Posts Tagged "Vaccines"

Limited data exists on the safety of MMR vaccine in adults. We reviewed reports of adverse events (AEs) to the Vaccine Adverse Event Reporting System (VAERS) to assess safety in this previously under-studied group.

VAERS is the national spontaneous vaccine safety surveillance system co-administered by CDC and the FDA. We searched the VAERS database for US reports of adults aged 19 years and older who received MMR vaccine from January 1, 2003 to July 31, 2013. We clinically reviewed reports and available medical records for serious AEs, pregnancy reports, and reports for selected pre-specified outcomes.

During this period, VAERS received 3,175 US reports after MMR vaccine in adults. Of these, 168 (5%) were classified as serious, including 7 reports of death. Females accounted for 77% of reports. The most common signs and symptoms for all reports were pyrexia (19%), rash (17%), pain (13%) and arthralgia (13%). We did not detect any new safety findings in empirical Bayesian data mining. We identified 131 reports of MMR vaccine administered to a pregnant woman; the majority of these vaccinations were in the first trimester and in 83 (62%), no AE was reported.

In our review of VAERS data, we did not detect any new or unexpected safety concerns for MMR vaccination in adults. We identified reports of pregnant women exposed to MMR which is a group in whom the vaccine is contraindicated, suggesting the need for continued provider education on vaccine recommendations and screening.

Source: Oxford Journals

Despite the recent Advisory below, it is still important to get vaccinated against Influenza this year. We offer the Quadrivalent Influenza vaccine which protects against 4 Influenza viruses including partial protection against the H3N2 virus.

Influenza activity is currently low in the United States as a whole, but is increasing in some parts of the country. This season, influenza A (H3N2) viruses have been reported most frequently and have been detected in almost all states.

During past seasons when influenza A (H3N2) viruses have predominated, higher overall and age-specific hospitalization rates and more mortality have been observed, especially among older people, very young children, and persons with certain chronic medical conditions compared with seasons during which influenza A (H1N1) or influenza B viruses have predominated.

Influenza viral characterization data indicates that 48% of the influenza A (H3N2) viruses collected and analyzed in the United States from October 1 through November 22, 2014 were antigenically “like” the 2014–2015 influenza A (H3N2) vaccine component, but that 52% were antigenically different (drifted) from the H3N2 vaccine virus. In past seasons during which predominant circulating influenza viruses have been antigenically drifted, decreased vaccine effectiveness has been observed. However, vaccination has been found to provide some protection against drifted viruses. Though reduced, this cross-protection might reduce the likelihood of severe outcomes such as hospitalization and death. In addition, vaccination will offer protection against circulating influenza strains that have not undergone significant antigenic drift from the vaccine viruses (such as influenza A (H1N1) and B viruses).

Because of the detection of these drifted influenza A (H3N2) viruses, this CDC Health Advisory is being issued to re-emphasize the importance of the use of neuraminidase inhibitor antiviral medications when indicated for treatment and prevention of influenza, as an adjunct to vaccination.

The two prescription antiviral medications recommended for treatment or prevention of influenza are oseltamivir (Tamiflu) and zanamivir (Relenza). Evidence from past influenza seasons and the 2009 H1N1 pandemic has shown that treatment with neuraminidase inhibitors has clinical and public health benefit in reducing severe outcomes of influenza and, when indicated, should be initiated as soon as possible after illness onset. Clinical trials and observational data show that early antiviral treatment can:

• shorten the duration of fever and illness symptoms;
• reduce the risk of complications from influenza (e.g., otitis media in young children and pneumonia requiring antibiotics in adults); and
• reduce the risk of death among hospitalized patients.

Source: CDC

Immunization helps prevent dangerous and sometimes deadly diseases. To stay protected against serious illnesses like the flu, measles, and tuberculosis, adults need to get their shots – just like kids do.

Immunization is especially important for adults 60 years of age and older and for those who have a chronic condition such as asthma, COPD, diabetes or heart disease.

Immunization is also important for anyone who is in close contact with the very young, the very old, people with weakened immune systems and those who cannot be vaccinated.

Annual flu shots can protect against seasonal influenza. The Center will continue to provide quadrivalent vaccines this flu season to keep our patients healthy all year long.

Sources: National Public Health Information Coalition and  healthfinder.gov

 

A 2-year randomized trial involving close to 32,000 volunteers at more than 100 sites has yielded evidence that a high-dose (HD) influenza vaccine intended for seniors offers significantly more protection in that age-group than the standard-dose (SD) vaccine, according to a New England Journal of Medicine report published today. The researchers concluded that the relative efficacy of the HD vaccine was 24.2% higher than that of the SD vaccine. About 1.4% of the volunteers in the HD group had a confirmed flu case, compared with 1.9% of those in the SD group.

The results, the authors say, suggest that flu cases in vaccinated seniors would drop by about 25% if they all received the HD vaccine instead of an SD vaccine. They also found that the vaccine had a good safety profile. Because the study did not include an unvaccinated group for comparison, the authors could not calculate how much either vaccine lowered the volunteers’ overall risk of contracting flu (absolute efficacy). (Because flu vaccination is recommended for all seniors, doing a trial with an unvaccinated group would be considered unethical.)

FDA required post-marketing trials

The HD vaccine, Fluzone High-Dose, made by Sanofi Pasteur, contains four times as much antigen (active ingredient) as standard vaccines contain—60 milligrams (mg) for each flu strain targeted, instead of 15 mg. The aim is to generate a stronger immune response in elderly people, whose immune systems are weaker than those of younger people. When the US Food and Drug Administration (FDA) approved the vaccine in 2009, the step was based largely on evidence that it increased the immune response in older people; the actual protection afforded by the vaccine had not yet been studied. Accordingly, the FDA stipulated that Sanofi would have to conduct further studies to assess the vaccine’s benefits. The study, sponsored by Sanofi, was conducted during the 2011-12 and 2012-13 flu seasons at 126 sites in the United States and Canada. The investigators recruited 31,989 adults 65 and older who had no moderate or severe acute illnesses. Half of them were randomly assigned to receive the HD vaccine and half the SD product.

The participants were told to report any respiratory symptoms during flu season, and they were contacted at least once a week during that time. The researchers defined a flu-like illness as a respiratory illness with sore throat, cough, sputum production, wheezing, or difficulty breathing, along with any of the following: a temperature above 37.2°C (99°F), chills, fatigue, headaches, or myalgia. Staff members were instructed to collect nasopharyngeal samples within 5 days after onset of illness for testing. In the HD group, 3,745 participants (23.4%) had at least one flu-like illness meeting the above definition, compared with 3,827 (23.9%) in the SD arm.

Low flu incidence in both groups

Overall, 529 volunteers had a lab-confirmed flu case—228 (1.4%) in the HD group and 301 (1.9%) in the SD group. This translated into 24.2% (95% confidence interval [CI], 9.7%-36.5%) higher efficacy in the HD group. This result met a benchmark set in advance by the FDA, the report says. The agency said the HD vaccine would be considered better than the standard one if the lower limit of the 95% CI exceeded 9.1%, because this provided confidence that the risk of confirmed flu was at least 10% higher with the SD vaccine. The researchers also found that the HD vaccine consistently showed better efficacy across different flu types, clinical illness definitions, methods of lab confirmation, and the two flu seasons.

Good safety profile

On the safety side, 1,323 volunteers in the HD group and 1,442 in the SD group had at least one adverse event, which meant that the relative risk for those in the HD group was 0.92 (95% CI, 0.85-0.99). Three people in the HD group had serious events that were deemed related to vaccination, but all three problems resolved before the end of the study. No one in the SD group had a serious event that was considered related to the vaccine. The investigators also found that immune responses as measured by hemagglutination inhibition titers were significantly higher in those who received the HD vaccine. The senior author and coordinating investigator of the study is Keipp Talbott, MD, of Vanderbilt University. “Until this trial came out we didn’t know if it [the HD vaccine] was going to be clinically better or not and now we know it is better,” he said in a Vanderbilt University Medical Center press release. “The overall efficacy of 24.2% against the primary end point [confirmed flu] indicates that about one quarter of all breakthrough influenza illnesses could be prevented” if the HD vaccine were used instead of the standard one, the report states.

The authors write that the vaccine’s absolute efficacy can be inferred only from other studies of the absolute efficacy of SD vaccines in seniors. They cite two previous studies that suggested that SD vaccines like the one used in the current study provided about 50% protection in the elderly. If that is accurate, they suggest, the absolute efficacy of the HD vaccine would be about 62%, which is similar to what has been seen with standard vaccines in younger adults. Another flu vaccine expert, however, questioned that efficacy estimate, saying it’s based on faulty data.

A ‘high-quality study’

Lisa Jackson, MD, MPH, an experienced flu vaccine researcher who was not involved in the study, called it “a high-quality and significant study,” adding, “It is one of the few trials of persons 65+ that used lab-confirmed virus detection as the endpoint.” Jackson, who is a senior investigator with the Group Health Research Institute in Seattle, said the only other similar study she could recall that used lab-confirmed detection of flu in seniors was one that compared vaccines with and without adjuvants. “Like the adjuvanted vaccine trial, we can see that the vaccine of interest performed better than standard vaccine, but we don’t know what level of efficacy was exhibited by the standard vaccine as there was no placebo arm,” she commented. “Given that there is now good data on the high-dose vaccine indicating that, basically, it does something, I think that warrants preferential use in older adults,” she said. She also suggested that its use should be considered in other groups, such as younger adults, HIV patients, and immunocompromised individuals. She added that it would be helpful to see a “number needed to treat” analysis or a cost analysis, since HD vaccine costs more than standard vaccines. A “number needed to treat analysis” would look at how many people would have to receive HD vaccine instead of SD vaccine to prevent one additional case of flu.

However, Jackson voiced a reservation about the authors’ estimate that standard vaccines have 50% absolute efficacy in seniors and that the HD vaccine thus might have 62% efficacy. She said the 50% estimate for the standard vaccine is not based on solid evidence, because both studies the authors cited had flaws.She also remarked that the low flu prevalence reported in the study (less than 2%) “is consistent with other studies and seems to be discrepant with the reportedly high rate of significant outcomes related to flu in this population.”

Source: Center for Infectious Disease Research and Policy

The Center offers high-dose, quadrivalent, preservative-free vaccinations.

The outbreak of the extraordinarily lethal Ebola virus has worsened in West Africa, with the contagion showing no sign of coming under control, prompting the Centers for Disease Control and Prevention on Thursday to warn Americans to avoid nonessential travel to Guinea, Liberia and Sierra Leone.

In addition to raising the health threat level to 3, the agency’s highest level, the CDC said it is sending 50 infectious-disease experts to the affected region and will assist airports in Africa in screening outbound passengers. The CDC had already alerted U.S. hospitals and doctors to be on the lookout for signs of Ebola fever and to question patients about their recent travel history and contacts.

“This is a tragic, painful, dreadful, merciless virus. It’s the largest, most complex outbreak that we know of in history,” said CDC director Tom Frieden in a news briefing Thursday.

A patient who was infected with the virus in Africa is expected to be treated at Emory University Hospital in Atlanta within several days, the university said in a statement Thursday. The patient, his or her identity undisclosed, will be treated at a special containment unit set up in collaboration with the CDC to treat people exposed to serious infectious diseases. A spokeswoman said she did not know when the patient will arrive or who the patient is. CNN, citing an unnamed source, reported that a plane left Cartersville, Ga., Thursday evening to evacuate two U.S. charity workers in Liberia infected with Ebola.

It would be the first time a patient infected with Ebola has been treated in the United States, according to a CDC spokeswoman.

“Every precaution is being taken to move those infected safely and securely, to provide critical care en route and to maintain strict isolation upon arrival in the United States,” said the CDC spokeswoman, Barbara Reynolds. “The safety and security of U.S. citizens is our highest priority. These are U.S. citizens who are returning to the United States for medical care. They are being returned under strict medical protocols for infectious diseases.”

Frieden warned that this outbreak will take at least three to six months to suppress, under the best of circumstances. There is no cure or treatment for the disease, in which the virus replicates rapidly throughout the body, causing multiple organ failure and, typically, death in a matter of days. In the latest outbreak, about 6 of 10 people infected have died.

Vaccine research is progressing, and human trials of a possible vaccine could begin as soon as September, Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said Thursday. The CDC’s Frieden said a vaccine is at least a year away.

That leaves officials with low-tech tools for battling the virus as it rages across West Africa and threatens to spread to other continents. Doctors and disease detectives need to find victims and quarantine them. They have to track down people with whom they’ve been in contact. Caregivers have to be meticulous in wearing formidable protective gear. Family members must be instructed on how to handle the bodies of the deceased.

That’s been the formula for stopping all previous outbreaks in Africa, with the hot virus essentially burning itself out.

“Most of those little outbreaks of varying sizes would be contained because they were in rural areas, where health workers could isolate the people and ultimately get the villages to stop doing the things that propagated it,” Fauci said.

But this outbreak is trickier, he said, because it covers a larger region and several countries with porous borders and weak health-care systems. At the same time, Fauci and other health officials say that Americans should not fear that the epidemic will take hold in the United States. That’s because Ebola, deadly as it is, is contagious only when a patient is sick with symptoms of the disease. The virus is spread by direct contact with bodily fluids after the symptoms appear.

A person who becomes infected will not show symptoms for five to 10 days, sometimes as long as three weeks. In that incubation period, the person isn’t contagious. The symptoms, when they come on, are severe, and U.S. officials are confident that they can isolate any patients should Ebola manage to spread here.

“Ebola poses little risk to the U.S. general population,” Frieden said.

“There is certainly a possibility that someone might get on a plane who is infected in Sierra Leone or Liberia and come to the United States. But the chance of it being spread here the way you are seeing there is extraordinarily low, to the point that the CDC and me and other officials feel confident that there’s not going to be an outbreak here,” Fauci said.

The World Health Organization is not recommending any travel restrictions or closure of borders at this time. The International Air Transport Association said it will follow WHO’s lead on travel restrictions.

“What is key about this disease is that if people aren’t showing symptoms, they’re not contagious,” said Jason Sinclair, a spokesman for IATA.

What sets Ebola apart from other viruses is its lethality. Even the deadliest strain of influenza, for example, kills no more than 1 percent of patients. But some areas of Africa with poor health care have been known to have a 90 percent mortality rate from Ebola during previous outbreaks.

Since the first report of the deadly virus surfaced in March, there have been 1,323 cases reported and 729 deaths, according to the WHO.

One death attributed to Ebola has been reported in Nigeria. Patrick Sawyer, 40, a Liberia-born American citizen who worked for the Liberian Finance Ministry, fell ill while traveling from Liberia to Lagos, Nigeria, with stops in Ghana and Togo, according to the Associated Press. He died in Lagos on July 25. He reportedly had been caring for his sister, who had died of Ebola several weeks earlier.

Governments across the globe, from Washington to Europe to Hong Kong, are gauging the appropriate response. White House deputy press secretary Eric Schultz said President Obama had been briefed about the Ebola outbreak. He said the Ebola crisis won’t affect next week’s summit of African leaders being held in Washington.

“I would tell you that we’re working closely with regional governments to stem the spread of the virus. We have no plans to change any elements of the U.S.-Africa Leaders Summit, as we believe all air travel continues to be safe here,” Schultz said.

About 10,000 people arrive in the United States from the affected region of Africa every three to four months, Frieden said. The CDC has protocols in place to protect against further spread of the disease. These include notification to CDC of ill passengers on a plane before arrival, investigation of ill travelers and, if necessary, quarantine. CDC also provides guidance to airlines for managing ill passengers and crew and for disinfecting aircraft.

The CDC already has a dozen staffers working in West Africa. They are operating in regions that have been torn by civil war. Frieden said one CDC group was driven away after a hostile reception and retreated to a neighboring country, though he did not give details. There have been a couple of dozen outbreaks of Ebola previous to this one, with the first in 1976. This outbreak began in Guinea in March.

Two American aid workers in Monrovia, Liberia, have contracted the virus and are in grave condition, according to a statement released by the Christian aid group Samaritan’s Purse. The group said that Kent Brantly, a physician, was offered an experimental serum sent to the country Wednesday, but that there was only enough for one person, so he asked that it be given to Nancy Writebol, a missionary worker with the Charlotte-based missionary organization SIM. However, a SIM spokesperson said both aid workers were given the serum.

“There are efforts to bring her back,” said Palmer Holt, a spokesman for SIM. “We’re feeling optimistic about the process of relocating non-essential personnel and the two patients.”

The group is evacuating some workers from Liberia, but medical staff members have been left behind to treat patients. The outbreak has prompted the Peace Corps to temporarily remove its 102 volunteers in Guinea, 108 in Liberia and 130 in Sierra Leone.

Sierra Leone has declared a state of emergency and is mobilizing police and the military to quarantine the epicenters of the disease. Sierra Leone’s top Ebola doctor fell victim to the virus and died.

“It is very worrying to hear any reports of international agencies pulling out at the time when there is an absolute need for additional medical experts and health workers to get control of this outbreak,” said Jason Cone, communications director at Doctors Without Borders. The organization said it has 552 staffers on the ground in the three affected countries and it desperately needs more resources to battle the contagion.

Michael Osterholm, director of the University of Minnesota’s Center for Infectious Disease Research and Policy, noted that Africa is a different place than it was 25 years ago. Africans travel much more often now, and this mobility boosts the chances for Ebola to spread.

The CDC’s Frieden expressed confidence that officials will get the situation under control eventually.

“Though it will not be quick, and it will not be easy, we do know how to stop Ebola,” Frieden said. “This is a marathon, not a sprint.”

Source: Washington Post

A government scientist cleaning out a storage room last week at a lab on the National Institutes of Health’s Bethesda campus found decades-old vials of smallpox, the second incident involving the mishandling of a highly dangerous pathogen by a federal health agency in a month.

The vials, which appear to date from the 1950s, were flown Monday by government plane to the Centers for Disease Control and Prevention headquarters in Atlanta, officials said Tuesday. Initial testing confirmed the presence of ­smallpox-virus DNA. Further testing, which could take up to two weeks, will determine whether the material is live. The samples will be destroyed after the testing is completed.

There is no evidence that any of the vials had been breached or that workers in the lab, which has been used by the Food and Drug Administration for decades, were exposed to infection. FDA employees did not receive an official communication about the discovery until Tuesday evening. One scientist, who works in the building and spoke on the condition of anonymity for fear of retaliation, said he learned about it Tuesday when his supervisor read a media report.

The FBI and the CDC’s division of select agents and toxins are investigating.

“Due to the potential bio-safety and bio-security issues involved, the FBI worked with CDC and NIH to ensure safe packaging and secure transport of the materials,” FBI spokesman Christopher M. Allen said in an e-mail to The Washington Post.

 

Experts explain the biosafety precautions and procedures at the National Emerging Infectious Diseases Laboratories. (Boston University)

This is the first time the deadly virus has been discovered outside the only two facilities in the world where smallpox samples are allowed, by international agreement, to be stored — a highly secure lab at the CDC headquarters in Atlanta and a virology and biotechnology research center in Novosibirsk, Russia.

Smallpox — which vanished from the United States just after World War II and was eradicated globally — killed hundreds of millions of people in the 20th century alone.

“It was considered one of the worst things that could happen to a community to have a smallpox outbreak,” said Michael Osterholm, a expert on bioterrorism and director of the Center for Infectious Diseases Research and Policy at the University of Minnesota. “It’s a disease that’s had a major impact on human history.”

There is no cure for smallpox, and historically about one-third of people who contract it die from the disease. Though not as readily contagious as some other diseases, such as influenza, smallpox promises plenty of misery once contracted. Symptoms include high fever, fatigue and fluid-filled lesions that often ooze and crust over, leaving survivors irreversibly scarred.

Last month, a safety lapse involving three CDC labs in Atlanta led to the accidental release of live anthrax bacteria. The incident resulted in as many as 84 employees having to get a vaccine or take antibiotics as a precaution and the reassignment of a lab director. Scientists failed to take proper precautions to inactivate bacteria samples before transferring them to other labs not equipped to handle live anthrax.

It is not entirely clear how the smallpox samples ended up in Building 29A on the NIH campus in Maryland. The building is an FDA lab, one of several the agency has operated on the NIH campus since 1972. The vials were discovered while employees were preparing for the lab’s move to the FDA’s main campus in White Oak, Md.

An FDA scientist on July 1 found several cardboard boxes containing dozens of glass vials, each several inches long and sealed with melted glass, according to CDC spokesman Tom Skinner. The boxes were in a storage room kept at about 40 degrees. Several vials were labeled as flu virus, mumps or typhus, he said. Sixteen vials were labeled “variola,” or smallpox, or were suspected of containing smallpox virus. Those vials were in a box with cotton padding. All the vials were immediately secured in a containment laboratory on the NIH campus. The 16 suspect vials were flown to Atlanta. Testing confirmed the presence of smallpox virus DNA in six.

“This was a lab that didn’t realize it had these vials,” Skinner said. Because the vials are made of glass and were sealed with melted glass, officials say the vials appear to date to the 1950s. He said the material could have been sitting around in the storage room “unbeknownst to the people up there for many years.”

In an e-mail late Tuesday, an FDA spokeswoman said the laboratories where the smallpox was discovered are used for biologics research, including research on vaccines. The agency noted that the regulation of vaccines, including the smallpox vaccine, was under the authority of NIH until July 1972, when it transferred to the FDA.

“Although an investigation is ongoing, it is likely that an investigator involved in smallpox research, prior to the time that smallpox was eliminated, may have left the boxes in a cold storage area,” FDA spokeswoman Jennifer Rodriguez said in the e-mail. “These were then only discovered as part of the inventory undertaken in preparation for the move of the FDA laboratories from the NIH campus in Bethesda to the consolidated FDA campus in Silver Spring.”

Rodriguez said the agency has completed an inventory of all common storage areas in its NIH campus buildings and found no other materials of public health concern.

“We are carefully examining our policies and procedures regarding the security of our laboratories and storage of biologic specimens,” she said. “We will ensure the implementation of a corrective action plan to ensure that our biological specimens are inventoried and properly secured.”

About 18,000 people work on the sprawling NIH campus in Bethesda. An NIH spokeswoman said the agency is planning a comprehensive search of all laboratory spaces. Officials did not notify employees about the discovery, she said, because the vials were checked and found to have no breaches. FDA laboratory staffers uninvolved in the discovery were notified by e-mail Tuesday evening, after the vials had been transferred to the CDC and confirmed to contain smallpox, Rodriguez said.

The CDC notified the World Health Organization. A spokeswoman for the WHO said any samples of the smallpox virus found outside the two facilities where it is allowed must be moved to those locations or destroyed.
Osterholm, the expert on bio­terrorism, likened the discovery to finding a long-forgotten trunk in an attic and said that biologists are no different from other people, collecting things and storing them. He said government officials handled the discovery appropriately and acted quickly and cautiously. “I’m not convinced this will be the last of these potential situations,” he said. “I wouldn’t be surprised if somewhere else in the world this same type of thing happens again.”

An accidental release of the virus potentially could sicken a small number of people who come into contact with it, though Osterholm said such an outbreak probably could be contained rapidly given today’s vaccine supplies and antiviral drugs. The more worrisome prospect, he said, would be if someone with bad intentions were able to aerosolize the virus and spread it over a large metropolitan area. “That could be a global crisis,” he said.

When smallpox was officially declared eradicated in late 1979, an agreement was reached under which any remaining stocks of the virus would be destroyed or sent to one of two secure laboratories — the CDC in Atlanta or the State Research Center of Virology and Biotechnology in Russia.

In the decades since, the scientific community has wrestled over whether to destroy the remaining stockpiles of the smallpox virus or hang on to them in case they are needed for research.

Those who argue in favor of destroying the remaining smallpox samples — a group that includes D.A. Henderson, who led a worldwide effort to eradicate the disease decades ago — point out that an effective vaccine exists and that maintaining live samples risks accidental infections or, worse, vials falling into the hands of terrorists. Other scientists, including officials at the CDC and NIH, have insisted that there is more valuable research to be done before scientists can say confidently that adequate protections exist against any future smallpox threats.

This spring at a meeting in Geneva, the World Health Assembly, the WHO’s decision-making body, revisited the question over whether to destroy the remaining stockpiles of smallpox. Amid sharply divided opinions on the issue, the group postponed a final decision.

Source: Washington Post

Members of Amish communities in Ohio traveled to the Philippines for heartfelt reasons: They were there on service projects to help less fortunate people. Unfortunately, they came home with unwelcome hitchhikers: measles viruses.

Those travelers hadn’t been vaccinated against this highly contagious disease, the Centers for Disease Control and Prevention said Thursday. As a result, they have triggered an outbreak of more than 130 cases, primarily among their unvaccinated friends and relatives in Amish communities.

Those travelers hadn’t been vaccinated against this highly contagious disease, the Centers for Disease Control and Prevention said Thursday. As a result, they have triggered an outbreak of more than 130 cases, primarily among their unvaccinated friends and relatives in Amish communities.

The cases reported to date are in 18 states. The CDC says 41 people have been hospitalized, but nobody has died so far.

There is a safe and effective measles vaccine (known as MMR), CDC officials note. But most cases these days are among people who have philosophical or religious objections to vaccination.

This outbreak has changed some hearts and minds, though. Melanie Amato at the Ohio Department of Health told Shots that more than 8,000 Amish people have lined up to be vaccinated for measles to help stem outbreaks in six Ohio counties.

Measles strikes more than 20 million people around the world each year. The Philippines is in the midst of an epidemic that has so far sickened 32,000 people, the CDC says. That’s one major source of the current outbreaks in the United States, though the virus has been imported by travelers to more than a dozen different countries. So far all of the cases in the U.S. have been connected to foreign travel.

People traveling overseas should make sure they have been vaccinated against measles, Dr. Anne Schuchat, director of the National Center for Immunization and Respiratory Diseases at the CDC, said at a press conference. If you’re not sure whether you have gotten the recommended two shots, go ahead and get them, she says.

Source: NPR

While adults make up 95 percent of those who die annually from vaccine preventable diseases, a new study from the University of Colorado School of Medicine shows their vaccination rates remain stubbornly low, representing a growing public health concern.

The study, published recently in the Annals of Internal Medicine, is the first to examine several important aspects of adult vaccination. Every year, 30,000 people on average die of vaccine preventable illnesses, almost all of them adult.

“Our study suggests that missed opportunities for adult vaccination are common because vaccination status is not being assessed at every (physician’s) visit, which is admittedly an ambitious goal,” said Laura Hurley, MD, MPH lead author of the study and an assistant professor of medicine at the CU School of Medicine. “Also, most physicians are not stocking all recommended vaccines.”

Recent estimates show only 62 to 65 percent of adults aged 65 and older received a pneumococcal or influenza vaccine respectively; just 20 percent of high risk adults between 19 and 64 received a pneumococcal vaccine and only 16 percent of those 60 and older got their herpes zoster (shingles) vaccination.

Hurley and her fellow researchers designed a national survey of primary care physicians in collaboration with the Centers for Disease Control and Prevention looking at how doctors assessed vaccination status and stocked the 11 recommended adult vaccines in 2012.

“Physicians reported a variety of barriers to vaccine stocking and administration but financial barriers dominated the list,” the study said. “Physicians in smaller, private practice often assume more risks from stocking expensive vaccine inventories and may be particularly affected by these financial barriers.”

According to Hurley, who also practices at Denver Health, many doctors expressed difficulty getting reimbursed by insurance for vaccines.

For example, the herpes zoster vaccine has been recommended since 2008 but is not widely stocked by physicians. One major reason for this, the study says, is that zoster is covered by Medicare Part D, a pharmaceutical benefit, and physicians report problems with reimbursement. At the same time, the vaccine can require substantial out-of-pocket costs for patients, making it less attractive to them as well.

As a result of these difficulties, many physicians are referring patients to pharmacies or public health facilities for vaccinations. “The most commonly reported reasons for referring patients elsewhere for vaccines included insurance not covering the vaccine,” the study said.

There were also problems coordinating vaccine records when done by someone who is not the patient’s primary care physician. The study makes recommendations for improving the overall situation.

It suggests using Immunization Information Systems or IIS, a confidential database that records all vaccine doses administered by providers in a certain area. The system can allow doctors to know the vaccination status of their patients.

The authors point out that the Affordable Care Act addresses financial barriers to vaccination for privately insured patients by requiring insurers to cover recommended vaccines with no co-pays when delivered by in-network providers. There have also been recommendations for legislative action aimed at making Medicare Part D less of an obstacle to adult vaccinations.

“I feel we need to take a more systematic approach to this issue,” Hurley said. “As the population ages this could easily grow into a more serious public health issue.”

Source: Science Daily