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Counselors Increased Newborn Vaccinations by 7.5%

Don Hackett — Mon, 05 Aug 2019 20:28:23 +0000

Reviewer:

John Paul Sanchez, PharmD

According to a recent McGill University article, deploying an ‘empathy-driven’ approach to discussing immunization with new mothers can help reduce vaccine hesitancy.

And, protect newborn infants from vaccine-preventable diseases.

This is good news since the World Health Organization (WHO) listed “vaccine hesitancy” as one of 10 threats to global health in 2019.

A research team tested and validated an intervention approach that significantly increased the intention of vaccination (15%) within parents who had received the intervention but also increased their child vaccination coverage (7.5%) at 7 months of age.

This 2018 study called PromoVac tested this vaccination intervention approach in the Estrie region of Quebec with nearly 2,400 families.

The better news is McGill University says the “Motivational Interview in Maternity for the Immunization of Children” (EMMIE) program is now being implemented in 15 hospitals in Quebec which together see over 50 percent of all births in the Canadian province.

The goal of the EMMIE Program is to encourage positive parenting attitudes toward immunization to better meet the recommended childhood immunization schedule.

The EMMIE intervention is a standardized information session lasting approximately 20 minutes during the postpartum stay of mothers in maternity care or during the baby's neonatal care.

The information session is based on motivational interviewing techniques for immunizing children with their parents. This moment in the hospital seems to be ideal for discussing the vaccination of their newborns.

The EMMIE approach is mostly used when someone is hesitant to make a choice.

The immunization counselor uses open-ended questions, affirmative statements, reflective listening, and careful summarization to help the new mother deal with any vaccine resistance she may have and become empowered to immunize her child.

Motivational interviewing is a proven technique that has been used for many years, especially in quitting smoking.

The WHO says vaccination is one of the most cost-effective ways of avoiding disease – it currently prevents 2-3 million deaths a year, and a further 1.5 million could be avoided if global coverage of vaccinations improved.

The reasons why people choose not to vaccinate are complex.

A vaccines advisory group to WHO identified complacency, inconvenience in accessing vaccines, and lack of confidence are key reasons underlying hesitancy.

Health workers remain the most trusted advisor and influencer of vaccination decisions, and they must be supported to provide trusted, credible information on vaccines.

In 2019, the WHO and partners are committed to supporting various programs to vaccinate every last child to eradicate preventable-diseases for good.

Sub Title:

Empathy-driven vaccine counseling enhanced vaccine awareness and decreased anti-vaxx attitudes

References:

Motivating Parents to Vaccinate: A Quebec Initiative

Impact of a vaccination promotion intervention using motivational interview techniques on long-term vaccine coverage

Motivational Interviewing Program for Childhood Immunization (EMMIE)

Informed Parents for Healthy Kids

WHO: Ten threats to global health in 2019

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Montana's Pertussis Outbreak Reaches 14 Cases

Don Hackett — Tue, 30 Apr 2019 15:08:29 +0000

Reviewer:

Health Department Investigating Several Pertussis Cases in Missoula Area

The outbreak of pertussis in Missoula, Montana has now doubled from 7 to 14 cases in one week, according to Ellen Leahy, R.N., Director of the Missoula City-County Health Department.

“Pertussis has now been found in about 8 different schools, and we have some adult pertussis cases as well as children, down to the age of 4,” said Leahy to NewsTalkKGVO.

Unfortunately, this pertussis outbreak may continue expanding.

“We have 37 more pertussis laboratory tests pending in Helena and we’ll get the results back from those by later this afternoon,” said Leahy.

Previously, on April 24, 2019, the Missoula City-County Health Department said it was investigating pertussis (whooping cough) in the Missoula area and has identified more than 300 close contacts who may have been exposed to the disease.

Ages for the confirmed cases range from preschool through teenager, with 1 case requiring hospitalization.

And, there is a mix of unvaccinated and vaccinated children among these pertussis cases. Which indicates the pertussis vaccine’s immunization may be ‘waning.’

During 2018, there were 13,439 pertussis cases and 10 related deaths reported to the CDC.

Recent studies have linked the increase in ‘whooping cough’ cases to the ‘waning’ of immunity from acellular pertussis vaccines.

A new study published on April 6, 2019, reported the pertussis vaccine's effectiveness (VE) was significant during the 10 years following vaccination.

But, after a few years, the VE decreased rapidly.

These researchers estimated vaccine effectiveness against pertussis was:

92% in 2–3-year-olds
90% in 8–9-year-olds
49% in children 12–13  years of age

Moreover, this study reported whooping cough immunity was not fully restored after an adolescent dose at 14–16  years of age.

Pertussis is one of the most prevalent vaccine-preventable diseases worldwide.

The World Health Organization has recommended that a switch from whole-cell to acellular pertussis vaccines for primary immunization in infants should only be considered if additional periodic boosters or maternal immunization can be ensured and sustained in the national immunization schedules.

These researchers and the Centers for Disease Control and Prevention (CDC) say patients should speak with a healthcare provider regarding any vaccine ‘waning’ questions.

In the USA, 2 vaccines help prevent whooping cough: DTaP and Tdap. These vaccines also provide protection against tetanus and diphtheria.

Children younger than 7 years old get DTaP, while older children, teens, and adults get Tdap.

Vaccine discount coupons can be found at Vaccine Discounts.

Vaccines can cause side effects, which should be reported to a healthcare provider or the CDC.

Sub Title:

Pertussis vaccine effectiveness can wane over time

References:

Immune persistence after pertussis vaccination

Whooping Cough Vaccine Protection ‘Wanes’

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Whooping Cough Vaccine Protection ‘Wanes’

Don Hackett — Tue, 09 Apr 2019 20:41:26 +0000

Reviewer:

Pertussis vaccine effectiveness in a frequency matched population-based case-control Canadian Immunization Research Network

The resurgence of pertussis, known as whooping cough, has occurred in several high-income countries, including the USA and Canada.

Pertussis is a highly contagious infectious disease caused by Bordetella pertussis.

Recent studies have linked the increase in ‘whooping cough’ cases to the ‘waning’ of immunity from acellular pertussis vaccines.

A new study published on April 6, 2019, reported the pertussis vaccine's effectiveness (VE) was significant during the 10 years following vaccination, but the VE then decreased rapidly.

Moreover, this study reported whooping cough immunity was not fully restored after an adolescent dose at 14–16  years of age.

These researchers estimated vaccine effectiveness against pertussis was:

92% in 2–3-year-olds
90% in 8–9-year-olds
49% in children 12–13  years of age

Further data showed the VE following the teenage booster:

76% in 14–16-year-olds
78% in those 16–22  years old
children who were up-to-date with the immunization schedule, VE declined from 87% during the first year to 74% after 8 or more years following their last vaccine dose

This was a case-control study of 1,335 cases statutorily reported to public health in Ontario and occurring between January 1, 2009, and March 31, 2015.

Previously, new research suggested the bacteria which causes the disease has mutated, which may be a cause for the pertussis vaccine’s waining.

This means the current acellular pertussis (aP) vaccine formulations may no longer be a perfect match for the ‘shifted’ bacteria.

The Centers for Disease Control and Prevention (CDC) Pertussis Working Group reported on March 13, 2019, that such genetic changes may be ascribed to vaccine-driven, immune selection.

Following the introduction of vaccines against pertussis, the burden of the disease dramatically decreased.

Globally, the World Health Organization estimated as many as 142,512 pertussis cases with an estimated 89,000 related deaths in 2015.

The most recent peak in US pertussis cases was in 2012 when 48,277 cases were reported to the Centers for Disease Control and Prevention (CDC).

In the USA, 2 vaccines help prevent whooping cough: DTaP and Tdap.

These vaccines also provide protection against tetanus and diphtheria.

Children younger than 7 years old get DTaP, while older children, teens, and adults get Tdap.

Vaccine discount coupons can be found at Vaccine Discounts.

Vaccines can cause side effects, which should be reported to a healthcare provider or the CDC.

Sub Title:

Pertussis vaccine effectiveness was only significant during the 10 years following vaccination

References:

Pertussis in Other Countries

Whooping Cough Vaccination

Whooping Cough Vaccine Efficacy May Be Waning

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Older Whooping Cough Vaccine May Actually Deliver Longer Protection

Don Hackett — Mon, 09 Jul 2018 20:27:12 +0000

Reviewer:

Whooping cough vaccine: The power of first impressions

Researchers at La Jolla Institute for Allergy and Immunology (LJI) reported today that individuals who had been inoculated with the newer pertussis vaccine mount a weaker recall response when receiving booster shots later on.

Traditionally the ability to induce a high antibody titer has been the yardstick against which vaccines have been measured.

"We see a dramatic imprinting effect depending on whether people received the old or the new pertussis vaccine as part of their original childhood immunizations," says the study's senior author LJI professor Alessandro Sette, Dr. Biol. Sci., head of the Division of Vaccine Discovery, in a press release.

"Even if the booster shots they received as middle and high schoolers or as adults contained the same vaccine the immune system still has a very striking recollection of what it saw during the first immunization."

Unraveling the differences between the two vaccines is key to an understanding of how to better prevent whooping cough and may also provide important lessons on vaccine efficacy in general, potentially applicable to other vaccines.

Specifically, this study found that the new vaccine fell short of generating a robust T cells response, which provides the long-term memory that allows the immune system to mount a rapid response if exposed to the pathogen.

"Ideally, you should engage both arms of a protective response against pathogens--B cells that produce antibodies and T cells that generate long-term memory," says first author Ricardo Antunes, Ph.D., a postdoctoral researcher in the Sette lab.

"But apparently the new vaccine fails to generate an adequate T cell response."

"Although B cells are a very important component of vaccine efficacy, the important role of T cells is being more and more appreciated and the key point of our study is to show that there are striking differences in the T cell response to the two different vaccines," says Antunes.

Bordetella pertussis, the bacteria that causes whooping cough, produces a toxin that causes uncontrollable, sometimes deadly coughing fits.

Before a vaccine became available, whooping cough killed thousands of people and caused hundreds of thousands to become ill year after year.

Despite the added booster shots, whooping cough cases in recent years began to increase, and by 2015 more than 20,000 cases were reported nationwide.

With the introduction of the first vaccine, which was crafted from dead bacteria, cases dramatically declined but unwanted side effects from the whole cell (wP) preparation led the U.S. and many other countries to switch to acellular (aP) formulas that relied on purified bacterial proteins to induce immunity.

Vaccination against the disease currently involves a series of five shots given to young children at 2, 4 and 6 months of age, somewhere between 15 and 18 months, and a fifth dose between 4 and 6 years old and a final booster between 11 and 12 years old.

Pregnant women receive a single shot in the third trimester of pregnancy to protect newborns, the population at highest risk for pertussis complications.

Since the birth years of the teenagers and young adults most affected by the sudden increase in pertussis cases coincided with the nationwide switch from the wP to the aP vaccine, the question arose whether the new vaccine formulation afforded less protection.

To look for answers, the LJI team recruited 114 healthy adults who had been originally vaccinated either with wP or aP in infancy and administered booster vaccinations with aP in middle and high school and as adults and analyzed their immune response at regular intervals.

Their results clearly showed that priming in the first few months after birth with the aP or wP vaccines induces different T cell responses.

Although both are initially capable of generating protective immunity, differences evolve over more than 15 years.

In addition to more subtle shifts in B cell populations and cytokine secretion, T cells originally primed with aP gradually lose the ability to respond to booster vaccination. "These cells just sit there and do nothing while T cells primed with wP respond with a pronounced boost," says Antunes. Detailed transcriptomics analyses revealed the diminished activity of genes associated with cell proliferation.

"Since we can see clear differences in the immune signatures induced by the two different vaccines within days of a booster, this suggests that a potential path forward would be to test if new vaccines might be able to reproduce the more protective signature," says Sette.

These researchers did not disclose conflicts of interest: Ricardo da Silva Antunes, Mariana Babor, Chelsea Carpenter, Natalie Khalil, Mario Cortese, Alexander J. Mentzer, Gregory Seumois, Christopher D. Petro, Lisa A. Purcell, Pandurangan Vijayanand, Shane Crotty, Bali Pulendran, Bjoern Peters and Alessandro Sette.

The study was funded in part by La Jolla Institute for Allergy and Immunology and the National Institute of Allergy and Infectious Diseases (HHSN272200900044C, NIH U19 AI118626, and NIH S10OD016262.)

Sub Title:

Pertussis aP or wP vaccines induce different T cell responses

References:

Th1/Th17 polarization persists following whole-cell pertussis vaccination despite repeated acellular boosters

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DTaP Vaccine Re-affirmed Safe for Children

Don Hackett — Fri, 08 Jun 2018 15:09:56 +0000

Reviewer:

Safety Surveillance of Diphtheria and Tetanus Toxoids and Acellular Pertussis (DTaP) Vaccines

Kelley Lu, PharmD

One of the most common questions about vaccines given to children is whether or not a vaccine is safe to administer.

To answer this question, the authors of a new study looked for adverse reactions associated with the diphtheria, tetanus toxoid and acellular pertussis (DTaP) vaccine, from 1991 to 2016.

This study reported only 11 percent of 50,157 adverse reports related to the DTaP vaccine over that time period were rated as serious reactions.

Most of the adverse reactions involved site erythema, swelling, warmth, and, in about 20%, fever.

In addition, almost 90% of the time the DTaP vaccine had been given in conjunction with other vaccines.

This means the adverse event reported might not have even be due to the DTaP vaccine itself.

These researchers said ‘In this assessment of the safety of DTaP vaccines (Infanrix, Daptacel, Kinrix, Pediarix, and Pentacel), we did not identify any new or unexpected safety issues.’

The data for this study came from the Vaccine Adverse Event Reporting System (VAERS) of the US Centers for Disease Control and Prevention (CDC).

The DTaP vaccine was administered to 84.6 percent of children between the ages of 19 and 35 months during 2016, says the CDC.

“While there is a great benefit to the DTaP, we also know that its immunogenicity is time-limited. Booster doses are required for teenagers and adults,” said infectious disease specialist Dr. Flor Munoz.

“Providing a booster dose to a pregnant woman not only protects the woman but persistence of immunity can help protect her baby.”

“We should be happy that we can effectively prevent the spread of pertussis and in turn its life-threatening complications through the DTaP vaccine,” said Dr. Muniz.

The first DTaP vaccine was approved by the Food and Drug Administration (FDA) for use in the United States in 1991.

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

“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 these diseases cases,” 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.

This study’s correspondence coordinator is Pedro L. Moro, MD, MPH, Immunization Safety Office, Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, 1600 Clifton Rd, MS D26, Atlanta, GA 30333. E-mail: pmoro@cdc.gov.

The authors have indicated they have no financial relationships relevant to this article to disclose. The funding was provided by the Centers for Disease Control and Prevention and the Food and Drug Administration

Sub Title:

Infanrix, Daptacel, Kinrix, Pediarix, and Pentacel DTaP vaccines reported safe

References:

Reporting Vaccine Issues Just Got Easier

Pertussis Outbreak Continues in California's ‘Wine Country’

Safer Pertussis Vaccines for Children: Trading Efficacy for Safety

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