of us today forget what it was like to live in a time when diseases like measles, polio and smallpox were so much more common and deadly.

I remember the time that I was not allowed to play with a friend because her mother had been sent to the “TB hospital” and I vividly remember the Sunday that we spent standing in the long lines to receive our sugar cubes laced with the polio vaccine.

During the early ’60s, I remember being put to bed in a dark room when it was thought I might have the measles. Most of all, I’ll never forget that several of my teachers wore braces because of the effects of polio.

My mother tried her best to prevent us from succumbing to any disease which may shorten our lives, so I’m thankful that when she died of cancer in 1982 she did not know that I had somehow contracted the hepatitis B virus.

In June 1995, I was diagnosed with hepatitis B about a week before my 25th wedding anniversary. A doctor told my husband that I had a sexually transmitted disease and that he should be tested and vaccinated. What the doctor failed to tell us at the time was that this hepatitis could be spread in many other ways. I had complete trust in my husband and, thank God he had faith and trust in me, so this suggestion of sexually promiscuity did not harm our marriage.

Within the week we were informed that my husband tested negative, as did my children, who have all been vaccinated.

I have tried for years to find out where I got the virus. Could it have been from my mother who died of liver cancer? Did I get it in grade school, or from dental work, surgeries? Did I get it in one of the hospitals or clinics where I have worked as an interpreter? Did I get it from a child who ran into me on the playground, or from the little girl who bit me while I was working in the Cincinnati Public Schools?

The only thing I can be sure of is that I did not get hepatitis B from sexual contact, drug use or tattoos. However, I have now arrived at a place of peace in my life by accepting the fact that I will never know the path of transmission—and I no longer search for that answer.

And this is my mother’s legacy to me: protect your children the best you can.

By Barbra Anne Malapelli Haun





Adults Young and Old Need Vaccines

21 05 2012

Adults know to wash hands and wear condoms to prevent infections. And we try to eat fruits and veggies to stay healthy. Some days, we even exercise.

One thing we don’t do enough of is get vaccinated.

Other than the flu vaccine in the autumn, I seldom think about vaccines for myself. I bet I’m not alone.

But, we should remember to vaccinate.

We make sure our kids wear seatbelts and helmets, cross the street at the light and keep a weather eye on the ocean for sneaker waves, and get all the vaccines they need.

For the most part, we follow the same safety rules, except for that one about vaccines.

I am determined to get myself fully vaccinated and to nag encourage friends to do the same. I don’t want to get sick and think “if only.”

If you’re like-minded, I’ve listed the diseases for which there are vaccines for adults 19 years of age and older. Not every adult will need every vaccine, so print out this post and take it to your provider, find out what vaccines you need, and realize that you may need more vaccines if you’re traveling outside the US:

  • Flu is a respiratory illness. It can cause fever, chills, sore throat, cough, muscle or body aches, headaches, tiredness, and a runny or stuffy nose. You get over it after several miserable days, unless you develop complications, some of which can be life-threatening.
  • Tetanus, diphtheria, and pertussis vaccines are combined for adults. Tetanus is caused by certain bacteria entering the body through a break in the skin. It’s the one that causes lockjaw, and can cause spasms and seizures. It has a surprisingly high death rate of 10 – 20% of cases. Diphtheria is caused by bacteria spread person-to-person and can damage the heart, kidneys and nerves. Pertussis, also called whooping cough, is a very contagious disease caused by bacteria. In some parts of the world, it’s called the 100-day cough. The “whoop” is most often heard from babies, for whom it can be a lethal infection.
  • Varicella, also called chickenpox, is a virus that spreads easily and causes a blistery rash, itching and fever. For some, it can cause severe complications including pneumonia or sepsis.
  • Human papillomavirus (HPV) is a sexually transmitted infection that is very common in the population. Most people get it and get over it, but some will develop genital warts or cervical or other types of cancers.
  • Zoster or shingles is caused by once having had chickenpox. The virus stays in the body after the chickenpox clears up and goes away, and years later can reactivate, causing pain and itching, followed by a rash.
  • Measles, mumps, rubella vaccines are also combined for adults. Measles is caused by a virus that makes you feel like you have a bad cold, along with a rash on the body and white spots in the mouth. It can develop into pneumonia or ear infections, sometimes requiring hospitalization. Rubella is also caused by a virus and brings with it a rash and fever. This infection can be devastating to the fetus if a woman is pregnant when infected. Mumps is caused by a virus with symptoms of fever, fatigue and muscle aches followed by the swelling of the salivary glands. Rarely it will cause fertility problems in men, meningitis or deafness.
  • Pneumococcal disease is caused by bacteria and can appear as pneumonia, meningitis, or a bloodstream infection, all of which can be dangerous.
  • Meningococcal disease is caused by various bacteria, and the available vaccines prevent many of these infections. The symptoms are varied and include nausea, vomiting, sensitivity to light and mental confusion. This disease can lead to brain damage, hearing loss, or learning disabilities.
  • Hepatitis A is caused by a virus. It’s generally a mild liver disease, but can rarely severely damage the liver.
  • Hepatitis B is also caused by a virus that damages the liver. Most adults are infected for a short time, but some become chronically infected. The infection can cause jaundice, cirrhosis or even liver cancer.

More information on these infections can be found on the CDC website.

Talk to your provider about these vaccines. Who can afford to get sick these days?

By Trish Parnell

Image courtesy of Lancaster Homes





Annie’s Dad

17 10 2011

(This testimony was given on behalf of PKIDs to a U.S. House of Representatives’ committee a few years ago. It is so compelling—and, unfortunately, still relevant—that we wanted to share it with you now.)

My name is Dr. Keith Van Zandt, and as a practicing family physician, I appreciate the opportunity to address this committee regarding hepatitis B vaccines. I have degrees from Princeton and Wake Forest Universities, and completed residency training in family medicine here in Washington at Andrews AFB.

Today, however, I am here as a dad. I have five children, two of whom my wife Dede and I adopted from Romania. Our youngest, Adrianna, was nearly four years old when we adopted her from the orphanage, and was found to have chronic active hepatitis B when we performed blood work prior to bringing her home.

She had contracted this from her mother, who died when Annie was nine months old, from the effects of her liver disease as well as tuberculosis. We have been very fortunate to have had some excellent medical care for Annie, but her first year with us was an endless procession of liver biopsies, blood draws and over 150 painful interferon injections I gave to my new daughter at home. Interferon is a form of chemotherapy for hepatitis B that has many side effects and only a 25 to 40% success rate.

We know first-hand the pain and family disruption this completely preventable disease can bring.

You have already heard testimony from some of the world’s leading experts on hepatitis B and its vaccine, and I can add little new information to that. As a family doctor, though, I see patients every day whose lives have been significantly improved by the immunizations we now have available. My forebears in family medicine struggled in the pre-vaccination era with the ravages of horrible diseases that are now of only historical interest.

Preventive immunizations have so changed our world that I am afraid that we no longer remember how horrible some of these diseases were. My family and I have made multiple trips to Romania to work in the orphanages, and unfortunately I have seen the effects of many of these diseases there.

I am certainly aware of the potential for adverse reactions to our current vaccines, but we must maintain the perspective that these reactions are extremely rare. My partners and I in Winston-Salem care for over 40,000 patients, and I can honestly say that in over 20 years of practice we have never seen a serious adverse reaction to any vaccine. I believe that the vast majority of family physicians around the country can say the same. Certainly, I do not wish to minimize the suffering and losses of families who have experienced these problems, but we must remember that immunizations remain the most powerful and cost-effective means of preventing disease in the modern era.

Personally, it still sickens me to know that the disease my daughter has was completely preventable if hepatitis B vaccines had been available to Annie and her mother.

Whereas 90% of adults who contract hepatitis B get better, 90% of children under the age of one go on to have chronic disease, and 15 to 20% of them die prematurely of cirrhosis or liver cancer.

I know first-hand the gut-wrenching feeling of being told your child has a chronic disease that could shorter their life. I know first-hand the worry parents feel when their hepatitis B child falls on the playground, and you don’t know if her bleeding knee or bloody nose will infect her playmates or teachers. I know first-hand the concern for my other children’s health, with a 1 in 20 chance of household spread of hepatitis, and the thankfulness I feel that they have had the availability of successful vaccines. I know first-hand the pain a parent feels for their child as they undergo painful shots and procedures for their chronic disease with no guarantee of cure.

I am not the world’s leading expert on hepatitis B or the hep B vaccine, but I am an expert on delivering the best medical care I can to my patients in Winston-Salem, NC. I am also not the world’s leading expert on parenting children with chronic diseases, but I am the world’s best expert on parenting my five children.

I know professionally that immunizations in general have hugely improved the lives of those patients who have entrusted their medical care to me. I know personally that had the hepatitis B vaccine been available to my daughter, her life and mine would have been drastically different. I am also thankful that my other children have been spared Annie’s suffering by being successfully vaccinated.

Anecdotes of vaccine reactions are very moving, but they are no substitute for good science. Please allow me to continue to provide the best medical care I can with the best system of vaccinations in the world, and allow me to keep my own family safe.

Thank you very much for your time.

Keith Van Zandt, M.D.