Friday, November 8, 2013

Got Asthma? Get this Vaccine!

This month I am focusing on vaccinations- the FLU vaccine, Tetanus, Pertussis, and now...the "pneumonia" vaccine.  This vaccine works against Streptococcus pneumonia, the "pneumococcal bacteria" which causes hundreds of thousands of cases of pneumonia, sepsis and meningitis in the United States every year. Before routine childhood immunization against this bacteria, there were also over 5 million ear infections per year caused by this organism. This bacteria has developed quite a bit of resistance to antibiotics, and the more serious pneumococcal diseases have a very high mortality rate ranging up to 37%, so everything we can do to prevent pneumococcal disease saves innumerable lives.

Recommendations for this vaccination USED to only be for adults over 65 or those adults who had their spleen removed or had severe immune-compromising illness. However,  in 2008, the ACIP (Advisory Committee on Immunization Practices) realized that the scientific evidence showed that adults who smoke or have asthma are at much higher risk of developing pneumococcal disease, and CHANGED the RECOMMENDATIONS to include ADULTS WHO SMOKE or HAVE ANY TYPE OF ASTHMA (exercise-induced,

There are two types of pneumococcal vaccine:  PPSV23 and PCV 13, which target the specific subtypes of this bacteria that cause the most disease.  Children receive PCV13 (trade name, Prevnar), as part of their infant series at 2, 4, 6, and 12-15 months of age.

ADULTS (19 -64) should receive the PPSV23 (trade name, Pneumovax) pneumococcal vaccination if they are a SMOKER; if they have ASTHMA or  DIABETES;  or if they have chronic lung, heart, liver or kidney disease, cochlear implants, a missing (removed) or non-functional spleen, or an immuno-compromising illness such as cancer or HIV disease.

ALL ADULTS over the age of 65 should receive a PPSV23 pneumococcal vaccine as well. If they already had a pneumococcal vaccine before the age of 65 (because they are asthmatic, or a smoker, or diabetic, etc.) then they need a BOOSTER  second vaccination at 65, or as soon as it has been at least 5 years since they received their first pneumococcal shot.

Adults with some of the more serious conditions that affect their immune system should receive both types of pneumococcal vaccine (for more details, see the CDC's Pneumonia Vaccine Q&A).

BOTTOM LINE: If you are over 65 or if you are aged 19-64 and you have asthma, diabetes or have not yet quit smoking, please talk to your doctor about getting the "pneumonia vaccine"! 

Thursday, November 7, 2013

Did I Hear a WHOOP?

As a Texas Aggie, I generally love to hear a "WHOOP" (especially during football season- gig 'em, Ags!) However, as a doctor, the word or sound "whoop" triggers concerns about Pertussis, the bacteria that causes whooping cough, which has been unfortunately on the rise in our community and across the United States.

What is whooping cough?

This highly infectious respiratory disease only infects humans, and causes nearly 50 million cases of disease each year. In the United States, we only see around 40,000 documented cases/year, but certainly have many more infections that are not recognized and treated.  Smokers, asthmatics, infants, pregnant mothers and people with compromised immune systems are at the highest risk for catching pertussis, but we are also seeing outbreaks in healthy, previously immunized populations (whose immunity has worn off over the years since their last booster vaccine.)

There are several stages of whooping cough infections. The first stage is like a common cold- stuffy, runny nose, low grade temperature and a slight cough. However, the second stage is what sets this disease apart. Instead of a mild lingering cough, the cough becomes more frequent and can be intensely severe- causing fits and spasms of coughing so hard that you vomit, and occasionally creating a "whoop" sound as you suck in air after a fit of coughing. Typically people describe this as the "worst cough" they have ever had. Finally, there is a several week convalescent stage where the cough gradually decreases and fades away.

How is pertussis diagnosed?

For a variety of reasons, doctors do not often test for pertussis. The test for pertussis requires a specific nasal swab that should be immediately sent off to the health department lab for evaluation. Blood tests can help to confirm an acute case as well (checking antipertussis toxin IgG levels).

How is pertussis treated?

Short courses of azithromycin or erythromycin will eliminate the virus from the upper respiratory tract. More serious infections (especially in infants) may require hospitalization for more aggressive treatment.

Why can't I get a zpak for my cough?

The vast majority of coughs are NOT pertussis, and in fact, are not caused by ANY bacterial source. The zpak, or any antibiotic, will only help improve coughs caused acutely by a bacterial infection (such as a pneumonia). The good news here is that although coughs can hang on for up to six weeks after a viral infection or with allergies, we do have other (non-antibiotic) medications such as broncho-dilating inhalers that can help clear them up.

How can I prevent pertussis? 

In a flashback to the previous blog on TETANUS, here is your answer: All children should receive the combination vaccine DTaP (diphtheria, tetanus and pertussis) five times in early childhood, at 2, 4, 6, 15-18 months, and age 4-6 years. Then, at 11-12 years, they should receive a BOOSTER combination vaccine, called Tdap (which has lesser, booster-level doses of the diphtheria and pertussis portions, noted with the lower case letters). Finally, everyone over the age of 19 who did NOT receive that Tdap during adolescence should get a one time vaccination with Tdap "now", regardless of the interval since their last tetanus booster, which was most likely simply a Td (tetanus/diptheria booster).

What's that little "a" for in Tdap and DTaP? 

That little "a" is for "acellular" pertussis. There were concerns about side effects from the original whole cell pertussis vaccines, so scientists were able to develop a newer version of the vaccine that only used a small portion of the pertussis cell. This section of the bacteria is still "large" enough to trigger a robust immune response, yet has fewer side effects.

BOTTOM LINE: Adults who have never received a tetanus booster that contains pertussis should update their immunizations at their next check up!

Monday, November 4, 2013

When was Your Last Tetanus Shot?

Since it's time for everyone's annual FLU VACCINE, I thought I'd take a few posts and reflect on a couple other vaccines. Today, let's talk about the TETANUS vaccine.

What does the tetanus vaccine do? Most people have heard that if you "step on a rusty nail", you should make sure you are up to date on your tetanus booster. Actually, this should be true for any significant breaks in the skin such as burns, puncture wounds or "road rash".  The tetanus vaccine boosts our immunity to the bacteria called Clostridium tetani, an organism that lives all around us, but especially in the soil, dust and any areas that my be in contact with manure or saliva.

What is tetanus (the disease)? Tetanus used to be called "lock jaw", and even Hippocrates knew about this disease nearly 30 centuries ago! This disease causes intense spasms of skeletal muscles, especially the neck and jaw muscles (making it impossible to open your mouth or to swallow). The infection can be very severe, and has a high mortality rate in children (1 in 5 cases.) We rarely see this disease in the United States now, thanks to routine vaccinations, but it still occurs in roughly one million people each year around the world.

The tetanus vaccine is the "T" in the DTaP series (Diptheria, Tetanus and acellular Pertussis.) All children should receive 5 routine doses- 2, 4, 6, 12-15 months, and 4-6 years. The next recommended booster comes at 11-12 years (or up to age 18) and is a slightly different preparation, the Tdap. The Tdap is still Tetanus, diptheria and pertussis, but the diptheria and pertussis (marked by the lower case letters) are reduced strength boosters since adolescents and adults no longer require the full strength childhood versions.

New changes in Tdap recommendations are the result of recent pertussis outbreaks in the United States, and include routine vaccination for all adults ages 19 and older with a single booster of Tdap (unless the individual received Tdap as an adolescent), as well as every pregnant women in her third trimester (for each and every pregnancy).

To clarify, after the basic 5 childhood immunizations of DTaP, an adolescent should receive one Tdap (the booster vaccine) between the ages of 11-18, then simply the Td (Tetanus/diptheria) booster every ten years. All adults who have only received the Td booster should receive one dose of Tdap now, regardless of how long it has been since their last Td shot.

BOTTOM LINE: Talk with your family doctor and check to see if your immunizations are up to date!