Whooping cough: Not just a problem for kids
Maryn McKenna, AHCJ board member and self-proclaimed “most vaccinated person on the planet,” writes about her own bout with whooping cough. She’d had her shots back in the day, but apparently whooping cough immunity conferred by childhood vaccines fades, and anyone over the age of 12 probably needs a booster. 
This is relevant because, while whooping cough is not generally fatal to adults, it’s easily transmitted to more vulnerable folks. And in California and across the country, it’s on the march and vaccine supplies are limited.
The worst news in this upsetting trend is this: We’re doing it to ourselves. As far as anyone can tell, the rise in pertussis is not due to any change in the organism, or to any mysterious error among the manufacturers who make pertussis vaccines. It’s due to vaccine refusal, to parents turning away from vaccines because they think the vaccines are more harmful than the diseases they prevent — or, more selfishly, because they think the wall of immunity created by other vaccinated children will protect their unimmunized ones.
That wall of immunity, McKenna says, hasn’t been helping the unvaccinated kids, who are 23 times more likely to pick up the disease than their immunized peers.
The Texas Tribune’s Ben Freed learns, through conversations with public health experts, that the “entirely preventable” disease can be stopped with vaccination rates between 80 percent and 85 percent. Unfortunately, adult rates are nowhere close to those numbers, though the state is taking steps to increase adult vaccinations.
California officials are urging people to get vaccinated as that state has now seen a six-fold increase in whooping cough this year.
Gates Foundation pledges $10 billion for vaccines
Bloomberg’s Phil Serafino and Yuriy Humber reported on Bill and Melinda Gates’ pledge to commit $10 billion of their foundation’s resources over the coming decade to developing vaccines for the world’s poorest countries. It will come in addition to the $4.5 billion the foundation has already committed to vaccine research and delivery. Gates called on governments and other organizations to join the effort, using a Johns Hopkins model to predict significant impacts.
By vaccinating 90 percent of the population in developing countries, the deaths of about 7.6 million children under the age of 5 could be prevented in the next decade, according to the Gates foundation. An additional 1.1 million lives would be saved by the introduction of a malaria vaccine beginning in 2014, the foundation said.
That malaria vaccination, developed by GlaxoSmithKline, is expected to be ready for patent by 2012.
Related
As part of a string of interviews that accompanied the release of Gates’ annual foundation letter, the heavyweight philanthropist told CNET’s Ina Fried that he has been surprised to find that vaccine distribution has turned out to be every bit as challenging as vaccine development. He also discussed his wide-ranging foundation-related travels and initiatives.
Lack of vaccinations may hurt ‘herd immunity’
USA Today’s Liz Szabo writes about experts’ fears that unvaccinated children will lead to outbreaks of some infectious diseases.
Experts say that parents may be reducing children’s “herd immunity” – keeping germs out of circulation by vaccinating kids. As an example, Szabo tells the story of one child who has a rare immune deficiency and developed meningitis.
Thanks to the success of vaccines, few parents today know anyone who has become sick with a serious contagious disease, says William Schaffner, an infectious-disease expert at Vanderbilt University School of Medicine. Instead, parents are often concerned about chronic illnesses, such as asthma, allergies or autism, which don’t have a clear cause.
Szabo cites statistics from The New England Journal of Medicine that show the number of children who are exempt from immunization requirements has gone up 50 percent from 1991 to 2004.
Bioethicist: Health workers must get H1N1 vaccine
Filed under: Hospitals, Hot Health Headline, Public health
On MSNBC.com, University of Pennsylvania bioethics professor Arthur Caplan takes a tough stand on flu vaccines for health professionals, imploring them to stop “whining” and “moaning.” “Doctors, nurses, respiratory therapists, nurses’ aides, and anyone else who has regular contact with patients ought to be required to get a flu shot or find another line of work,” Caplan writes. According to Caplan, a 100 percent workers’ vaccination rate can cut patient flu deaths and worker sick days by about 40 percent, and thus health workers who claim mandated flu shots are an infringement of their rights are forgetting a key ethical tenet of their profession, that they put the interests of the patient above their own.
Photo by llu_lu via Flickr
It’s the idea of rights infringement that really sets Caplan off:
Excuse me? What rights might those be? The right to infect your patient and kill them? The right to create havoc in the health care workforce if swine flu hits hard? The right to ignore all the evidence of safety and efficacy of vaccines thus continuing to promulgate an irrational fear on the part of the public of the best protection babies, pregnant women, the elderly and the frail have against the flu? Those rights?
Caplan’s a fellow and former associate director of the Hastings Center, a nonpartisan bioethics think tank.
Related
A just-released survey conducted by the American Society of Health-System Pharmacists finds that health workers are asking pharmacists the same questions (PDF) that patients are asking:
- Is the H1N1 vaccine safe? (Patients: 52%, Hospital Employees: 54%)
- Do I need to get the H1N1 vaccine? (Patients: 33%, Hospital Employees: 43%)
- Will there be enough H1N1 vaccine to around? (Patients: 27%, Hospital Employees: 27%)
The ASHP also says that “While pharmacists are authorized to administer vaccinations to adults [in most states], the survey also finds that most hospitals are not planning to utilize pharmacists for this service. ” The organization - made up of 35,000 members who include pharmacists, pharmacy technicians and pharmacy students - is encouraging hospitals and health systems to use pharmacists to administer vaccines to increase vaccination rates. The survey also looks at other H1N1 influenza preparedness issues as well.
OIG: Are we ready for a flu pandemic?
The Department of Health and Human Services’ Office of Inspector General has released two reports assessing just how prepared Americans are for a flu pandemic. Their findings? Communities are on the right track when it comes to preparing for a surge in patient numbers, but they’re not as ready as they could be. Likewise, there’s still more to be done before local organizations will be ready to distribute vaccines and antiviral drugs.
A surge of flu victims
In the Southern Hemisphere, where the flu season has already struck, the biggest systemic issue was lack of space in intensive care units overwhelmed by H1N1 victims. Are American communities doomed to more of the same? After reviewing the coordination, volunteer recruitment/organization, medical equipment, alternate care and triage and admission guidelines of 10 localities as of late summer 2008, the OIG’s answer is a resounding “not quite.” (Get the full 37-page report here.)
The OIG’s to-do list for the assistant secretary for preparedness and response?
- Keep emphasizing those five areas that we evaluated
- Make sure that, when states and localities do medical surge preparedness exercises, they then document and address the lessons they learned from those activities.
- Those lessons everyone just documented? Make sure they share them with everyone else too. Preferably through the CDC. Then the feds can work to address specific local issues.
- Consider working with states (or even the federal government) to “develop appropriate legal protections for medical professionals and volunteers who respond to public health emergencies and who may need to alter standards of care.”
Getting vaccines/antivirals to the right place, at the right time
According to HHS, “even a mild pandemic could cause between 2 million and 7.4 million deaths worldwide” and H1N1 looks to be a “moderate” one. Vaccination is a key component of the prevention plan, which is why the OIG evaluated the pandemic flu plans of 10 communities in the categories of “Receiving & Staging, Dispensing, Tracking, Vulnerable Populations, Priority Groups, Security, Storage, and Transportation.” In general, they found that the communities need to practice more, plan for all eight categories and make those plans “actionable.” In general, folks were best at planning for receiving/staging and dispensing and worst at planning for security, storage and transportation.(Read the whole 57-page report here.)
Based on those findings, the OIG recommended that the CDC:
- Work with states to figure out why folks are still in the “early stages” of planning and help them make some progress
- Prioritize which of the eight areas states should focus on in order to improve local readiness as quickly as possible.
- Emphasize “actionable” plans that “identify the organizations or individuals responsible for carrying out specific actions and the sources that would be necessary to staff distribution and dispensing positions” that are “supported by valid, detailed formal agreements with partnering agencies.”
- Again, make sure locals keep track of what they’ve learned in preparedness exercises and that they make plans to correct any deficiencies. Also, make sure they share plans and “emerging promising practices.”
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