Hot Shots

ImmTrac Modernization

House Bill 772 is in the Senate Health and Human Services committee at the state legislature. This bill would improve ImmTrac, the state immunization registry, and save the state money by acknowledging the fact that well over 95 percent of the state’s parents want to participate in this valuable safeguard of their child’s immunization records, and having parents and young adults only required to complete paperwork if they choose to opt out of the system rather than obtain written consent for every individual. It will continue to protect the privacy of records and allow individuals who wish not to participate to do so.

As the system currently functions, every parent has to consent or decline at the birth of their infant, with that paperwork needing to be processed by the birth registrar and the state. The change would mean that only the declinations need to be processed, saving the system about 90-95% of the processing and work time. Also, when children turn 18, they are currently sent a notice in the mail to go online and renew their consent as adults.

If your child is anything like mine, getting them to read and respond to real mail (as opposed to email) is really difficult, and many kid’s records then are purged from the system at age 19 – just when they begin to need them again for college and job requirements.

Kudos to Representative Donna Howard for sponsoring this bill. 

HPV Vaccine Works, but Many American Parents Still Squeamish

Here is a bit of great vaccination news for my readers - HPV vaccination not only protects those who are vaccinated against genital warts, but reduces the likelihood that others in their generation will suffer from them.  It will be years more before we prove that cervical cancer rates decline, but this striking reduction in rates of genital warts is reason enough to be vaccinated!  We in Texas need to follow Australia's lead and promote HPV vaccination for all Texas teens!

Click here for the FOX News article.

Breastfeeding Can't Replace Immunizations

Dr. Mouzoon was a featured guest on MOMmunizations blog, talking about how breastfeeding is the best line of defense for your newborn baby.

Click here to read the story.

Health Care Innovations Exchange

Late last year, I blogged about our uncoordinated system of medical care in the US.  The value of systematic health care can't be overstated in terms of reducing cost and increasing effectiveness.  As just one example of this, within Kelsey-Seybold, our OB/Gyn doctors have access to immunization support services not found in most private OB offices.  This has resulted in a yearly increase in the proportion of our pregnant women who are protected by immunization against the flu (and Tdap as well!).  For more information, check out this link:

Vaccine Reactions – What do they mean?

Vaccine reactions cause a lot of unnecessary concern for most parents and patients.  Most vaccine reactions occur at the site of the vaccination, whether injected, ingested or sprayed into the nose. These reactions – soreness in the muscle, redness or itchiness in the overlying skin, mild stomach upset or runny nose and sore throat – are signs that the vaccine is working.  When your immune system recognizes a protein that is “not mine,” it sends white blood cells and a host of specific proteins to the area to check out the threat and respond to it. These cells and proteins cause the local reaction, and sometimes fever.

Fever:  Fever is a generalized response of the immune system that heightens its performance against illness as well as to immunizations.  Recently it was reported that giving Tylenol to lower the fever response of infants to routine immunizations may in fact make them less protected by the vaccine!

Anaphylactic Reactions: There are serious vaccine reactions that should not be ignored.  The most common are severe allergic reactions, especially those characterized by wheezing or swelling of the airway, generalized hives, and lowering of blood pressure.  These are “anaphylactic” reactions, and require immediate medical attention or may be fatal. 

Anaphylactic reactions are uncommon (1 to 50 episodes per million vaccine doses, depending upon the vaccine) and easily treated, but require avoidance of that vaccine or perhaps components of that vaccine in the future.

This type of reaction usually occurs within minutes to hours of immunization, and is the reason most doctors keep immunized patients around for a bit after the immunization. Let your doctor know if you have a history of severe allergic reactions to antibiotics or vaccinations.  Some vaccines have antibiotics such as neomycin or polymixin in them.

Arm Swelling: Some individuals will get a marked swelling of the entire arm when they receive a tetanus/diphtheria booster.  This “arthus reaction” is painful and a good reason to avoid that vaccine in the future unless your particular risk is high – if, for example, your occupation puts you at high risk for injury and tetanus exposure, or you are traveling to an area with a diphtheria outbreak.  This is lso a type of allergic immune response.

Weakened Immune Systems: Folks with weakened immune systems can have serious infections from live virus vaccines – most notably MMR, Varicella, and Yellow Fever vaccines.  Those with known genetic or medical conditions that impair their immune systems should not be vaccinated with these vaccines, and those on medications such as steroids or cancer chemotherapy should wait until their immune system recovers before being immunized.  The infections caused by these vaccines are much like those caused by the “real deal” – measles (including encephalitis), chickenpox (including pneumonia), and yellow-fever (“viscerotrophic disease,” which attacks all of the major organs).

Neurologic Reactions: In rare instances, individuals will have neurologic reactions that are difficult to link directly to the vaccine.  Auto-immune syndromes exist that can occur days to months after infections or after vaccinations. It is often not clear what the causative agent is.  These may include Bell’s palsy, a temporary paralysis of facial nerves more often associated with strep throat and viral illnesses and Guillain-Barre syndrome, a temporary but widespread paralysis which most often follows campylobacter diarrhea

New Flu Vaccines

When is a flu vaccine really new? When its components change, as they usually do annually? When the method of delivery changes, as with the new intradermal vaccine? When the amount given changes, as with the High-Dose vaccine for folks over 65? 

Or is it only new when the means of manufacturing it change, like when the nasal mist came out and the vaccine could be given as a live virus instead of injected as a killed one? Or when preservative-free vaccine became available in response to concerns about vaccine preservatives?

Next year, there will be a “cell culture” flu vaccine available, which will be just like the vaccine made in chicken eggs, except that it will be made in cell cultures instead. This is a great advance for those who are severely allergic to eggs, as they will now be able to be vaccinated. It will also allow for the manufacture of large quantities of vaccine without needing chicken eggs, and may shorten the time it takes to produce adequate vaccine each season – but other than how it is made, it will be the same old vaccine.

There is also a “quadrivalent” flu vaccine on the horizon. For years, we have had “trivalent” (TIV) flu vaccine, with two strains of influenza A and one of influenza B in it. Deciding which influenza B to include can be tricky, and some seasons have had more than one strain circulating, so one company has decided to produce the vaccine with two different B strains in it. This will provide a modest reduction in your chance of catching the flu, particularly if you’re not good about getting your vaccine every year.

 I think every one of these new vaccines is an advance against the flu, which still kills more people than any other vaccine-preventable disease in the US. The more weapons we have against the flu, the better! Ask your physician which “new” vaccine is best for you – though you may be surprised that the old one is still just fine for almost everyone!

Where is YOUR shot record?

When was the last time you had an immunization besides the influenza vaccine?  Did you get a shot record to keep?  Is it in your wallet, at home in a file, or have you misplaced it since then?  Do you know if you have had two MMR vaccines?  If you were born after 1957, you need two doses before you travel.  When was your last tetanus booster?  Did it contain the pertussis (whooping cough) vaccine?  If you need a transfusion or get an accidental blood exposure, do you know if you have had Hepatitis B vaccine?  If you got pneumonia vaccine in the hospital, did the record of it get to your medical chart?

Most adults’ shot records are scattered across several immunization providers over the course of their lifetime.  Because our healthcare system is un-coordinated by and large, information from one provider is often not shared with another.  Old records become unavailable due to provider retirement, uncertainty of which doctor gave immunizations, and because immunizations are given in places where records are not maintained (health fairs, etc.)  Immunization histories are important for your health, and often for employment and other purposes as well.

In the past, immunization registries were limited to children.  Now it is possible to load your immunization records in a secure online registry that will make them available to your physicians in the future and also keep them safe should you lose your copy.  The Texas Immunization Registry, ImmTrac, has a secure website for this purpose: http://immtracforeveryone.com/en/welcome – and I encourage every adult to register!  You should make sure that your doctor knows about ImmTrac, as well, and ask your insurer and your doctor’s office to participate by uploading their patient immunization histories into the registry. 

Shot records are too important to lose.  Sign up for ImmTrac and keep your records safe!

Immunization and the Healthcare Conglomeration

When we talk about a healthcare system in the U.S., we really should be talking about a conglomeration, because the word “system” implies that there is some inherent organization involved.

Instead, we have innumerable physician offices, clinics, pharmacies, hospitals, non-profit healthcare providers, mid-level providers, insurers, pharmaceutical companies and state, local and federal government and – all trying to work together, but each focused on their own primary mission.

In the area of adult immunizations, the system is totally unorganized.  The basics of even keeping track of who has been immunized have only recently been addressed with the addition of adult records to immunization registries and the impending birth of Health Information Exchanges, which are encouraged in the Affordable Care Act (which, by the way, does a lot to improve access to immunizations for the population as a whole).

Physicians in all types of medical specialties know the benefits of immunization.  Surgeons promote tetanus boosters for dirty wounds, and Ear, Nose and Throat Doctors know that pneumococcal vaccines reduce the rates of ear and sinus infections as well as pneumonia.  It is clear to internists and cardiologists that flu shots reduce the number of people who die from heart attacks – though it is less clear why this is the case!

There are a lot of physicians – surgeons, ENTs, cardiologists and more – who could, or should be promoting immunization but aren’t.  People trust their physicians, and when physicians recommend immunization, generally people follow that advice. It is my belief that every physician, or their nurse, should screen for needed vaccines at every visit.

 If a vaccine is needed, even if it isn’t available in that medical practice, the patient can be referred to their primary care provider or a pharmacy for vaccination. Then be sure to ask the patient to fax a record of the immunization back, or use their cell phone to capture an image of the record, so that it can be added to their medical record.

Don’t Be In Denial About West Nile

Although this blog is supposed to be about immunizations, I can’t help myself.  I am very interested in prevention and in travel medicine as well, so the recent outbreaks of West Nile Virus have my attention.  All of us in Houston need to learn “Mosquito Precautions” that are generally taught to travelers to countries with malaria and yellow fever!

In Dallas, and now in Houston, cases of West Nile disease are on the rise.  In many neighborhoods, you can see unusual numbers of dead birds on the ground, felled by this infection. This is a mosquito-born illness, one of several that are present in the U.S.  St. Louis Encephalitis and also some cases of dengue fever have been propagated by mosquitoes here. And, historically, both Yellow Fever and malaria were common in the southern states.

West Nile is worse this year than ever before and Texas has reported over half of the cases.  Most cases of West Nile virus are mild and not even diagnosed, but the virus can cause encephalitis, chronic disability and death.  Recent reports suggest that kidney disease may also be caused by this virus.  There is no specific treatment for West Nile virus infection and no vaccine.

Prevention of mosquito bites is the way to go.  I know that no one likes the smell of mosquito repellants, but those with DEET are best, followed by those with picaridin.  Dawn and dusk are the worst times to be outside, and in my neighborhood, those are prime jogging and dog walking times with lots of bare skin showing.

You’re probably going to shower after you run anyway, so USE INSECT REPELLANTS!  Move your jogging time to earlier or later, when it is either fully dark, or well into daylight.  Wear long sleeves and long pants to walk your dog if you don’t use repellants, and avoid perfumes and bright colors.

Insecticide-treated clothing is also available.  Around your home, eliminate standing water and adjust your sprinklers so that the gutters don’t keep puddles afterwards.

For full information on West Nile infections, check out the CDC website, http://www.cdc.gov/ncidod/dvbid/westnile/

Flu Vaccine: It’s Never Too Soon

It’s never too soon to prevent illness.  Influenza vaccine is already available for this year, a full month ahead of usual arrival. This year’s vaccine has two new virus strains, as scientists try to keep up with the changes the flu bug makes in its constant efforts to evade our immune system. Vaccine given now will protect you from the three included influenza types for at least a year, and likely more.

You may be thinking that influenza is not much of a threat after the mild season we had last year.  Influenza rates across the country were down, and the season not only started late, it ended early.  No one is sure why the season was so mild, but one good possibility is that immunization against influenza has been widely available and widely used for the last three years. No vaccine shortages and increased interest in getting vaccinated due to the pandemic flu of 2009 means that more people overall were immunized. 

Remember, when immunization works, NOTHING HAPPENS.  No one gets sick.  If  you were immunized and did not get sick, you also did not spread illness to others.  That means, if you were immunized, you can probably take credit for last year’s mild flu season. Primary care doctors everywhere saw record low numbers of patients last winter.
Don’t be complacent about getting your flu vaccine this year based on our mild season last year – be part of the scheme to keep the flu away again this year!

More Options Than Ever Before

This year there are more options available for influenza vaccine than ever before.  Everyone 6 months and older should get vaccinated, and everyone has at least two vaccines to choose from!

Individuals of all ages can get the regular flu shot.  It comes in two “flavors,”- a multi-dose vial and preservative free.  Children less than age 3 get a smaller dose than adults, and children younger than age 9 should get two doses spaced a month apart if they haven’t had two seasonal flu vaccines since July 2010.

Don’t like shots?  If you are healthy (no chronic diseases like asthma or diabetes), and age 2 to 49, you can have the nasal mist vaccine, FluMist.  If you are 18-64, you can have the “mosquito-bite” intradermal vaccine, which uses a micro-fine, very short needle that just barely goes into the skin. 

Folks 65 and older may want to consider Fluzone High-Dose, which is just like the regular flu shot, but more of it (not a bigger shot, just more concentrated).  Unfortunately, older individuals have less robust immune systems, and don’t get as good of protection from regular flu shots as we would like, and High-Dose results in a better vaccine response.  Consider this vaccine especially if you have other illnesses that flu makes worse, like COPD or emphysema or heart disease.

Finally, one manufacturer is developing a flu vaccine with four strains of influenza virus- two A types and two B types, instead of  the usual three.  This may be the standard of care in a few years.

Influenza B strains don’t seem to replace each other as much as A strains do, so for several years we have had two different B strains circulating, and the vaccine has only had protection against one.  This vaccine may be hard to find this year, because most doctors and pharmacies ordered their vaccine before this option became available.  It will also likely be offered to adults only in its first year out.