Showing posts with label vaccination. Show all posts
Showing posts with label vaccination. Show all posts

Wednesday, March 11, 2015

Measles in the United States: Not Just Imported from Disneyland but from China

By: Lewis First, MD, MS; Editor-in-Chief  

     We have all read by now, and perhaps some have experienced, children with measles in our practices thanks to the recent outbreak that seems to have started at Disneyland.  But taking a family vacation to the theme park is not the only way to spread this virus into our country. 
     Su et al. (doi: 10.1542/peds.2014-1947) remind us this week about the introduction of measles into the US in 2013 via newly-adopted children with cerebral palsy adopted from China who had gone unimmunized in both China prior to adoption and after arrival into this country. The authors explain how this might have happened and what needs to be done to prevent this kind of measles importation from occurring going forward.       
     This article makes for a most fascinating read, especially in light of what we have been experiencing with the surge of this virus in our country, largely in unimmunized children.  Spread the word (rather than the measles) about this article especially to those who see newly arrived internationally adopted children so appropriate vaccinations such as the MMR can be administered as soon as possible to those previously unimmunized.

Related Links

Wednesday, March 4, 2015

Spreading Out the Vaccine Schedule: Do We Do What Some Patients Request?

By: Lewis First, MD, MS; Editor-in-Chief
          With the ongoing measles epidemic, vaccine discussion has again reared up with lots of debate on the merits of giving live vaccines like the MMR, with some parents more concerned about the potential for side effects (rare though they may be) compared to the serious risk of their young child actually getting the disease that can be prevented by the vaccine.  
     One strategy to combat vaccine refusal is to stagger or delay giving live vaccines until a child’s brain has developed past the point where they might be detected with an autism spectrum disorder or other behavioral or developmental abnormality for which vaccines are being inappropriately and inaccurately blamed.  So how many of us are asked to delay routine vaccination until children are older? (despite young children being more susceptible to the infections to which we immunize at a young age)
     Kempe et al. (doi:10.1542/peds.2014-3474) surveyed pediatricians and family physicians to look at the frequency of requests being made to them by families to spread out vaccines for children less than 2 years.  They also report on whether pediatricians and family physicians agree to that request, and what strategies they use to hold the line and not delay the schedule. 
     One of the more shocking statistics revealed in this troubling study is that 93% of health care providers note they experience requests to delay vaccination  with almost a quarter of pediatricians surveyed noting that one out of ten parents makes this request. What is even more thought-provoking is that almost ¾ of those surveyed agreed sometimes or always to spread out the vaccines despite knowing that timely administration is in the best interest of the patients they care for. 
     Take a shot at reading this provocative study and then reflect on whether you can empathize with the pediatricians who responded to this survey—or better yet, share your response to this study or what you do in practice with us by sharing a comment at the bottom of this blog or via an e-letter or posting on our Facebook or Twitter sites.

Friday, January 16, 2015

Examining Lows And Highs Of Meningococcal Disease Statistics

Editorial Board Member Joann Schulte, DO, MPH  
Courtsey of Dawn Huczek @Flickr
     It’s the pictures that I remember when I think of meningococcal disease.   I think of purpura on legs and worse, a couple of infants who developed gangrene on a hand or foot.  Children with such complications are rare in the USA these days, according to new research published this month in Pediatrics.  Meningococcal disease is at historic lows in the United States (0.15 per 100,000 persons), but incidence remains highest among infants less than 1 year of age. 

     MacNeil et al. (doi: 10.1542/peds.2014-2035) used surveillance data for the period 2006-2012 collected by the Active Bacterial Core (ABC) surveillance program, which covers about 13.6% of the US population.  That population included 350,000 infants < 1 year of age. During the study period, an estimated 113 cases occurred annually among the infants with an overall incidence of 2.74 cases per 100,000 infants.  Most of the cases were caused by serotype B (64%).  Serogroup Y caused 16% of the cases and serotype C was implicated in 12% of the cases.  The ABC program is funded by the Centers for Disease Control and Prevention. 

      The authors also indicated that a new vaccine and innovative immunization strategies will be needed before meningococcal disease can be combatted as effectively as Haemophilus influenzae type B (HIB) and pneumococcal disease have been.  Meningococcal vaccines in use in the USA now do not include protection against serogroup B.  The vaccines currently in use provide protection against serogroups C and Y.  Vaccines to prevent serogroup B meningococcal are in clinical trials now, but licensure is likely several years away.  When a meningococcal vaccine is licensed, an innovative strategy will be needed because most meningococcal disease among young infants occurs in the first six months of life.  That’s before the two or three doses of vaccine can be given to induce immunity in a child.  So as in the effort against pertussis, innovative strategies will be needed.  Possibilities include maternal immunization or targeting the adolescent/young adult population where carriage rates are high.

      Maybe someday those pictures of meningococcal disease complications that I remember will be a historical artifact.  But before that, some clever work is going to have to be done by public health physicians and infectious disease specialists.

         Related Links:

Tuesday, November 25, 2014

The Pneumococcal Vaccine: Rates of Pneumonia and Sinusitis Before, After Implementation

By: Lewis First, MD, MS; Editor-in-Chief 
Sneeze photo by Anna Gutermuth via Flickr

I don’t think many of us would argue with the benefits of the pneumococcal vaccine in reducing rates of pneumococcal bacteremia and sepsis—but what about other manifestations of this infection—i.e. pneumonia and sinusitis?

Lindstrand et al. (doi: 10.1542/peds.2013-4177) performed a population-based study in Sweden of all hospitalizations pre- and post-introduction of the pneumococcal vaccines (PCV 7 and PCV 13) to look at hospitalizations for these two disorders. Their results are dramatic (in a very positive sense)!

If you had any doubt as to the effectiveness of immunizing against pneumococcus, this study being early released this week will do a “doubt-ectomy”—and hopefully not just for health care professionals but for families who may be less convinced about the need to vaccinate their children.

The study makes some sharp points about the reduction in hospitalizations that can be attributed to the administration of this vaccine—but read it for yourself and see what I mean.

Monday, September 22, 2014

Two Pertussis Vaccine Studies Shed More Light on Benefits vs. Risks

By: Lewis First, MD, MS; Editor-in-Chief 
Photo via the National Institute for Health

It seems that no matter how many studies we publish on the advantages of vaccinating children against pertussis with the Tdap vaccine, some families ask for even more evidence—so this week, we provide two studies to add to the published benefits of this vaccine.

The first by Quinn et al. (doi:10.1542/peds.2014-1105) focuses on the benefits of “cocooning”, the process of vaccinating close adult contacts of newborn infants against pertussis during a pertussis epidemic in Australia. This was especially effective if parents were vaccinated pre-pregnancy.

The second by Vogt et al. (doi:10.1542/peds.2014-0723) debunks the belief that pertussis immunization in infancy may increase the chances of developing asthma by adolescence as measured by asthma medication use in adolescence. Again, the data convincingly shows no association between pertussis vaccine administered in 1993-1994 and asthma medication prescribed for the study cohort of more than 80,000 children 2008-2010.

If you are looking for two nice studies to further provide vaccine-hesitant parents of your patients with added reassurance that their infant should receive this important vaccine (and parents should get a booster if they haven’t gotten one recently), then take a deep breath. The findings these two studies cough up should help you make your case.

Related Reading:

Thursday, September 18, 2014

Delivering High-Quality Care to All Children Under the Affordable Care Act

By: Lewis First, MD, MS; Editor-in-Chief 

Photo by 401(k)2013 via Flickr
If you’re practicing in the United States, chances are, you've wondered how the far-reaching requirements of the Affordable Care Act (ACA) will impact your patients’ health. This week we are fortunate to publish two very topical special articles worth your attention.

The first by Cheng et al. (doi: 10.1542/peds.2014-0881) focuses on the potential risks to children caused by the ACA’s turning over child and adolescent healthcare delivery decision making to individual states. The authors suggest the changes in the insurance market need to be careful not to worsen child health outcomes just because they don’t return the same immediate savings that some of the adult metrics and changes proposed by the ACA are intended to do—thus putting children at risk.

The second special article by Limper et al. (doi: 10.1542/peds.2014-1339) looks at the benefits of school-located vaccination programs for teens. To accommodate the ACA’s mandates to maintain quality and healthy outcomes while reducing costs of care, schools could be an ideal location to improve vaccination rates in our adolescent population.

So how concerned are you with the implications of the Affordable Care Act for children? Would you consider helping to establish a school-based vaccination program, or is that something your department of health should undertake. What effect would a school-based vaccination program have on your practice?

Read both of these timely articles and then inject your comments via response to this blog or on Facebook or Twitter.

Related Reading:

Monday, September 15, 2014

Post-Vaccination Seizures: Though Infrequent, Why do They Occur?

Photo by the World Health Organization
By: Lewis First, MD, MS; Editor-in-Chief 

Much anti-vaccine spin has been attributed to the risk of seizures and subsequent epilepsy occurring after administration of some vaccines, and while ongoing epilepsy has not been proven to be a common complication after a post-vaccine seizure, one wonders why epilepsy occurs.

Is it something about the vaccine or is it something about the wiring of a child’s brain that predisposes it to an increased risk of ongoing seizure activity? As it turns out, the latter appears to be true—at least according to an article by Verbeek et al. (doi:10.1542/ peds.2014-0690) being early released online this week.

The investigators studied a cohort of almost 1,000 children in the Netherlands who experienced seizure activity 24 hours after getting an inactivated vaccine or five to 12 days after a live attenuated vaccine and followed those who were given the diagnosis of epilepsy to see if an etiology is found other than the vaccine for ongoing seizures. As it turns out, genetic and anatomic structural defects are identified in the majority of these children, thus making those without such predisposing factors at minimal if any risk for ongoing epilepsy after receiving a vaccine.

This study can be very useful in helping convince families to vaccinate their children in the absence of neurologic underlying abnormalities—but don’t take our word—read this study yourself and see if you don’t agree.

Related Reading:

Wednesday, August 27, 2014

Effect of a Pertussis Epidemic on Vaccination Status: Coughing Up Some Interesting Findings

By: Lewis First, MD, MS; Editor-in-Chief 
Photo by  Sandy Chase via Flickr

From late 2011 throughout 2012, a pertussis epidemic occurred in Washington State. One would think that an epidemic would result in an uptick in infants being up-to-date on their pertussis vaccinations, but think again—at least after you read the study by Wolf et al. (doi: 10.1542/peds.2013-3637) we are early releasing this week.

If an epidemic doesn't prompt parents to insure their infants are vaccinated, just what will? Drs. Jessica Atwell and Daniel Salmon (doi: 10.1542/peds.2014-1883) reflect on the implications of this study in a topical commentary that accompanies this study.

We welcome your thoughts on this study and commentary and on what you are doing to improve your own vaccination rates in your practice, since an epidemic does not appear to be a significant change agent. Share your comments with us via a response to this blog, an eLetter or on Facebook or Twitter.

Related Reading: