Healthsifter by mary desmond pinkowish, since 2003

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.

Which Parents Fear Vaccines the Most?

The answer may surprise you--or not. Read this interview with Seth Mnookin, author of The Panic Virus: A True Story of Medicine, Science, and Fear, at Science Insider. Here's a hint: If there's a Whole Foods store in your neighborhood, non-vaccinating parents may be counting on you to vaccinate your kids to protect their kids. Confused? Read more.

The Flu Shot: It's a Necessity, Not an Accessory

Nice job by Ariel Kaminer in the New York Times today, debunking the reasons--some of them pretty funny if completely wrong--that New Yorkers are giving this year for not getting a flu shot. Memo to the CDC: Here's an idea for next year--put out the word that the shot is in short supply but high demand. Apparently that's spirit of competition that gets people in and sleeves rolled up.  

And really, understand this: You can't get the flu from the flu shot. Does anyone still not get this? 

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. 

Eggs Be Gone: A New Way to Make Flu Vaccines, Finally

As reported by NPR, researchers are working hard to develop a faster way to make more flu vaccine that don't involve the old, slow way that requires eggs. The Wall Street Journal reports today that Novartis is ramping up to start producing these vaccines in cell cultures that will also be faster and make eggs unnecessary. In addition, Protein Sciences, Inc., of Meriden, CT, just landed a $35 million contract with the feds to start work on a system that "inserts genetic material from a flu virus into another virus that infects insect cells. The infected insect cells produce proteins that are then used to create a vaccine for humans," according to the Journal, which quotes Anthony Fauci, MD, director of the National Institute of Allergy and Infectious Diseases, as saying that this vaccine is a year or two away from market.

Egg-produced vaccines are a problem for people who are allergic to eggs--if you can't eat them, you probably shouldn't get a shot made with them. According to the American Academy of Allergy and Immunology, about 1.6% of kids--and a smaller percentage of adults--have egg allergies. A bigger problem for everyone is the length of time it takes to produce flu vaccines. It sounds like help may be on the way.

Acetaminophen to Reduce Fever After Vaccination: Skip It

Some babies and young children get a fever after vaccinations, so pediatricians sometimes recommend giving acetaminophen, the active ingredient in Tylenol and other pain relievers, before the shots to ward off the high temp. But research conducted in the Czech Republic on babies during the first 15 months of life and published in a recent issue of Lancet suggests that this may not be a great idea.

• Not that many babies actually got a high fever (39.5 degrees C or higher) after vaccination--or had serious adverse reactions or so-called febrile seizures.
• Babies who got acetaminophen at about the same time they were vaccinated produced much lower levels of helpful antibodies to the HIB bug, the diphtheria, tetanus, and pertussis bugs, and to several pneumococcal species. 

You can read a summary of the Lancet article here.

CDC Q&A About the H1N1 (Swine) Flu Vaccine

Here's everything the CDC wants you to know about the H1N1 (Swine) flu vaccine, which will probably be available this fall. You may end up getting two flu shots this year--one of the regular ones as well as the H1N1 shot.

As Medscape wrote here, the rush to production means that some shortcuts in safety testing may be necessary in order to have 60 to 80 million doses ready by the end of the year. An excerpt:

"Initial doses likely will go to those most severely hit by the pandemic so far: infants, toddlers, school-age children, pregnant women, and adults with risk factors for severe flu disease. Next week, the CDC's vaccine advisory board will recommend a priority list for exactly who will first get the vaccine.

Meanwhile, the Canadians say they will have a vaccine surplus. We'll see.

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.