Archive for the ‘Immunization’ Category

Question About Newer Pneumococcal Vaccines

Q: In May of 2014, I was in the hospital for inguinal hernia repair and was offered the Pneumovax® 23, which I had been wanting for some time but none of my doctors would approve it. I did not ask for the Pneumovax® 23 at this time; it was offered to me and I accepted. I recently requested the Prevnar® 13, but my doctor denied it because I am not yet 65 (I understand the usual guidelines). I do have chronic health issues, which I believe would be an exception to the guidelines. What I don’t understand is, why give one without the other? Why be protected by 23 but not the additional 13?

The Pneumovax® 23 and Prevnar® 13 vaccines have 12 serotypes or variations, in common, which protect you against over the same 12 variations of the illness. Prevnar® 13 covers one more serotype, and Pneumovax® 23 covers 11 more serotypes. If you get immunized with Prevnar® 13 you are only getting 1 new serotype compared to the older vaccine.

What’s the main difference between the two vaccines? Although you don’t get as broad of coverage because of only 13 serotypes compared to 23 serotypes, the immune response from the Prevnar® 13 has been shown to be is a little bit better than with the Pneumovax® 23.

The Prevnar® 13 vaccine is recommended for all adults 65 years and older, but for younger adults ONLY IF you have a medical condition that causes you to be immunocompromised, such as removal of your spleen, HIV infection, organ transplant, chronic kidney failure, or long term use of immunosuppressive drugs like cortisone or Humira®. If you have one of those conditions, the Prevnar® 13 would give you a little better protection.

Since you received the Pneumovax® 23 before age 65, you should get another dose of it at or after age 65. However, for the best protection you should wait at least 11months or 1 year before getting the other pneumococcal vaccine. This means that if you get the Prevnar® 13 at age 65, you should wait a year before getting the Pneumovax® 23.

According to the Centers for Disease Control and Prevention (CDC), the maximum number of pneumococcal vaccines needed three: up to 2 doses of the older Pneumovax® 23 vaccine and only 1 dose of the Prevnar® 13. Most pharmacies carry both vaccines and can administer them to you. If your doctor declines to give you Prevnar®13, you have the option of going to your local pharmacy and having them give it to you.

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Another Pneumonia Shot

Q: What’s this about a new pneumonia shot? Do I need another one?

Probably. If you are 65 years old or older you should get two different “pneumonia shots” but you only have to get each of them once for lifelong protection. The vaccine that’s been used in infants is now recommended to be given to older adults in addition to the older adult formulation already being given.

Although many people call it a “pneumonia shot” it doesn’t really protect you against getting pneumonia. It really protects against infections caused by a particular bacteria. This bacteria has several names, including pneumococcus, Streptococcus pneumonia or S. pneumoniae. Pneumococcus can cause life-threatening infections of the lungs, the blood and the brain both in very young and in older people. Children younger than 2 years old and adults 65 years and older are most vulnerable to serious infection by pneumococcal bacteria.

Thousands of adults are hospitalized with life-threatening pneumonia caused by pneumococcal bacteria, and 18,000 adults age 65 and older die every year from pneumococcal infections. Pneumococcal bacteria can also cause an infection of the blood, called bacteremia and meningitis, which is infection of the lining of the brain.  According to the Centers for Disease Control and Prevention (CDC) based in Atlanta, pneumococcal bacteria are responsible for 1 out of every 5 cases of meningitis in the United States and are the most common cause of bacterial meningitis in children under 5 years of age.

Meningitis from infection with S. pneumonia is very difficult to treat with antibiotics. 40% of adults over the age of 65 who contract pneumococcal meningitis will die and those who survive are often left with permanent damage to their brain and nervous system. The CDC’s Active Bacterial Core Surveillance System documented 41,000 cases of serious pneumococcal disease with 4,900 deaths during 2006, and considers it one of the most preventable causes of death in the United States.

With more than 90 strains called serotypes of pneumococcal bacteria floating around, these vaccines protect us against the strains most responsible for severe infections by targeting a polysaccharide compound unique to each.

The CDC is now recommending giving Prevnar 13 vaccine to older adults as well as young children, for two reasons. Prevnar 13 will give protection against one  serotype that’s not included in the other one. It’s also made with an extra protein, added which acts to trigger a stronger immune response, making it more effective.

The CDC recommends all adults 65 years old and older receive BOTH pneumococcal vaccines, Prevnar 13 and Pneumovax 23. Most adults need only 1 shot of each in order to achieve lifetime immunity, but not at the same time. These vaccines should be given at least 1 year apart. Medicare will pay for each one.

Do you need the “new” pneumonia shot called Prevnar 13?

1.    YES, if you are over 65 years old and have never had a pneumococcal vaccine. The CDC recommends you get the other vaccine (Pneumovax 23) too, but one year later than your first one.

2.    YES, even if you’ve already had a shot of the Pneumovax 23, as long as it was at least a year ago. If you were younger than 65 years old when you got your first pneumococcal vaccine, you may eventually need another shot of Pneumovax 23, but you need to wait at least one year after getting vaccinated with Prevnar 13 and at least 5 years after a previous dose of Pneumovax 23.

3.    YES, if you are not yet 65 years old but have a medical condition that puts you at a higher risk of getting a serious infection. Your doctor can help you decide if you should get it.

4.    Possibly, if you are a healthy adult between 50 and 65 years old. Because one dose of Prevnar 13 will cost around $180, I suggest checking with your insurance first to see if they would pay for any of it before making a final decision.

Medicare will pay for both pneumococcal vaccines regardless of which one you get first, but ONLY if you get them at least 11 months apart. More information about the pneumococcal vaccines is available at www.cdc.gov/features/adult-pneumococcal.

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Is It Flu Season Again?

October 6th, 2014. Filed Under: consumer information, Immunization, Influenza.

Q: Last week I saw an advertisement for getting flu shot at a local pharmacy chain. It was only the first week of September, but they were already offering flu shots. Is that the best time to get vaccinated against the flu?

The peak flu season in the United States runs from October through March, with most infections occurring in February. After getting a flu shot it takes about 2 weeks to become fully effective and gives you the best protection for the next 12 weeks, after which your flu protection slowly decreases. Will one flu shot last you an entire flu season, even if you get it in September? If you are young and healthy, the answer is yes; one shot will provide you with good protection for the entire flu season.

Unfortunately, older Americans do not get as much protection against the flu from flu shots. The Center for Disease Control (CDC) recommends getting a flu shot anytime after the vaccine becomes available because they don’t want to miss any opportunity for most Americans to get vaccinated. But if you are over 60 and it’s convenient for you, it might be better to wait and get your shot a little later to match up your 12 weeks of best protection from the vaccine with the peak month of illness from influenza, which is typically in February.

If you are over 65, it’s especially important you get a flu shot. Every year between 5-20% of Americans become ill with influenza. Those age 65 and older have an increased risk of serious complications from influenza such as pneumonia, dehydration and worsening of chronic conditions such as lung disease, congestive heart failure and diabetes. 90% of the deaths associated with influenza occur in the over-65 age group.

One of the biggest challenges to preventing deaths from influenza is just keeping up with it.  Measles, mumps, and chicken pox viruses have stayed pretty much the same over the decades we’ve had vaccines against them. Not so with influenza; it keeps changing its shape, making it harder for our immune system to detect and respond to. The World Health Organization (WHO) keeps track of influenza patterns across the world with centers in Tokyo, Beijing, Melbourne, London and Atlanta.

Most new types or strains of influenza start in China, where farmers live among the animals they raise. Various influenza strains infect geese, chickens, ducks, pigs and humans, sometimes without any outward signs of illness. While inside its host, the virus reproduces itself millions of times. Small errors can occur during the replication process and instead of an exact copy the virus may end up slightly different. If the new version proves to be better at causing disease than the original strain, it replaces it, introducing a more powerful strain into the world.

If two different strains infect the same host, it’s possible for them to come in contact with each other as they reproduce. If part of one strain accidently swaps part of itself with another strain instead of with itself, a “new” influenza strain is created. Most scientists believe the next pandemic will be from an influenza virus that was accidentally transformed like this.

Most human influenza is caused by 2 strains, called A and B. The A strain causes more severe symptoms and is associated with pandemics. The particular strains chosen for each season’s flu vaccine are selected because they are most likely to infect you, to cause you serious illness and can be grown into a commercial vaccine in time for flu season. Traditionally, influenza vaccines have had 3 strains and are called trivalent: two A strains and one B strain but starting last year there are vaccines with 4 strains, two each of A and B.

Influenza vaccine has been traditionally grown in eggs, but some of this year’s vaccine was produced using newer techniques. Flublok® uses recombinant technology to grow influenza virus completely without eggs and is safe for people who have a severe egg allergy. Another vaccine is grown in cell culture, which is exciting because it produced vaccine more rapidly than the traditional way. Having more rapid methods for producing influenza virus would be of great value during influenza pandemic.

There were no new strains of influenza circulating this past year, so this fall’s flu vaccine is the same formula as the ones used last year. Because your protection from last year’s vaccination has faded, be sure to get another flu shot. There’s more for you about the flu at http://www.cdc.gov/flu/keyfacts.htm.

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Not Just A Pneumonia Shot

December 14th, 2012. Filed Under: Immunization, Influenza.
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Q: I get a flu shot every year. Don’t I need a pneumonia shot, too?

What many people call the “pneumonia shot” is actually a vaccine that protects you from being infected by a particular type of bacteria instead of against a particular disease.

This bacteria has several names: pneumococcus, Streptococcus pneumonia and S. pneumoniae. The vaccine that protects against it is called pneumococcal vaccine, which is designed to protect you against life-threatening infections of the lungs (pneumonia), the blood and the brain (meningitis).

Amazingly, pneumococcus bacteria doesn’t ALWAYS cause serious infection. It’s not unusual to find it living in our nose or throat from time to time without causing any signs or symptoms of infection. Having bacteria living on our skin or inside our bodies without causing an infection is called colonization. The Centers for Disease Control (CDC) based in Atlanta estimates that up to 10% of all Americans are colonized with pneumococcus at any one time and most of us have been colonized with it at some point during the past year.

The most common infection caused by pneumococcus is a bacterial ear infection in children called otitis media. Before a vaccine became available in 1997, pneumococcus was responsible for 5 million cases of otitis media in children every year.

S. pneumoniae got its name from its ability to cause pneumonia, the most deadly complication of contracting influenza or “the flu”. Between 100,000 and 135,000 adults each year are hospitalized with life-threatening pneumonia caused by pneumococcal bacteria.

Other serious infections caused by pneumococcal infection include a blood infection called bacteremia and meningitis, infection of the lining of the brain.  According to the CDC this bacteria is responsible for 1 out of every 5 cases of meningitis in the United States and is the most common cause of bacterial meningitis in children under 5 years of age.

Meningitis from infection with S. pneumonia is very difficult to treat with antibiotics. 40% of adults over the age of 65 who contract pneumococcal meningitis will die and those who survive are often left with permanent damage to their brain and nervous system.

The CDC’s Active Bacterial Core Surveillance System documented 41,000 cases of serious pneumococcal disease with 4,900 deaths during 2006, and consider it one of the most preventable causes of death in the United States.

The populations at greatest risk for serious disease are children who are younger than 2 years old and adults 65 years old and older. At this time there are 2 different pneumococcal vaccines used in the United States, one for each of these two age groups.

Most adults will need only 1 shot in order to achieve lifetime immunity, although in certain medical conditions a second shot may be recommended.

You SHOULD get vaccinated with pneumococcal vaccine IF:

 1.            You are over 65 years old and have never had the vaccine.

 2.            You have had one vaccination but you were not yet 65 years old at the time AND it has been at least 5 years since your first vaccination.

 3.            You are not yet 65 years old but have a medical condition that puts you at a higher risk of getting a serious infection. A medical condition that increases your risk would include cigarette smoking, diabetes, asthma, heart or lung disease, kidney or liver disease, or an impaired immune system including HIV infection or AIDS, cancer, or an organ transplant. Additional conditions that have been linked to serious disease are having a cochlear implant to treat severe hearing loss or having fluid leaking from your brain.

4.            You are not yet 65 years old but have a medical condition that puts you at a higher risk of getting a serious infection AND it has been at least 5 years since your first vaccination.

Unlike influenza vaccine, with just one shot your pneumococcal vaccination should last a lifetime.

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Can The Flu Vaccine Give You The Flu?

Q: My husband doesn’t get a flu vaccine because he swears, “it gives me the flu”. Can the flu vaccine actually give you the flu?

My husband believes this, too.  His memory of “getting the flu from the flu vaccine” is from getting the “swine flu” vaccine back in 1976. Because he remembers feeling sick soon after his immunization shot, he has avoided getting vaccinated for influenza ever since.

My very first flu shot was also from the swine flu vaccine in 1976, and like my husband, I vividly remember having muscle aches, headache and fever afterward. Like him, I avoided getting a flu shot for years, until in 1990, influenza put me flat on my back in bed for 2 weeks. After that, I started getting the flu shot every year, and I haven’t been sick like that since.

There are two types of influenza vaccine available in the United States: inactivated vaccine and live attenuated vaccine. The most common type is the inactivated flu vaccine, which is injected. It’s not alive, so it cannot infect you. When injected, the dead virus triggers your immune system to make antibodies against it.

The live vaccine works by reproducing itself and multiplying until your immune system sits up and notices, then makes antibodies against it. This is just like when you are infected with it, but the live virus has been changed (attenuated) so that it doesn’t cause any disease symptoms.

Flumist® is a live attenuated vaccine made of influenza virus that has been genetically modified to prevent it from reproducing in the lungs. It only replicates in the nose, mouth and upper throat. First introduced in 2003, it is approved only for people between the ages of 2 and 49.

The main types of adverse reactions to vaccines are local, systemic and allergic. The most common type of reaction is local, the area right around the spot where you received the injection. Redness, tenderness and swelling are the most common types of local reaction, and occur in half of all vaccinations.

Allergic reactions are rare, and are not always from the actual organism. Allergic symptoms can be triggered by cell culture material such as eggs, stabilizing compounds or by the preservative, thimerosol.

Systemic reactions to ANY vaccination, not just influenza, can give us fever, malaise, muscle aches, nausea, or headache, with malaise and headache the most common ones reported. Because these reactions are similar to symptoms of common viral illnesses, it’s easy to confuse these vaccine side effects with a viral illness.

Another reason we can get confused is how we refer to most viral illnesses as either having “a cold” or “the flu”. We say, “I’ve got the flu” whenever we suffer from muscle aches with headache or fever. Or we’ll say, “I have stomach flu” to describe having nausea or diarrhea. We call a lot of illnesses “the flu”, but infection with influenza virus is very rare outside of the winter months.

As the United States learned the hard way during the 1976 swine flu debacle, it’s important to be sure that each new influenza vaccine is not just effective, but safe. The Food and Drug Administration (FDA) and Center for Disease Control and Prevention (CDC) choose which strains of influenza to use for the upcoming  flu season in late February to allow enough time to do that. They need time for the drug companies to be able to grow the vaccine and then for clinical trials to measure each formulation for immunogenic response, called “immunogenicity”, and its ability to cause adverse reactions, also called “reactogenicity” before approving it for use.

In 2010, clinical trials for 2 adult vaccines against influenza in Western Australia found that although each formulation created adequate immunity, one vaccine had significantly more muscle aches and fever reported with it than the other one. The one with the greater “reactogenicity” was not approved for use in children.

Influenza causes over 36,000 more deaths every year in the US, with 90% occurring in Americans 65 years and older. When offered a flu shot every fall, my husband has always said, “I’ll take my chances.” Before this year, I’ve let him be. But now that my beloved is 63, I’m going to ask him to reconsider.

This year, I’ve decided to take the CDC Flu Vaccination Pledge:  “I have already received my flu vaccine but will encourage my friends and family including my dear husband to do so, for the 2012-2013 season.”

It’s not too late to vaccinate!

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What Goes Into the Flu Vaccine?

A “flu shot” is different than other vaccines because the influenza virus is different. Vaccines against other viruses like measles, mumps, and chicken pox have stayed pretty much the same over the decades they have been in use. Influenza is different because it changes its shape almost continuously, and when it does, the vaccine against it loses its effectiveness. The biggest public health challenge of influenza is keeping up with the changes in the virus so that the vaccine that protects us against it can be updated to match.

There are 3 main types of influenza virus, also caused strains: Influenza A, Influenza B, and Influenza C. Influenza A causes most cases of influenza in humans, as well as the most severe. Most widespread epidemics, called pandemics have been caused by Influenza A. The most recent formulations of influenza vaccine contain 3 different strains of influenza: 2 strains of A and one strain of B. This will probably change next year because the FDA has just approved a new formulation that will allow a total of 4 strains in the vaccine.

How likely we are to become ill with influenza depends on whether we have been exposed to it before, and how effectively our immune system can respond to it.

When we come in contact with someone sick with influenza virus, we’ll be able to fight it off more effectively if we’ve encountered that particular strain before. This is because we have antibodies left over from our previous encounter with it. If we are exposed to a strain of influenza that is new to us, we’re more likely to become sick from it because we don’t have any antibodies left over to help us fight it, and have to start making them before we can fight back.

The flu vaccine will only protect us against the 3 specific strains of influenza that it contains. Once the virus changes, the vaccine doesn’t protect against the new strain as well. In order for the flu vaccine to continue to protect us, it has to be changed to match. To do this, we need to keep track of the influenza virus so that that we’ll know when it’s made another change. Since most new strains of influenza start in China, a nationwide network of surveillance is not enough. To keep up with influenza, you need a global network, like the one used by the World Health Organization, or WHO.

The WHO tracks currently circulating strains of influenza with over 100 influenza centers in more than 100 countries. These centers funnel information into five Centers for Reference and Research on Influenza, based in London, Melbourne, Tokyo, Beijing and Atlanta. These centers report on which flu viruses are currently circulating, identify newly emerging virus strains, and assess how these match up with current influenza vaccine components.

Which strains of influenza get included in our flu vaccine? The two main criteria used to decide which of the many strains of influenza circulating around the globe are included in the upcoming vaccine are the likelihood of a particular strain to cause significant illness in the United States, and the severity of the symptoms it causes.

Each February, the WHO meets to summarize the results of their ongoing global monitoring of influenza and to make recommendations of specific strains to include in flu vaccine formulas used in the Northern Hemisphere. They meet later in the year to select strains recommended for the Southern Hemisphere.

The WHO met in Geneva on February 23, 2012 to report on global influenza patterns and make recommendations for the Northern Hemisphere vaccine. Attending that meeting was a representative from the Center for Disease Control and Prevention (CDC), based in Atlanta. On February 28th, the CDC and the Food and Drug Association’s (FDA) Vaccines and Related Biological Products Advisory Committee voted on the exact formulation of our influenza vaccine.

The decision needs to be made as soon as reasonably possible, to allow time for vaccine makers to create the nearly 200 million doses that will be needed for the US population.

National Influenza Vaccination Week is December 2-8, 2012. Have you and your loved ones had their flu shot for this year? It’s not too late. Pharmacies and medical clinics have plenty of vaccine. Please contact them today to get your flu shot.

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