Healthsifter by mary desmond pinkowish, since 2003

More on Whooping Cough: Why Are We Still Talking About This Infection?

It should be a distant memory. Read this excellent article by Paul Howard and James R. Copland in City Journal that explains why we may be hearing more, not less about pertussis in the future. Why did nearly 8,000 little California kids get pertussis in 2010--and 10 of them die? Lack of access to vaccine? Not quite. Howard and Copland explain here:

Last October, the National Committee for Quality Assurance issued a report finding that vaccination rates among privately insured two-year-olds declined by nearly 4 percent in 2009—even as rates among enrollees in Medicaid, the government-run insurance program for low-income families, increased. In fact, 91.2 percent of children in Medicaid received the measles-mumps-rubella vaccination, compared with 90.6 percent of children in private plans. In California’s wealthy Marin County, public health official Fred Schwartz reports that parents are “signing waivers to opt out of immunizing kindergarten-bound children.” About 7 percent of all children entering kindergarten in Marin County are unvaccinated, the seventh-highest percentage among California’s 58 counties. It isn’t surprising, then, that Marin County accounts for 15 percent of all California whooping-cough cases, despite having just 0.67 percent of the state’s population.

 Breathtaking. In the same issue, you might also enjoy Theodore Dalrymple's review of Deadly Choices: How the Anti-Vaccine Movement Threatens Us All, by Paul A. Offit.

Another Look At the Shingles Vaccine

The back story: The risk of shingles, a painful and often debilitating reactivation of chickenpox, can be lowered by a vaccine with the trade name Zostavax. It's not perfect: the vaccine lowers the risk of shingles by about 50% in older adults and reduces the risk of a nasty complication--postherpetic neuralgia (terrible persistent pain after the skin symptoms go away)--by close to 70%. Result: The CDC recommends that everyone age 60 and older get vaccinated. 

Now the story: For ages, doctors have thought that shingles was a one-time deal and that one episode protected you from subsequent episodes unless your immune system was punky. But according to a study in the current issue of Mayo Clinic Proceedings, the risk of shingles appears to be the same whether you've already had it--or not. Investigators looked at data from 1700 people who had a first episode of shingles and followed them for an average of 8 years. They found that 5% had a second episode; if they had been looking at a similar population of folks who had never had shingles, they would have expected about the same percentage to get shingles. The risk of a second episode was higher among women and in people who'd had pain for 30 or more days after the first one. You can read the summary of the original article or read the story at ScienceDaily.

Should people who've had shingles should get the vaccine to protect against another shingles outbreak?To my knowledge, no one has looked at the effectiveness of the vaccine when given to people who've already had shingles, so there's no data on which to base that decision. I hope my mother is reading. Stay tuned.

Pertussis, aka the 100-Day Cough, is Up

Pertussis rates are increasing, and under-vaccination is not the culprit according to Tara Parker-Pope's article in today's New York Times. Her description of devastating coughing fits in her fully vaccinated 11-year-old daughter is enough to send you packing to the doctor for a booster shot. Pertussis (also known as whooping cough) rates are up 7-fold from last year in California and are also up in Pennsylvania. Overall, as many as 3 million Americans may get the infection this year. 

It's bad enough that adolescents and adults may experience pertussis as "the 100-day cough" (it just doesn't go away), but babies can die of the infection. Many of them become infected before they're old enough to get the vaccine and are exposed to adults or teens with pertussis.

And why are an increasing number of adults, and especially teens getting sick? The problem seems to be waning immunity even after getting all the recommended immunizations. And you know all the warnings we get about not demanding antibiotics from our doctors for head colds? Well, it's possible that back in the day when doctors did hand out antibiotics for what appeared to be colds, they were actually treating early pertussis. No way should we routinely take antibiotics for colds, but we could get tested for pertussis more often. Unfortunately, lab tests for pertussis are pretty sketchy right now. 

As I wrote earlier this summer, my doctor gave me a Tdap (tetanus, diphtheria, and acellular pertussis) vaccine this spring. You can ask about it too. To hear what whooping cough sounds like, check out WhoopingCough.net, a site maintained by a British doc who recommends that if necessary you record your cough so your doctor can hear it (in case there's a problem with diagnosis). Think your cough doesn't matter? This baby probably caught the infection from an adult, maybe even a parent or grandparent:

Pertussis, aka Whooping Cough: What You Should Know in 2010

Dr. Glenn Braunstein hits all the high points about pertussis, better known as whooping cough in his great column today at the Huffington Post. California is experiencing its worst epidemic of this underestimated infection right now, with rates four times higher than this time last year. Babies with the infection often require hospitalization and may even die. Adults have an easier time (although the cough can linger seemingly forever), but they can spread pertussis with incredible ease and efficiency to more vulnerable people, including babies. 
If you have kids, make sure their vaccines are up-to-date. And if you're an adult, get the booster. I actually got mine last week. The shots also also protect against tetanus and diphtheria. Good deal. 

Travel Medicine and Vaccines: It's Not Just About Swine Flu

A bit overwrought...

In her column in today's Wall Street Journal, Laura Landro reminds us that Swine flu is the least of the health problems that travelers may encounter this summer. Here's an excerpt:

While swine flu has dominated the news as a concern for travelers, experts say other infectious diseases pose a far greater threat as the summer travel season gets under way. Especially worrisome are mosquito-borne diseases, including malaria, dengue fever, Japanese encephalitis, chikungunya fever and yellow fever, which are now spreading in areas where they weren't previously a danger. Travelers are also at increased risk for intestinal and skin-burrowing parasites, tick-borne diseases, sexually transmitted diseases, typhoid fever and the age-old scourge, traveler's diarrhea.

The CDC's Yellow Book is the bible of travel medicine. You can find the online version here. A new edition comes out online shortly.

What Do You Want to Know About Vaccines?

Here's a link to information sheets for all vaccines currently available in the United States. The sheets are categorized for parents/patients and for physicians. You should be able to access all.

More on the Autism Vaccine Link, Not

Here's a portion of Slate's good article on the proceedings, which they cheekily titled "In Your Eye, Jenny McCarthy":

At one point in testimony, a University of Virginia pediatric neurologist named Robert Rust tried to explain the dogged persistence of the vaccines-cause-autism theory. The believers have many data points at their fingertips, thanks to the Internet. Rust compared them to Tycho Brahe, the 16^th-century astronomer who convinced his contemporaries that the sun revolved around the Earth. Frustrated parents and scientists who have long rejected the vaccine-autism connection frequently return to that analogy. Alison Singer quit her leadership position in the charity Autism Speaks because she tired of its demand for more vaccine studies. "The question has been asked and answered and it's time to move on," she told Newsweek last month. "We need to be able to say, 'Yes, we are now satisfied that the earth is round.' "

Autism Claims Quashed in "Vaccine Court"

Feb. 12, 2009 -- The federal "vaccine court" has rejected claims that either the measles/mumps/rubella vaccine or thimerosal in vaccines caused children's autism.

The vaccine court -- shorthand for the Office of Special Masters of the U.S. Court of Federal Claims -- administers a system that since 1988 has overseen all claims for compensation due to injury from vaccinations.

Today's ruling is a major setback for the more than 5,000 cases in which families claim that the MMR vaccine, either alone or due to the mercury-based thimerosal preservative in the vaccine, caused a child's autism.

Read more at WebMD.

This ruling would be a relief if it meant that people would accept the scientific evidence that vaccines do not cause autism. I wish.

Gawker: Is Autism the Disease of the Internet Age?

Check out the entire post at Gawker. Here's a segment:

Every age, it seems, gives rise to its own medical hysteria rooted in our collective fears. Could the Internet's dehumanizing effect be driving us to fixate on autism?

It's a timely obsession. Just as polio captured the Cold War's feeling of paralysis, AIDS hysteria spoke to the sexual hangover from the '70s, and Prozac Nation answered the unease we felt about the '90s boom, autism is the disease of the moment for a time when computers are making us all feel less than human...

The sliding scale of autism may be precisely what makes it so gripping now. The worry now: Are we all perhaps a bit autistic? Is the Internet turning us into robots, unable to express our emotions without mechanical help? Instant messaging famously suppresses social cues. Needing to type ":-)" to communicate our pleasure may give the tiniest hint of what the disease may be like.

There are a host of conspiracy theories about the rise in autism diagnoses, including the completely debunked notion it has something to do with vaccines. The consensus seems to be that we're seeing more autism cases because we're more primed to look for its symptoms. In other words, we see autism everywhere because we want to. And we look for it in our kids because we're obsessed with whether we have it ourselves.

Also have a look at an article in today's NY Times Science Times about Paul Offit, MD, and his new book about autism and the non-relationship to vaccines. Offit is a well-regarded chief of infectious diseases at Children's Hospital in Philadelphia. He is also co-inventor of a rotavirus vaccine and stands to make millions from it. As a result, many on the anti-vaccine side feel justified in deriding his pro-vaccine stance. Maybe that's why so many of them have sent him death threats. The man won't even do a public book signing because of the hostility. Actress Amanda Peet is in his camp--and also experiencing the anti-vaccine movement's wrath. This passage from the Times article explains why:

In an interview with Cookie, a magazine for parents, Ms. Peet called antivaccine parents “parasites” because they relied on other children’s immunity to protect their own. She later apologized for the word but emphasized that parents should get their medical advice from doctors, “not from me or any other celebrity.”

"Parasites" was too strong a word, because unvaccinated kids don't harm vaccinated ones. Still, Peet's point is well taken, and I especially like her admonition to avoid celebrities when you want health advice. Seriously.

Shingles Vaccine: Yes or No?

The CDC now recommends the shingles vaccine for most people aged 60 and over. Should you get it? You should know that it reduces the risk of getting shingles by about 50%, meaning its effectiveness is only so-so. If you get shingles after having the vaccine, the episode will probable be less severe than if you had not received the vaccine. It's probably safe to say that most people who've had shingles--a nasty, painful, and sometimes protracted reemergence of the chickenpox infection they had as kids--regret not getting the shot. Read more about the pros and cons in the article by Peter Loftus in The Wall Street Journal's Health Matters. 

Photo courtesy of the CDC/Dr. K.L. Hermann