Tag Archives: vaccine

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New England Journal of Medicine comments on Antivaccinationist

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

Commentary on British Medical Journals finding that autism study was an elaborate fraud

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.

Continue reading

An excellent review on the future developments of influenza vaccines

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.

Seasonal Influenza Flu – How often do side effects occur?

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.

Influenza vaccination reduces MI and stroke in elderly- a published study

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.

Who gets the pneumovax?

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

Remember:

  • 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

Chart showing who gets 23-valent pneumovax

  1. 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.
  2. 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.
  3. 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.
  4. 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.
  5. 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.
  6. 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.