Posts Tagged ‘diphtheria’

Vaccination/Immunization: Part 3 Adults and the disease risks some of us take

Saturday, February 16th, 2013

You need protection against viruses and bacteria that lurk out there

After reading a number of articles, I decided that Lynnette and I  are up to date on all our vaccinations, but many adult are not; the CDC on Feb 1, 2013, published an online review titled "Noninfluenza Vaccination Coverage Among Adults--United States 2011" that reveals a sad picture. The first two sentence sums it up, "Vaccinations are recommended throughout life to prevent vaccine-preventable diseases and their sequelae. Adult vaccination coverage, however, remains low for most routinely recommended vaccines and well below Healthy People 2020 targets."

I had only a vague idea what does Healthy People 2020 referred to, so I found the definition on a CDC website. 

In December of 2010 the Department of Health and Human Services (HHS) launched a multi-faceted ten-year program with four major goals for our American population: 1). Attain high-quality, longer lives free of preventable disease, disability, injury, and premature death. 2). Achieve health equality, eliminate disparities, and improve the health of all groups. 3). Create social and physical environments that promote good health for all. 4). Promote quality of life, healthy development, and healthy behaviors across all life stages.

It's obviously a huge undertaking and HHS came up with 1,200 objectives (sic) organized into "topic areas" (42 of those) each covering something felt to be very important in our public health. That's too big of a chunk for me to even think of writing about today.

So in this post I'll focus on vaccinations for adults.

Every year an Advisory Committee on Immunization Practices is given the charge of reviewing and updating the recommendations for childhood vaccinations and also those for adults. The Annals of Internal Medicine published the adult schedule and comments on its changes January 29, 2013.

Let's go back to the non-influenza vaccination article; the discussion was on immunizations to protect us against tetanus, diphtheria and pertussis/whooping cough combined as Tdap; pneumococcal pneumonia, hepatitis A, hepatitis B, herpes zoster (AKA shingles), and the human papillomavirus (HPV).

The Tdap numbers were startling to me. Only 55.4 of adults over 65% are protected and <65% of adults from ages 19 to 64, but  fatality rates for tetanus are over 13%. Far too many people are taking chances with a terrible, but preventable disease. The American Geriatrics Society is urging all of us over age 65 to have the Tdap shot, to protect ourselves and our grandkids (from pertussis in the latter case).

I've written on pertussis, but to recap we're seeing more cases in the U.S. (22,550 were  reported in 2010 and many more, especially among the elderly, are never reported). There have been epidemics of pertussis in 2012-2013. If you think you're still immune to whooping cough  because you had the childhood vaccination five-shot series, you should know that an person's immunity wanes from 98% protection to 70% after five years have elapsed.

There hasn't been a case of diphtheria in this country since 2003, but lots of us travel to countries where that disease is endemic (regularly found) and the case-fatality rate for respiratory diphtheria is 5-10%.

The pneumoccocal vaccination rate for those in this country who are 19 to 64 and considered at high risk for this kind of infection (e.g., anyone whose immune system isn't at its best) is only a tad over 20%, while the 2011 figures for those of us over 65 are much higher, at 62.3% in 2011. Even in the older age group the data showed Caucasians have gotten this immunization much more commonly then Asians, Hispanics or blacks, all of whom had vaccination rates <50%.

I've had the herpes zoster shot, but I'm in the 15.8% (20111 figures) who've done so. I never wanted to have shingles after knowing two people who had prolonged excruciating pain from this disease.

HPV is the most common sexually-transmitted viral disease in the United States. The CDC says, "Almost every sexually active person will acquire HPV at some point in their lives." In doing so they increase their risk of certain cancers; in a major CDC study that covered everyone in the U.S. from 2004-2008 there were over 33,000 HPV-associated cancer cases per year.

There are a host of reasons people don't get vaccinated. The CDC has an article online that covers the topic of common misconceptions about the need to continue vaccination. Some people think that infectious diseases were being prevented by improvements in sanitation/hygiene even before immunizations were developed. Or they may believe that a majority of us have already been vaccinated so they don't need to (the herd immunity concept) or that certain "lots" of a particular vaccine are dangerous. Some think we've gotten rid of all the diseases that vaccines can prevent, so they reject having themselves get the shots.

Especially if "out there." in your case, means most of the world

Unfortunately, none of these concepts are valid and many of us travel to parts of the world that have much worse immunization statistics than America does. So, if we're not vaccinated before our trips, we run the risk of bringing home a disease and spreading it to others.

 There are some significant changes coming in the vaccination arena, but I'll save those for another time, including a few words on Hepatitis A and B. For now I'd suggest asking your physician is she/he thinks you're current in all the immunizations you need; that's especially true if you are planning a major trip somewhere outside the country.




So why are you coughing? Part one: pertussis

Sunday, January 13th, 2013

I had planned to write a followup post on personality psychology, but got sidetracked by a severe sore throat and a peculiar cough. I barked in a double rhythm over and over again. Three months ago I had an episode with a similar cough, was eventually diagnosed as having bronchitis and was treated with a short course of antibiotics. This felt more like a viral upper respiratory infection (URI), but I had problems swallowing (the med-speak term is dysphagia). I ate hard boiled egg whites and apple sauce and yogurt for the first two days of this illness. That was four days ago and I'm much better now; the  sore throat is gone and last night I got eight plus hours of sleep, uninterrupted by any coughing spells. I have a virus, but there's been a lot of concern at the national level about several diagnostic possibilities that I turned out not to have.

The first issue to mention is pertussis, AKA whooping cough. When I had my similar episode months ago, the friends we were visiting in Washington asked if I might have whooping cough. They said their state was in the midst of a pertussis epidemic. Now I had thought of it as a). a disease affecting the very young and b). a thing of the past because of vaccinations.

It turns out I was wrong on both counts. The National Library of Medicine's website outlines the entity: it's bacterial, not viral, in origin, is a URI, lasts ~ 6 weeks, and is most dangerous to infants. But it can affect us at any age and with most youngsters being vaccinated it's more commonly seen in adolescents and adults (2012 estimates were 100 cases per 100,00). Its hallmark is a peculiar cough that starts when the infected person tries to take a breath and ends in a "whoop." That paradigmatic sound is rare in those under six months of age and in adults.

Whooping cough doesn't just affect Botswana

And, in contrast to my thought that pertussis was something that I studied in the 1960s, but of little consequence today, the CDC has a webpage on pertussis outbreaks that classify it as an endemic disease (i.e., one that's always around) that has moderate peaks every 3-5 years and some severe outbreaks.

I found an article online from the Huffington Post from July of 2012 that said yearly whooping cough cases, prior to the development of an effective vaccine in the 1940s, used to number in the hundreds of thousands . Then case reports fell markedly to less than 5,000 per year. That lasted about twenty-five years with a distinct climb in the 1990s. In 2004, 2005 and especially in 2010, case numbers soared to greater than 25,000.

The CDC's provisional figures for 2012 were much higher, over 41,000 cases with 18 deaths, mostly in infants younger than 3 months.

I remembered that the American Medical Association had recently urged that all adults 65 and older get an update on their vaccination for pertussis. The easiest way appeared to get a Tdap shot, a booster vaccination against tetanus (lockjaw), diphtheria and pertussis. My problem was I had a tetanus vaccination in April, 2012, after cutting myself on a piece of metal, but I'm pretty sure they used Td (i.e., a vaccine for tetanus and diphtheria, but not pertussis). That apparently had been the recommendation in past years for those of us over 65. I've asked my physician to track down which I received and will ask, if I did get Td, if it's safe to get Tdap now, nine months later.

Diphtheria, formerly a major killer of children, is now extinct or nearly so in the United States, with no confirmed cases here since 2003 (That's not the case elsewhere in the world!). So why don't they give adults a booster with "Tap," a tetanus and pertussis vaccine? Perhaps it's because adults often travel overseas  and could conceivably be exposed to diphtheria.

This person may need a tetanus booster; how about Tdap?

A March 2012 American geriatric panel suggested it would be relatively simple to give older adults Tdap. It's also relatively difficult to diagnose whooping cough from other cough-causing diseases in older adults and pertussis can be dangerous in those over 65 according to a Duke University geriatrics professor.

Many of us in the 65+ age range have young grandchildren (or even great grandchildren) and should avoid infecting them with a serious disease. The Advisory Committee on Immunization Practices has advised we get Tdap when we need a tetanus booster and is looking into the possibility of giving it to those who've had a similar shot once before.