MMWR: CDC Interim Guidance On Polio Vaccination For Travelers To/From Countries With WPV

Credit MMWR

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Two months ago (May 5th) the World Health Organization -  after convening a meeting of their Emergency Committee on the recent spike in polio cases in the Middle East and parts of Africa- Declared  Polio Spread A Public Health Emergency Of International Concern (PHEIC).

 

A month later, the CDC published a HAN (Health Alert Network) Advisory with New Vaccination Requirements For Travel To Countries With Active Polio.

 

Yesterday the MMWR fleshed out these new vaccine requirements in an early release called:

 

Interim CDC Guidance for Polio Vaccination for Travel to and from Countries Affected by Wild Poliovirus

Early Release

July 7, 2014 / 63(Early Release);1-4

Gregory S. Wallace, MD1, Jane F. Seward, MBBS1, Mark A. Pallansch, PhD1 (Author affiliations at end of text)

(Excerpt)

Vaccine Recommendations and Requirements

Advisory Committee on Immunization Practices (ACIP) and CDC recommendations are evidence-based and provide public health recommendations to the general public on the basis of the best available epidemiological and scientific data to prevent poliovirus infection. This includes recommendations for travelers visiting countries with WPV circulation in the last 12 months or countries and provinces where they will be in situations with a high risk for exposure to persons with imported poliovirus infection.

Three countries are still endemic for polio (Afghanistan, Nigeria, and Pakistan). Countries where WPV has circulated during the previous 12 months include those endemic countries and those with polio outbreaks or environmental evidence of active WPV circulation during this time (Cameroon, Ethiopia, Equatorial Guinea, Iraq, Israel, Somalia, and Syria). Travelers working in health-care settings, refugee camps, or other humanitarian aid settings in these and neighboring countries might be at particular risk for exposure to WPV.

Recommendations for vaccination under the International Health Regulations differ from ACIP and CDC recommendations and include exit requirements for proof of polio vaccination when leaving the country at borders or through airports. If implemented by a country, these requirements could be mandatory and are intended to prevent exportation of WPV.

Vaccine Recommendations for Travelers to Countries with WPV Circulation

Persons at greatest risk for acquiring polio are unvaccinated persons. In the United States, infants and children should be vaccinated against polio as part of a routine immunization series. Before traveling to areas with WPV circulation, all travelers should ensure that they have completed the recommended age-appropriate polio vaccine series and have received a booster dose, if necessary.*

Infants and Children

In the United States, all infants and children should receive 4 doses of IPV at ages 2, 4, and 6–18 months and 4–6 years (10). The final dose should be administered at age ≥4 years, regardless of the number of previous doses, and should be given ≥6 months after the previous dose. A fourth dose in the routine IPV series is not necessary if the third dose was administered at age ≥4 years and ≥6 months after the previous dose (11). Infants and children traveling to areas where there has been WPV circulation in the last 12 months should be vaccinated according to the routine schedule. If the routine series cannot be administered within the recommended intervals before protection is needed, an accelerated schedule can be used as follows: 1) the first dose should be given to infants aged ≥6 weeks, 2) the second and third doses should be administered ≥4 weeks after the previous doses, and 3) the minimum interval between the third and fourth doses is 6 months.

If the age-appropriate series is not completed before departure, the remaining IPV doses to complete a full series should be administered when feasible, at the intervals recommended for the accelerated schedule. If doses are needed while residing in the affected country, the polio vaccine that is available (IPV or OPV) may be administered.

Adults

Adults, who are traveling to areas where there has been WPV circulation in the last 12 months and who are unvaccinated, incompletely vaccinated, or whose vaccination status is unknown should receive a series of 3 doses: 2 doses of IPV administered at an interval of 4–8 weeks; a third dose should be administered 6–12 months after the second. If 3 doses of IPV cannot be administered within the recommended intervals before protection is needed, the following alternatives are recommended:

• If >8 weeks are available before protection is needed, 3 doses of IPV should be administered ≥4 weeks apart.
• If <8 weeks but >4 weeks are available before protection is needed, 2 doses of IPV should be administered ≥4 weeks apart.
• If <4 weeks are available before protection is needed, a single dose of IPV is recommended.

If <3 doses are administered, the remaining IPV doses to complete a 3-dose series should be administered when feasible, at appropriate intervals, if the person remains at increased risk for poliovirus exposure. If doses are needed while residing in the affected country, the polio vaccine that is available (IPV or OPV) may be administered.

Adults who have completed a routine series of polio vaccine are considered to have lifelong immunity to poliovirus, but data are lacking (12). As a precaution, persons aged ≥18 years who are traveling to areas where there has been WPV circulation in the last 12 months and who have received a routine series with either IPV or OPV in childhood should receive another dose of IPV before departure. For adults, available data do not indicate the need for more than a single lifetime booster dose with IPV.

(Continue . . . )

 

New York State’s New HCW Flu Vaccination Policy

Photo Credit – CDC PHIL

 

 

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Four years ago (2009), with the specter of the H1N1 pandemic looming, the state of New York attempted to mandate that all health care workers (HCWs) receive a yearly flu shot.

 

But due to a shortage of pandemic H1N1 vaccine that fall, and vigorous protests (and threats of legal action) by employees, in October of 2009 we saw New York Rescind Mandatory Flu Shots For HCWs.

 

Since that time, the debate over mandatory flu vaccinations for HCWs has raged. While the CDC only recommends the flu shot, many professional medical organizations have adopted policies calling for mandatory vaccination of health care workers.

 

APIC Calls For Mandatory Flu Vaccination For HCWs

AAP: Recommends Mandatory Flu Vaccinations For HCWs

SHEA: Mandatory Vaccination Of Health Care Workers

IDSA Urges Mandatory Flu Vaccinations For Healthcare Workers

 

While many infection control experts see this as a long overdue step in patient and co-worker protection, some HCWs see this as an infringement of their rights to decide what will be injected into their bodies (see HCWs: Refusing To Bare Arms & HCWs: Developing a Different Kind Of Resistance).

 

In July of this year, the CDC reported – after seeing increases in the update of flu vaccines by HCWs over the past few years – that last year (2012-13) saw little improvement over the previous year (see CDC: Uptake Of Flu Vaccine By HCWs).

 

• Available as PDF  [627 KB, 15 pages]

 

In recent years a growing number of medical facilities have implemented mandatory flu vaccination as a condition of employment, including Seattle’s Virginia Mason Medical Center and BJC Healthcare of St. Louis, Missouri  (see here and here).

 

Some states have begun to consider laws requiring HCW immunization, including last October when Rhode Island Adopts New Flu Vaccination Requirements For HCPs.

 

Earlier this month, New York state quietly passed a regulation that would require – once flu season begins – for all health care workers either to be vaccinated against influenza, or `wear a surgical or procedure mask while in areas where patients or residents may be present’.

 

Essentially, this approach allows HCWs with medical or ethical objections to flu vaccination to opt out and elect to wear a surgical facemask during flu season when in close contact with patients.

The entire regulation may be read at this link.

 

Critics point out that we really don’t know just how effective masks are in preventing the transmission of influenza to patients. The assumption is, by helping to contain respiratory secretions, they would help reduce transmission. 

 

But by how much?  No one knows.

 

Of course, flu vaccines aren’t close to being 100% effective either.

 

Most years (see CIDRAP: The Need For `Game Changing’ Flu Vaccines), protection from the flu shot runs under 60% for healthy adults, and probably even less for those over 65 or with weakened immune systems.

 

While admittedly imperfect solutions - given the increased risk to patients of serious illness or death from influenza - reasonable measures that can reduce the spread of the flu in the healthcare environment are increasingly being considered. 

 

Love the idea or hate it – short of an overturn in the courts – the requirement for annual flu vaccinations in HCWs appears to be gaining traction across the country.

OIE: H7N9 Represents An `Exceptional Situation’

 

Map Credit ECDC

 

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While I was away from my desk Crof posted a statement (see OIE on the "exceptional nature" of H7N9) from the OIE (World Organization For Animal Health) that discusses the difficulties inherent in containing an avian influenza outbreak that doesn’t visibly sicken poultry.

 

First excerpts from the statement, and OIE FAQ, and then I’ll return with more.

 

The OIE, World Organisation for Animal Health, highlights the exceptional nature of the influenza A(H7N9) event notified by China

Paris, 11 April 2013 – According to the official reports sent to the OIE by the Chinese Veterinary Authorities, poultry that have tested positive for the presence of influenza virus A(H7N9) and are also suspected of being the source of reported human cases, do not show any visible signs of disease, making it very difficult to detect this virus in poultry.

 

“Based on the information currently available we are facing a rather exceptional situation, because we are dealing with an influenza virus of very low pathogenicity for poultry which has the potential to cause severe disease when it infects humans”, stated the Director General of the OIE, Dr Bernard Vallat.

(Continue . . . )

 

 

The OIE also has a rather extensive FAQ on H7N9 Avian Influenza, portions of which are excerpted below:

 

Can culling be used as a control measure?

If the infection is detected in animals, generally a culling policy is used in the efforts to control and eradicate the disease.

Requirements include (and are described in the OIE Terrestrial Animal Health Code):

• humane destruction of all infected and exposed animals (according to OIE animal welfare standards);
• appropriate disposal of carcasses and all animal products;
• surveillance and tracing of potentially infected or exposed poultry;
• strict quarantine and controls on movement of poultry and any potentially contaminated vehicles and personnel;
• thorough decontamination of infected premises ;
• a period at least 21 days before restocking.

In the case of low pathogenic avian influenza like the current outbreaks of H7N9 declared by China, stamping out is generally applied at the level of the infected farm or within a short radius around the infected premises. 

Does OIE recommend vaccination of animals to control the disease?

When appropriate vaccines are available, vaccination aims to protect the susceptible bird populations from potential infection. Vaccination reduces viral excretions by animals and the virus’ capacity to spread. Vaccination strategies can effectively be used as an emergency effort in the face of an outbreak or as a routine measure in an endemic area. Any decision to use vaccination must include an exit strategy, i.e. conditions to be met to stop vaccination.

 

Careful consideration must be given prior to implementing a vaccination policy and requires that the recommendations from the World Organisation for Animal Health (OIE) on vaccination and vaccines are closely followed (www.oie.int\downld\AVIAN INFLUENZA\Guidelines on AI vaccination.pdf).

In short, vaccination should be implemented when culling policies cannot be applied either because the disease is endemic and therefore widely present, or the infection in affected animals is too difficult to detect.

What are the OIE recommendations for trade in poultry from a country infected with influenza A(H7N9)?

The risk analysis to be used by importing countries in order to protect their territory from pathogens introduction is very complex and is based on a long list of OIE standards.

In the case of outbreaks of low pathogenic avian influenza of the H7 strain in potential exporting countries, the trade recommendations that apply can be found in the OIE Terrestrial Animal Health Code (Chapter 10.4; 2013). These measures are science-based and should not result in unjustified trade barriers; they include zoning and the testing of the animal populations of origin.

What compensation measures should be applied for the concerned farmers?

Systems for financial compensation of farmers and producers who have lost their animals as a result of mandatory culling requested by national authorities vary around the world; they may not exist at all in some countries. The OIE encourages national authorities to develop and propose compensation schemes because they are a key to early detection and transparency in reporting the occurrence of animal diseases, including avian influenza.

What are the food safety recommendations?

Animals which have been culled as a result of control measures in response to an outbreak of avian influenza, including the A(H7N9) virus, should not enter the food and feed chain as a precautionary and regulatory measure.

There is no evidence to suggest that the consumption of poultry or eggs fit for human consumption could transmit the AI virus to humans.

What is the public health risk associated with avian influenza?

AI viruses are highly species-specific, but have, on rare occasions, crossed the species barrier to infect humans. This disease should not be confused with seasonal human influenza (flu), a very common human disease (generally caused by human H1 and H3 viruses). Transmission of AI viruses to humans has occurred when there is close contact with infected birds or heavily contaminated environments.

 

Human disease has usually been related to the transmission of a highly pathogenic virus of animal origin. The current influenza A(H7N9) virus notified to the OIE by China is low pathogenic for poultry; investigations are being conducted to demonstrate possible links with the human cases, as the genetic similarity has already been established.

 

Due to the potential for human infection, it is recommended that people working with, or in contact with poultry suspected of being infected with AI viruses, wear protective clothing including face masks, goggles, gloves and boots.

What prevention measures are recommended at the farm level?

It is essential for poultry producers to maintain biosecurity practices to prevent introduction of the virus in their flock:

• keep poultry away from areas frequented by wild fowl;
• keep control over access to poultry houses by people and equipment;
• do not provide elements on property that may attract wild birds;
• maintain sanitation of property, poultry houses and equipment;
• avoid the introduction of birds of unknown disease status into flock;
• report illness and death of birds; 
• appropriate disposal of manure and dead poultry; 
• vaccinate animals when appropriate.

 

 

 

The `exit strategy’ on vaccination mentioned in the second section above has been a largely ignored feature of the OIE avian flu recommendations for years.

 

In Avian influenza and vaccination: what is the scientific recommendation?, the OIE reiterated their strong recommendation that humane culling be employed to control avian influenza, and advising that vaccines should only be used as a temporary measure.

 

While the OIE conceded that some nations may require the use of vaccines for `several years', they have consistently urged that countries move away from that program and towards the more conventional culling policy. 

 

A policy change that has thus far failed to take hold in places like China, Vietnam, Indonesia, and Egypt.

 

For some reasons behind this lack of movement towards a culling policy, you may wish to revisit Food Insecurity And The Control Of Bird Flu.

Pakistan: Another Polio Vaccination Related Murder

 

 

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The murderous vendetta against polio vaccination teams in Pakistan continues with word today that a policeman was killed in the northwestern town of Mardan while guarding a team of polio vaccination workers.

 

Over the past 2 and a half months we’ve seen horrific coordinated attacks made against aid workers, either involved with or associated with the Polio Vaccination drives in Pakistan.

 

The first attack (see Pakistan: 6 Polio Workers Murdered) was reported on December 18th, the next day (see Pakistan: Fresh Attacks On WHO/UNICEF Polio Workers) we learned of 3 more deaths, and on January 1st  the headlines read : 7 More Aid Workers Killed In Pakistan.

 

Since then, additional attacks have occurred. Pakistan is one of 3 countries where the polio virus is still endemic (the others being Afghanistan and Nigeria).

 

Nigeria has also seen violence directed at polio workers. Earlier this month we saw Nigeria: Nine Polio Workers Murdered, presumably as part of a larger effort to impose Sharia law in Nigeria by a militant Islamist group.

 

The Pakistan attacks appear related to the Taliban’s  condemnation of polio immunization campaigns after the use of a sham hepatitis vaccination campaign as a CIA cover in the pursuit of Osama Bin Laden (see Maryn McKenna’s Update: Pakistan, Polio, Fake Vaccines And The CIA).

 

This from AFP.

 

Policeman killed in fresh attack on polio team

AFP

PESHAWAR: A policeman was shot dead Tuesday while protecting a polio vaccination team, police said, bringing the death toll in such attacks to 20 since December.

 

No one has claimed responsibility for the killings.

 

Tuesday’s killing happened at Ghalla Dher on the outskirts of the northwestern town of Mardan, on the second day of a three-day local anti-polio campaign.

(Continue . . . )

Pakistan To Resume Polio Vaccinations

 

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Three times in recent weeks we’ve seen horrific coordinated attacks made against aid workers, either involved with or associated with the Polio Vaccination drives in Pakistan.

 

The first attack (see Pakistan: 6 Polio Workers Murdered) was reported on December 18th, the next day (see Pakistan: Fresh Attacks On WHO/UNICEF Polio Workers) we learned of 3 more deaths, and on January 1st  the headlines read : 7 More Aid Workers Killed In Pakistan.

 

 

Pakistan is one of 3 countries where the polio virus is still endemic (the others being Afghanistan and Nigeria).

 

Taliban leaders condemned polio immunization campaigns after the use of a sham hepatitis vaccination campaign as a CIA cover in the pursuit of Osama Bin Laden (see Maryn McKenna’s Update: Pakistan, Polio, Fake Vaccines And The CIA).

 

Today, news from Agence France-Presse that rather than reinstituting a high profile national vaccine campaign, small well-guarded teams will begin local, targeted and low profile vaccination campaigns.

 

Security measures include excluding female health workers from participating in some of the higher risk zones, and banning motorcycles in and around vaccination sites in an attempt to prevent drive-by shootings.

 

Follow the link below for further details from AFP.

 

Pakistan resumes polio vaccines under tight security

Published on 04 Jan 2013

 

 

For more perspective on why Pakistan’s vaccination program is considered so vital by many public health authorities, we have this excellent report by CIDRAP NEWS editor Robert Roos.

 

 

WHO says polio drive must push on despite Pakistan setbacks

Robert Roos News Editor

Jan 3, 2013 (CIDRAP News) – In the wake of recent killings of polio vaccinators in Pakistan, some questions are being raised about the all-out push to eradicate polio, but the World Health Organization (WHO) says the world can't afford to back off on the eradication drive now.

 

"We've never had so few cases or such a small footprint of the virus, so we know this opportunity is not going to come back," Sona Bari, the WHO's polio eradication spokesperson, told CIDRAP News. "We've never been here before. It's now or never."

(Continue . . . )

 

The above is a small excerpt of a very long, and informative article. Well worth reading in its entirety.

Pre-Pandemic Vaccinations Revisited

 

Photo Credit PHIL

 

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In the wake of the publication of the Fouchier & Kawaoka studies (see here & here) - which suggest that the H5N1 virus may be only a few mutations away from being able to transmit among mammals – once again concerns over the possibility of a bird flu pandemic have taken center stage.

 

Despite its relative mildness, the 2009 H1N1 pandemic demonstrated the difficulty (read: impossibility) of creating, manufacturing, and rapidly deploying an emergency pandemic vaccine to billions of people in the face of a fast spreading influenza virus.

 

Were an H5N1 pandemic to break out today, even with small quantities of a vaccine already stockpiled, the vast majority of people around the world would not see a vaccine in anything less than six to twelve months.

 

And while the true CFR (Case Fatality Ratio) of the H5N1 virus remains disputed (see Revisiting The H5N1 CFR Debate), many researchers still believe it has the potential to be as deadly – or deadlier – than the 1918 Spanish Flu.

 

All of which as recently led to the resurfacing of a controversial, but potentially life-saving idea: the creation and distribution of a pre-pandemic vaccine.

 

While we’ve discussed this idea before, it was recently aired in the journal Science in an article called:

 

Influenza: Options to Improve Pandemic Preparation

Rino Rappuoli, Philip R. Dormitzer

 

While other solutions, including development of a `universal vaccine’, and improvements in our capacity to quickly produce and distribute vaccines were on their list, number one on their hit parade was the creation and distribution of a pre-pandemic H5 vaccine.

 

A pre-pandemic dose of an adjuvanted H5N1 vaccine – even if it were not an exact match to an emerging pandemic strain – is expected would blunt the impact of the H5N1 virus while the population waits for the arrival of a booster shot.

 

This idea is explored today in a Reuter’s story:

 

ANALYSIS-Bird flu vaccine now? More than a shot in the dark

 

 

As this article points out, an effective pre-pandemic vaccination program could take 3 to 5 years to conduct, and would cost billions of currently hard-to-find healthcare dollars. 

 

One of the biggest obstacles would be the public’s reaction to accepting a vaccination against a virus that – as yet – does not routinely infect humans.   

 

And no doubt, the anti-vaccine and internet conspiratorialists would have a field day with such a program.

 

This proposal, however, isn’t new.

 

We looked at this option in May of 2010 (see The Prime Of Our Lives), when the Journal Nature ran an opinion piece by Dr. Klaus Stohr, former head of the World Health Organization's global influenza program, supporting the idea of global pre-pandemic vaccination.

 

The problem is (aside from the not-insignificant costs, logistics, and difficulties gaining public acceptance) is predicting which influenza strain is likely to emerge next.  

 

Few would have pegged the H1N1 virus – a cousin to one that had been circulating for decades – to show up as a pandemic virus in 2009.

 

Which means we could spend billions priming against an H5 pandemic, only to get blindsided by an H7 or H9 virus.

 

It’s a calculated risk, though many scientists would point out that an H5 pandemic – at least right now – seems to pose a greater risk simply due to its record of lethality in humans.

 

And in fact, this strategy was employed in Japan back in 2008, when their limited stockpile of H5N1 bird flu vaccine was about to expire. 

 

They decided to `store it’ in the arms of healthcare and public safety workers, rather than pour it down the drain (see Japan Begins Pre-Pandemic Inoculation Of Health Care Workers). A similar program was launched in 2010 (see Taiwan Offers Public Bird Flu Vaccinations.)

 

Of course, we won’t know how well this little experiment works until an H5N1 pandemic breaks out, and recipients of this vaccine are shown to have fared better than those who weren’t `primed’.

 

But the idea is rooted in science.

 

In the summer of 2008 we saw a study, published in the of The Journal of Infectious Diseases, which showed that people who received an experimental H5N1 vaccine in Hong Kong 8 years before developed a strong immune response after receiving a single booster shot of a clade 1 H5N1 vaccine.

 

Influenza vaccines have an exceptionally good safety record, yet when millions of shots are given a small number of adverse reactions – some of them serious – are expected to occur.

 

When a clear and immediate viral threat is at hand, it is fairly easy to accept the risk-benefit equation presented by accepting a vaccine. But when no threat currently exists, one’s tolerance for risk – no matter how slight – tends to diminish.

 

Making a pre-pandemic jab a tough sell to an increasingly dubious public.

 

While the science makes sense (and yes, I’d probably avail myself of a shot were it made available), when you add up the costs, public relation concerns, and the sheer logistics of delivering a pre-pandemic shot to hundreds of millions (or even billions) of people, you have a formidable task.

 

One that, despite the potential benefits, governments don’t appear to be inclined to undertake right now.

Study: Safety Of Drive-Thru Vaccination Clinics

 

Photo Credit PHIL

 

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During a severe influenza pandemic some health departments have developed plans to conduct drive-thru vaccination clinics in order to speed up the dispensing of vaccines and to prevent the cross-exposure of people queuing up for the shots.

 

While studies have shown the advantages of conducting drive-through vaccination clinics (see The Efficiencies Of Mass Vaccination Clinics) there have been nagging concerns over the slight possibility that a vaccine recipient might experience a syncopal event (fainting) after driving away.

 

 

We’ve a study today, recently published in the Journal of Emergency Management, that finds the odds of a driver fainting post-vaccination to be extraordinarily low. 

 

In fact, they liken it to being less than the odds of being struck by lightning.

 

First a link to the study, then some excerpts from the press release.

 

Drive-thru influenza immunization: Fifteen years of experience

Ruth M. Carrico, PhD, RN, FSHEA, CIC; W. Paul McKinney, MD, FACP; Nicholas Adam Watson, JD; Timothy Wiemken, PhD, MPH, CIC; John Myers, PhD, MSPH
May/June 2012; pages 228-232

Abstract
Background: In 1995, a yearly drive-thru immunization program was initiated in Louisville, KY. Since then, more than 50,000 doses of influenza vaccine have been administered, with no reports of syncopal episodes or vehicular accidents.

(Continue . . . )

 

The press release, from the University of Louisville is excerpted below:

 

 

 

University of Louisville study dispels concerns about drive-thru flu clinics

Critics have pointed to fainting risks and subsequent auto accidents as reasons for concern when using drive-thru influenza immunization clinics, according to Ruth Carrico, PhD, RN, FSHEA, CIC, associate professor, division of infectious diseases, University of Louisville School of Medicine.

 

A review conducted by Carrico and UofL faculty W. Paul McKinney, MD, FACP, Timothy Wiemkan, PhD, MPH, CIC and John Myers, PhD, MSPH found these fears to be unfounded. Since the beginning of an annual drive-thru immunization program initiated 1995 at the University of Louisville Hospital, more than 50,000 doses of the influenza vaccine have been administered, with no reports of fainting episodes or related auto accidents. The study, Drive-thru influenza immunization: Fifteen years of experience published recently in the Journal of Emergency Management.

<SNIP>

This summer, Carrico plans to release a toolkit about how communities can develop drive-thru immunization clinics. It will include information on how to organize a clinic, how to train and orient staff, how to set-up the clinic and how to evaluate the success. The toolkit will point to experiences and lessons learned from the 2009 H1N1 influenza pandemic and will be available through the UofL Center for Health Hazards Preparedness website: www.publichealthtools.com

 

(Continue . . . )

PNAS: H1N1 Vaccination Produced Antibodies Against Multiple Flu Strains

 

Photo Credit – CDC PHIL

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In January of 2011 we saw a report out of Emory University and the University of Chicago that found that some people infected with the 2009 H1N1 virus appeared to have developed antibodies against other flu strains as well (see H1N1 And The Road To A Universal Flu Vaccine). 

 

An unusual and unexpected result, leading researchers to wonder if receiving the inactivated H1N1 vaccine (as opposed to being infected with the virus) produced a similar response.

 

Yesterday, the results of another study (from the same researcher centers) were published in PNAS that looked at the B cell responses of 24 healthy adults immunized with the inactivated pandemic 2009 H1N1 vaccine.  

 

 

And much like the earlier study, they found that a majority of vaccinated subjects had produced broadly cross-reactive B cells (antibodies).

 

First a link to the study and abstract, followed by excerpts from the press release.

 

Pandemic H1N1 influenza vaccine induces a recall response in humans that favors broadly cross-reactive memory B cells

Gui-Mei Li, Christopher Chiu, Jens Wrammert, Megan McCausland, Sarah F. Andrews, Nai-Ying Zheng, Jane-Hwei Lee, Min Huang, Xinyan Qu, Srilatha Edupuganti, Mark Mulligan, Suman R. Das, Jonathan W. Yewdell, Aneesh K. Mehta, Patrick C. Wilson, and Rafi Ahmed

 

 

Public release date: 21-May-2012

Emory University

Pandemic 2009 H1N1 vaccination produces antibodies against multiple flu strains

Discovery brings researchers closer to goal of 'universal' flu vaccine

The pandemic 2009 H1N1 vaccine can generate antibodies in vaccinated individuals not only against the H1N1 virus, but also against other influenza virus strains including H5N1 and H3N2. This discovery adds an important new dimension to the finding last year that people infected with pandemic 2009 H1N1 virus produced high levels of antibodies that were broadly cross-reactive against a variety of flu strains.

 

<SNIP>

 

The researchers analyzed B cell (antibody) responses in 24 healthy adults immunized with the inactivated pandemic 2009 H1N1 vaccine. Vaccination caused a rapid increase in production of monoclonal antibodies that were capable of neutralizing multiple flu strains. Three of the antibody types also were able to stick to the "stalk" region of the virus that does not change as much as other regions and thus could provide a basis for a vaccine with broader and more reliable protection.

 

Antibodies that are broadly reactive against multiple influenza strains are rarely seen in people after infection or vaccination with seasonal flu, the authors note. In the 24 vaccinated individuals in the current study, the majority of flu antibodies neutralized more than one influenza strain and also seemed to be the result of B-cell memory resulting from previous exposure to other flu strains.

(Continue . . . )

 

 

 

The generation of broadly cross-reactive antibodies after either infection with, or vaccination against, the 2009 H1N1 virus is an unusual outcome and scientists are working to determine exactly why this occurred.

 

Although flu viruses mutate constantly, it is known that there are parts of the flu virus (notably in the `stalk’) that change little over the years and are common across multiple strains. 

 

One of the strategies being employed in the creation of a universal vaccine is to target these stable regions of the virus, and hopefully create protection against a wide range of flu strains over multiple years with just one shot.

 

According to an MSNBC report, researchers involved in this study speculate that because H1N1 was such a "new" strain of flu, it forced the body to activate a rare type of B cell that produced antibodies that targeted this stable region in the `stalk’ of the virus.

 

While test subjects showed signs of antibody cross-reactivity against  H1N1, H3N2, and even H5N1, it isn’t certain whether these antibody responses are vigorous enough to prevent infection or illness, or how long they may last.

 

Still, one can’t help but wonder if the relatively mild flu season of 2011-12 might not have been due - at least in part – to some lingering levels of protection derived from the 2009 H1N1 pandemic vaccine or virus.

 

No doubt fodder for another study as scientists continue to work to understand the mysteries of influenza.

 

While the goal of creating a universal flu vaccine is still a ways off, it is hoped that these latest results will one day assist in the development of that holy grail of influenza virology.

EID Journal: Revisiting The `Canadian Problem’

 

Photo Credit PHIL

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In September of 2009, just as the second wave of the H1N1 pandemic was ramping up, news of an unpublished study began to surface in Canada that suggested that those who had received a seasonal flu shot the previous year were more susceptible to the new pandemic virus than those who hadn’t.

 

Helen Branswell, science and medical reporter for the Canadian Press, was among the first to report on it (see Branswell On The Canadian Flu Shot Controversy).

 

 

This bombshell – which began to be known as `the Canadian problem’, sent shockwaves through public health agencies, many of whom were just days away from starting up their seasonal flu vaccination campaigns as they waited for the arrival of the H1N1 pandemic vaccine expected later in the fall.

 

Suddenly, there was genuine concern that with a pandemic virus on the way, that rolling out the seasonal vaccine might be the wrong thing to do.

 

The CDC and the World Health Organization both scrambled to look at their available data, and stated that they could find no correlation between the seasonal vaccine and susceptibility to the pandemic flu . . . but that they would continue to look.

 

Meanwhile, with concerns rising, a number of Canadian Provinces halted or announced delays in their seasonal flu shot campaign, even though the study had yet to be published (see Ontario Adjusts Vaccination Plan).

 

October saw a number of new reports and studies that failed to corroborate the (still unpublished) findings, including a study published in the BMJ (British Medical Journal) that suggested exactly the opposite - that getting the seasonal flu vaccination may be slightly protective against the swine flu  (see When Studies Collide).

 

By November, with no compelling corroboration of the `Canadian Problem’, Canada’s National Advisory Committee on Immunization (NACI) came out in favor of resuming seasonal flu jabs (see NACI: Canada Should Resume Seasonal Flu Vaccinations).

 

The controversy wasn’t over, however.

 

In April of 2010 these Canadian studies were finally published by PLoS Medicine. Writing for CIDRAP, Maryn McKenna   detailed their findings.

 

New Canadian studies suggest seasonal flu shot increased H1N1 risk

Maryn McKenna Contributing Writer

Apr 6, 2010 (CIDRAP News) – Despite a rapidly launched range of studies, investigators in Canada are still unable to say—or to rule out—whether receiving a seasonal flu vaccination in the 2008-09 season made it more likely that Canadians would become ill from 2009 pandemic H1N1 flu.

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Other studies, however, failed to show any correlation, leaving us with a bit of a mystery on our hands. 

 

Fast forward to today and we’ve another study that appears ahead of print in May’s edition of the CDC’s EID Journal that looks at this supposed link, and once again, finds no evidence to support it.

 

 

Volume 18, Number 5—May 2012

Research

No Association between 2008–09 Influenza Vaccine and Influenza A(H1N1)pdm09 Virus Infection, Manitoba, Canada, 2009

Salaheddin M. Mahmud , Paul Van Caeseele, Gregory Hammond, Carol Kurbis, Tim Hilderman, and Lawrence Elliott

Abstract

We conducted a population-based study in Manitoba, Canada, to investigate whether use of inactivated trivalent influenza vaccine (TIV) during the 2008–09 influenza season was associated with subsequent infection with influenza A(H1N1)pdm09 virus during the first wave of the 2009 pandemic.

 

Data were obtained from a provincewide population-based immunization registry and laboratory-based influenza surveillance system.

 

The test-negative case–control study included 831 case-patients with confirmed influenza A(H1N1)pdm09 virus infection and 2,479 controls, participants with test results negative for influenza A and B viruses. For the association of TIV receipt with influenza A(H1N1)pdm09 virus infection, the fully adjusted odds ratio was 1.0 (95% CI 0.7–1.4). Among case-patients, receipt of 2008–09 TIV was associated with a statistically nonsignificant 49% reduction in risk for hospitalization.

 

In agreement with study findings outside Canada, our study in Manitoba indicates that the 2008–09 TIV neither increased nor decreased the risk for infection with influenza A(H1N1)pdm09 virus.

 

 

While the bulk of studies have shown no causal link between receipt of the seasonal vaccine and contracting the 2009 H1N1 virus, the results have not been 100% in alignment.

 

Leaving us with a bit of a mystery.  Why should some Canadian studies differ from those done elsewhere?

 

One fascinating hypothesis that might explain these disparate findings was proffered back in 2010 in the journal Eurosurveillance.

 

The authors suggested that infection by any influenza (or perhaps, any I-L-I) ramps up the body’s immune system for a time, making that person temporarily less susceptible to infection by another respiratory virus.

 

Since the pandemic arrived on the heels of the flu season in the northern hemisphere, those who received flu shot in the fall and thereby avoided illness might have been more likely to catch the pandemic strain than someone who had endured a bout of flu (and thereby acquired temporary generic immunity) over the winter.

 

You’ll want to read the entire paper, but I’ve included excerpts (reparagraphed for readability) from the abstract below.

 

 

Eurosurveillance, Volume 15, Issue 47, 25 November 2010

Perspectives

Seasonal influenza vaccination and the risk of infection with pandemic influenza: a possible illustration of non-specific temporary immunity following infection

H Kelly , S Barry, K Laurie, G Mercer

ABSTRACT (Excerpts)

We found no evidence that seasonal influenza vaccine increased the risk of, or provided protection against, infection with the pandemic virus.

 

Ferret experiments have suggested protection against pandemic influenza A(H1N1) 2009 from multiple prior seasonal influenza infections but not from prior seasonal vaccination.Modelling studies suggest that influenza infection leads to heterosubtypic temporary immunity which is initially almost complete.

 

We suggest these observations together can explain the apparent discrepant findings in Canada and Victoria. In Victoria there was no recent prior circulation of seasonal influenza and thus no temporary immunity to pandemic influenza. There was no association of seasonal influenza vaccine with pandemic influenza infection.

 

In Canada seasonal influenza preceded circulation of the pandemic virus. An unvaccinated proportion of the population developed temporary immunity to pandemic influenza from seasonal infection but a proportion of vaccinated members of the population did not get seasonal infection and hence did not develop temporary immunity to pandemic influenza.

 

It may therefore have appeared as if seasonal vaccination increased the risk of infection with pandemic influenza A(H1N1) virus.

 

 

It’s an attractive theory, and it has been suggested that this form of temporary immunity might even help explain why influenza pandemics tend to come in waves.

 

But it’s just a theory.

 

While results from today’s EID study match well with most of those in the literature, the authors warn that:

 

Additional epidemiologic and experimental investigations are needed to clarify the relationship between TIV use and infection with the pandemic strain.

 

Good science takes time.

 

And that means that while the evidence is currently lopsided against there being a link, more research will be needed before the `Canadian Problem’ can be fully and truly resolved.

NPM11: Giving Preparedness A Shot In The Arm

 

Note: This is day 9 of National Preparedness Month.  Follow this year’s campaign on Twitter by searching for the #NPM11 hash tag.

This month, as part of NPM11, I’ll be rerunning some edited and updated older preparedness essays, along with some new ones.

 

# 5826

 

 

While it may not leap immediately to mind when one thinks about emergency preparedness, getting and staying current with appropriate vaccines is one of the best ways to prepare for a disaster.

 

As it is September, now is the time to be arranging for your yearly flu vaccination.  ACIP  recommends that virtually everyone over the age of 6 months get the flu vaccine every year.

 

And it’s good preparedness advice, particular since during a disaster or prolonged emergency you are more likely to be tired, run down, and are probably at a greater risk of catching the flu.

 

 

In the wake of a disaster thousands of people may find themselves temporarily crowded together in shelters, where an influenza virus could spread rapidly.

 

Imagine trying to evacuate your home quickly with a couple of very sick kids, or the difficulties you might encounter finding a place to stay if your family were visibly ill with a communicable disease.

 

A simple flu vaccination each fall could go a long way towards preventing those difficult scenarios.

 

Most people think of vaccines as kids stuff.  Something you outgrow the need for.  But that isn’t true. 

 

Adults need vaccines as well.

 

During a major disaster - such as an earthquake, hurricane, or flood -  thousands, perhaps tens of thousands of people may sustain injuries ranging from small cuts and scrapes to major trauma.

 

And any of those who have let their tetanus booster vaccination lapse are at risk of serious, even life threatening, infection.

 

Even if you can obtain a tetanus shot immediately after an injury (and that could be problematic in a mass casualty event), that may not prevent infection.  It can take up to two weeks to build antibodies after getting the shot.

 

 

Tetanus is relatively rare in the United States (see Tetanus Surveillance --- United States, 1998—2000) due to aggressive vaccination campaigns, but worldwide, this infection still claims hundreds of thousands of lives each year. 

 

And the Tetanus booster shot also protects against Diphtheria and Pertussis (Whooping Cough) – an old scourge that once was almost vanquished here in the United States, but has returned with a vengeance in recent years (see California Reports 9th Pertussis Fatality of 2010)

 

 

If you have kids, talk to their pediatrician or your family doctor about what vaccinations they require. Adults can either ask their physicians, or refer to this handy vaccination schedule for adults provided by Immunize.org.

 

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Vaccines have excellent safety records. Yes, taking any medicine – including a vaccine – entails some (usually miniscule) degree of risk. But those risks pale when compared to the dangers of catching the diseases they are designed to prevent.

 

Influenza alone kills tens of thousands of people every year in this country.

 

 

Ready.gov urges all Americans to follow these 3 steps to better preparedness:

GET A KIT

MAKE A PLAN

BE INFORMED

 

But if you want to be truly prepared, I would recommend you consider adding an important 4th step.

 

Get a shot

 

MMWR: ACIP Updated Flu Vaccination Recommendations

 

 

 

# 5764

 

ACIP, the Advisory Committee on Immunization Practices, issued their recommendations that practically everyone over the age of 6 months receive a yearly flu vaccine back in 2010.  

 

ACIP reinforces that recommendation in today’s release of the CDC’s MMWR providing updated guidance for the approaching flu season.  

 

 

Prevention and Control of Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices (ACIP), 2011

Early Release

August 18, 2011 / 60(Early Release);1-6

 

(EXCERPTS)

Vaccine Strains for the 2011--12 Influenza Season

The 2011--12 U.S. seasonal influenza vaccine virus strains are identical to those contained in the 2010--11 vaccine. These include A/California/7/2009 (H1N1)-like, A/Perth/16/2009 (H3N2)-like, and B/Brisbane/60/2008-like antigens. The influenza A (H1N1) vaccine virus strain is derived from a 2009 pandemic influenza A (H1N1) virus (3).

Recommendations for Vaccination

Routine annual influenza vaccination is recommended for all persons aged ≥6 months (1). To permit time for production of protective antibody levels (4,5), vaccination should optimally occur before onset of influenza activity in the community, and providers should offer vaccination as soon as vaccine is available. Vaccination also should continue to be offered throughout the influenza season.

 

Although influenza vaccine strains for the 2011--12 season are unchanged from those of 2010--11, annual vaccination is recommended even for those who received the vaccine for the previous season. Although in one study of children vaccinated against A/Hong Kong/68 (H3N2) virus, vaccine efficacy remained high against this strain 3 years later, the estimated efficacy of vaccine decreased over the seasons studied (6). Moreover, several studies have demonstrated that postvaccination antibody titers decline over the course of a year (7--10). Thus, annual vaccination is recommended for optimal protection against influenza.

Vaccine Doses for Children Aged 6 Months Through 8 Years

Children aged 6 months through 8 years require 2 doses of influenza vaccine (administered a minimum of 4 weeks apart) during their first season of vaccination to optimize immune response. In a study of children aged 5 through 8 years who received trivalent inactivated vaccine (TIV) for the first time, the proportion of children with protective antibody responses was significantly higher after 2 doses than after 1 dose (11).

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FIGURE 1. Influenza vaccine dosing algorithm for children aged 6 months through 8 years --- Advisory Committee on Immunization Practices (ACIP), 2011--12 influenza season

 

 

 

This ACIP release also focuses on those with egg allergies, who in the past have been advised against taking the flu vaccine.

 

Recent studies have indicated that many with mild to moderate allergies to eggs can safely take the flu vaccine, and so this release offers the following recommendations.

 

Recommendations Regarding Persons with Egg Allergy

Each of the following recommendations applies when considering influenza vaccination of persons who have or report a history of egg allergy.

1. Persons who have experienced only hives following exposure to egg should receive influenza vaccine with the following additional measures (Figure 2):
   a) Because studies published to date involved use of TIV, TIV rather than LAIV should be used.
   b) Vaccine should be administered by a health-care provider who is familiar with the potential manifestations of egg allergy.
   c) Vaccine recipients should be observed for at least 30 minutes for signs of a reaction following administration of each vaccine dose.
   Other measures, such as dividing and administering the vaccine by a two-step approach and skin testing with vaccine, are not necessary.

2. Persons who report having had reactions to egg involving angioedema, respiratory distress, lightheadedness, or recurrent emesis, or persons who required epinephrine or other emergency medical intervention, particularly those that occurred immediately or within minutes to hours after egg exposure are more likely to have a serious systemic or anaphylactic reaction upon reexposure to egg proteins. Before receipt of vaccine, such persons should be referred to a physician with expertise in the management of allergic conditions for further risk assessment (Figure 2).

3. All vaccines should be administered in settings in which personnel and equipment for rapid recognition and treatment of anaphylaxis are available. ACIP recommends that all vaccination providers be familiar with the office emergency plan (18).

4. Some persons who report allergy to egg might not be egg allergic. Those who are able to eat lightly cooked egg (e.g., scrambled eggs) without reaction are unlikely to be allergic. Conversely, egg-allergic persons might tolerate egg in baked products (e.g., bread or cake); tolerance to egg-containing foods does not exclude the possibility of egg allergy (35). Egg allergy can be confirmed by a consistent medical history of adverse reactions to eggs and egg-containing foods, plus skin and/or blood testing for immunoglobulin E antibodies to egg proteins.

5. A previous severe allergic reaction to influenza vaccine, regardless of the component suspected to be responsible for the reaction, is a contraindication to receipt of influenza vaccine.

Lancet Perspective: Mandatory Flu Vaccination For HCWs

 

 

Photo Credit – CDC PHIL

# 5709

 

 

A perspective appears today in The Lancet by Arthur Caplan, Ph.D., who is director of the Center for Bioethics at the University of Pennsylvania, on the ethics of mandating yearly influenza vaccination for Health Care Workers (HCWs).

 

Arthur Caplan is the author and/or editor of nearly 25 books, and more than 500 journal articles. He writes a regular column on bioethics for MSNBC.com, and is a frequent guest commentator on NPR, CNN, MSNBC, and for major newspaper outlets, including the New York Times and Washington Post.

 

In 2008, Discover Magazine named him one of the 10 most influential people in science.

 

Not known for mincing words (see Arthur Caplan On `Flunking The Swine Flu Test’ for an earlier example), Caplan states that: “Vaccination is a duty that one assumes in becoming a health-care provider.”

 

He argues that the evidence overwhelmingly shows that vaccinating HCWs helps to protect patients from infection (and possible death), and that the influenza vaccine is both safe and effective.

 

Citing language common to all oaths sworn by health care professionals (Doctors, Nurses, Techs, etc.), he points out the universal concept that the interests of the patient must come first, and that all HCWs must honor the core medical principal of, “First, do no harm.”

 

Both tenets, he argues, are violated when HCWs fail to accept a yearly flu vaccination.

 

Yet every year, despite awareness campaigns and the endorsement by many medical organizations, less than half of all healthcare providers in the United States and the UK voluntarily agree to take the vaccine.

 

You can read the entire piece at the link below, after which I’ll return with more.

 

The Lancet, Volume 378, Issue 9788, Pages 310 - 311, 23 July 2011

doi:10.1016/S0140-6736(11)61156-2

Time to mandate influenza vaccination in health-care workers

 

 

 

While strongly advocating HCW influenza vaccination, the CDC has stopped short of mandating them. I blogged on this back on June 23rd, 2010  in  CDC: Proposed Influenza Infection Control Guidance.

 

Numerous professional medical organizations have adopted policies calling for mandatory vaccination of HCWs, however.  A few earlier blogs on that include:

 

APIC Calls For Mandatory Flu Vaccination For HCWs

AAP: Recommends Mandatory Flu Vaccinations For HCWs

SHEA: Mandatory Vaccination Of Health Care Workers

IDSA Urges Mandatory Flu Vaccinations For Healthcare Workers

 

While many infection control experts see this as a long overdue step in patient and co-worker protection, this is a hugely divisive issue, with many HCWs believing that it is an infringement of their rights to decide what will be injected into their bodies.

 

I’ve covered HCW’s objections to forced flu shots in the past, including:

 

HCWs: Refusing To Bare Arms

HCWs: Developing a Different Kind Of Resistance

 

 

Given that hospitalized patients are often at increased risk of serious illness or death from influenza, reasonable measures that can reduce the spread of the virus – such as improved vaccination rates and better infection control measures - are vital areas that many healthcare facilities need to review and improve.

 

In recent years an increasing number of hospitals have managed to implement mandatory flu vaccinations, including Seattle’s Virginia Mason Medical Center and BJC Heathcare of St. Louis, Missouri  (see here and here).

 

 

The Immunization Action Coalition (IAC) maintains a terrific website with extensive information on vaccines, and includes a growing `Honor Roll’ of organizations and practices that have adopted a mandatory flu shot policy (some exemptions may apply).

 

As we saw last month in SHEA: Improving HCW Flu Vaccine Uptake, some facilities are offering employees an alternative to taking the vaccine. This from a recent edition of Infection Control and Hospital Epidemiology.

 

An Alternate Approach To Improving Healthcare Worker Influenza Vaccination Rates

Lisa M. Esolen, Kimberly Kilheeney, Richard E. Merkle

 

Essentially, this approach allows HCWs with medical or ethical objections to flu vaccination to opt out and elect to wear a surgical facemask during flu season when in close contact with patients.

 

 

Increasingly, hospitals are looking at this as both a liability and an economic issue, on top of their concerns over patient welfare. 

 

Of course, legal challenges still lie ahead.

 

But love the idea, or hate it, the momentum appears to be moving in the direction of mandatory influenza vaccinations for Health Care Workers.

Pssst! Immunity . . . Pass it On

 

 

 

# 5648

 

 

Two related stories today involving expectant mothers and vaccines that have been in the news over the past 48 hours.

 

Both suggest that one of the best ways to protect a newborn baby against influenza and pertussis is to vaccinate the mother before she gives birth.

 

In both cases, newborn infants are too young to receive vaccines during the first months out of the womb, but may acquire limited immunity from antibodies passed on from the mother.

 

First from the Advisory Committee On Immunization Practices (ACIP) meeting this week, a recommendation that pregnant women and other adults who will be in close contacts with a soon-to-be born infant receive the Pertussis vaccine.

 

CIDRAP has the details in last night’s news scan. 

 

 

ACIP recommends pertussis vaccine for pregnant women

To protect infants in a time of increasing pertussis cases, pregnant women as well as teens and other adults in close contact with newborns should receive pertussis (whooping cough) vaccine, an advisory group to the US Centers for Disease Control and Prevention (CDC) said yesterday. The panel, the Advisory Committee on Immunization Practices (ACIP), also recommended meningococcal vaccine for high-risk infants at 9 months, according to MSNBC. The CDC still needs to decide on the recommendations but often follows ACIP guidance.

(Continue . . . )

 

 

A second report, this time from Wake Forest Baptist Medical Center, revolves around a study that appears this month in American Journal of Obstetrics & Gynecology.

 

Impact of maternal immunization on influenza hospitalizations in infants

American Journal of Obstetrics and Gynecology, 2011; 204 (6): S141 DOI:

Katherine A. Poehling, Peter G. Szilagyi, Mary A. Staat, Beverly M. Snively, Daniel C. Payne, Carolyn B. Bridges, Susan Y. Chu, Laney S. Light, Mila M. Prill, Lyn Finelli, Marie R. Griffin, Kathryn M. Edwards.

 

It found that by analyzing data collected by CDC and the New Vaccine Surveillance Network between 2002 and 2009 (before the H1N1 pandemic), that infants born to mothers who had received the flu vaccine during pregnancy were more than 45% less likely to be hospitalized with laboratory confirmed influenza.

 

This isn’t the first time that studies have shown the benefits to the newborn child derived from maternal vaccination.  

 

Last October, in Study: Protecting Two With One Shot I blogged on Lisa Schnirring’s CIDRAP News story regarding a study that showed that babies born to mothers who received the flu vaccination experienced fewer infections and hospitalizations during their first six months than babies whose mothers did not.

 

And two years before that, we had a study conducted in Bangladesh (see CIDRAP’s Study: Flu shots in pregnant women benefit newborns) that offered pretty much the same conclusion.

 

Pregnant women (and their unborn child) are at particularly high risk from influenza due to changes in the mother’s immune system during pregnancy.  This is something I’ve written about often, mostly recently in BMJ: Perinatal Outcomes After Maternal 2009/H1N1 Infection.

 

Which is why the CDC encourages pregnant women to get the flu vaccine.

 

Pregnant Women Need a Flu Shot!

Photo Credit – CDC

If you're pregnant, a flu shot is your best protection against serious illness from the flu. A flu shot can protect pregnant women, their unborn babies, and even their babies after birth.

 

(Continue . . .)

 

 

 

While the importance of maternal flu vaccination has been stressed in pediatric journals in the past, this most recent study is geared for the OB/GYN audience, which will hopefully induce them to recommend flu shots to their patients.

 

For more on this, here is a link to the Press Release.

 

Wake Forest Baptist Medical Center

Influenza vaccination during pregnancy protects newborns

WINSTON-SALEM, N.C. – June 23, 2011 – Infants born to mothers who received the influenza (flu) vaccine while pregnant are nearly 50 percent less likely to be hospitalized for the flu than infants born to mothers who did not receive the vaccine while pregnant, according to a new collaborative study by researchers at Wake Forest Baptist Medical Center and colleagues.

(Continue . . . )

 

 

And for more on the re-emergence of Pertussis in this country, you may wish to read:

 

California Reports 9th Pertussis Fatality of 2010

California Whooping Cough (Pertussis) Update

California: Pertussis Epidemic