Posts for: August, 2018
Whooping Cough, Claimed the Life of a San Bernardino County Infant
The California Department of Public Health (CDPH) announced [Tue 17 Jul 2018] pertussis, better known as whooping cough, claimed the life of a San Bernardino county infant. This is the 1st confirmed infant death from the disease since 2016, when 2 deaths occurred.
"This baby's death is a tragedy for the family and for California as a community, as this is a preventable disease," said Dr Karen Smith, CDPH director and state public health officer. "This serves as a grim reminder that whooping cough is always present in our communities, and immunizations are the 1st line of defense."
What whooping Cough looks and sounds like: https://www.youtube.com/watch?v=TIV460AQUWk
Akron's Children's Hospital Video about Pertussis: https://www.youtube.com/watch?v=8QWdEwjBEBw
Each year, 50-200 California infants are hospitalized with pertussis. CDPH and the Centers for Disease Control and Prevention (CDC) recommend that expectant mothers receive the whooping cough booster shot (also called Tdap, or tetanus, diphtheria and acellular pertussis vaccine) at the earliest opportunity between 27 and 36 weeks of every pregnancy, even if previously immunized. Getting immunized during pregnancy boosts a mother's immunity and passes on protective antibodies directly to their babies before birth. This helps protect newborns until they are old enough to begin receiving their own whooping cough immunizations at 6 to 8 weeks of age.
"No baby should have to be hospitalized due to a vaccine-preventable disease, and certainly no baby should die," said Dr Smith. "To give babies the best protection, I urge all pregnant women to get vaccinated against whooping cough as early as possible during the 3rd trimester of every pregnancy."
To avoid the spread of whooping cough, CDPH also recommends that:
- parents immunize their babies against whooping cough as soon as possible. The 1st dose is recommended at 2 months of age, but can be given as early as 6 weeks of age;
- California 7th grade students [should] receive the whooping cough booster, Tdap;
- adults should receive a whooping cough booster once in their lives.
Source: Hoy Digital [in Spanish, machine trans, edited
Two children under 2 [years of age] died in the last week at the Robert Reid Cabral Children's Hospital because of whooping cough, a contagious and vaccine-preventable disease. The dead are a girl aged 15 months from the community of Cambita, San Cristóbal and another one of 3 months, who lived in La Romana.
Also, another 28 children have been admitted with this disease, which calls the attention of the pediatricians of the hospital, since the vaccine that immunizes is included in the Expanded Program of Immunizations (PAI).
The official website of the Ministry of Health, in the epidemiology component, defines pertussis as an endemic respiratory disease that commonly affects children under the age of 5, with infants under 6 months of age at the highest risk of complications, but also it can affect teenagers and adults. The use of the vaccination scheme with DPT [diphtheria, pertussis, tetanus] or pentavalent [diphtheria, tetanus, pertussis, hepatitis B, and _Haemophilus influenzae_ type b (Hib)] is the main prevention measure, while pertussis outbreaks tend to occur every 3 to 4 years, according to official information.
So far this year , 29 probable cases of whooping cough have been reported, 7 in the last 4 epidemiological weeks. As many as 9 out of 10 cases correspond to children under 1 year of age. Santo Domingo Norte and Santiago are the demarcations that register the highest number of cases.
Faced with this situation, the Ministry of Health instructed the provincial directorates and corresponding health areas to ensure adequate research and response to preventable diseases.
Dr. T comments:
For every case of reported Whooping Cough, 100 cases go unreported and unrecognized. Teens and adults are usually not as sick as children under age one year, but they are highly contagious. Whooping Cough is called the 100 day cough. Sometimes the cough is so bad, that one can break a rib or two. Women who are pregnant are antibody factories. That is why pregnant women are encouraged to have the Tdap vaccine shot every pregnancy in their last trimester even if they have had it before. The antibodies against Pertussis that they produce because of the Tdap vaccine passes through the placenta to their babies offering them some protection until their babies are old enough to receive immunizations to stimulate their own immune systems to produce their own protective antibodies.
The same reasoning applies to pregnant women getting the influenza shot in their last trimester as well. Babies can not get a flu shot until they are six months old. So in addition to the gift of life, mothers who get the flu shot (in season) and a Tdap also give the gifts of antibody protection to their newborn infants. Not a bad way to start a healthy life!
The Wrong way to Cover Your Mouth when coughing!
If a person has had the disease, Whooping Cough, this disease does not convey life-long immunity as many other illnesses do. Appropriate immunizations against Whooping Cough also do not convey life-long immunity to the disease. All teens and adults should have at least one Tdap vaccine. Right now there is no recommendation for adults to have Tdap booster, however we know that Whooping Cough antibody protection from a Tdap only lasts 3-5 years. Even though we depend on a mother's Tdap antibodies passing through the placenta to protect her baby, even though it is not Public health Policy, it still seems wise to me that all adults who are going to be around a newborn in the baby's first year of life should have a current Tdap "booster" if it has been more than 3 or 4 years since the adult's last Tdap. Perhaps National Policy will eventually change to this recommendation. Don't know! But I do know that Pertussis antibodies from a Tdap only last 3-5 years and then are gone.
All forms of Whooping Cough immunizations are effective and safe and can be given with any other vaccine that is needed, e.g. influenza vaccine, etc. As a community we depend on each other for many things. This includes protection from serious disease. We expect restaurant employees to wash hands before they leave the restroom. We expect each other to not drink and drive, to not text and drive, to cover our face appropriately when we cough. Similarly, we should expect each other to get safe and effective immunizations to protect each other, our children and our families from preventable contafious disease.
Ask your doctors about your current immunizations status and that of your children. If you've not had a Tdap, get one. If you've not had a flu shot, plan to get one. The flu shot is now so purified, that even people with egg allergy can get one. September and October are perfect months for a flu shot. The flu shot is preferred this year, 2018, over the nasal spray influenza vaccine.
Measles Cases Hit Record High in Europe & Outbreaks in the Americas
Source: World Health Organization Regional Office for Europe [edited]
Over 41 000 children and adults in the WHO European region have been infected with measles in the first 6 months of 2018. The total number for this period far exceeds the 12-month totals reported for every other year this decade. So far, the highest annual total for measles cases between 2010 and 2017 was 23,927 for 2017, and the lowest was 5,273 for 2016. Monthly country reports also indicate that at least 37 people have died due to measles so far this year .
"Following the decade's lowest number of cases in 2016, we are seeing a dramatic increase in infections and extended outbreaks," says Dr Zsuzsanna Jakab, WHO Regional Director for Europe. "We call on all countries to immediately implement broad, context-appropriate measures to stop further spread of this disease. Good health for all starts with immunization, and as long as this disease is not eliminated we are failing to live up to our Sustainable Development Goal commitments."
Of the countries in the region, 7 have seen over 1000 infections in children and adults this year  (France, Georgia, Greece, Italy, the Russian Federation, Serbia, and Ukraine). Ukraine has been the hardest hit, with
over 23,000 people affected; this accounts for over half of the regional total. Measles-related deaths have been reported in all of these countries, with Serbia reporting the highest number of 14.
"This partial setback demonstrates that every person who is not immune remains vulnerable no matter where they live, and every country must keep pushing to increase coverage and close immunity gaps, even after achieving interrupted or eliminated status," says Dr Nedret Emiroglu, Director of the Division of Health Emerge
ncies and Communicable Diseases at the WHO Regional Office for Europe.
This link is a CDC webinar with useful Measles information. It is a little technical, but not without value to the general public. I hope you will find it of interest: https://emergency.cdc.gov/coca/calls/2019/callinfo_052119.asp.
Measles Can Be Stopped
The measles virus is exceptionally contagious and spreads easily among susceptible individuals. To prevent outbreaks, at least 95 percent immunization coverage with 2 doses of measles-containing vaccine is needed every year in every community, as well as efforts to reach children, adolescents and adults who missed routine vaccination in the past.
While immunization coverage with 2 doses of measles-containing vaccine increased from 88 percent of eligible children in the region in 2016 to 90 percent in 2017, large disparities at the local level persist: some communities report over 95 percent coverage, and others below 70 percent.
WHO is working closely with Member States currently facing outbreaks to implement response measures, including enhanced routine and supplemental immunization as well as heightened surveillance to quickly detect cases. WHO is also working with other countries to attain the 95 percent threshold.
"At this midterm juncture for the European Vaccine Action Plan, we must celebrate our achievements while not losing sight of those who are still vulnerable and whose protection requires our urgent and ongoing attention," concludes Dr Jakab. "We can stop this deadly disease. But we will not succeed unless everyone plays their part: to immunize their children, themselves, their patients, their populations -- and also to remind others that vaccination saves lives."
Source: Mirror [edited]
Measles cases have hit a record high across Europe with more than 41,000 children and adults infected in the 1st 6 months of this year . That figure is nearly double the highest number of yearly cases recorded since 2010.
At least 37 people are thought to have died due to the highly contagious disease so far this year , although there have been no fatalities in the UK.
Between July 2017 and June 2018, there were just under 1000 cases of measles in Britain, compared to 531 confirmed cases for the whole of 2016. Meanwhile, there have been 760 cases in the 1st 6 months of this year  in the UK alone compared to 187 in the last half of 2017.
"Following the decade's lowest number of cases in 2016, we are seeing a dramatic increase in infections and extended outbreaks" said Dr Zsuzsanna Jakab, World Health Organization (WHO) Regional Director for Europe.
"We call on all countries to immediately implement broad, context-appropriate measures to stop further spread of this disease.
"Good health for all starts with immunization, and as long as this disease is not eliminated we are failing to live up to our Sustainable Development Goal commitments."
In May , it was reported that the UK was facing unprecedented cases of measles.
Anyone who has not received 2 doses of the MMR [measles, mumps, rubella] vaccine is at risk, while young people mixing in close proximity, for example at festivals or at University, are more vulnerable.
Last year , measles cases rocketed by 300 percent across Europe as some parents refused to vaccinate their children. That led to more than 20,000 people being infected causing 35 deaths, according to figures from the WHO.
Before the introduction of a measles vaccine in 1963, there were serious epidemics every 2-3 years, causing an estimated 2.6 million deaths globally each year.
Measles had virtually been eradicated in Britain before confidence in the MMR vaccine collapsed in the late 1990s after now-discredited Dr Andrew Wakefield wrongly claimed the measles, mumps, and rubella jab was linked to autism.
The best way to prevent outbreaks is to ensure that at least 95 percent of the population is immunized with 2 doses of the measles vaccine. High rates of vaccination allow for "[community] immunity" that can protect vulnerable people such as infants who are too young to be vaccinated and those who can't be vaccinated because of medical reasons.
But vaccine skepticism remains high in many parts of Europe. A 2016 global survey of vaccine confidence led by researchers at the London School of Hygiene and Tropical Medicine found Europe to be the region that was least confident in vaccine safety.
In Italy, for example, a loud anti-vaccination movement has been bolstered by populist, anti-establishment politicians, reported the Associated Press. In Romania, superstitions abound, such as using cabbage juice to ward off the disease, while celebrities such as TV star Olivia Steer have publicly promoted anti-vaccine stances.
While immunization rates increased among eligible children in Europe in 2016, there are still some communities that report below 70 percent coverage.
WHO says it is working closely with those countries currently facing outbreaks to implement enhanced immunization as well as heightened surveillance to quickly detect cases.
"We can stop this deadly disease," said Jakab. "But we will not succeed unless everyone plays their part: to immunize their children, themselves, their patients, their populations -- and also to remind others that vaccination saves lives."
Source: Forbes [edited]
Being purists, the CDC is not calling the current upswing in measles cases an "outbreak" -- defined as 3 cases in an area within a month -- but any "reasonable person" would likely do so.
In 2000, we said that measles had been eliminated in the US. In 2016, there were 86 cases, and in 2017, 118 cases. The year is only half over, yet we already have 107 cases across 21 states and DC, including 8 clusters that meet the CDC definition.
Hopefully, we won't have a repeat of some of the larger recent outbreaks --like Disneyland in the winter of 2014-15, which resulted in 145 cases in 7 states and 2 other countries, or the 383 cases, mostly among unvaccinated Amish in Ohio, but there is a growing threat of larger outbreaks due, in large part, to changes in immunization patterns and lower rates of vaccination.
Many dismiss measles almost as a rite of passage. We have been so successful, that most people have never seen a case nor understand how serious it can be, with high fevers. One in 10 get ear infections; this may lead to life-long complications, like the deafness of one of my friends. One out of every 20 children with measles gets pneumonia, and this is a common cause of death. One child of 1000 will get encephalitis, a brain inflammation and swelling that can leave seizures, blindness, deafness, or learning disabilities. Worst, measles kills 1-2 per 1000 infected kids.
Roald Dahl's description of his 7-year-old daughter's death [The Washington Post <https://tinyurl.com/yd57tnvv>] is heartbreaking.
All of this is readily avoided by a series of 2 immunizations.
Measles is transmitted through the air, or by droplets, so just being near someone is enough to get infected. The virus can remain in the air and be transmitted even after the infected person has left the room. It is highly
contagious -- if one person has measles, 90 percent of those close to the index person will also become ill. Making measles even more easily transmitted is that people are contagious for up to 4 days before the rash appears.
Infection may easily be missed, as most physicians have never seen a case, and it won't be high on their radar. It can look similar to an allergic drug rash, but measles is often accompanied by fever, cough, runny nose, and conjunctivitis, where a drug rash is more likely itchy and without these other symptoms.
More than 10 percent of those infected require hospitalization.
ProMED-mail Rapporteur Mary Marshall
Measles is easily controlled with a safe and efficacious vaccine, MMR (measles, mumps, rubella). There is no reason children have to suffer severe disease from measles and in some cases die due to this disease. It is irresponsible of parents not to have their children vaccinated; the link between vaccination and autism has been disproved, yet parents continue to cling to it. The consequences are clearly evident from the global increase in disease following measles infection. And it is particularly important to protect children who cannot be immunized due to immunological issues, such as children receiving chemotherapy to treat cancer and other conditions. Furthermore, it is far more costly to treat individuals following infection because they have not been vaccinated.
It is not only measles that one can easily protect against by vaccination, but also other vaccine-preventable diseases. There was recently a case of varicella (chicken pox) in an 11-month baby causing a stroke after infection, the virus
having been transmitted from unvaccinated older siblings , demonstrating why chickenpox vaccine is so important.
"The case highlights the dangers -- both to one's own children and to those of others -- that are associated with skipping vaccinations. Widespread vaccination protects kids who can't get vaccinated either because they are younger than 1 year, like the boy in the report, or because they have immune system problems. In recent months, there have been numerous chickenpox outbreaks around the country, a result of pockets of parents who have opted not to vaccinate, assuming either that their kids won't get the disease or will simply tough it out if they do."
A confirmed case of measles prompted Contra Costa County, California public health officials [22 Aug 2018] to warn residents and visitors they may have been exposed to the highly contagious airborne illness. The infected person visited several popular indoor venues in Contra Costa County, Los Angeles County, and Arizona, and officials in the latter areas have issued their own advisories.
This serves as a reminder that even though the USA is considered free of measles, i.e., no endemic transmission except through introduced cases, measles can be brought into the country by tourists and following travel by citizens to regions where there still are a high number of measles cases. According to the WHO, measles cases have reached a record high in Europe this year , with more cases recorded in the first 6 months of 2018 than any other 12-month period this decade. Therefore, parents must maintain vaccination of their children.
 PAHO / WHO Epidemiological Update 20 Aug 2018
Source: PAHO / WHO [edited]
Between epidemiological week (EW) 1 and EW 33 of 2018, a total of 5,004 confirmed measles cases, including 68 deaths, were reported in 11 countries in the Americas:
Antigua and Barbuda (one case),
Argentina (8 cases),
Brazil (1237 cases, including 6 deaths),
Canada (19 cases),
Colombia (60 cases),
Ecuador (17 cases), Guatemala (one case),
Mexico (5 cases),
Peru (4 cases),
the USA (107 cases),
and the Bolivarian Republic of Venezuela (3545 cases, including 62 deaths).
Commentary by Dr. T:
The world gets smaller every year. We live in an international city. We go to Europe and Europe comes to us as do other parts of the Americas and the rest of the world as well. Maintaining our community protected by safe and effective immunizations for adults and children is everyone's responsibility. We are our brothers' keepers. Talk to your doctors about your immunization status and that of your families.