Category Archives: Vaccine

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For the 2018-2019 influenza immunization season, AAP recommends flu shot

Category : Advice , Vaccine

The American Academy of Pediatrics recommends pediatricians give children inactivated influenza vaccine (flu shot) in the upcoming season and use live attenuated vaccine (intranasal flu vaccine, aka Flumist) only as a last resort.

  • Annual influenza vaccination is recommended for everyone 6 months and older.
  • For the 2018-’19 season, the AAP recommends inactivated influenza vaccine (IIV3/4) as the primary choice for all children because the effectiveness of LAIV4:
    • was inferior against A/H1N1 during past seasons; and
    • is unknown against A/H1N1 for this upcoming season.
  • LAIV4 may be offered for children who would not otherwise receive an influenza vaccine (and for whom it is appropriate by age and health status).
  • As always, families should receive counseling on these revised recommendations for the 2018-’19 season.

http://www.aappublications.org/news/2018/06/07/influenza060718


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Why get flu vaccine: from Huffington Post

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From Huffington Post: With summer decidedly behind us, it’s time to start thinking about where to get this year’s flu shot.

Yes, it’s flu season again. And yes, the best way to protect yourself from coming down with the virus is still a vaccine.

Dr. Tom Frieden, director of the U.S. Centers for Disease Control and Prevention, made that message loud and clear Thursday at the annual National Foundation for Infectious Diseases press conference on flu vaccines.

“If we could increase vaccination coverage in this country by just five percent more, that would prevent about 800,000 illnesses and nearly 10,000 hospitalizations,” said Frieden. “Flu vaccine is one of the best buys in public health.”

How 2016’s vaccine is different than last year

This year, there are two basic types of flu vaccines: one that protects against three strains of flu, and one that protects against four.

Both flu vaccines protect against the strains seen early in the season in the U.S., including the commonly known H1N1 (swine flu), H3N3 and a Type B strain. The only difference between the two is that the “quadrivalent” vaccine also protects against a second Type B strain.

While it seems logical that more coverage is better, the CDC doesn’t have a recommendation for which one to get ― just that you scoop up whichever shot is available.

“The problem is that a vaccination deferred is often a vaccination forgotten,” Frieden explained. In other words, it’s most important that you get a shot soon rather than holding out for one you might prefer.

There is one big change to the CDC’s flu shot recommendations: People who were counting on the nasal spray form of the vaccine will have to settle for a shot. The CDC recommends only the injection for preventing the flu for the 2016-17 season after concerns arose last year about the effectiveness of the spray.

Of the 144 million Americans who got vaccinated against the flu last year, about 20 million opted for the nasal spray.

Don’t wait until the last minute to get your shot

Last year’s flu season was moderate; there were fewer doctor’s visits, hospitalizations and deaths linked to flu and pneumonia compared to the preceding three seasons. The 2015-16 season started picking up in late December and continued to swell through early March, but don’t wait until the beginning of this December to get inoculated.

For one reason, it takes time to build the antibodies to fight the flu. In adults, the shot takes effect after about two weeks. For kids under eight who may need two shots to be fully vaccinated, injections have to be spaced more than four weeks apart, so the earlier they get the first shot, the better.

Secondly, there’s no way to predict when you’re going to come into contact with someone who has the flu and could spread it to you. It’s best to be vaccinated before the virus starts sweeping through your community.

Ideally, the CDC says, everyone should get their flu vaccine by the end of October, although shots received later in the year will still be beneficial.

Flu shots save lives

Unlike the common cold, the flu can progress from congestion and fatigue to more serious symptoms, like fever, chills and muscle aches that can knock you out for several days.

Medical complications caused by the flu include pneumonia, blood infections, diarrhea and seizures. In worst case scenarios, the flu can lead to death, especially for the very young or the very old.

While the CDC does not directly count deaths related to influenza, their analyses estimate that they can range from 3,000 to about 49,000 people per year. Vaccines can prevent this: During the 2012-13 season, over 100 children died of the flu or flu-related complications, but 90 percent of those children did not receive the flu vaccine.

The vaccine is also extremely important for pregnant women, who are at an increased risk of hospitalization and death from flu. In addition to protecting them from the flu, the vaccine is also linked to the prevention of preterm delivery and gives young infants immunity during the first six months of their life, when they are too young to get the vaccine themselves.

There’s also evidence to show that vaccines can prevent flu-related complications, like heart attack and stroke in older populations, said Dr. Wilbur Chen, chief of adult clinical studies within the Center for Vaccine Development.

People ages 65 and older should also make sure they’re up to date with their pneumococcal vaccine too, which can prevent pneumococcal pneumonia, a serious flu-related complication.

Of course, there’s no guarantee that the vaccine will 100 percent protect you from the virus. However, people who get the vaccine are less likely to get ill and are less likely to spread the disease to others. If you get vaccinated and still end up with the flu, it’ll probably be less serious than it would have been had you not gotten the shot.

Nearly everyone should get a flu shot

Anyone over the ages of six months old who doesn’t have medical conditions that would cause them to react badly to the shot should get one.

The CDC lists special populations for whom a severe bout of flu could cause serious medical complications, saying these groups should be prioritized in the event that there’s a shortage of vaccines. In no particular order, they are children ages six months to five years old; people 50 years old and over; immunosuppressed people (including those who are immunosuppressed because of medicine or HIV); pregnant women; children and teens on long-term aspirin therapy; nursing home residents; people with asthma, diabetes or other chronic diseases; the extremely obese; and Native Americans/Alaska Natives.

People who have severe, life-threatening allergies to the vaccine, or anyone who has ever had Guillain-Barre syndrome, will have to skip their shot and rely on theherd immunity of those around them to be protected.

During the 2015-16 flu season, about 46 percent of Americans over the age of six months got vaccinated, a slight decrease from the year before.

“It’s not perfect; we wish it were better,” said Frieden about the vaccine. “But it will cut your risk of flu, if the match is good, by at least a half. And that’s far better than anything else you can do to protect yourself against the flu.”


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10 years experience of HPV vaccine in Australia, from BBC

A decade on, vaccine has halved cervical cancer rate

iconmonstr-facebook-5-48 iconmonstr-email-11-48 Researchers are continuing to refine the effectiveness of the HPV vaccineImage copyright GETTY IMAGES

Image caption Researchers are continuing to refine the effectiveness of the HPV vaccine

The world’s first cancer vaccine was administered in Australia exactly 10 years ago.

Since then, the human papilloma virus (HPV) vaccine has been rolled out across 130 countries and halved the number of new cervical cancers.

The HPV vaccine also protects against cancers in the throat and mouth in both men and women.

Prof Ian Frazer said the vaccine could eradicate cancers caused by HPV within 40 years.

“It helps not only control cervical cancer but also the oropharyngeal cancer – the cancers inside the mouth that are caused by these viruses,” Prof Frazer, chief executive of the Translational Research Institute, said.

“If we vaccinate enough people we will eliminate these viruses because they only infect humans. And in Australia there’s already been a 90% reduction in infections in the 10 years the programme has been running.”

A HPV vaccine being administered to a patient via injectionImage copyright GETTY IMAGES
Cervical cancer is one of the few human cancers that is known to be directly caused by a viral infection

‘Very common indeed’

HPV is a very common virus that lives on our skin and other areas of the body, including the mouth, genital areas and anus. It can be passed through skin-to-skin contact and genital contact.

The virus is most often passed during vaginal and anal sex, but can also be transmitted through oral sex.

“The papilloma viruses that cause cancer are very common indeed,” Prof Frazer said.

“Most people get rid of the virus themselves without knowing they’ve contracted it, but 1% of the population that get it get persistent infection that lasts over five years. If they do that they’ve got a very good chance they’ll get a cancer.”

Prof Frazer, the late molecular virologist Dr Jian Zhou and a research team used genetic engineering to build a virus replica to create the vaccine. With millions of doses of the vaccine administered worldwide, the number of new cases of cervical cancer has reportedly halved.

Professor Ian Frazer at work in a hospital laboratoryImage copyright GETTY IMAGES
Image caption Professor Ian Frazer at work in a hospital laboratory in Brisbane, Australia, 10 years ago

“We know that 170 million doses of vaccine have been given out,” Prof Frazer said.

“If you do the sums on that, one in a hundred people were going to get a cancer that could kill them.”

Still improving

Some parents have reservations about their children being vaccinated on the grounds that it may encourage promiscuity. Others object to vaccinations over safety fears.

“In countries like the US where the vaccine isn’t so widely taken up, that’s a little bit disappointing because cervical cancer still kills several thousand women in the US,” he said.

“Then, of course, we’ve got the problem of the 250,000 people that die from cervical cancer in the developing world.”

Researchers are continuing to refine the effectiveness of the vaccine and ensure more widespread inoculation.

“We’re moving from a vaccine that protects against two common strains of the virus that cause cancer to a vaccine that protects against nine common strains,” Prof Frazer said.

“If we get that rolled out we will eventually get rid of all cancers that get caused by this virus.”

The Underused HPV Vaccine, from the New York Times

About HPV and the Vaccine to protect against it (From the CDC)

HPV vaccine for males (from the CDC)


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The Underused HPV Vaccine, from the New York Times

Category : Advice , Vaccine

The Underused HPV Vaccine

You’d think that when parents are told of a vaccine that could prevent future cancers in their children, they’d leap at the chance to protect them. Alas, that is hardly the case for a vaccine that prevents infections with cancer-causing human papillomavirus, or HPV. The vaccine, best given at age 11 to 12, is currently the most underutilized immunization available for children.

HPV is by far the most common sexually transmitted infection in the United States, and nearly every sexually active person becomes infected at some time in life. The virus in one or another of its variants causes more than 90 percent of cervical cancers, as well as most cancers of the vulva, vagina, anus, penis and oropharynx, which includes the back of the throat, base of the tongue and tonsils. It also causes genital warts.

Every year, the Centers for Disease Control and Prevention reports, about 14 million Americans become infected with HPV, most of them teenagers or young adults, and a cancer caused by HPV is diagnosed in an estimated 17,600 women and 9,300 men.

Yet, when one of my sons was urged to get the HPV vaccine for his boys, ages 11 and 14, he replied, “Why? They’re not yet sexually active.” I reminded him that not all sex is consensual, and exposure to the virus does not require sexual penetration. However, his response reflects a common misunderstanding among millions of parents, and often their children’s doctors, of the value of the vaccine and the fact that it is most effective if given to preteenagers when the immune response is strongest and before they are exposed to an offending form of the virus.

But as of 2014, only 40 percent of girls and 21 percent of boys ages 13 to 17 had received all three doses of the HPV vaccine, whereas 88 percent of boys and girls had been vaccinated against tetanus-diphtheria-pertussis and 79 percent had gotten the meningococcal vaccine.

There are several explanations for the low rate of HPV immunization among young teens. One is that the vaccine is relatively new — it was first approved in 2006 — and expensive. At about $300 a dose, the three-dose series can approach $1,000 a child, although now, as with other government-recommended vaccines, it is covered by insurance with no co-pay, and the federal Vaccines for Children program provides free vaccination for children who are uninsured or underinsured, according to the American Cancer Society.

The society last month updated its immunization guideline for the HPV vaccine, bringing it in line with the advice issued two years ago by the federal Advisory Committee on Immunization Practices. While the committee considered evidence primarily from company-sponsored studies, the cancer society looked at additional studies conducted by independent researchers.

The society also more carefully defined the effect of age at the time of immunization, finding decreased effectiveness with age that underscores the importance of early vaccination.

“If the vaccine is to be given to people 22 to 26, doctors should inform patients that it is less effective,” said Debbie Saslow, the director of cancer control intervention for the cancer society. Still, it is not too late to immunize college students who did not get the vaccine when they were younger, she said.

A second obstacle to wider HPV immunization is the erroneous belief that it would promote teenage promiscuity, an argument more commonly used to counter birth control advice for teenagers. There is no direct connection between the vaccine and sexual activity and no reason to suggest one, said Dr. Saslow, the lead author of the cancer society’s updated guidelines. If asked, a parent or doctor could simply say the vaccine prevents infection by a very common virus that can cause cancer.

Although some early publicity for the vaccine focused on preventing sexually transmitted disease, Dr. Saslow said, “first and foremost, this is a cancer-prevention vaccine. Multiple studies have shown no negative impact on any measure of sexual activity among girls given the HPV vaccine. You don’t tell teenagers learning to drive not to wear a seatbelt because it may encourage them to run red lights.”

Parental support for having 11 and 12 year old children vaccinated against HPV has been very weak, with only one in five thinking it should be required for school entry. Several states have proposed mandatory vaccination for school entry, and a national sampling of 1,501 parents of children ages 11 to 17 showed that including an “opt out” provision would almost triple parental support for such a requirement, according to researchers at the University of North Carolina Gillings School of Global Public Health.

The most pernicious argument against HPV immunization involves postings on the web of undocumented horror stories that some parents attribute to the vaccine, not unlike the misattribution of autism to the vaccine for measles-mumps-rubella. None of the accounts of severe adverse effects parents have linked to the HPV vaccine have been borne out by sound research.

Three HPV vaccines have been developed, although only one, which protects against nine variants of the virus, now remains on the market. The C.D.C. has stated unequivocally that clinical trials have shown them all to be “very safe.”

Before being licensed in 2009, the vaccine called Cervarix, which protects against the two variants of HPV linked to cervical cancer, was studied in more than 30,000 females. The four-variant vaccine called Gardasil, licensed in 2006 for females and in 2009 for males, was studied in more than 29,000 recipients, and the newest nine-variant vaccine, called Gardasil 9, licensed in December 2014 and the only one now sold, was studied in more than 15,000 males and females.

“Each HPV vaccine was found to be safe and effective,” the agency has declared.

The most common side effects are local pain, redness or swelling at the site of the intramuscular injection. As with other vaccines given to teenagers, fainting sometimes occurs, and patients should be advised to sit or lie down for 15 minutes after getting the vaccine.

The three-dose vaccines should be given to boys and girls as follows: The first dose should ideally be given at age 11 or 12, but can be given to children as young as 9 or to young adults through age 26. The second dose is administered one or two months after the first. And the third dose is given six months after the first. Protection is not complete until all three doses are received. However, there is no maximum interval; if any dose is delayed, it should be given at the next opportunity. There is no need to restart the series.

The vaccine can be safely administered at the same time as other vaccines are given, like the Tdap, meningococcal or influenza vaccine. Although HPV vaccine should not be given during pregnancy, no fetal harm has yet been shown when pregnancy was discovered after one or more doses of the vaccine were administered.

Thus far, there is also no indication that vaccine protection diminishes with time. Individuals followed for up to 10 years post-immunization have shown no sign of decreased protection, and booster doses are not required.

About HPV and the Vaccine to protect against it (From the CDC)

HPV vaccine for males (from the CDC)


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Why Meningococcal Vaccine (From Children’s Hospital of Philadelphia)

Category : Advice , Vaccine

About 1 in 20 children with meningitis caused by meningococcus and about 1 in 3 children with bloodstream infections (i.e., sepsis) caused by meningococcus will die from the infection. Death from sepsis can occur within 12 hours of the beginning of the illness. Meningococcus is one of the most rapid and overwhelming infectious diseases known to man.

The disease

What is meningococcus?

The bacterium, Neisseria meningitidis, primarily targets children younger than 1 year of age. Because meningococcus is contagious, outbreaks can occur in childcare centers and schools. Cases also occur in high schools and on college campuses.

Meningococcus usually causes meningitis (inflammation of the lining of the brain) or sepsis (an infection of the bloodstream). Symptoms of meningitis include stiff neck, headache, fever and drowsiness. Symptoms of sepsis caused by meningococcus include fever, shock and coma. The disease is so rapid that a child can be perfectly well and, in a matter of only a few hours, be in a coma. For these reasons, meningococcal infections that occur in childcare centers, elementary schools or high schools often cause panic in the community. Every year about 800 to 1,500 people in the United States are infected with meningococcus and about 120 die. Meningococcus can also cause pneumonia and arthritis.

Consequences of meningococcal infection occur in about 12 of every 100 survivors and include limb amputation, skin grafting, hearing loss, seizures, kidney disease and mental retardation. About 10 of every 100 people infected with meningococcus will die from the disease. Immunization is the most effective way to reduce the incidence of death and permanent sequelae caused by meningococcus.

How do you catch meningococcal infection?

Usually meningococcal infection is acquired after intimate contact with an infected person. Intimate contact includes kissing, sharing food or beverages, or staying in the same house or room (including a classroom) for more than four hours a day.

Because smoking disrupts the lining of the throat, people who smoke are at increased risk of some infections, including pneumococcus and meningococcus. Both of these vaccine-preventable diseases can cause meningitis.

The vaccine

How are the meningococcal vaccines made?

Two types of meningococcal vaccines are available. One has been available for several years and protects against four of the five types of meningococcus (A, C, Y, and W-135). The other version is newer and protects against the fifth type of meningococcus, type B.

Meningococcus A, C, Y and W-135 vaccine

This meningococcal vaccine is similar to those for pneumococcus and Haemophilus influenzae type b (Hib) in that protection against disease occurs when one develops antibodies to the sugar (or polysaccharide) that coats the bacterium. A meningococcal vaccine, made using only the polysaccharide coating of meningococcus, has been available for several years. Unfortunately, children less than 2 years of age are not very good at making immune responses to the polysaccharide alone.

In order for young children to make an immune response, the polysaccharide must first be attached to a harmless protein. (see How Are Vaccines Made?). The polysaccharide attached to the protein is known as a conjugate vaccine. There are two conjugated meningococcal vaccines:

  • One, available since 2005, can be given to people between 9 months and 55 years of age
  • The second, available since February 2010, can be used in people between 2 and 55 years of age

In both vaccines, the polysaccharides have been stripped from the surface of four of the five different types of meningococcal bacteria that cause disease and each is linked to a harmless protein. The four conjugated polysaccharides are combined into a single shot.

Meningococcal B vaccine

Hib and pneumococcal vaccines have been easier to make than the meningococcal vaccine. The Hib vaccine was easier to make because there is only one type of Haemophilus influenzae that commonly causes severe disease in children (type b). The pneumococcal vaccine was easier to make than the meningococcal vaccine because, although there are about 90 different types of pneumococcus, most of the disease in children is caused by 13 types. Therefore, the pneumococcal vaccine contains these 13 different types of polysaccharides — each linked to a protein.

Although there are only five different types of meningococcus that commonly cause disease (types A, B, C, Y and W-135), it has been very difficult to make a vaccine that includes type B, and meningococcus type B accounts for two-thirds of meningococcal infections in infants and one-third of meningococcal infections in adolescents and adults. Two vaccines to prevent meningococcus type B were licensed for use in adolescents in 2015 — Bexsero® and Trumenba®.  Both of these vaccines were made using proteins, not polysaccharides, that reside on the surface of the bacteria. Trumenba contains two proteins, and Bexsero contains four.

Who should get the meningococcal vaccine?

The A, C, Y, W-135 meningococcal vaccine is recommended for:

  • Adolescents and teens 11 to 18 years old
  • Children and adults without a spleen (see additional information about MenHibRix® below)
  • Children and adults who lack a particular group of serum proteins, called complement proteins, that help the body fight infection (see additional information about MenHibRix® below)
  • College freshmen living in dormitories
  • People exposed to someone infected with meningococcus during an outbreak if the type of meningococcus is one contained in the vaccine (types A, C, Y or W-135)
  • Children and adults who will be traveling to sub-Saharan Africa between December and June
  • Military recruits
  • Lab workers who work with the bacteria

The meningococcal B vaccine is recommended for:

  • All 16- to 18-year olds
  • People aged 10 years and older who have complement deficiencies, no spleen or a spleen that does not function
  • Lab workers who work with the bacteria
  • People exposed to someone infected with meningococcus type B during an outbreak, such as on a college campus

Does the meningococcal vaccine have side effects?

The meningococcal vaccines may cause pain or tenderness where the shot is given, but do not cause any serious side effects. Although a possible association with Guillian-Barre Syndrome (GBS) was investigated, no causal association was found.

http://www.chop.edu/centers-programs/vaccine-education-center/vaccine-details/meningococcal-vaccine


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