The New England Journal of Medicine publishes a perspective article on the antivaccinationist movement
This issue of the New England Journal of Medicine published a well written article on the antivaccinationist movement. This article was written after accusations of fraud were brought against Wakefield. Continue reading
The British Medical Journal (BMJ) today published an article that went further than the previous position of merely retracting the article published by Wakefield in the Lancet by outright calling the article not just bad science but a deliberate fraud. Anyone who read the original article when it came out would have thought that it did not make sense then either. Yet the lay press ran with the article. Conspiracy theorist, most of whom probably did not read the article ran with the idea that we are poisoning our children.
This review was published in the Nov 18th, 2010 issue of the New England Journal of Medicine. It does a great job detailing the vaccine production and some of the pitfalls in developing newer universal vaccines; influenza vaccines that do not require annual shots. It is a must read.
Lately I have been approached several times about the incidence of fever post vaccination. Data suggests that it is a rare and benign issue at best. In a placebo controlled trials it was no more frequent than in the control group.
Placebo-controlled trials demonstrated that among older persons and healthy young adults, administration of TIV is not associated with higher rates for systemic symptoms
Therefore the presence of low grade fever or the concern for fever should not be a contraindication for vaccination.
Also of interest is the recurring concern for Guillian-barre. In this series there were no cases in over 4 million doses administered.
This is link to the 2010-11 summary of the reported adverse reactions to influenza vaccination.
Just another reason to have the elderly vaccinated every year with Influenza vaccine along with appropriate 23-valent pneumococcal vaccine (when is pneumovax given?).
This prospective study in Hong Kong observed readmission rates among 36,000 elderly patients. The study found statistically significant decrease in the number of deaths, pneumonia, strokes and myocardial infarctions among the studied population.
One may ask “What does a vaccine have to do with prevention of stroke or MI?”. The reasons are that this population is at risk for these stressful infections. The burden of these conditions (sepsis) can further stress a compromised elderly patient and can “push” them into a stroke or and MI. These vaccine may not even completely prevent the illnesses themselves but by reducing the stress of the illness can go a long way in reducing morbidity and mortality from other conditions such as MI and strokes.
Also of note that very few if any “side effects” that are often cited in the lay media were seen. If there were more side effects it should have been seen in the higher hospitalization rate. In fact the vaccinated group had lower death and hospitalization rates.
For more information read the reference:
1. Hung, Ivan F N, Angela Y M Leung, Daniel W S Chu, Doris Leung, Terence Cheung, Chi-Kuen Chan, Cindy L K Lam, et al. 2010. Prevention of acute myocardial infarction and stroke among elderly persons by dual pneumococcal and influenza vaccination: a prospective cohort study. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America 51, no. 9 (November): 1007-16. doi:10.1086/656587. http://www.ncbi.nlm.nih.gov/pubmed/20887208.
A lot of confusion about who gets vaccinated with the 23-valent pneumococcal vaccine. I put together this article to help clarify some of the common questions.
Invasive pneumococcal disease is the most common vaccine preventable disease worldwide
- There is no contraindication to give pneumovax at hospital admission.
- Invasive pneumococcal disease is the most common vaccine preventable disease worldwide. 40,000 deaths are attributable to invasive pneumococcal disease in the US annually.
- Current 23-valent polysaccharide vaccine covers 95% of the most common causes of invasive pneumococcal disease.
- Vaccination reduces rates of death from invasive pneumococcal disease. At least half of these deaths are preventable with vaccination.
- Pneumovax reduces duration of hospitalization for CAP. (see reference)
- Pneumovax reduces rates of death from myocardial infarction and strokes as shown in a recent prospective trial (see reference)
- The goal of pneumovax is to reduce death from invasive pneumococcal disease NOT to reduce the number of pneumonia cases.
- The current national average for patients 65 years of age and over is 65% coverage. This is too low.
- To address the issue of why only one dose after the age of 65 please see the attached algorithm that I put together. I hope that it better explains who needs to be vaccinated and how often. The recommendations are that EVERYONE get one dose of pneumovax after the age of 65. Anyone with additional risk factors will get the greater interval of vaccination per the higher risk group.
Chart showing who gets 23-valent pneumovax
- Fisman, David N, Elias Abrutyn, Kimberly A Spaude, Alex Kim, Cheryl Kirchner, and Jennifer Daley. 2006. Prior pneumococcal vaccination is associated with reduced death, complications, and length of stay among hospitalized adults with community-acquired pneumonia. Clinical infectious diseases: an official publication of the Infectious Diseases Society of America 42, no. 8 (April): 1093-101. doi:10.1086/501354. http://www.ncbi.nlm.nih.gov/pubmed/16575726.
- Hung, Ivan F N, Angela Y M Leung, Daniel W S Chu, Doris Leung, Terence Cheung, Chi-Kuen Chan, Cindy L K Lam, et al. 2010. Prevention of acute myocardial infarction and stroke among elderly persons by dual pneumococcal and influenza vaccination: a prospective cohort study. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America 51, no. 9 (November): 1007-16. doi:10.1086/656587. http://www.ncbi.nlm.nih.gov/pubmed/20887208.
- Dominguez, Angela, Lluis Salleras, David S Fedson, Conchita Izquierdo, Laura Ruiz, Pilar Ciruela, Asuncion Fenoll, and Julio Casal. 2005. Effectiveness of pneumococcal vaccination for elderly people in Catalonia, Spain: a case-control study. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America 40, no. 9 (May): 1250-7. doi:10.1086/429236. http://www.ncbi.nlm.nih.gov/pubmed/15825026.
- Vila-Córcoles, Angel, Olga Ochoa-Gondar, Imma Hospital, Xabier Ansa, Angels Vilanova, Teresa Rodríguez, and Carl Llor. 2006. Protective effects of the 23-valent pneumococcal polysaccharide vaccine in the elderly population: the EVAN-65 study. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America 43, no. 7 (October): 860-8. doi:10.1086/507340. http://www.ncbi.nlm.nih.gov/pubmed/16941367.
- Johnstone, Jennie, Thomas J Marrie, Dean T Eurich, and Sumit R Majumdar. 2007. Effect of pneumococcal vaccination in hospitalized… [Arch Intern Med. 2007] – PubMed result. Archives of internal medicine 167, no. 18 (October): 1938-43. doi:10.1001/archinte.167.18.1938. http://www.ncbi.nlm.nih.gov/pubmed/17923592.
- Jackson, Lisa a, and Edward N Janoff. 2008. Pneumococcal vaccination of elderly adults: new paradigms for protection. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America 47, no. 10 (November): 1328-38. doi:10.1086/592691. http://www.ncbi.nlm.nih.gov/pubmed/18844484.
The preliminary results from the last H1N1 2009 vaccination season are in. So far no excess cases have been reported with the vaccine when compared to previous vaccination years. More people developed Guillain Barre without vaccination than with the vaccine (total numbers). The rate of cases per 100,000 population were slightly greater in those with vaccination than those without vaccination (0.8 per 100,000 persons greater). These results are consistent with the expected safety profile as seen in previous years.
No statistically significant association between GBS and 2009 H1N1 vaccination has been seen
More information on the history of Guillain Barre and vaccinations
Preliminary Results: Surveillance for Guillain-Barré Syndrome After Receipt of Influenza A H1N1 2009 Monovalent Vaccine — United States, 2009–2010.
We have almost completed data collection from this years influenza vaccination season. participation has been higher among healthcare associates when compared to previous seasons at 68%. Despite the improvements it is still too low to see the true benefit of herd immunity.
The most frequent reason to refuse inoculation is fear of complications. Of the 1900 doses given this year there were only 8 reported complication. Sounds like a lot at first but 7 of these were merely pain at the site of injection, yes we tracked even issues as minor as that. The remaining one felt faint and was taken to the ER only to be released back to work two hours later. No one called in sick in the subsequent weeks related to the vaccination. And there was no Gullian barre either!
Overall a successful vaccination season but hope to do better next year.
The Centers for disease control (CDC) released safety data on the current season H1N1 monovalent vaccine. Based on data collected a total of 82 adverse events were reported per million doses. This is in comparison to 47 cases per million doses seen in the seasonal influenza vaccine. At first this may seem much higher but the proportion of serious adverse effects was about the same.
Of the 3,783 adverse events reported in the 438,376 doses monitored, 204 adverse effects were categorized as serious (ending in death, hospitalization, disability) similarly 283 serious events were reported for seasonal influenza vaccination.
Of the 13 deaths that were reported nine had underlying illneses. One death occurred after a motor vehicle accident. There were no common conditions or causes of death in the 13 deaths.
With regards to Guillain Barre there were a total of twelve possible cases were reported. Of these only 4 actually met the definition of Guillain Barre.
Overall the number of adverse effects appear to be few and most of them of minor consequences. This is similar to the data published in the New England Journal of Medicine earlier. There are of course limitations in the data especially not being able to detect very rare associations but they will be after all “very rare”.
The healthcare community especially has done a remarkable job with H1N1 given the short time available to mount a response to the impending threat.
This weeks issue of the New England Journal of Medicine published and article on mandatory health care worker vaccination.
Increasing health care vaccination rates for influenza above the dismal 40% that is usually seen would help decrease transmission of influenza in health care facilities from health care worker to patient. Many of whom are too susceptible to complication of influenza. Vaccinating the health care worker is primarily to protect the patients more than the health care worker. As a bonus it has also been shown to keep health care worker absenteeism down during high hospital census months.
Though I think it is in principle a good idea. I was unsure of the constitutional and legal implications of this. This article does a good job at presenting the legal aspect of this issue. Mainly citing courts upholding vaccination where the public health safety takes precedence over personal preferences.
A few hospitals in Illinois have already instituted mandatory vaccination successfully. This may become the norm in future seasons.
Mandatory Vaccination of health care workers