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





Flu and the drifting virus

5 12 2014

HiResWe get immunized against flu every year. It’s annoying, but the strains or types of viruses that cause flu are constantly changing, so the vaccines have to change.

Scientists track the viruses and figure out what will be dominant each year, and they keep those in mind as they concoct the vaccines.

This year, as has happened in the past, one of the dominant strains “drifted.” Over time, it’s changed enough that now the vaccines won’t protect against it because they no longer recognize it.

No one realized this strain that had drifted was around until this year’s vaccines had already been produced.

The vaccines we have will protect against a chunk of flu viruses floating around, but not this one. Which means, if you’re unlucky enough to become infected with this particular strain of flu virus, you’ll need to get into your provider ASAP if you have flu symptoms, such as:

  • Fever
  • Cough
  • Body or muscle aches
  • Chills
  • Runny or stuffy nose
  • Sore throat
  • Diarrhea
  • Vomiting

Your provider will put you on antivirals, which will help your body fight the infection. You need to get started on antivirals within a couple of days of symptoms appearing.

Don’t mess around with flu. It sounds like an old-timey illness that doesn’t mean much these days, but based on reports covering a 30-year span from 1977 to 2007, CDC estimates that, in any given year, there are between 3,000 and 49,000 flu-related deaths.

In addition to immunizing, make sure family members are cleaning their hands many times each day. The areas in the home that are frequently touched, like doorknobs, desktops, remotes, and faucets should be disinfected daily.

Keep your hands off of your eyes, nose, and mouth. Our hands pick up germs which enter our bodies when we rub our eyes or touch our noses or mouths.

Protect others by covering your coughs and sneezes, and stay home if you feel ill. Well, stay home AFTER you visit your provider.

That’s about it for flu right now. If you have questions, call the office or drop a line in the comments section.

 

By Trish Parnell





Our Children Are Worth Every Penny

4 04 2014

A life-changing event—one involving our children—will make any parent regret what they could have, or should have, done. I have firsthand experience of this.

I held my daughter Abigale in my arms while she died of one of our world’s biggest vaccine-preventable killers of children, pneumococcal disease.

Abigale was just shy of her 6th birthday.

My name is Shannon Duffy Peterson. I’m a parent of four children, a business owner, and, through PKIDs, an advocate for immunization.

My younger children are at home in Sleepy Eye, MN, and my oldest, Abigale, is up in heaven with her grandparents.

Abigale

Abigale

In 2001, my five-year-old daughter became a statistic when she died of a vaccine-preventable disease. Abigale became infected with pneumococcal bacteria during the 2001 influenza vaccine shortage. She was not vaccinated for either disease.

When our children were born, my husband, DuWayne, and I were adamant about vaccinating our children. We wanted our children to be protected against everything. We wanted healthy children.

At that time, we had a pediatrician who did not push vaccinations and did not recommend the most recent vaccines available. Consequently, my children did not have their chickenpox, flu, or pneumococcal vaccinations.

February 18, 2001, began as a normal Sunday; we took the children to Sunday school, went to church together, played throughout the day, danced with them to music, and then relaxed with them before bedtime by playing a board game.

Abigale said she suddenly wasn’t feeling well and had a headache. We had her lie down, took her temperature, it was 101.5, and gave her some Motrin.

She started to vomit up the medicine. We thought she had the flu. We thought this was strange because she’d had the same illness and a sinus infection two weeks earlier, but she was in kindergarten and we knew of the many germs the kids pass around.

We became alarmed when a rash developed all over her body that we had never seen before, but we suspected it to be a high fever rash. I called the emergency room and was told it was a flu going around with high fever, vomiting, and diarrhea, and to just treat the fever alternately with Motrin and Tylenol and a tepid bath.

Abigale was tired and we put her to bed planning to check on her quite frequently but hoping she would sleep off the flu. Throughout the night we kept changing her bedding and bathing her to break the fever, even though she seemed pretty lethargic, and we ended up sleeping with her to comfort her.

We awoke later to her crying for “Mommy,” as she had fallen out of bed while attempting to make it to the potty. It was then, while cleaning her up, that my husband noticed the tremendous blotches on her skin and said, “This is not normal and we have to get her to the emergency room right away.”

We woke up our little boy, got them both in the truck, and drove as fast as we could the 21 miles to New Ulm. We called the hospital on the way to say we were coming and prayed for the best.

I sat in the back with the children, comforting Abigale. When she said to me, “Mommy I hurt so bad all over,” I assured her it was from the sickness and held her in my arms the best that I could while we were all buckled up. Those were the last words I would ever hear from my beautiful little girl. She died in my arms while we were driving.

When we arrived at the hospital they called a code blue and attempted for one hour to revive her. Her heart never started, and they were breathing for her.

She was pronounced dead at 7:20am Monday, February 19th. Our hearts broke that day as our son, Abigale’s little brother, witnessed all this and we had to tell him that his playmate, his bedtime companion, had died and there was nothing Mommy and Daddy or the doctors could do to save her.

Two hours after we arrived home from saying goodbye to our first born, our son started to experience some of the same symptoms as his sister, and I rushed him to the clinic. They got us in immediately and started running tests.

While we were waiting for results, Samuel, our son, started to vomit.

I couldn’t believe this was happening all over again and was holding him on the floor of the doctor’s office when our pediatrician came in with Abby’s preliminary autopsy results, stating that she’d had overwhelming sepsis caused by streptococcus pneumonia, congenital asplenia (absence of a spleen) and hemorrhagic adrenal glands. I thought I would lose both my children that day.

While my daughter’s death happened quite quickly and I wasn’t able to save her by rushing to the hospital, I was able to save my son by hospitalizing him directly after her death for two days, as he was extremely sick.

With hospitalization and medication he recovered enough to be released from the hospital in time to attend his sister’s funeral.

My world changed in those life-altering 3 days; I now understand the importance of vaccines and how children’s lives depend on them.

I am asking all parents to make sure all kids are kept healthy and to vaccinate children. If we do this, we will save lives. It is our responsibility, as parents and medical professionals, to protect our children, and to try to protect all children.

It is not ok, in my opinion, to reduce the number of pneumococcal conjugate doses children get based on cost, or on the fact that we have, thankfully, a full immunization schedule. We listened to our pediatrician, we didn’t vaccinate, and we lost our Abigale. We almost lost our son, Samuel.

I’m sure all of you follow the recommended vaccine schedule. If a primary dose of the pneumo vaccine is removed, it will save some dollars and mean one less vaccination for kids, but it will also mean more kids will die. More kids will be hospitalized. More kids will be in pain.

If you follow such a schedule and your child is hospitalized or if you should lose your child to this cost-saving measure, well, that would be unthinkable. It’s not an acceptable risk for your family, or mine, or anyone else’s.

Why would we ever choose to increase infection when we can decrease the number of cases through simple vaccination?

Thank you for allowing me to share my story.

 

 

by Shannon Duffy Peterson

 

[The ACIP is discussing whether or not to recommend removing a primary dose of pneumococcal vaccine for children. This is Shannon’s testimony in response to that discussion.]





Flu – You Have a Choice

20 03 2014

Kristi was a beautiful, intelligent elementary school teacher, and my only sibling. She was healthy, and ran or walked several miles many times a week.

She was active in the community, supporting anything for children. And she made sure her own two children were given lots of experiences by visiting zoos and national parks, camping, playing sports, and doing lots of other activities.

She was always on the go somewhere to do something.

She encouraged all of us to spend time with family, and to put aside our daily chores so that we wouldn’t miss out on opportunities to make memories.

She was an avid photographer and literally had thousands of photos stored on memory cards.

Sisters

Sisters

She was always the one to pick up on someone being left out, and took time to show them kindness and love. Kristi developed many strong relationships because of this positive attitude. She was very strong-willed, fighting for what she believed was the right thing in life.

My sister was someone special.

Since Kristi taught first grade, she was frequently exposed to colds and illnesses. Even though she was healthy, on December 12th, 2013, she began to develop symptoms of influenza. She had a headache, extreme fatigue, nausea and vomiting, and a hacking cough.

She went to her physician, who prescribed Tamiflu® and told her to take some over-the-counter flu relief medications.

She made a choice to not purchase the Tamiflu because, even with insurance, the cost was $65, and she had Christmas presents left to buy. Kristi didn’t want anyone to do without a precious gift, particularly her children.

The next two days she began to worsen, to the point she couldn’t get out of bed to get herself fluids. Friends came by to help her and brought her Gatorade®. My mother took her chicken noodle broth, and she was able to get out of bed on Sunday, December 15th.

She still complained of a headache, but drank lots of fluids to try to build up her strength. Kristi’s fever continued, and she started noticing some chest pain Sunday evening while in the shower. Once out, she said it went away. Urgent care had already closed, so she told us she would return to her doctor’s office on Monday morning just to make sure she wasn’t developing any complications.

My mother asked her if she had gotten a flu vaccine this year and she said, “No, but I will definitely get one next year!” She was so scared of needles that she opted to not get a vaccine, thinking lots of people get the flu and suffer through it a few days and get better.

She was not this lucky.

On December 16th, at 1:13pm, only four days into her illness, I got a call from my dad saying an ambulance had been called to her house and it didn’t sound good.

Hearing those words from my dad, who was an EMT, made me know it was serious. As I rushed to the hospital, I picked up my mom from her work and tried to reassure her to stay calm. I tried to prepare Mom for Kristi maybe being on a ventilator or unconscious, just in case.

As we approached the hospital ER doors, my father came out with tears rolling down his cheeks, and my mother instantly knew without him speaking. She desperately asked, “She didn’t make it?” He quietly shook his head. And as I stood there clinging to my parents as they mourned the death of their child I thought of my mother’s words I had so quickly brushed off, “People die from the flu, Sharon.”

As a registered nurse, I have taken care of many patients with influenza and they have recovered. I brushed it off when my mom had been worrying over the weekend because my sister was healthy! She was active. She was an adult with no complications.

Kristi was so healthy, she gave my dad a kidney 10 years ago. At her regular check-ups, her physician always said things looked great and she was doing well.

Healthy adults don’t die from the flu!

She was a fighter, she was so strong-willed. People like that don’t succumb to the flu.

But, I was wrong. Healthy adults and children die every year from the flu because they do not get vaccinated—the number one way to prevent infection.

Losing a sister, and having to see my parents mourn the loss of their first-born, was the hardest thing I have ever faced in my life.

Seeing the pain in their eyes, the thousands of tears shed, was crushing to me. I not only lost my sister but had to watch my parents’ pain, knowing I could not fix this.

But one thing I know is it could have been prevented. It only takes a minute. The pain of a needle doesn’t compare to the pain of watching your family suffer through grief, trust me! Influenza can be prevented with a simple vaccine taken yearly.

It’s your choice. Please make the decision to vaccinate yourself against this deadly illness.

by Sharon Hicks





A Brother’s Love

14 03 2014

My older brother, Evan, and I were 12 1/2 months apart.  We were the “twins” who weren’t really twins, but who shared a bond so close, that I still can’t believe he is gone.

I never needed to worry about having friends around, because I always had Evan.  We both loved sports, and I have the greatest memories of growing up playing baseball, soccer, and basketball together.  It was a great family time, and one I hope to impart to my children.

Evan wanted to be a pitcher on a college baseball team, and my dad took him around to different colleges in Georgia.  After tryouts at Georgia Southwestern University, Evan was asked to join the team as a walk-on player.

Me and Evan

Me and Evan

He was at a small university, but he loved it and loved his team.  I was attending the University of Georgia, and I was so proud of my brother for following his dream.  Both of us had plans to become orthopedic sports physicians and practice medicine together.  We would get married, our children would not only be cousins but best friends—everything was planned out, everything was in motion.

Then, Evan came down with a violent migraine, so we thought.

The ER physicians diagnosed him as having a “little virus,” but it wasn’t a “little virus.”  It was bacterial meningitis, or more specifically, “meningococcal disease.” My parents were told he had a 5% chance of survival.

I can only imagine, now that I am a parent myself, what horror they must have felt hearing that their son might die.  I was on spring break with some friends in Florida, and my parents couldn’t reach me until much later that night.  I immediately left to drive to the hospital where Evan was being treated.

In a spirit of youthful optimism, I felt that if Evan knew I was by his bedside, he would rally, just as each of us could always get the other one to rally.

But this horrible disease was stronger than all of the prayers and love being sent to Evan.  My parents and I watched the disease ravage Evan’s body,  as gangrene set in on his arms and legs.  We watched the machines monitoring Evan, willing the numbers to be stable, for some sign of improvement.

As Evan was transferred to a third hospital, a burn unit, we were told that Evan had a 1% chance of survival.  I remember asking my mom about life after death.  I didn’t understand how my brother could be so sick.  Evan went in for surgery to try to save his life, and both arms and legs were amputated.

That still wasn’t enough.

I watched my brother, in a medically induced coma, lie in bed with stumps, his face and body bloated from kidney failure.  I cried, I prayed, I begged.  I would go listen to music in my car, to try to escape from the reality of what was happening.

Then, Evan suffered 10 hours of grand mal seizures, and that caused irreversible brain swelling, and a herniated brain stem.

My brother, who I loved so much, was brain dead.

We all watched as Evan was disconnected from life support, flat-lined, and carried away in a body bag.  Those are my last images of my brother.

I missed that quarter of school, because Evan had been in the hospital almost a month.  When I went back, it was with a renewed determination to be a doctor.  I did get admitted to medical school, and when I graduated, I fist-pumped my arm, and said to myself, “Evan, I did this for both of us.”

I still talk to Evan, I still miss him so much, and I carry his memory with me everywhere.  My daughter’s middle name is Evan. When I got married, I did not have a best man, because that spot was reserved for Evan.

When my parents and I found out that Evan’s death could have been prevented with a vaccine, that was being routinely used in the military, it just made no sense.  Why hadn’t any of us been told about the vaccine?

Needless to say, I am a staunch vaccine advocate, and as a primary care physician, I make sure that all of my patients are up-to-date on all CDC-recommended vaccinations.

It really is your choice, and your life. Take control and protect yourself against infections by getting immunized.

by Ryan Bozof





Pneumo – It’s All About the Numbers

3 03 2014

DDWhen we are immunized, we usually have to get several shots, or doses, before we’re protected against a disease.

Nearly all vaccine-preventable diseases require more than one dose of vaccine to provide us with a strong immune response. It’s not fun, but it’s better than fighting all those infections.

Last summer, an article in Pediatrics described a study which looked at the cost-effectiveness of removing a primary dose of 13-valent pneumococcal conjugate vaccine (PCV13).

This vaccine helps to prevent pneumococcal infections, which can mean anything from an ear infection to pneumonia to meningitis. It can be a dangerous and deadly infection.

Right now, this vaccine is a four-dose series. The first three doses are primary doses, and the fourth dose is a booster.

A primary dose “primes” the immune system, allowing our bodies to develop stronger immunity with each primary dose we receive. The booster dose is the last shove to get us over the top, helping our bodies to develop long-lasting immunity against a particular disease.

The study in Pediatrics was the topic of conversation at PKIDs for several weeks, and, while we were surprised that removing a dose was up for consideration (and you’ll see why in a minute), we thought it was probably more of an intellectual exercise than a course of action that our public health leaders in the US would take.

After all, our tradition in the US is to use all of the tools we have to protect our citizens and prevent infections.

Come to find out, this is more than an exercise in “what if.”

In February, I attended the Advisory Committee on Immunization Practices (ACIP) meeting in Atlanta.

(As noted on their website, the ACIP “is a group of medical and public health experts that develops recommendations on how to use vaccines to control diseases in the United States. The recommendations stand as public health advice that will lead to a reduction in the incidence of vaccine preventable diseases and an increase in the safe use of vaccines and related biological products.”)

Based on that meeting, it sounds like they’re looking at removing a primary dose as a real option.

This may give us an opportunity to save money—$400 to $500 million—but it’s not a risk-free deal. In order to save that money, we have to be willing to see harm come to a lot of people.

This flies in the face of what we, as health advocates, say every day to the folks we meet, which is: Get immunized! Use the safe and effective prevention tools available to protect yourself and your family from unnecessary infections.

It’s easier to make this kind of money-saving decision if the conversation is all about the numbers: the dollar amount saved, the numbers of increased cases of disease, the numbers of hospitalizations and deaths.

Numbers are easy to talk about because they’re not personal.

But this decision to remove a primary dose of vaccine is personal. The consequences will be felt by our people, our loved ones, our friends, and our neighbors. We can’t dehumanize this process by just talking about the numbers.

If the third primary dose is removed, an average of 2.5 more people will die each year. Who are those people? One could be my niece, Millie, who’s just learning to crawl. Another could be your grandson, who loves cheerios and bananas.

Forty-four more people will get invasive pneumococcal disease. My daughter could get meningitis, and your son could get a bloodstream infection.

Fifteen hundred more people will be hospitalized for pneumonia. When my oldest was a toddler, she was hospitalized for pneumonia. It’s a terrifying experience and one that I would not have anyone else go through, if possible.

An additional 10,000 of our friends and neighbors and loved ones will have to be treated for pneumonia as outpatients.

Twenty-three hundred more ear tubes will have to be inserted into the tiny ears of children that we know.

A staggering 261,000 more children will get earaches, fevers, and possibly ruptured eardrums.

All of this happens if we decide to save money and remove a primary dose of PCV13.

It’s all about the numbers. We just have to decide which numbers are more important to us as a nation—the dollar amounts or our people?

by Trish Parnell





Rotavirus, Vaccination, and Intussusception

15 01 2014

Rotavirus is a nasty little germ that targets our stomach and intestines, making them swollen, red, and sore.

The intestines help digest the food and liquid we take in, and they make poop out of what doesn’t get absorbed into our bodies.

When the rotavirus attacks, it can cause our poop to turn into watery diarrhea. Fever, vomiting, and pain are often part of the disease.

In younger kids and babies, the diarrhea and vomiting can be nonstop, causing a serious loss of body fluids (dehydration).

The CDC says that “Rotavirus is the leading cause of severe diarrhea in infants and young children worldwide. Globally, it causes more than a half a million deaths each year in children younger than 5 years of age.”

We have effective vaccines—hospitalization rates have dropped 96 percent in the US since the vaccines became available, and the overall number of infections has plummeted.

There’s something that can happen that’s a rare side effect of the rotavirus vaccine. It’s called intussusception. The important thing to know is that intussusception happens anyway in the infant population, but with the vaccine, there appears to be a tiny increase in numbers of those affected.

Intussusception is when one part of the intestine slides into another, similar to a telescope closing. This causes a blockage in the intestines which requires hospitalization and sometimes surgery.

In the US, there are about 34 intussusception-related hospitalizations per 100,000 babies in the first year of life.

These cases happen whether a baby has been vaccinated against rotavirus or not. It’s called the “background” rate.

There has been a slight uptick in cases of intussusception with vaccination against rotavirus. For those babies vaccinated, the increase in rates of intussusception appears to be 1 to 5 cases per 100,000 babies.

We’re talking about this because a couple of studies have been done and these are the findings. It’s important to know all that we can when making health decisions for our children.

We parents don’t want to expose our babies to anything that might harm them. In the case of rotavirus disease and vaccination, it’s clear that the greater risk by far is the disease.

Talk to your baby’s healthcare provider and make the informed decision to protect your young one against rotavirus. It can be a deadly disease.