vaccines

RECENT POSTS

The Good News, Bad News Story On Measles

Back of female with measles/ Wellcome Library, London. Wellcome Images/flickr

Back of female with measles/ Wellcome Library, London. Wellcome Images/flickr

By Alexandra Morris
CommonHealth Intern

Lately, when you hear about measles in the news, the reports tend to be grim: outbreaks in 2011 and 2013 in the U.S., parents who are choosing not to vaccinate their children for religious or philosophical reasons. But a new report from the CDC this week paints a bigger – and far more heartening – picture: from 2000 to 2012, 13.8 million deaths were prevented through measles immunizations globally. In other words, a population roughly the size of New England is still alive thanks to the measles vaccine.

Deaths from measles have dropped 78% since 2000. “These figures represent historic lows for estimated measles deaths globally,” said James Goodson, a co-author of the CDC report published in this week’s Morbidity and Mortality Weekly Report.

Since 2000, the Measles and Rubella Initiative – a partnership between various agencies including the CDC and the World Health Organization – has provided over a billion doses of measles vaccinations worldwide.

Measles was eliminated in the U.S. in 2000, but there have been a couple of recent spikes in cases. Just last year, there were three times as many measles infections in the U.S. than in previous years. In raw numbers, that translates to 189 cases, according to the CDC. While that doesn’t seem like a lot, such a highly contagious disease can spread rapidly, especially among people who haven’t been vaccinated.

Countries around the world are also aiming to eliminate measles by 2020 or earlier. Europe, for example, set a goal of measles elimination by 2015. But it doesn’t look like they’re on track to meet that goal, said Goodson. That may be due in part to parents’ fears about the possibility of vaccine side effects.

In 1998, a British medical journal issued a report suggesting the measles vaccine was linked to autism cases, which led to a sharp decline in vaccinations. Although the report was discredited, and later retracted by the journal, parent and anti-vaccine groups continue to fight against routine immunizations.

Misinformation is a major threat to vaccine efforts, say public health officials. Continue reading

Mass. Rolling Out Registry To Track Who Got Which Vaccines

In the United States, the flu season can range from November through March, and even past March in some years. Here, a CDC employee receives a flu vaccine from CDC Staff Nurse. (James Gathany/CDC)

 (James Gathany/CDC)

“Hello. Just for your information, Massachusetts is rolling out a statewide database that will track everybody’s vaccines — it’s expected within the next few months — and you can opt out if you want, but otherwise, it will keep track of which vaccines you’ve gotten.”

That shpiel was my assignment at our school’s flu vaccine clinic yesterday, and I dutifully reeled it off several hundreds times to people waiting in line for their shots and sprays. Most commonly, the response was an indifferent nod; a few people seemed downright pleased and grateful, and one — exactly one — person sounded incensed and asked for more information about opting out.

In case you, too, are potentially incensed, or just naturally curious, the new vaccine registry is called the Massachusetts Immunization Information System, and I’m happy to report that its helpdesk actually did answer helpfully and promptly when I just called its number, 617-983-4335. The registry has been in the process of enrolling health-care providers over the last couple of years, I was told, and now has about one-third of the state’s providers enrolled.

Also: The law that creates the registry stipulates that patients must be informed when their doctor starts sharing their vaccine information with the state, and can limit that sharing if they choose.

The Boston Globe wrote back in 2011 that Massachusetts, normally a frontrunner on public health issues, is oddly lagging on its vaccine registry. Public health reporter Kay Lazar wrote:

State lawmakers, facing opposition from insurers, failed for the past two years to act on the proposal, which would assess a fee on health insurance plans to raise the estimated $1 million to $2 million a year needed to run a registry.

But now insurers have dropped their opposition, and supporters, worried that federal funding for the project will dry up, have ratcheted up their lobbying for the state’s financial support, suggesting that, for the first time, Massachusetts will join the rest of the country with a registry that physicians say is essential. Continue reading

Insights On Why Some Girls Are Skirting The HPV Vaccine

Public health officials have been somewhat puzzled by low rates of HPV vaccination: only 54% of adolescent girls receive the first dose of the 3-part vaccine series, and only 33% complete it.

What gives? Doctors recommend it. It’s safe and effective. It has the potential to save thousands of lives every year. So why aren’t more people getting the HPV vaccine?

A young girl after getting the HPV vaccine

A young girl after getting the HPV vaccine

A new study by doctors and public health researchers at the University of Colorado sheds light on who remains unvaccinated and why. (While the full article has not yet been released, the authors recently presented their research with an abstract and poster.) It builds on previous findings that deserve mention: women of low socioeconomic status have the highest risk of developing cervical cancer because of their limited access to other preventative measures, like annual exams and pap smears. In other words, poor women need the HPV vaccine the most. But among the girls who begin the vaccine series, minorities and the impoverished are much less likely to complete it.

To find out why, the researchers, led by Sean O’Leary, MD, MPH, interviewed the parents of girls with an incomplete HPV vaccination. They recruited both English-speaking and Spanish-speaking parents for the study to see if there were any major differences in reasoning or access to care.

As it turns out, two big issues appear to be at play here: parents don’t understand the importance of completing the vaccine series, and healthcare providers aren’t following up about scheduling doses 2 and 3. Spanish-speaking parents had particular trouble with the latter; one parent reported that their provider was “not clear on when to get the next [shot in the series],” even though they wanted their daughter to complete the series “because we are responsible.”

What we’re looking at, it seems, is a bit of a break-down in doctor-patient communication. Continue reading

New Push To Mandate Flu Vaccine For Health Workers — But Some Push Back

As Massachusetts prepares for flu season, there’s a growing push to make flu vaccinations mandatory for health care workers, WBUR’s Martha Bebinger reports:

Numbers released by the state Department of Public Health show that 84% of hospital staff were vaccinated last year. But there is a range, with some hospitals at 47% and others at 99%. The consumer advocacy group Health Care for All’s director, Amy Whitcomb Slemmer, says various vaccination options should address most people’s objections.

vaccinearm“We’re trying to make sure folks are healthy,” Whitcomb Slemmer said. “We want hospital workers to continue to do their job. The time has come to require hospital employees and health care personnel to be vaccinated against the flu.”

The Massachusetts Hospital Association has filed legislation that would mandate flu vaccination for hospitals workers. But some health care workers — like the nurses union — object to forced preventive care. Continue reading

The Checkup On Shots: Vaccine Updates, Facts And Fictions

Somehow, over the last few years, one of modern medicine’s greatest achievements has turned into one of modern American parents’ most fraught subjects.

In this episode of The Checkup, our podcast on Slate, we offer Shots: Vaccine Facts And Fictions, in which we attempt to have a rational, fact-based discussion about some of the vaccines you may encounter in the immediate future: the flu vaccine and, if you have pre-adolescent children, the HPV vaccine.

(To listen to The Checkup now, click on the arrow above; to download and listen later, press Download; and to get it through iTunes click here.)

This year’s flu vaccines offer consumers more choices than ever: there’s a nasal version, a quadrivalent (four-strain) option, a “short-needle” option and an egg-free vaccine for people with allergies, among others. And even though it still feels like summer in some parts of the country, doctors are urging people to get their flu shots early.

The HPV vaccine was introduced seven years ago but, according to the CDC, only about half of girls are getting one or more doses, and only about one-third are getting the full three-dose course. This despite word from public health officials that it’s highly effective for preventing HPV — the most common sexually transmitted infection in the U.S. and a principal cause of cervical cancer — and so far, pretty safe. (It’s recommended for boys as well as girls, both because boys can spread HPV and because there’s a notable rise in HPV-related cancers in older men. See: Michael Douglas and oral sex. )

Doctors say a variety of obstacles stand in the way of more widespread use of the HPV vaccine. There remains the stigma of a vaccine for a sexually transmitted infection.  Also, when you’re talking about an 11-year-old,  preventing cervical cancer may seem less urgent than, say, preventing measles. Finally, there’s a general sense of “vaccine fatigue” among parents bombarded with so many official recommendations and competing agendas.

 

For more info, check out this HPV fact sheet created by our intern, Rachel Bloom:

gardasil-fact-sheet-image

Readers, please let us know how you’re handling vaccines for your family this year. Anything we can learn from your experience?

This Year’s Flu Vaccines: What To Know, And Why Not To Punt

An ad for vaccines outside a Brookline, Mass., pharmacy on Sept. 20, 2013. (Carey Goldberg/WBUR)

An ad for flu vaccines outside a Brookline, Mass., pharmacy on Sept. 20, 2013. (Carey Goldberg/WBUR)

It feels premature, off-seasonally odd, a bit like all the Halloween candy already on store shelves in August.

Flu is a cold-weather plague, yet the pharmacy signs advertising flu vaccines are already out on the sidewalks now, beneath the benevolent sun of perfect 70-degree days and leaves just beginning to tinge their edges with red and yellow.

But flu vaccine experts say that it’s really not too early to get vaccinated, and there’s a bit more to know this year as you roll up your sleeve. There are new and myriad options in flu vaccines, including:

• A “quadrivalent” vaccine that protects against four strains of flu virus rather than the usual three.

• New egg-free flu vaccines for people with egg allergies.

• High-dose “super” vaccines for older people.

• Short-needle vaccines (I’m not sure if I got one of these last year, but I was pleasantly shocked at how tiny the needle was and how little it hurt.) For shot-haters, nasal vaccines remain available for many as well.

Health authorities emphasize that flu vaccine “shopping” shouldn’t get in the way of just getting it done. Flu is no joke, killing an average of 24,000 Americans a year, including dozens of children.  USA Today offers a nice rundown of the options here, and the CDC’s flu vaccine page is here. I also spoke with Dr. Michael Jhung, a flu vaccine expert at the CDC’s National Center for Immunizations and Respiratory Diseases. Our conversation, edited, is below, but first, my own personal favorite flu-vaccine tip: A 90-minute bout of exercise soon after a flu shot could help jump-start your antibody production, according to a recent study that suggests it might even double your antibodies

CG:  First of all, I’m seeing these ads for flu vaccines in pharmacies already now in September, and it seems ridiculously early; flu season doesn’t even peak until January, and also, doesn’t the vaccine wear off after a while? So I’m thinking, maybe I’ll get it, but not now . . . How would you respond to that?

MJ: That’s a great question. I think a lot of people entertain the idea of getting an influenza vaccine, but then they put it off and they say, ‘Well, the season hasn’t started, I have plenty of time.’ But the fact of the matter is, the best time to get an influenza vaccine is before the season starts, not during the season.

And influenza seasons are very unpredictable from year to year. Continue reading

Opting-Out Of Vaccines; Dipping Below Herd Immunity

Graphic Credit: Jan Willem Tulp http://tulpinteractive.com

Graphic Credit: Jan Willem Tulp http://tulpinteractive.com

With more and more families opting out of vaccinating their kids, one of the most sacred of public health goals, the concept of herd immunity, is being threatened.

A recent piece in Scientific American featured tantalizing graphics — on view above — illustrating this scary trend.  According to this analysis, the vaccination rates in some states — Oregon, West Virginia and Colorado, for instance, are shockingly low. So low, in fact, that they’ve dropped below the “herd immunity” levels (or what is thought to be the safe threshold) for MMR (measles, mumps and rubella) and DTP (diphtheria, tetanus and pertussis).

So what’s the deal with herd immunity?  According to the CDC, a population has reached herd immunity when a sufficient proportion is immune to a particular infectious disease.  Immune population members get that protection either by being vaccinated or by having a prior infection.

The epidemiological concept is based on this logic: Continue reading

CDC: Many U.S. Girls Not Getting HPV Vaccine Despite Its Effectiveness

Even though the HPV vaccine has been deemed safe and effective for protection against developing cervical cancer and certain head and neck cancers, only about half of U.S. girls have received the vaccine.

Here’s the latest from the CDC:

Despite the availability of safe and effective HPV vaccine, many girls remain unprotected for HPV infections and therefore HPV-related cancer and disease.

vaccinearmHowever, high HPV vaccination coverage is possible in the United States with existing infrastructure and healthcare utilization. HPV vaccination coverage of adolescent girls failed to increase from 2011 to 2012. Only 53.4 percent of girls received 1 or more doses of HPV vaccine and only 33.4 percent received the complete 3-dose series.

National safety monitoring data continue to indicate that HPV vaccine is safe. Large post-licensure studies have shown no serious safety concerns have been identified in seven years. However, despite the availability of safe and effective vaccines, many girls remain unprotected for HPV infections. If HPV vaccine was administered at healthcare encounters when other recommended vaccines were administered, vaccination coverage could be as high as 93 percent.

Improving providers’ practice patterns so they use every opportunity to offer HPV vaccines and are well-equipped to address questions from parents will be necessary to further reduce HPV-associated cancers.

Here’s NBC News on the just-released CDC numbers:

…many are missing the shots even as they get other vaccinations during doctor visits, the Centers for Disease Control and Prevention says. That’s even though the vaccine is very effective and has already started to affect rates of infection with the human papilloma virus (HPV).

“One of the top reasons is their doctor didn’t recommend (it),” CDC director Dr. Tom Frieden tod reporters in a conference call.

“We are dropping the ball,” he added. “We are missing the opportunity to give HPV vaccine… This is a huge disappointment.”

Even so, studies have shown HPV infections fell by half after vaccines became available. “HPV vaccine works even better than we hoped,” Frieden says. “HPV vaccine is safe.”

Public health officials note that boys should get the vaccine too (see also: Michael Douglas and oral sex). Here’s the conclusion of an op-ed we ran last year by Paula A. Johnson, executive director of the Connors Center for Women’s Health and Gender Biology, and chief of the division of women’s health at Brigham and Women’s Hospital and Robert Haddad, chief of head and neck oncology at Dana Farber/Brigham and Women’s Cancer Center, and associate professor of medicine, Harvard Medical School:

The HPV vaccine cuts across gender lines. It is as much a male issue as a female issue. In addition to educating the public, the medical establishment needs to acknowledge the link HPV has to, not one, but many types of cancer. We need to educate parents of the risks so they can make informed decisions when it comes to protecting their children during routine vaccination visits. By moving away from viewing the HPV vaccine as a political, moral or religious flashpoint, we can finally embrace this vaccine for what it truly is, a vaccine that reduces our children’s risk for certain types of cancer, and what we hope will be the first in a long line of vaccines against cancer during our lifetimes.

Needling The Anti-Vaccine Crowd: Who Gets Blamed When Kids Get Sick?

Dr. Shapero/Flickr

Dr. Shapero/Flickr

Art Caplan’s view on vaccinations and civic responsibility initiated an infectious response on the Harvard Law School blog where it first appeared and among WBUR’s Here & Now listeners who tuned into the show earlier this week.

Caplan, the founding head of the Division of Bioethics at New York University Langone Medical Center, argues that parents who veto vaccinations should be held legally responsible to any party that gets sick because of that decision.

Now, as anyone who has ever written about vaccines and parenting knows, when you touch on these topics, the comments can get pretty emotional.

Here’s Paloma Smith:

…stop looking for excuses for your reckless behavior. Your child should be vaccinated, period. That is why diseases in this country are much less of a concern than in third-world countries. Continue reading

Lingering Questions And Answers About The Shingles Vaccine

Shingles (Wikimedia Commons)

A case of shingles (Wikimedia Commons)

In case you missed our earlier post and Radio Boston segment on the shingles vaccine, here’s the CliffsNotes version:

Whether to get the shingles vaccine is a complex personal decision, and here are some points to consider as you make it: Your risk of shingles  – a painful, blistery rash – rises dramatically as you age. The vaccine, Zostavax, is about 51% effective at preventing shingles but far more effective at preventing a potentially life-ruining complication, a chronic pain condition called postherpetic neuralgia. The vaccine is approved for age 50 and up, and it is generally covered by health insurance if you’re over 60, but coverage for younger people gets spotty, and Zostavax is not cheap, costing up to $200 or so. And preliminary studies suggest that the vaccine’s protection wears off somewhat after a few years.

Left scratching your head? Join the club. I’ve decided to get the vaccine out of sheer terror — I’ve just heard too many horror stories, and the post brought more in the comments section. But because shingles is not generally contagious, your decision does not affect others, so you’ll hear no preaching from me about whether you should get it. I do, however, want to add a few points of information in response to readers’ very good questions:

Q: What about children who have had the chicken pox vaccine? Will they be able to contract shingles in the future? I’ve asked a couple of physicians, and they did not know the answer. 

A: According to the CDC: The short answer is yes, but the risk is a small fraction of the risk following chickenpox itself. In case you wish to know more, chickenpox can be mild and unrecognized during infancy or in utero, or following vaccination (the vaccine does not prevent all infections). So kids may get the vaccine and also (often unknowingly) be infected with the natural virus. Also, the weakened virus used to formulate the varicella vaccine can in fact cause shingles. But the risk for all of these seems low and rates of shingles in children and adolescents seem to be declining.

Q: What are the risks for someone who never got chicken pox as a child?  Should I get the chicken pox vaccine (in my mid thirties) or wait and get the shingles one? Continue reading