Other Immunization News
By contactus@priority-pediatrics.com
November 27, 2014
Category: Uncategorized
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Powdered Measles Vaccine Found Safe in Early Clinical Trials
University of Colorado Boulder (11/24/2014)

"Early human testing suggests that a measles vaccine delivered in powder form with a puff of air causes no adverse side effects. An online report in the journal Vaccine describes how researchers developed a dry-delivery technique for the measles vaccine that would remove the need for injections and liquid storage, which reduces the risk of contamination and the need to dispose of needles. Co-author Robert Sievers, a fellow of the Cooperative Institute for Research in Environmental Sciences, and his team tested the powdered and inhaled vaccine in 60 healthy men who were already immune to measles. They tested delivery with two devices--the Aktiv-Dry PuffHaler and BD Technologies Solovent--and compared them with the usual under-the-skin liquid injection method. The men showed no clinically relevant side effects and also had some evidence of a positive immune response. Because they were already immune, however, the study could not yet compare effectiveness of the vaccines based on immune response."

This is very interesting_the possibility of a room temperature stored powder puff of Measles vaccine requiring no needle injection for kids in our future. I'll keep an eye open for this over the coming years.  Also in the next few years, I've heard there will be a bandaid application of influenza vaccine to apply to one's skin. The bandaid contains numerous Micro-needles (painless) on which there is dry flu vaccine that penetrates the skin with application and gentle pressure. All great ideas that I hope will come to fruition in the near future.

Dr. T

 

"Immunization for Streptococcus Pneumoniae Infections in High-Risk Children
Pediatrics -- AAP Policy Statement (11/14)

In a new policy statement, the American Academy of Pediatrics recommends that children ages six to 18 years old who are at elevated risk of invasive pneumococcal disease (IPD) receive a single dose of the PCV13 pneumococcal conjugate vaccine. Children in this age group with immunocompromising conditions such as HIV infection, sickle-cell disease, CSF leaks, or cochlear implants should receive one dose of PCV13 if they have no previously received the vaccine. PCV13 should be given regardless of whether they have received PCV7 or the pneumococcal polysaccharide vaccine (PPSV23) before. The routine use of the PCV7 and PCV13 vaccines has dramatically reduced the incidence of IPD attributable to serotypes of Streptococcus pneumoniae contained in the vaccines. Recommendations for the use of PCV13 in healthy children and for PPSV23 have not changed."

There are 90+ different individual pneumococcal bacterial serotypes. Some are more common as a cause of disease than others. The first vaccine against pneumococcus was Pneumovax (PPSV23) which was developed against the 23 most common serotypes from the 90+. This vaccine worked very effectively for persons age two years and older, but did not work well in infants who have the greatest burden of pneumococcal illness. Because of this reality Prevnar 7 (PCV7) was developed to contain the most 7 common serotypes of the 90+. PCV7 is very effective in infants and became one of the standard routine vaccines in our vaccine immunization schedule. Unfortunately pneumococcal serotypes that were not included among the 7 of Prevnar 7 came to the fore over the subsequent years to cause increasing illness in infants and young children. As a result research scientist modified Prevnar 7 to contain an additional 6 pneumococcal serotypes. Now our infant vaccine is called Prevnar 13 and is has replaced Prevnar 7 for many years. This process of vaccine modification will likely continue over the coming decades if we observe a changing landscape of pneumococcal serotypes as a cause of pediatric disease.

Prevnar 13 and Pneumovax (the original PCV23) is now available and indicated for persons over age 60 to protect them from pneumococcal disease as a consequence of our seniors' normally weakening immune system with age. Pneumococcal bacteria is a common cause of bacterial pneumonia. In addition, this bacteria can cause other serious diseases: meningitis, blood born infection, bone infection, sinusitis, ear indection, and heart infection. Decades ago when I was in training to become a pediatrician, I would see at least one case of pneumococcal meningitis a month. Now that we have PCV13 (and PCV 7 before that) doctors in training rarely see pneumococcal meningitis at all during their entire career. An important point to remember is that this bacteria is STILL COMMON, but disease is prevented by immunization. The bugs are not gone, but only kept in check by the antibodies created through immunization. Of course, antibodies are created through natural infection too, but at great cost, including death or serious injury from terrible illness. 

I am thankful this Thanksgiving for having this tool, PCV immunization (PCV 7, 13 & 23) to protect my patients. Antibiotics to treat or cure PCV disease pale in comparison to the ability to prevent PCV disease. 

Dr. T

 

Vaccination Exemption Rates High in Spokane Schools
KXLY.com (WA) (11/18/14) Luna, Aaron

"Schools and healthcare providers in Washington State are concerned about an increasing number of parents who refuse to vaccinate their children against dangerous but preventible diseases such as whooping cough and measles. Last year, Washington saw a 4.6 percent exemption rate for children entering kindergarten, compared to a national exemption rate of 1.8 percent. Some exemptions are for medical or religious reasons, but most are because the parents do not want their children vaccinated. Some experts are concerned that the medical-exemption form in Washington is too confusing, increasing the number of exemptions, so health officials are working on a new form for 2015. At Jefferson Elementary on the South Hill in Spokane, nearly 12 percent of students are not vaccinated, one of the district's highest exemption rates. In addition, several other elementary schools have exemption rates higher than 10 percent."

In Atlanta, I am concerned that we too are experiencing an ever increasing number of parents who are choosing to delay, defer or not immunize their children at all against preventable diseases. Although there have been a limited number of children with Whooping Cough and even a couple with Measles last year, the more parents who choose not to immunize their children, the greater the probability that these disease can blossom in our community as they have in others. Only time will tell when we reach that criticial mass of vulnerability. Watch the news and you will be the first to know when that happens. 

When it happens even immunized individuals will be at risk because there is NO 100% effective vaccine. Sometimes even when vaccines work their protection wears off over the years and the individual is again vulnerable. Or we age and as stated above, our immune system weakens and our previous strong protective antibodies diminish leaving us vulnerable_thus the PCV 13 & 23 boosters for persons over age 60 years, and the more potent influenza vaccine for seniors as well.  Some viruses change their genetic makeup annually_thus the annual influenza vaccine is necessary for yealry protection. Some vaccines do not provide lifelong immunity. For example, the DTaP. The P (Pertussis = Whooping Cough) provides adequate antibody protection for 3-5 years. For this reason we now have the Tdap which is given to kids at age 11 years and to ALL ADULTS who have not had at least one Dtap. Probably the Tdap will replace the routine Tenanus booster which adults are supposed to have every tens years, but most forget. This has not yet been decided by the public health authorities. 

There is little a parent can do to find out the immunization status of others who might put their children at risk of exposure to contagious diseases. For close friends and relatives, one can ask about their immunization status, and count on their love for your family to participate in our community immunization program to update and maintain their vaccine protection.  "You can lead a horse to water, but you can't make him drink." On the other hand, you don't have to go into the barn to ride the horse, or even have a horse for that matter. 

But a parent can inquire of institutions (child care, preschool, and one's primary and secondary schools, Sunday schools) as to their policies for their staff and their students' having the required immunizations for attendance. What if your child is in home day care where there may be only 2 or 3 other children? You can still ask the adult caretaker is she/he knows the vaccine status of the other kids and are they fully immunized. You may not be entitled to know the individual child's identity, but if you learn that the adult(s) or the child(ren) are underimmunized, you have the power of the purse and you can find another facility if the caretakers won't excude underimmunized children from their programs. If you choose to have your children stay in an insitution with inadequate student and/or staff immunization coverage, you at least know the risk you take should serious illness break out. 

I encourage you to be proactive in knowing your child(ren)'s childcare and school immunization policies and the number of underimmunized kids enrolled even though you should not expect to learn their identities. Foreknowledge is forewarned. And with knowedge comes great power, and as Spiderman's Uncle said, "With great power comes great responsibility."  Get and stay immunized. Ask your relatives and close friends to protect themselves and by doing so, also protect those they love.  At this Holiday Season, ask yourselves "Are we our brothers' keeper?" If you say Yes, get your family immunized to protect all our brothers and know that you are doing the right thing.

Dr. T

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