Public Health

FDA Approves Tetanus, Diphtheria, Pertussis Booster For Adults 65+

This photomicrograph shows Bordetella pertussis bacteria using Gram stain technique. Credit: CDC. In October 2010, the Advisory Committee on Immunization Practices (ACIP) issued a new recommendation for Tdap vaccination -- the booster vaccine that provides protection against tetanus, diphtheria, and pertussis (whooping cough). While the vaccine had previously been recommended as a one-time booster for adults up to age 64, replacing an individual tetanus booster, the committee voted to expand that recommendation: anyone older than 65 who had not received a prior dose of Tdap should receive one if they expected to have close contact with an infant younger than 12 months old.

This recommendation was made partially in light of the California whooping cough epidemic. While whooping cough is typically less severe in adults, the infection can still be passed to infants, for whom infections are much more severe. Study data has indicated that grandparents, for example, are the ultimate source of the infection in 6-8% of cases. However, the committee noted that there was a direct benefit to the individual as well, since whooping cough tends to be more severe in adults older than 65 than in younger adults. (For more details, see "Advisory Committee Votes for Expanded Pertussis Vaccine Recommendations" from the History of Vaccines blog.)

Although this recommendation was issued last October, some adults older than 65 who wanted to receive a Tdap booster had difficulties obtaining one due to confusion between the ACIP's recommendation and the FDA's approved label usage for the vaccine at the time. Neither of the two Tdap vaccines (Sanofi Pasteur's Adacel and GlaxoSmithKline's Boostrix) was approved by the FDA for use in adults older than 65. More

Research May Provide New Possibilities for Universal Influenza Vaccine

Influenza A virus, transmission electron microscopy, 31,710x. Copyright Dennis Kunkel Microscopy, Inc. Each year, researchers select three influenza strains to include in the seasonal flu vaccine. Because there are so many different strains of the influenza virus, and because it mutates so rapidly, this selection is always a guess—a highly educated one based on global surveillance data, but still a guess.

In some years, the selections turn out to be remarkably accurate. During the 2010-2011 flu season, for example, the three strains selected for the seasonal flu vaccine were a very good match to strains circulating in the wild. In other years, however, researchers haven’t been so lucky. And since immunity to one strain of the flu doesn’t necessarily provide protection against other strains, a poor match between the vaccine strains and the circulating ones may mean an ineffective flu vaccine.

Researchers have long hoped to develop a so-called “universal” flu vaccine: one that could provide protection against all, or at least most, of the many strains of influenza capable of making people sick. If such a vaccine could be developed, the need for a new seasonal shot every year could be a thing of the past. More

Pacific Health Summit: June 21-23

HOV at Pacific Health Summit Just a week after a June 13 summit at which public and private donors committed $4.3 billion to continue funding the GAVI Alliance’s efforts to immunize the world’s poorest children, another vaccines summit played out in Seattle. The Pacific Health Summit, a yearly conference examining a different global health issue, convened June 21-23 with the goal of connecting decision makers in science, industry, policy, and public health to improve health by combining the latest in scientific advances with industrial innovation and effective policy. Past topics have included multi-drug resistant tuberculosis, maternal and child health, malnutrition, and pandemic influenza. More

Meningococcal Vaccine Showing Early Promise in Africa

Scanning electron microscope image of Neisseria meningitidis, 3,750x. Copyright Dennis Kunkel Microscopy, Inc. Last December, the History of Vaccines blog covered the introduction of MenAfriVac to the African meningitis belt, an area stretching from Senegal to Ethiopia, where epidemic waves of meningitis occur and can last up to three years. In the largest of these epidemic waves in history, meningitis killed more than 25,000 people from 1996 to 1997.

Polysaccharide vaccines are sometimes used to try to control outbreaks after they have begun: so-called “emergency vaccination” efforts designed to keep meningococcal epidemics from spreading further. However, these types of reactive efforts are very expensive and difficult to manage, and polysaccharide vaccines do not induce long-lasting immunity against meningococcal bacteria. (For more about the different types of vaccines, see our article and Types of Vaccines activity.)

Within these African epidemics, between 80 and 85% of cases are caused by a single group of meningococcal bacteria: group A. In 2000, a group of global health leaders gathered together by the World Health Organization (WHO) determined that a meningitis vaccine could be developed specifically for use in Africa: a low-cost vaccine that would focus solely on the Group A bacteria. The Bill & Melinda Gates Foundation provided a ten-year grant for what would become the Meningitis Vaccine Project (MVP). More

'No Bones About It' Features HoV Guest Speaker Michael Willrich

Michael Willrich addresses a crowd of about 100 at the College of Physicians. The latest episode of "No Bones About It," The College of Physicians of Philadelphia's popular YouTube series, features historian Michael Willrich. Willrich recently spoke at the College for a well-attended History of Vaccines event and discussed his most recent book, POX: An American History, which chronicles the smallpox outbreaks at the turn of the 20th century. Before the event, he sat down with Robert Hicks, director of the Mütter Museum and the College's Historical Medical Library, and the host of "No Bones About It." In this episode, Hicks and Willrich discuss compulsory vaccination, the intersection between civil liberties and public health, and the beginnings of the American anti-vaccination movements in the late 19th century. More

National Infant Immunization Week: Spotlight on Measles

U.S. measles cases dropped rapidly after vaccine use became widespread in the 1960s. (Click for full size.) National Infant Immunization Week is April 23-30 this year. This week, the History of Vaccines blog features posts about several diseases that can be prevented by vaccination of infants.

Rubeola, or measles (as it's more commonly known) is an extremely contagious viral disease. It causes a distinctive rash, fever that can reach 104°F or higher, runny nose, and cough, and has many potential complications including ear infection (in about 10% of cases) and pneumonia (about 5% of cases). In about one in a thousand cases, the patient develops encephalitis, a swelling of the brain. About one out of every thousand patients will die.

The rubeola virus spreads easily and rapidly via coughs and sneezes, and remains active and infectious in the air for up to two hours. As a result, a person can become infected just by breathing the air in a room that was occupied by a measles patient as much as two hours earlier. There is no treatment for the disease, although supportive care may be provided, and efforts may be made to lower the patient's fever. More

National Infant Immunization Week: Spotlight on Rotavirus and Pertussis

Transmission electron micrograph of intact rotavirus particles. National Infant Immunization Week is April 23-30 this year. This week, the History of Vaccines blog features posts about several diseases that can be prevented by vaccination of infants.

Although its name is not as well known as those of diseases like chickenpox or measles, rotavirus is the most common cause of severe diarrhea in children and infants worldwide. Before a vaccine was introduced in the United States, the disease caused more than 400,000 doctor's visits and 200,000 emergency room visits each year, causing as many as 60 deaths annually in U.S. children younger than five.

The virus spreads easily among children, and can also be passed from children to those with whom they're in close contact. Rotavirus spreads via the fecal-oral route -- that is, from the waste of an infected person to the mouth of another individual. This can occur via contamination on hands or objects like toys.

Rotavirus can be prevented by vaccination. The first dose of the vaccine series is recommended at two months of age. More

National Infant Immunization Week: Spotlight on Diphtheria

Diphtheria is still endemic in these countries. (Click on the image to view it at full size.) National Infant Immunization Week is April 23-30 this year. This week, the History of Vaccines blog will feature posts about several diseases that can be prevented by vaccination of infants.

Diphtheria, now nearly unknown in the United States, was once a common childhood affliction. In 1921 the country recorded more than 200,000 cases and more than 15,000 deaths, with the highest percentage of fatal cases among children younger than five. Although the last recorded case in the United States was in 2003, diphtheria remains endemic in many countries.

The disease is caused by a bacterium, Corynebacterium diphtheria, although the actual damage is not done by the bacterium itself. Instead, it secretes a toxin that damages the body's tissues. The most unique symptom of diphtheria is a thick gray substance that can spread over the nasal tissues, tonsils, larynx, and/or pharynx. This substance, called a pseudomembrane, can block the airways; in fact, diphtheria was known in Spain as "el garatillo" -- "the strangler." The toxin produced by the bacterium can also travel through the bloodsteam and damage other organs. More

Cholera Outbreak in Haiti May Reach Almost Double Predicted Cases

Dr. Jaime Ferrán Inoculating for Cholera in Spain, 1885. Image courtesy National Library of Medicine. In October 2010, cholera broke out in Haiti for the first time in decades, devastating the country while it was still recovering from the 7.0 magnitude earthquake that killed hundreds of thousands and left millions homeless just nine months earlier. In typical conditions, cholera can be treated easily with an oral rehydration solution or, in severe cases, via intravenous fluids to replace what is lost to vomiting and diarrhea. With quick treatment, nearly all patients recover. Left untreated, however, the dehydration and shock caused by the disease can kill within a matter of hours.

In Haiti, the country’s already-poor infrastructure had been additionally damaged by the earthquake, leaving conditions ripe for water- and food-borne diseases; within a month’s time, the cholera outbreak had spread across the country and killed almost 1,000 people. By the end of the year the death toll in Haiti had passed 3,000, and the Haitian government predicted that there would be more than 400,000 cases by the end of October 2011. Now, researchers at the Harvard School of Public Health and the University of California San Francisco have found that the number may reach almost twice that, predicting 779,000 cases of cholera and 11,100 deaths by the end of November. More

Interview with Paul Offit and Seth Mnookin

On March 1, The History of Vaccines hosted "Vaccine Science, Realities, and Fears in the Popular Mind" at The College of Physicians of Philadelphia. Paul Offit, MD, an infectious disease physician and vaccine developer, and Seth Mnookin, a contributing editor at Vanity Fair, discussed their new books as well as the past and future of vaccination as depicted in the media, among parents, and in the medical world. More

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