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Which Vaccines Are Required Before Grandparents Hold Newborns?

Don Hackett — Tue, 03 Dec 2019 17:42:45 +0000

Reviewer:

CDC: Transcript: Vital Signs – Maternal Vaccination

Nothing brings a family together more than the birth of a new loved one. But, part of taking care of vulnerable infants is to protect them against transmittable diseases.

For parents, it is reassuring to know when someone who wants to hold their baby is up-to-date with their vaccines.

The Centers for Disease Control and Prevention (CDC) says ‘newborn babies do not have fully developed immune systems, making them particularly vulnerable to infections.’

Furthermore, during an October 9, 2019, Vital Signs webcast, the CDC said ‘there are 2 vaccines grandparents need prior to contacting the newest family member.’

Influenza and pertussis – or whooping cough – are serious infections that can be fatal for babies, especially for those who are too young to be vaccinated directly.

The CDC’s Principal Deputy Director, Dr. Anne Schuchat said during this webcast that these vaccination requirements are related to under-vaccinated mothers.

‘Women who are pregnant are more than twice as likely to be hospitalized if they develop influenza, compared with similarly aged women.’

‘During influenza seasons between 2010 and 2018, women who were pregnant accounted for up to 34 percent of influenza-associated hospitalizations among women 15-44 years old, though only around 9 percent of women in this age group are pregnant.’

‘For infants who get whooping cough, the disease can be life-threatening.’

‘More than half of infants under 12 months who are hospitalized for pertussis are under 2 months and out of all the fatalities reported for whooping cough in all ages, nearly 70 percent occur in babies less than 2 months old.’

‘When infants get whooping cough they are usually very sick and have difficulty breathing, eating, drinking, or sleeping.’

‘Today, we are stressing the importance of two safe and effective vaccines for pregnant women—and the risks to both women and their babies when these vaccines are not given during pregnancy,’ concluded Dr. Schuchat.

During the 2017–18 influenza season, 49.1 percent of pregnant women received influenza vaccination before or during pregnancy, and just 54.4 percent of women with a live birth received Tdap during pregnancy.

And, only 32.8 percent received both of the CDC’s recommended vaccines.

These vaccines are the annual flu shot and a vaccination that prevents whooping cough.

Influenza:

Infants are one of the highest risk groups for severe infection and possible death if they become ill. Babies are unable to be vaccinated for influenza until 6 months of age, and it’s a 2-shot vaccine, so they will not be protected until they’re 7 months old.
In terms of flu, healthy adults may be able to infect other people beginning 1 day before symptoms develop and up to 5 to 7 days after becoming sick.
This means parents cannot always determine if someone will make their baby sick simply by looking for symptoms of illness.
Influenza immunization during pregnancy was first recommended by the US Surgeon General in 1960.
As of November 9, 2019, a total of 4 influenza-associated pediatric fatalities have occurred during the 2019-2020 season. The CDC confirmed 143 pediatric fatalities during the 2018-2019 flu season.
Vaccine suggestion: the CDC has approved various flu vaccines for the 2019-2020 influenza season, which are discussed in this article. But, the CDC suggests pregnant women get a flu shot and not the nasal spray influenza vaccine for the current flu season.

Whooping cough (Pertussis):

Whooping cough is extremely contagious and can be deadly for babies, especially younger than 2 months of age.
Because of this, pregnant women are recommended to have this vaccine with every pregnancy.
Protective antibodies are at their highest about 2 weeks after getting the vaccine, but it takes time to pass them to your baby. So the preferred time to get a Tdap vaccine is early in your third trimester.
And the amount of whooping cough antibodies in your body decreases over time. That is why the CDC recommends you get a Tdap vaccine during each pregnancy.
Whooping cough can sometimes appear to be nothing more than the common cold, which hides the true danger it poses to babies. It may take time for symptoms of these illnesses to appear.
Whooping cough symptoms usually develop within 5 to 10 days after exposure, but it can take up to 3 weeks in some cases.
During 2018, the CDC’s provisional data indicates about 1,100 pertussis related cases in infants under 6 months of age.
Vaccine suggestions: Two vaccines in the United States help prevent whooping cough: DTaP and Tdap. More information can be found at this CDC page.

The optimal timing for these vaccines is at least 2 weeks before coming in contact with an infant, as that is about how long it takes for the body to mount an immune and protective response.

Parents, brothers and sisters, babysitters, and other caregivers can all help prevent the spread of disease by getting vaccinated too.

Vaccines news to protect newborns published by Precision Vaccinations

Sub Title:

Vaccines protect infants while their immune systems gain strength

References:

CDC: Create a Circle of Protection Around Babies

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Either Td or Tdap Vaccines Are Safe

Don Hackett — Thu, 24 Oct 2019 00:04:04 +0000

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ACIP recommends two options for pertussis vaccination

The Advisory Committee on Immunization Practices (ACIP) voted unanimously to recommend that when the Td vaccine (tetanus and Diptheria) is indicated the Tdap (tetanus, Diptheria and pertussis) vaccine is an acceptable option in most situations.

Heidi Splete with MDedge News reported from the Centers for Disease Control and Prevention (CDC)’s meeting on October 23, 2019, that the ACIP members agreed that current data support the use of either the Tdap or Td vaccine in three areas:

as a decennial booster
for tetanus prophylaxis and in the setting of wound management
for additional catch-up doses based on the immunization schedule for persons aged 7 years and older

Additionally, ‘the safety data showed no differences between Tdap and Td, including data regarding pregnant women,’ said Fiona Havers, M.D., of the CDC’s National Center for Immunization and Respiratory Diseases.

The ACIP’s revised language advises that booster doses of “either Td or Tdap” every 10 years throughout life are recommended for continued protection against tetanus and diphtheria.

In addition, either Td or Tdap should be used if a tetanus toxoid–containing vaccine is indicated for prophylaxis in nonpregnant individuals.

For catch-up recommendations, which also apply to pregnant women, the ACIP committee approved the following wording for a series of 3-doses for individuals aged 7-18 years and 19 years and older who have never been vaccinated, that “the preferred schedule is a dose of Tdap (preferably the first dose), followed by either Tdap or Td at least 4 weeks afterward and another dose of either Td or Tdap 6-12 months later.’

‘Individuals in these same age groups who are not fully vaccinated should receive one dose of Tdap, and a dose of either Td or Tdap, if additional doses are needed.’

Previously, the CDC’s MMWR reported a study’s findings on October 18, 2019, that highlighted influenza and pertussis disease burden among pregnant women and infants and vaccination coverage among pregnant women in the USA, and suggest that disease burden could be reduced by improving vaccination coverage.

This study found maternal influenza and Tdap vaccination coverage rates reported as of April 2019 were 53.7 and 54.9 percent, respectively.

Among women whose healthcare providers offered vaccination or provided referrals, 65.7 percent received the influenza vaccine and 70.5 percent received the Tdap vaccine.

The most commonly reported reasons for non-vaccination were believing the vaccine is not effective (influenza; 17.6%) and not knowing that vaccination is needed during each pregnancy (Tdap; 37.9%), followed by safety concerns for the infant (influenza =15.9%; Tdap = 17.1%).

Although pregnant women differ in responses to vaccination offers and referrals, healthcare providers remain their most trusted source of vaccine information, said the CDC.

Starting maternal vaccination discussions with patients early in pregnancy can offer providers multiple opportunities to share information tailored to individual patients’ needs and address vaccination-related concerns.

Recommendations made by the ACIP are not considered final until they are published in the Morbidity and Mortality Weekly Report.

The CDC’s ACIP members had no financial conflicts to disclose.

Vaccine news published by Precision Vaccinations

Sub Title:

Td or Tdap vaccination every 10 years recommended for protection against tetanus and diphtheria

References:

CDC: Vital Signs: Burden and Prevention of Influenza and Pertussis Among Pregnant Women and Infants

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Should Under-Vaccinated Patients Be Fired?

Don Hackett — Mon, 19 Aug 2019 21:46:54 +0000

Reviewer:

Mott Poll Report: What to do with unvaccinated children in the doctor's office?

A recent C.S. Mott Children's Hospital National Poll on Children's Health asked a national sample of parents of children 0-18 years old about how primary care offices should handle children whose ‘parents refuse all vaccines.’

This University of Michigan study published on August 19, 2019, reported that 30 percent of parents polled say that their child’s primary care office ‘should ask parents who refuse all vaccines to find another health provider.’

“When a family refuses all childhood vaccines, it puts providers in a challenging position,” said Mott Poll co-director Sarah Clark, MPH, in a press release.

“A completely unvaccinated child is unprotected against harmful and contagious diseases, such as measles, pertussis, and chickenpox.”

“Children who skip vaccines also pose a risk of transmitting diseases to other patients.”

“This can be especially risky exposure for vulnerable populations, including infants too young to receive vaccines, elderly patients, patients with weakened immune systems or pregnant women.”

The poll based on responses from 2,032 parents also found that many parents are unaware of policies in their child’s primary care office regarding unvaccinated children.

Thirty-nine percent of parents say their provider has a policy requiring children to get all recommended vaccines.

And, only 6 percent of parents say their child’s primary care office doesn’t allow unvaccinated children to use the same waiting area as other patients, while 2 percent say the office allows unvaccinated children to use the waiting area if they wear a mask.

Twenty-four percent of parents say their child’s primary care office allows unvaccinated children to use the same waiting area as other patients with no restrictions.

Typically, Clark says, ‘child health providers will have multiple discussions with parents to explain the importance of childhood vaccinations, and to answer any questions the parents have about possible side effects.’

“In addition to explaining how vaccines protect the health of the child, providers also may share information about why an unvaccinated child exposes other children and patients to dangerous health risks too.”

In the USA, vaccines recommended by the Centers for Disease Control and Prevention (CDC) are often given in conjunction with well-child visits, with the primary care provider.

Barriers in scheduling appointments or parents’ awareness about recommended vaccines may cause children to experience delays in vaccination or to miss some vaccines.

A less common situation – but increasing in recent years – is the parental refusal of all vaccines for their child.

“Primary care providers need to think carefully about whether to institute policies to prevent their patients from being exposed to vaccine-preventable diseases and then communicate those policies to all patients in their practice.”

“Any parent – and particularly parents of infants or immunocompromised children – should ask their child’s primary care provider about policies surrounding unvaccinated children,” Clark added.

This University of Michigan Mott Poll asked a national sample of parents about their awareness of current policies, and preferences for future actions, in how their child's primary care office handles the subset of parents who refuse all vaccines for their children, even after multiple discussions.

Sub Title:

Unvaccinated children expose others to dangerous health risks reported University of Michigan Mott Poll

References:

Should Doctors Accept Unvaccinated Children as Patients?

CDC: Vaccines and Preventable Diseases Recommended Vaccines by Age

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Pertussis Outbreak Continues in California's ‘Wine Country’

Don Hackett — Mon, 04 Jun 2018 14:06:27 +0000

Reviewer:

Whooping Cough Cases on the Rise in Marin County

The ongoing pertussis outbreak in Marin County, California is continuing to impact children, reported local health officials.

“Most of the recent pertussis cases have occurred in school-aged children, with infants at the greatest risk for severe complications,” said Dr. Matt Willis, Marin County’s Public Health Officer, in a press release.

‘Unvaccinated children are at least 8 times more likely than fully vaccinated children to get pertussis and then spread it,” said Dr. Willis. “Most infants who become ill with pertussis are infected by a household contact, often a sibling attending school.”

During April and May 2018, 36 pertussis cases were reported to the Marin County Department of Public Health, which is located north of San Fransico.

Previously, on March 26, 2018, the Marin County Health and Human Services’ Communicable Disease Prevention and Control investigated 65 cases of pertussis in Marin County.

Marin County reported 44 pertussis cases in 2017, and 30 cases in 2016.

“We want to stress the importance of making sure our school children are up to date with their vaccines,” Dr. Willis said.

The largest pertussis outbreak in CA was in 2010 when more than 9,000 cases were reported state-wide and about 350 in Marin County.

“Other Bay Area counties are also seeing more pertussis this spring,” Dr. Willis said. “Only time will tell if we’re heading for another outbreak of the magnitude of 2010.”

There were 17,972 reported pertussis cases in the United States in 2016, including six infant deaths, according to the Centers for Disease Control and Prevention (CDC).

Children in California are considered fully vaccinated if they receive the recommended 5 pertussis vaccine doses before age 6, and a booster vaccine between ages 10-12. The CDC’s recommendations are similar to CA.

Pertussis, a bacterial infection that spreads through coughing or sneezing, usually begins with common-cold symptoms before characteristic whoop or coughing fits appear, says the CDC.

Additionally, a 2017 study found a significant increase in the number of pregnant women who received a tetanus toxoid, reduced diphtheria toxoid and acellular pertussis vaccine, commonly known as Tdap.

Research from Boston University’s Slone Epidemiology Center found that 51 percent of pregnant women in the control group of its Birth Defects Study received the Tdap vaccination.

This is an increase from 2013 when only 28 percent of pregnant women received the Tdap vaccination.

“Newborns at highest risk for pertussis-associated complications are too young to be vaccinated, but Tdap vaccination during pregnancy can reduce the potential for morbidity and mortality in this vulnerable population,” these researchers said.

Additionally, this study found the Tdap vaccination during the third trimester of pregnancy was 85 percent more effective than postpartum vaccination at preventing pertussis in infants aged younger than 2 months.

To provide infants with indirect protection from pertussis, in 2006, the Advisory Committee on Immunization Practices (ACIP) recommended postpartum Tdap administration to mothers.

In 2012, this ACIP recommendation was expanded to include all pregnant women during every pregnancy, with the optimal time for vaccination in the third trimester.

The CDC reported there is no evidence of adverse fetal effects from vaccinating pregnant women with an inactivated virus or bacterial vaccine or toxoid.

According to this research, 96 percent of the Tdap vaccines were administered in a traditional healthcare setting, such as an obstetrician, primary care physician or prenatal clinic.

“We help women better understand the importance of getting the Tdap vaccine to protect their newborn,” said Soni Bozeman, Pharm.D., a Clinical Pharmacist with Brookshires Grocery Pharmacy.

“We believe easy, affordable access to Tdap vaccines for parents and grandparents alike is key to decreasing the cases of whooping cough,” said Bozeman.

There are two kinds of Tdap vaccines, both are combined with vaccines for other diseases:

Diphtheria, tetanus, and pertussis (DTaP) vaccines
Tetanus, diphtheria, and pertussis (Tdap) vaccines

The current CDC vaccine price list can be found here. Discounts for vaccines can be found at this webpage.

Vaccines, like any medicine, can have side effects, says the CDC. You are encouraged to report negative side effects of vaccines to the FDA or CDC.

Sub Title:

Unvaccinated children are 8 times more likely to contract pertussis and then spread it

References:

Pertussis Outbreak

Safer Pertussis Vaccines for Children: Trading Efficacy for Safety

Whooping Cough Vaccines are Safe but Side Effects Can Occur

Help Protect Babies from Whooping Cough

More Mothers Protecting Babies Before Birth

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Whooping Cough Is Defeating Vaccines

Don Hackett — Mon, 25 Sep 2017 13:43:49 +0000

Reviewer:

Kelley Lu, PharmD

The relationship between mucosal immunity, nasopharyngeal carriage, asymptomatic transmission and the resurgence of Bordetella p

The global resurgence of pertussis, known as whooping cough, can largely be attributed to the ‘immunological failures of acellular vaccines’, researchers from the Boston University School of Public Health discussed in a new journal article.

“The resurgence of pertussis in the acellular vaccine era is evolving into a slow-moving, global public health crisis,” the researchers wrote.

According to this research, the incidence of whooping cough in the US has been rising slowly since the 1970s, but the pace of this has accelerated sharply since acellular pertussis vaccines replaced the earlier whole cell vaccines in the late 1990s.

A similar trend occurred in many other countries, including the UK, Canada, Australia, Ireland, and Spain, following the switch to acellular vaccines.

The key question is why?

The article, published in F1000 Research, points to the differences in mucosal immunity between whole-cell pertussis (wP) vaccines and the newer acellular pertussis (aP) vaccines.

“This disease is back because we didn’t really understand how our immune defenses against whooping cough worked, and did not understand how the vaccines needed to work to prevent it,” said Christopher J. Gill, associate professor of global health and lead author of the article.

“Instead we layered assumptions upon assumptions. This is definitely not where we thought we’d be in 2017.”

Up until the 1950s, there were millions of cases of whooping cough around the globe each year, with numerous fatal cases in infants.

The introduction of whole-cell pertussis (wP) vaccines led to a 99 percent reduction in cases.

Later, as wP vaccines raised concerns of possible rare neurologic adverse events, aP vaccines were licensed and used in a number of countries starting in the early 1990s.

Since then, cases of whooping cough have risen sharply. In 2014, there were more than 32,000 cases reported in the US.

The researchers examined mathematical models of pertussis transmission, and found that, contrary to existing assumptions, although both vaccines blocked symptomatic disease, wP vaccines also blocked infections in animals while aP vaccines did not.

Other differences included wP vaccines’ ability to induce a stronger herd immunity and robust TH17 responses, which confer mucosal immunity, while aP vaccines only induced TH2 responses.

Experimental and immunologic data have shown that aP vaccines do not provide herd immunity, while mathematical models imply otherwise.

The researchers proposed a hypothesis to reconcile the contradictory findings: Herd effects from aP vaccines may be the result of modifications in disease presentation that lead to reduced possibility of transmission rather than induced resistance to infection.

The researchers also considered the role of several known factors in the rise of whooping cough cases, including detection bias, waning of immunity, and evolutionary shifts in the bacteria’s genome.

They found that, while contributing to the increase in incidence, these factors alone do not fully explain existing epidemiologic data.

Citing the urgency of the growing health crisis, the authors emphasized the need to go beyond the limitations of animal models and provide human data to further examine the arguments put forth in their article.

Pertussis is primarily a toxin-mediated disease.

The bacteria attach to the cilia of the respiratory epithelial cells, produce toxins that paralyze the cilia, and cause inflammation of the respiratory tract, which interferes with the clearing of pulmonary secretions. Until recently, scientists thought that B. pertussis did not invade the tissues; however, recent studies have suggested that the bacteria are present in alveolar macrophages.

The author(s) declared that no grants were involved in supporting this work: Christopher Gill, Pejman Rohani, Donald M Thea.

Sub Title:

Pertussis research shows that aP vaccines do not provide herd immunity

References:

Resurgence of Whooping Cough May Owe to Vaccine’s Inability to Prevent Infections

Christopher J. Gill, MD

An improved whole cell pertussis vaccine with reduced content of endotoxin

A Controlled Trial of a Two-Component Acellular, a Five-Component Acellular, and a Whole-Cell Pertussis Vaccine

Pertussis (Whooping Cough)

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Long Term Health Threats From Hurricane Harvey

Don Hackett — Sun, 03 Sep 2017 12:05:37 +0000

Reviewer:

Disaster Pharmacy Assistance

Kelley Lu, PharmD

Texas Governor Greg Abbott has issued a warning that floodwaters from Hurricane Harvey would remain a health hazard for several weeks.

Gov. Abbott said "although the rains have stopped, the expertise of Texas physicians, nurses and pharmacists will be called upon as people begin to return their homes and rebuild their lives."

"People need to understand this is not going to be a short-term project. This is going to be a multi-year project for Texas to be able to dig out of this catastrophe," Abbott said on "GMA".

Based on the health problems people in New Orleans faced after Hurricane Katrina in 2005, experts expect major public-health emergencies, environmental illnesses, and virus outbreaks in the aftermath of Harvey.

Hurricane Harvey has created several health questions from residents of the Houston, Texas area, such as:

1. Can I get a bacterial infection from the floodwaters?

Yes. Health officials expect an increase in gastrointestinal problems from bacteria breeding in stagnant floodwaters that can contain Escherichia coli (E. coli), Shigella, and Vibrio vulnificus.

In a report issued one month after Hurricane Katrina in 2005, the Centers for Disease Control and Prevention (CDC) said it had counted 24 cases of hurricane-related wounds infected with Vibrio vulnificus and Vibrio parahaemolyticus, of which six were fatal.

2. Can you catch cholera from the floodwaters?

Probably not. The Houston sanitary system was not breached. Which means bacteria have not been released into the drinking water. But, officials have also warned residents who rely on small municipal water systems of potential contamination, and have urged them to boil their water.

Cholera is an extremely virulent disease that can cause severe acute watery diarrhoea. It takes between 12 hours and 5 days for a person to show symptoms after ingesting contaminated food or water.

Most of those infected with cholera will have no or mild symptoms, and can be successfully treated with oral rehydration solution.

Safe oral cholera vaccines should be used in conjunction with improvements in water and sanitation to control cholera outbreaks and for prevention in areas known to be high risk for cholera.

3. What about water quality from private water wells?

Hundreds of thousands of Houston-area residents rely on private wells that may have been breached. Health officials recommend If flood water goes into your well, you should have the water tested.

The EPA is conducting damage assessments of both drinking water and wastewater systems to identify impacts to critical assets and assist in the recovery.

And, if you have any doubts, the EPA strongly suggests boiling your water before consumption.

4. Can I get HIV from the flood water?

No, flood waters do not convey HIV. HIV isn’t spread through flood water. Additionally, there is no risk of HIV transmission from scratches because no body fluids are transferred between people, which is how HIV is passed.

5. What about other diseases such as West Nile?

The greatest health risk, according to the WHO, “comes from population displacement. If people are crowded in shelters with insufficient sanitation, that could create the conditions for disease to spread.”

In 2005, a study found in the wake of Hurricane Katrina, there was initially no increase in cases of West Nile virus, which is spread by mosquitoes. But, after Hurricane Katrina, 200,000 refugees ended up in 750 shelters in 18 states, and there were scattered outbreaks of various diseases.

A 2008 study found there were no significant or lasting increases in mortality rates in the greater New Orleans area following Hurricane Katrina.

6. Should I worry about catching the Zika virus?

The timing of Harvey is a major consideration for Zika. Texas has been on alert for the Zika virus this summer, and have reported one local transmission, but several travel-related Zika cases.

Texas has several weeks left in its summer season and virus spreading mosquitoes could certainly reappear before the fall weather arrives.

If mosquitoes do return in September, “those will be nuisance mosquitoes,” says Chris Van Deusen, a spokesman for the Texas DSHS, “However there is certainly a potential that we could see disease vectors in increasing numbers.”

With the ongoing threat of Zika, the Texas Department of State Health Services has updated its advice to test pregnant women three times during pregnancy, rather than two times.

7. Will Harvey impact Houston’s mental Health?

Yes, according to research in 2015, mental health issues are actually the most predictable and durable of health problems that follow floods. The stress of flooding triggers post-traumatic stress disorder, even for people with well-managed illnesses, floods often mean a disruption in therapy and prescriptions.

This is important because acute stress-related response, if not addressed properly, can evolve to more severe disorders such as PTSD and depression. Therefore, information about PTSD symptomatology, depression, and risk of suicide should be routinely assessed.

8. Do I need a Tetanus booster?

Both the Centers for Disease Control and Prevention and the Occupational Health and Safety Administration recommend that anyone involved in flood cleanups ensure that their tetanus vaccination status is up to date, every ten years. Tetanus is uncommon in the United States, with an average of 30 reported cases each year.

Nearly all cases of tetanus are among people who have never received a tetanus vaccine. The disease is particularly common and serious in newborn babies and their mothers, when the mothers are unprotected from tetanus by the vaccine.

9. Will the air quality in Houston be tested?

Yes, the Houston Health Department air-inspection teams will begin on Tuesday to monitor air quality around the city’s petroleum and chemical manufacturers, targeting roughly 100 of the largest locations.

The EPA said Sunday that 70% of air-monitoring equipment that had been shut down ahead of the storm in the Houston area, Corpus Christi and Beaumont is back up and running. The remaining equipment should be operating by next week.

To find additional Hurricane Havery information related health issues and emergency resources, various pharmacy associations have compiled easy to use listings:

Sub Title:

Health experts predict public-health emergencies, environmental illnesses, and virus outbreaks in the aftermath of Harvey

References:

Hurricane Harvey Pharmacy Resources

Vibrio Species Causing Vibriosis

Drinking Water: Consumer Concerns

How to Sample Your Well Water and Understand the Results

HIV/AIDS

Flooding and Mental Health: A Systematic Mapping Review

When Are Tetanus Shots Needed?

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When Are Tetanus Shots Needed?

Don Hackett — Wed, 30 Aug 2017 19:49:14 +0000

Reviewer:

Kelley Lu, PharmD

Study shows tetanus shots needed every 30 years, not every 10

For those people in Houston recovering from hurricane Harvey's damage, or a first-responder helping in the recovery effort, health officials are suggesting you check your immunization for tetanus.

This means, do you know when you last had a tetanus shot?

If you are working in the floodwaters full of debris, too murky to clearly see, your risk of a puncture wound is real.

"Routine tetanus boosters are sufficient," said Chris Van Deusen, director of media relations for the Texas Department of State Health Services.

"We're anticipating possible requests for tetanus vaccine for unvaccinated people."

“In decades past, the concern that people caught up in flooding might have let their tetanus protection lapse led to recommendations to vaccinate after hurricanes,’ said Mark K. Slifka, Ph.D., a professor at the Oregon National Primate Research Center.

"But that didn’t always happen and there were no surges in tetanus cases after natural disasters.”

Both the Centers for Disease Control and Prevention (CDC) and the Occupational Health and Safety Administration recommend that workers involved in flood cleanups ensure that their tetanus vaccination status is up to date, every ten years.

Today, tetanus is uncommon in the United States, with an average of 30 reported cases each year. Nearly all cases of tetanus are among people who have never received a tetanus vaccine.

The disease is particularly common and serious in newborn babies and their mothers, when the mothers are unprotected from tetanus by the vaccine, tetanus toxoid.

The CDC reports that 10 percent of tetanus cases are fatal.

But, new research suggest tetanus shots could deliver protection for 10, 20 and possibly even 30 years.

“We have always been told to get a tetanus shot every 10 years, but actually, there is very little data to prove or disprove that timeline,” said Dr. Slifka.

“When we looked at the levels of immunity among adults, we realized that antibody titers against tetanus lasted much longer than previously believed.”

Dr. Slifka’s research produced mathematical models combining antibody magnitude and duration predict that 95% of the population will remain protected against tetanus for ≥30 years, without requiring another booster vaccination.

Dr. Slifka’s revised vaccination schedule could also have a substantial impact on U.S. healthcare costs. His data suggests a reduction of approximately $280 million per year in costs.

Of course, this whole system only works when kids get the recommended five doses during childhood - and just because tetanus and diphtheria are rare in developed countries, it doesn't make them any less deadly.

“Over the last decade, we have seen that mainly recent immigrants or older people who did not receive at least three doses of the tetanus vaccine are the ones at highest risk for a fatal case of tetanus,” said Dr. Slifka.

Tetanus is caused by Clostridium tetani, a spore-forming bacterium that is found in soil. When those spores enter the body, often through a puncture wound, the bacteria start to produce toxins that induces muscle contractions, especially in the jaw and neck.

Tetanus vaccines became commercially available in the United States in 1938, but routine vaccination was not widely practiced until the mid-1940s.

Deaths attributable to tetanus have declined 99 percent since the prevaccine era.

There are four kinds of vaccines used to protect against tetanus, all of which are combined with vaccines for other diseases:

DTaP: Pediatric diphtheria, tetanus, and acellular pertussis (whooping cough) vaccine (Spanish)
DT: Pediatric diphtheria and tetanus vaccine
Td: Older children and adults tetanus and diphtheria vaccine (Spanish)
Tdap: Older children and adults tetanus, diphtheria, and acellular pertussis (whooping cough) vaccine

Most pharmacies offer various tetanus vaccines. The CDC Vaccine Price List provide the private sector vaccine prices for general information.

Discounts for vaccines can be found here.

These researchers did not disclose any conflicts of interest: Erika Hammarlund Archana Thomas Elizabeth A. Poore Ian J. AmannaAbby E. Rynko Motomi Mori Zunqiu Chen Mark K. Slifka.

This research was supported in part by the National Institutes of Health (Public Health Service grant R01 AI098723 to E. H., A. T., E. A. P., A. E. R., and M. K. S. and grant U01 AI082196 to E. H., A. T., E. A. P., I. J. A., and M. K. S.), the Oregon Clinical & Translational Research Institute Biostatistics & Design Program (M. M. and Z. C.), and the Oregon National Primate Research Center (grant, 8P51 OD011092-53 to M. K. S.).

Sub Title:

Tetanus is caused by Clostridium tetani a spore-forming bacterium producing toxins

References:

Historical Comparisons of Morbidity and Mortality for Vaccine-Preventable Diseases in the United States

Tetanus-Toxoid Emergency Boosters — A Reappraisal

Fact Sheets on Natural Disaster Recovery: Flood Cleanup

Immunization Unit

The Role of Pharmacists in Tetanus Management and Prevention

Vaccines to Prevent Tetanus

About Tetanus

New Study Suggests We Don't Actually Need a Tetanus Booster Every 10 Years

Tetanus

Texas Urges Health Precautions for Residents Affected by Hurricane Harvey

Worker Safety After a Flood

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Venezuela and Haiti Losing Control of Diphtheria

Don Hackett — Thu, 24 Aug 2017 20:37:14 +0000

Reviewer:

Shane Kyral, PharmD

Diphtheria in the Americas - Summary of the situation

Highly contagious and deadly for children under age 5, diphtheria appears to be in close proximity to the USA.

Venezuela, Haiti, and to some degree Brazil, have reported 204 suspected or confirmed diphtheria infections during 2017, according to the Pan American Health Organization (PAHO).

Since July 2016, Venezuela has reported 447 suspected diphtheria cases, of which 51 were confirmed, along with 7 deaths.

Of the patients with lab-confirmed illnesses, 78% hadn't received the complete vaccination series, and 15% were unvaccinated.

In Haiti, only 18.2% of the confirmed cases were vaccinated, and 27.3% were unvaccinated.

The United States recorded 206,000 cases of diphtheria in 1921, resulting in 15,520 deaths. Starting in the 1920s, diphtheria rates dropped quickly due to the widespread use of vaccines.

Between 2004 and 2015, only 2 cases of diphtheria were recorded in the United States, according to the Centers for Disease Control and Prevention (CDC).

In the United States, there are four vaccines used to prevent diphtheria: DTaP, Tdap, DT, and Td. Each of these vaccines prevents diphtheria and tetanus.

DTaP and Tdap vaccines also help prevent pertussis, commonly known as whooping cough.

Two of these vaccines, DTaP and DT are given to children younger than 7 years old, while Tdap and Td are given to older children and adults.

Equine diphtheria antitoxin (DAT) is the mainstay of treatment and is administered after specimen testing, without waiting for laboratory confirmation. DAT is available to physicians under an investigational new drug protocol by contacting CDC at 770-488-7100.

Diphtheria can be treated and cured successfully with antitoxin and antibiotics if started early enough. An antibiotic (erythromycin or penicillin) should be used to eliminate the causative organisms, stop exotoxin production, and reduce communicability. Antimicrobial prophylaxis (erythromycin or penicillin) is recommended for close contacts of patients.

Diphtheria’s name originates from the Greek word for “leather hide,” a reference to the gray, leather-like coating left behind in the nose and throat areas generated by the toxin diphtheria bacterium.

This pseudomembrane appears within 2–3 days of illness covering the mucous lining of the tonsils, pharynx, larynx, or nares and can extend into the trachea.

The pseudomembrane is firm, fleshy, grey, and adherent; it will bleed after attempts to remove or dislodge it. Fatal airway obstruction can result if the pseudomembrane extends into the larynx or trachea, or if a piece of it becomes dislodged.

Diphtheria is passed person-to-person through oral or respiratory droplets, close physical contact, and rarely, by fomites. The incubation period ranges between 2–5 days.

According to the CDC, the overall case-fatality rate for diphtheria is 5%–10% when treatment begins soon after diagnosis.

Sub Title:

Four vaccines prevent diphtheria: DTaP, Tdap, DT, and Td

References:

22 august 2017: Diphtheria – Epidemiological Update

Infectious Diseases Related to Travel

Diphtheria

Identification of a Human Monoclonal Antibody To Replace Equine Diphtheria Antitoxin for Treatment of Diphtheria Intoxication

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