IMMUNE SYSTEM STAYS DEPLETED UP TO 3 YEARS AFTER MEASLES

IMPORTANCE OF MEASLES VACCINE TO PREVENT DAMAGING INFECTIONS

FRIDAY, May 8, 2015 (HealthDay News) -- Children who survive a measles infection remain vulnerable to other potentially deadly infections for as long as two or three years after the measles infection, according to research published in the May 8 issue of Science.

Michael Mina, Ph.D., of Princeton University in New Jersey, and colleagues analyzed public health data from before and after mass measles vaccinations began in Denmark, England, Wales, and the United States. They verified that the childhood mortality rate in those countries did indeed fall by about 50 percent following the introduction of the measles vaccine. Further, they found that children in those countries who contracted and survived the measles were more likely to subsequently die from another infectious disease.

Children's immune systems in England and Wales appeared to be weakened for as long as 28 months following a measles infection, during which time they were at increased risk for death from a viral or bacterial disease, the researchers reported. In the United States, the effect lasted about 31 months, and in Denmark, about 26 months.

"These results provide population evidence for a generalized prolonged (roughly two- to three-year) impact of measles infection on subsequent mortality from other infectious diseases," the authors write. The effect appears specific to measles. The research team conducted a similar analysis on pertussis, and found no association between a country's pertussis rate and subsequent childhood deaths due to other infectious diseases.

COMMON CHILDHOOD VACCINE CUTS CHANCE FOR "SUPERBUG" - STUDY SAYS

FRIDAY, Oct. 10, 2014 (HealthDay News) -- The childhood pneumococcal vaccine helps children avoid the suffering and danger of ear infections, meningitis and pneumonia. And a new study suggests it may provide an added bonus: cutting down on infections from antibiotic-resistant "superbugs."

First used in children in 2010, the pneumococcal vaccine was linked to a 62 percent reduction between 2009 and 2013 of drug-resistant infections of bacterial pneumonia, meningitis and bloodstream infections for children under 5.

"The vaccine is an important tool against antibiotic resistance," said lead researcher Sara Tomczyk, an epidemic intelligence service officer in the Respiratory Diseases Branch of the U.S. Centers for Disease Control and Prevention.

"Along with appropriate antibiotic use, it is part of the solution to protecting ourselves against the growing threat of antibiotic resistance," she added.

The pneumococcal vaccine is currently recommended for all children age 5 and younger. Pneumococcal bacteria can cause ear infections, pneumonia and meningitis. It is the most common vaccine-preventable bacterial cause of death, the researchers noted.

Antibiotic-resistant strains are especially worrisome because standard drugs do not seem to help fight these bacteria. 

But the advent of the pneumococcal vaccine may have lessened the danger. According to Tomczyk, more than 4,400 cases of antibiotic-resistant, invasive pneumococcal disease were prevented between 2010 to 2013.

"Not only does this vaccine prevent pneumococcal infection, which means fewer antibiotics are prescribed, but it also prevents antibiotic-resistant infections," she added.

Tomczyk said the vaccine has been so effective that the U.S. government's Healthy People 2020 goal of reducing bacteria-resistant pneumococcal disease from 9.3 to 6 cases per 100,000 children was achieved nine years early and has since dropped to 3.5 cases per 100,000.

The vaccine is required in three-quarters of states before a child can be admitted to day care, Tomczyk noted, and 85 percent of U.S. children have by now received the recommended four doses.

Pneumococcal conjugate vaccine is given in four doses, at 2, 4 and 6 months of age and at 12 through 15 months.

The results of the study were scheduled to be presented in Philadelphia on Oct. 8 at IDWeek, the annual meeting of a number of groups focused on infectious disease. Experts note that findings presented at medical meetings are typically considered preliminary until published in a peer-reviewed journal.

Dr. Adriana Cadilla, a pediatrician at Miami Children's Hospital, said, "It's wonderful news that we have proof that the vaccine works as well as it does."

It has clearly reduced antibiotic-resistant pneumococcal disease, she added. "It seems to be doing a great job. It is something parents should make sure their children have."

The vaccine is not just for kids, Tomczyk stressed. One dose is recommended for all adults 65 and older, followed by a dose of the pneumococcal polysaccharide vaccine six to 12 months later. 

There are more than 90 types of pneumococcal bacteria, she noted. The pneumococcal conjugate vaccine protects against 13 of the most common severe pneumococcal infections among children, while the pneumococcal polysaccharide vaccine protects against 23 types of pneumococcal bacteria, including those most likely to cause serious disease, which is why both are recommended for older adults.

Additionally, one dose of the pneumococcal vaccine is recommended for adults 19 and older who have certain cancers, HIV or kidney failure, followed by doses of polysaccharide vaccine, Tomczyk said.

Measles Journey Highlights Risk to Unvaccinated Kids

Minnesota outbreak began with a toddler traveling overseas, study says

MONDAY, June 9, 2014 (HealthDay News) -- A measles outbreak in Minnesota offers a case study of how the disease is transmitted in the United States today: An unvaccinated person travels abroad, brings measles back and infects vulnerable people -- including children who are unprotected because their parents chose not to vaccinate them.

That's the conclusion of a report published online June 9 in Pediatrics that details the 2011 outbreak that sickened 19 children and two adults in the state.

It began when an unvaccinated 2-year-old was taken to Kenya, where he contracted the measles virus. After returning to the United States, the child developed a fever, cough and vomiting. However, before measles was diagnosed, he passed the virus on to three children in a drop-in child care center and another household member. Contacts then multiplied, with more than 3,000 people eventually exposed.

Nine of the children ultimately infected were old enough to have received the measles-mumps-rubella (MMR) vaccine but had not.

In most of those cases, the child's parents feared the MMR vaccine could cause autism, according to researchers at the Minnesota Department of Health.

That idea -- first raised in 1998, by a British doctor named Andrew Wakefield -- has been discredited, said Pam Gahr, an epidemiologist who led the new research.

"But I think that as long as autism remains unexplained, the idea [that the MMR is a cause] will persist," Gahr said.

In the Minnesota outbreak, the child infected in Kenya was of Somali descent, as were most of the children whose parents had declined the MMR vaccine because of safety fears.

And that's consistent, Gahr said, with a striking decline in MMR acceptance among Minnesota's relatively large Somali population. In 2004, the number of Somali children in the state who were on schedule with their MMR topped 90 percent.

"By 2010, that was down to just 54 percent," Gahr said.

From what the health department learned in parent interviews, the decline seemed to stem from misinformation about an MMR-autism link.

Despite the unique circumstances of the Minnesota outbreak, though, measles can happen anywhere people are unvaccinated, said Dr. Andrew Pavia, chief of pediatric infectious diseases at the University of Utah in Salt Lake City.

"These outbreaks occur in all types of settings," said Pavia, who was not involved in the current study.

U.S. measles cases are at a 20-year high this year, the U.S. Centers for Disease Control and Prevention reported last week. As of May 30, the agency had received reports of 334 measles cases in 18 states.

Nearly all of the outbreaks involved unvaccinated people who brought measles back after a trip overseas, the CDC said.

The hardest-hit state is Ohio, where people in several Amish communities were infected after unvaccinated missionaries traveled to the Philippines and carried the measles virus back.

Amish communities have historically had low vaccination rates. And a 2011 survey of Amish parents who refused to vaccinate found that nearly all cited safety fears.

According to Pavia, the safety concerns of parents in the Minnesota outbreak illustrate the "power of bad information."

The MMR-autism link proposed by Wakefield was later found to be based on fraudulent data, and many studies since have found no connection between the vaccine and autism.

"Wakefield has been thoroughly debunked," Pavia said.

Gahr noted that these days, most parents never had or even saw a case of the measles. So some might dismiss it as just another childhood infection, she said.

But measles can prove serious, or even deadly. About 30 percent of people with measles develop a complication such as ear infection, diarrhea or pneumonia, the CDC says. Among children, one in 1,000 suffers brain inflammation, and one or two out of every 1,000 die.

"Even if you don't develop complications," Pavia said, "the disease is miserable."

Measles typically begins with a fever, cough, runny nose and "pink eye." After several days, a rash emerges around the face and neck, then spreads to the rest of the body.

"The thing is, we have the power to prevent it," Pavia said.

In the case of the Minnesota outbreak, he added, "the first infection that spread in the community was misinformation. The second was measles."

SAFER TO GIVE MMR AND CHICKEN POX VACCINES SEPARATE FOR FIRST DOSE, RESEARCHERS SAY

MONDAY, June 9, 2014 (HealthDay News) -- Toddlers who get a newer vaccine that fights four infections in one jab have a slightly increased risk of fever-induced seizure, a large new study confirms.

At issue is a vaccine that targets measles, mumps, rubella and varicella (chickenpox) in one shot, instead of giving the traditional MMR and varicella vaccines separately.

In theory, one shot sounds better than two. But in the new study, 1-year-olds who received Priorix-Tetra -- the MMRV vaccine used in Canada -- were twice as likely to develop a fever-related seizure as children who got separate MMR and chickenpox shots.

The findings are in line with a 2010 study of the MMRV vaccine used in the United States, known as ProQuad.

In the United States, parents now have to explicitly ask for the MMRV if they want their toddler to have it, said Dr. Nicola Klein, who led the ProQuad study.

But even with the increased risk posed by the MMRV vaccine, the odds of a brief, fever-related seizure are extremely low.

And the seizures aren't dangerous, "though they are scary for parents," said Klein, co-director of the Kaiser Permanente Vaccine Study Center in Oakland, Calif.

She said children are actually much more likely to suffer a high fever and seizure if they were to catch the measles.

"Get your child vaccinated," she stressed. "We're in the middle of a 20-year high in measles cases."

Fevers are part of the immune system response, whether to infection or vaccination.

It's not clear why the MMRV is more likely to cause a fever-related seizure than the separate shots, said Shannon MacDonald, a post-doctoral fellow at the University of Calgary in Alberta, Canada, who led the new study. But one theory maintains the combined vaccine triggers a stronger immune response and a higher fever in some children, which makes a seizure more likely.

MacDonald's findings, published online June 9 in CMAJ (Canadian Medical Association Journal), are based on records for almost 278,000 Alberta children between the ages of 12 and 23 months. The children received either the MMRV or separate MMR and chickenpox shots on the same day.

Overall, the study found, children's seizure rate peaked seven to 10 days after they were vaccinated. At that point, there were almost six seizures for every 10,000 doses of the MMRV, versus two seizures for every 10,000 doses of the separate vaccines.

"You see the same increase in risk with these different formulations," said MacDonald, referring to the Priorix-Tetra and ProQuad vaccines.

The traditional approach -- separate MMR and chickenpox vaccines -- seems safer.

"There's no question children should be vaccinated," MacDonald said.

As of May 30, the U.S. Centers for Disease Control and Prevention had received reports of 334 measles cases in 18 states. Nearly all have involved unvaccinated U.S. residents who traveled to countries where measles is common, then brought the virus home with them.

Besides causing misery -- fever, cough, and a body-wide rash -- measles infection can lead to serious complications. Up to 5 percent of infected children develop pneumonia, the CDC says, while one in 1,000 suffers brain inflammation. And for every 1,000 children who develop measles, one or two will die.

But parents should be aware that the MMRV carries a higher seizure risk and discuss that with their pediatrician, MacDonald said. Some parents may still want the combined shot, to spare their child from two needle jabs, she added.

Based on the ProQuad study, the U.S. Advisory Committee on Immunization Practices changed its stance on the MMRV. Now it says that unless parents ask about the combined vaccine, doctors should default to separate shots for young children getting their first dose of the MMR and chickenpox vaccines.

The story is different, though, with the second dose, typically given between the ages of 4 and 6 years. In general, fever-related seizure is uncommon at those ages, and the advisory committee says the MMRV is the better option.

Measles Vaccine Refusal Helps Make 2014 a Record Year

Robert Lowes

May 29, 2014

The number of measles cases in 2014 through May 23, the highest year-to-date total since 1994, has the Centers for Disease Control and Prevention (CDC) worried that the virus may become endemic again on US soil as it spreads from overseas travelers to pockets of vaccine refusers.

The CDC has received reports of 288 confirmed cases of measles — none fatal — from January 1 through May 23, with 280 associated with importation from at least 18 countries, according to an article published online May 29 in the Morbidity and Mortality Weekly Report. Most of the 45 individuals who actually imported the virus were US travelers returning from abroad.

In 69% of the 288 cases, the person was unvaccinated. In another 20%, vaccination status was unknown. For 195 US residents who had measles and were unvaccinated, 165, or 85%, declined a shot for religious, philosophical, or personal reasons.

The United States had 764 measles cases in 1994 through May 23, and 963 by year's end, according to data released at a press conference today.

The CDC declared in 2000 that the United States had eliminated measles as an indigenous disease, meaning there was no longer any year-round endemic transmission of the virus. Although this country's status has not changed, other countries such as the Philippines are rife with the disease.

Anne Schuchat, MD, director of the CDC's National Center for Immunization and Respiratory Diseases, warned at the press conference that the findings are a "wake-up call."

"Measles anywhere in the world can reach our country, and unvaccinated Americans are at risk," said Dr. Schuchat. "Measles can really get out of control quite quickly. You can get indigenous spread if you can't break the chain of transmission."

As of now, 15 scattered US outbreaks that account for 79% of all cases are "being contained," said Dr. Schuchat. The largest outbreak, involving 138 cases, has hit unvaccinated Amish communities in Ohio that had dispatched aid workers to the Philippines, which is recovering from last year's Typhoon Haiyan.

Vaccinate Before Takeoff

One key to lowering the measles case count, said Dr. Schuchat, is for Americans with international travel plans to get 2 doses of the measles, mumps, and rubella (MMR) vaccine if they haven't been vaccinated or don't know their immunization status. The 2-dose regimen also applies to healthcare workers and childcare attendants who are catching up on measles protection. As always, pregnant women and individuals with suppressed immune systems should not receive the vaccine.

Dr. Schuchat noted that individuals born before 1957 probably had measles at some point, which relieves them from getting the shot. The vaccine debuted in 1963. She described it as "very safe and effective."

Routine vaccination for children consists of a first dose at 12 to 15 months of age and a second dose at 4 to 6 years of age. If someone is traveling internationally with a child aged under 12 months, however, the CDC recommends a single dose before departure. Such a child should receive a second dose at 12 to 15 months and a third at least 28 days later. Children aged 12 months or older should have 2 doses separated by at least 28 days.

More information on the CDC's recommendations for measles vaccination is available on the agency's Web site.

Morb Mortal Wkly Rep. Published online May 29, 2014. Full text

VACCINATING AWAY MRSA

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University of Iowa Hospitals and Clinics: Vaccinating Away MRSA

Written by Akanksha Jayanthi  | March 31, 2014

"Instead of immunizing against [Staphylococcus causing bacteria], we prevented the organism from being able to set up the disease," says Patrick Schlievert, PhD, professor and chair of microbiology at the University of Iowa Carver College of Medicine and lead researcher of the study.

In animal model trials trials, the vaccine provided sterilizing immunity, meaning it produced an immune response completely eliminating the infection. In one trial, Dr. Schlievert and researchers introducedStaphylococcus bacteria into rabbits at extremely high doses, up to four million times more bacteria than normal. When the researchers injected their vaccine and then administered theStaphylococcus bacteria into the rabbits' lungs, 86 of the 88 rabbits had sterilizing immunity after seven days.

The next step for the Iowa researchers is conducting safety studies, which Dr. Schlievert says could be complete as early as in the next couple of years, pending FDA approval. If all goes well, the implications of this vaccine could be greatly effective and potentially eliminate the threat of certain Staphylococcus infections for good.

"The bad thing is Staphylococcus aureus varieties come and go. They emerge and they disappear and new strains come and they disappear," Dr. Schlievert says. "The thing we've seen consistently over the years is these three targets that we have are maintained over the long term, so we think by protecting against them, we will have a vaccine that will work against any variety of Staphylococcus aureus and would extend into the future."

ROTAVIRUS VACCINES IN THE NICU

Rotavirus Vaccination Appears Safe to Administer in NICU

Written by Akanksha Jayanthi (Twitter | Google+)  | May 20, 2014

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Administering the rotavirus vaccine in the neonatal intensive care unit appears to be safe, despite previous literature discouraging the practice, according to a study in Pediatrics Infants should receive the rotavirus vaccine by 104 day old, after which they become age-ineligible. However vaccination is discouraged during hospitalization due to concerns with live attenuated virus transmission. Researchers retrospectively identified unvaccinated infants located near vaccinated infants within 15 days of vaccination. They screened unvaccinated infants for gastrointestinal symptoms to identify potential transmission.

Researchers identified 24 vaccinated infants in the NICU and 801 neighboring unvaccinated infants.

Seventy-six percent of vaccinated infants had no symptoms after vaccination. Of those who did have symptoms, they were not related to the vaccination. Of the neighboring unvaccinated infants, 1.2 percent experienced symptoms, but, again, none were directly related or attributed to the vaccination.

Researchers concluded the vaccine was "well tolerated" in infants in the NICU, and the majority of post-vaccination symptoms were attributed to pre-existing symptoms. They suggest further evaluation of safety and transmissibility is still needed.

California City Sees Spike in Whooping Cough Cases

By Laila Kearney

April 24, 2014

(Reuters) - A Southern California city has seen a spike in reported whooping cough cases so far this year, with the number of infections nearly tripling compared to all of last year, possibly due to a less potent vaccine or lower vaccination rates, officials said on Wednesday.

Some 43 cases of pertussis have been documented since January in Long Beach, a city of about 470,000, up from 15 cases reported in all of 2013 and four cases reported in 2012, Long Beach Health Officer Michael Kushner said.

"We've never had so many cases in such a short amount of time," Kushner said.

Kushner said the rise in whooping cough cases in Long Beach was likely due to a drop in vaccinations or booster shots, a weakened vaccine or infections that are left untreated.

Across the nation, the number of reported whooping cough cases has ballooned since the 1990s, when there were fewer than 10,000 reported infections each year, according to the U.S. Centers for Disease Control and Prevention (CDC).

Overall, U.S. infections hit a 50-year high in 2012 with 48,277 reported cases, but the number dropped by half last year and appears to be decreasing slightly in 2014, said CDC spokesman Jason McDonald.

McDonald said the long-term increase could be linked to the vaccine, which was modified in the 1990s to decrease adverse side effects, such as seizures.

"What we may have done is given up to a little bit of potency in doing that," McDonald said. Vaccination rates have consistently remained high and are likely not the cause of any spikes in reported cases, he added.

The CDC is currently researching possible potency problems with the current vaccine, McDonald said.