Experts Call for Increased Awareness and Vaccination Rates Among All Adults CDC Unveils New Vaccination Data Showing Continuing Need to Improve Rates

Young adults may have grown up in an era of information overload, but they have alarmingly little awareness of the risks of vaccine-preventable diseases and the need to keep up with vaccinations into adulthood, new data show.

For example, 84 percent of Americans over the age of 50 know that tetanus causes lockjaw and that they need to get a tetanus shot every 10 years. By contrast, just 49 percent of young adults aged 18 to 26 are aware of that fact, according to a survey commissioned by the National Foundation for Infectious Diseases (NFID).

“Unless all adults, and young adults in particular, get more savvy and keep up with recommended immunizations, the nation could be vulnerable to outbreaks of vaccine-preventable disease down the road,” warned William Schaffner, MD, president-elect of NFID and chairman of the Department of Preventive Medicine at Vanderbilt University, at a news conference attended by top U.S. public health officials and other medical experts. All underscored the importance of vaccination throughout the lifespan of an individual, not just in childhood.

Experts say that overall lack of awareness and knowledge among adults runs parallel to lower vaccination levels. According to the latest National Health Interview Survey (NHIS) released by the U.S. Centers for Disease Control and Prevention (CDC), while we are seeing positive movement in some adult vaccination levels, rates still lag behind national targets across the board.

“Just as we prioritize protecting children with vaccines, we must also prioritize vaccination of adults as part of optimal preventive care,” said Assistant U.S. Surgeon General and director of the National Center for Immunization and Respiratory Diseases Anne Schuchat, MD. “Adult immunization saves lives, prevents illness and will help us rein in the cost of healthcare by keeping the nation healthy.”

NFID’s medical director, Susan J. Rehm, MD, vice chair of the Department of Infectious Disease at the Cleveland Clinic, unveiled the NFID survey data showing that fewer than half of all American adults are “extremely or very familiar” with a number of vaccine-preventable diseases that can cause severe illness or death. To highlight this, just 20 percent of those surveyed were aware of pneumococcal disease, a vaccine-preventable disease that kills up to 4,500 adults in the U.S. every year.

Of special concern, experts said, is the lack of knowledge and awareness among young adults aged 18 to 26. For example, just 30 percent of young adults know that flu, which can be prevented with a vaccine, kills more Americans than any other vaccine-preventable disease. By contrast, 59 percent of adults over the age of 50 are aware of that fact, the survey found.

“This pattern is not surprising,” said Dr. Rehm. “Our childhood vaccination program is so successful that adolescents cross into young adulthood having been extremely well protected against vaccine-preventable diseases and therefore have little or no personal experience with them. This may signal trouble in the future. As these young adults go on to have their own families, if they don’t realize the importance of getting vaccinated for themselves, they may not prioritize it for their children either. That could make outbreaks of many vaccine-preventable diseases possible again.”

NFID, which has long advocated for optimal use of all vaccines recommended by public health officials, has embarked on a campaign to raise public awareness about the need for adults – including young adults – to keep up with immunizations after childhood. (For a list of diseases and vaccines, go to www.adultvaccination.org.)

Adult Vaccination Levels Lag

The latest data from CDC show that there are still too few Americans taking advantage of vaccines recommended to protect them from infectious diseases. Influenza and pneumococcal vaccination levels remain at 66.6 percent and 60 percent, respectively, for those over age 65. Other adult vaccination levels are lower – 6.7 percent for shingles in those 60 and older; about 10 percent for human papillomavirus (HPV) vaccine in women 19 to 26 years of age and about 15 percent for Tdap in those 19 to 64 years of age.

It should be noted that Tdap booster is recommended in place of one tetanus-diphtheria (Td) booster vaccine, which is recommended every 10 years. Since Tdap has only been licensed since June 10, 2005, a substantial portion of the population has not yet reached the 10-year timing milestone since their last Td vaccine. The coverage level for any Td-containing vaccine is 64 percent for those 19 to 49 years of age, 63 percent for those 50 to 64 years of age and 52 percent for those 65 and older.

While influenza and pneumococcal vaccination levels are highest and have remained somewhat steady, these rates are disappointing, because influenza and pneumococcal vaccines have long been a part of the adult schedule and the coverage goal is 90 percent. Also of concern are racial and ethnic disparities in coverage levels in people 65 and older. Influenza coverage level in non-Hispanic whites in this age group is above the national average at 69 percent, while the rates for non-Hispanic blacks and Hispanic persons 65-plus are well below at 53 percent and 51 percent, respectively. Similarly, for pneumococcal disease, whites 65-plus have higher coverage levels than non-Hispanic blacks and Hispanics at 64 percent, 44 percent and 36 percent, respectively.

“Immunity is a lifetime continuum and should be the goal for all adults as part of good preventive care and wellness,” said Dr. Schuchat. “We need to make a strong, long-term commitment to adult immunization as a nation if we are to realize the full benefits of the many vaccines available to us.”

While the NFID-sponsored survey found that most adults were very familiar with flu and chickenpox, both of which can be prevented by vaccines, it found that most adults were not very familiar with a host of other infectious diseases that can be prevented with vaccines. In addition to pneumococcal disease, these include shingles, hepatitis B, pertussis and HPV, which causes cervical cancer.

Although young adults were more likely than older adults to be very familiar with HPV and pneumococcal disease, they were much less likely than older adults to be aware of the threat from other vaccine-preventable diseases.

Physicians Have Most Influence Over Whether Adults Are Vaccinated

The survey found that personal physicians had the most influence on whether adults are aware of vaccine-preventable diseases and whether they keep up with their vaccinations, and that people who get annual physical exams are more likely to be vaccinated than those who don’t visit their doctor every year.

At the news conference, Stanley A. Gall, MD, professor of obstetrics, gynecology and women’s health at the University of Louisville, said that OB-GYN doctors could play an important role in making sure that the women they see are up-to-date with vaccinations. “Women may not only make better decisions about their own immunity based on input from an OB-GYN, but they may also bring immunization messages home to other family members,” he said.

Robert H. Hopkins, MD, associate professor at the University of Arkansas for Medical Sciences, called for stepped-up attention to the fact that adults need to take a more active role in good preventive care, which includes getting vaccinated. “Mid-life is a time when people typically begin to face new health hazards, such as obesity and diabetes, and are therefore more vulnerable to the infectious diseases that vaccines can prevent. But even if middle-aged people are otherwise healthy, vaccines are an essential component of continued good health,” he said.

Cora L. Christian, MD, a member of AARP’s Board of Directors stressed the importance of vaccinating 50-plus Americans, particularly those who care for children and older loved ones. “The sandwich generation of Americans who may provide care for both their children and older parents are particularly vulnerable to infectious diseases,” Christian said. “It’s critical for caregivers and anyone 50-plus to get annual influenza vaccinations so they can avoid getting sick and prevent the spread of flu to their families. Just as important, people 65 and older should ask their doctor about a pneumococcal vaccine.”

The NHIS has monitored the health of the nation since 1957. NHIS 2008 data were collected through interviews with approximately 29,000 households.

The NFID survey, conducted by Opinion Research Corporation, was based on telephone interviews with 1,001 Americans aged 18 and older Feb. 19-22, 2009. The margin of error is plus or minus 3 percent.

Source: National Foundation for Infectious Diseases


Pre-chewed Food Could Transmit HIV

  • Author: Health Informer
  • Filed under: Health News
  • Date: Jul 22,2009

First three cases of likely HIV transmission to infants via pre-chewed food suggest cautioning HIV-positive caregivers against pre-chewing food; also a need for more data

Researchers have uncovered the first cases in which HIV almost certainly was transmitted from mothers other caregivers to children through pre-chewed food. The source of HIV in the pre-chewed food was most likely the infected blood in the saliva of the people who pre-chewed the food before giving it to the children. The researchers said their findings suggest that HIV-infected mothers or other caregivers should be warned against giving infants pre-chewed food and directed toward safer feeding options.

The cases indicate that physicians and clinics should routinely include questions about pre-chewing food in their health screening of infant caregivers who have HIV or are suspected of the infection. Also, possible cases of HIV transmission through pre-chewed food should be reported to public health agencies to help increase understanding of the prevalence of such transmission.

Led by Aditya Gaur, M.D., of St. Jude Children’s Research Hospital, with colleagues from St. Jude (Marion Donohoe, CPNP), the University of Miami (Charles Mitchell, M.D., and Delia Rivera, M.D.) and the Centers for Disease Control and Prevention (Kenneth Dominguez, M.D., Marcia Kalish, Ph.D., and John Brooks, M.D.), the researchers published their findings in the August 2009 issue of the journal Pediatrics. Gaur is an assistant member of the St. Jude Infectious Diseases department.

Giving infants pre-chewed food has been reported to transmit infections such as streptococcus and the hepatitis B virus, Gaur said. However, until these cases there was no evidence that the blood-borne HIV could be similarly transmitted. The source of blood in the saliva of the person pre-chewing the food for the child may likely have been visible or microscopic bleeding from the gums or some other part of the mouth, he added.

In their paper, the researchers described three cases in which pre-chewed food was likely the source of HIV transmission to infants.

The case that led to this published report was a 9-month-old infant who was referred to St. Jude because she was HIV positive after earlier tests had been negative.

“Her HIV-positive mother had not breastfed her, and further investigation had ruled out transmission by blood transfusion, injury or sexual abuse,” Gaur said. Also, genetic testing, led by Kalish at the CDC, showed that the daughter had been infected with the same HIV strain as the mother.

“Fortunately, the St. Jude nurse practitioner, Marion Donohoe, was very thorough in her questioning about feeding practices, and she asked about pre-mastication. It turned out this mother had fed her daughter pre-chewed food,” Gaur said.

When Gaur contacted Dominguez at the CDC about the possible case of transmission via pre-chewed food, the center alerted him to two similar cases previously reported by senior author Mitchell and colleague Rivera from the University of Miami. Those cases were not reported to the public at the time because of the lack of sufficient evidence of transmission via pre-chewed food. One case involved pre-chewing by an HIV-infected mother, and the other an HIV-infected aunt who was the caregiver.

Gaur said that information in the three cases suggests that one factor aiding such transmission was mouth bleeding in the caregiver, as well as in the infant due to teething or infection. He also said caregivers’ lack of adherence to their own drug-treatment regimens probably increased their blood HIV levels, increasing the likelihood of transmission.

“These three cases are persuasive enough that they justify cautioning HIV-positive caregivers against giving infants pre-chewed foods,” Gaur said. “Also, we hope increased awareness of this possible mode of transmission will bring more cases to light and more thorough studies, which can either substantiate or refute this transmission route.” Also important, Gaur said, will be the results of surveys now being conducted in collaboration with other research groups in the United States and abroad to determine the extent of infant feeding using pre-chewed food.

The findings do not warrant a blanket recommendation against pre-chewed food for infants, the researchers emphasized. The practice, which has been reported from many parts of the world including the United States may be integral to providing adequate infant nutrition and grounded in culture and tradition. On a global level, educating HIV-positive caregivers will require cognizance of culturally sensitive issues and potential nutritional consequences linked to pre-chewing, the investigators said. The findings also do not imply that HIV can be transmitted through saliva during oral contact such as kissing. In the cases the researchers studied, HIV transmission was likely enabled by bleeding gums or open mouth sores.

“Importantly, this report does not challenge the accepted belief that saliva does not carry HIV and that transmission does not occur in kissing,” Gaur said. “The exception is that transmission can occur when the people involved have damaged mucosa in their mouths, and blood is mixed with the saliva.”

Source: St. Jude Children’s Research Hospital


From the start of the HIV epidemic, it appeared that some of the people who were infected with the virus were able to ward off the fatal effects of the disease longer than others.

Recent studies have begun to unravel the cause of this phenomenon, and new research suggests that African Americans with the disease have a unique survival advantage if they have both a low white blood cell count (known as leukopenia) and a genetic variation that is found mainly in persons of African ancestry. This study was prepublished online on July 20, 2009, in Blood, the official journal of the American Society of Hematology.

The research showed that African Americans with HIV who possess both a variation in the gene for the Duffy antigen receptor for chemokine (DARC) and leukopenia have slower HIV-to-AIDS progression rates than HIV-infected European Americans with leukopenia. Previous studies showed that the same DARC variant conferred protection for persons of African ancestry against a particular form of malaria, and that persons of African descent have, on average, lower white blood cell (WBC) counts than persons of European ancestry. Leukopenia is one of several blood conditions observed frequently in patients with HIV-1 infection, but its impact on disease course is relatively unknown.

“Even though leukopenia is tied to both African ancestry and faster disease progression, we found that compared with European Americans, African American patients with HIV who have leukopenia do not necessarily experience this expected outcome,” said lead author Sunil Ahuja, MD, of the Veterans Administration (VA) Research Center for AIDS and HIV-1 Infection and the University of Texas Health Science Center in San Antonio.

This study evaluated data from the Air Force subset of the U.S. Military’s HIV Natural History Study and included genetic and clinical data from 1,132 participants. The researchers tested for the presence of the DARC variation and evaluated patients’ WBC counts from diagnosis and throughout the course of the disease to determine the impact of different levels of WBC counts on survival rates. The prevalence of leukopenia at the time of diagnosis was significantly higher in African Americans (28 percent) than in European Americans (15 percent) or other ethnicities (13 percent). The average WBC counts were also significantly lower during the course of the disease in African Americans with HIV than in other ethnicities.

The researchers found that leukopenia was generally associated with a faster disease progression from HIV to AIDS, independent of known predictors of AIDS development. “On average, leukopenic European Americans progressed nearly three times faster than their non-leukopenic African or European counterparts,” explained Hemant Kulkarni, MD, first author of this study. “However, leukopenic African Americans had a slower disease course than leukopenic European Americans, even though twice as many African Americans in the study had leukopenia.”

The investigators found that the DARC variation, not race, explained the differences in WBC counts in African Americans with HIV. Among those who were leukopenic, only those with the DARC variation experienced a significant survival benefit. Additionally, this survival advantage became increasingly pronounced in those with progressively lower WBC counts, suggesting that the interaction between DARC and WBC counts was the primary influence on slowing HIV disease progression in African Americans.

“The results of this collaborative study highlight the importance of accounting for other factors, such as the white blood cell count, to uncover the full effects of genetic variations that may influence HIV disease course,” said Capt. Gregory Martin, MD, United States Navy, program director for the Infectious Diseases Clinical Research Program (IDCRP) and an expert on infectious diseases who was not involved with the study.

“White blood cells are intricately linked to inflammation, and inflammation is known to fuel HIV disease progression. Thus, future studies will need to decipher whether the interaction between the DARC variant and low white blood cell counts results in a reduced inflammatory state,” said Vincent Marconi, MD, of the IDCRP.

The U.S. Centers for Disease Control estimates that about 1 million people in the United States are living with HIV or AIDS, and that about 60,000 individuals are infected with HIV each year.

The study represents a collaboration between investigators at the IDCRP at the Uniformed Services University of the Health Sciences, Bethesda, MD, the VA, and the University of Texas Health Science Center at San Antonio. The study was funded by the National Institutes of Health and the VA.

Source: American Society of Hematology


Statement by Tyler Wilson, President and CEO, the American Association for Homecare

In their effort to find savings in the healthcare system, the Obama administration and Members of Congress have been eyeing Medicare’s home medical equipment (HME) sector for cuts. This sector provides medical oxygen, respiratory therapy, hospital beds, wheelchairs, walkers and other equipment and services that allow people to get the care they need at home instead of in a hospital or nursing home.

Already in 2009, Medicare payments for the most commonly prescribed home medical equipment categories have been cut by 9.5 percent. Medical oxygen reimbursement has been cut by 27 percent so far this year. Another measure aimed at cutting HME costs further is so-called “competitive” bidding.

“The American Association for Homecare urges Congress to recognize that home care is a cost-effective alternative to more expensive forms of care, and should therefore be a critical component — not a casualty — of American health care reform. Current and proposed cuts to Medicare’s home medical equipment sector are not an effective way to reduce overall Medicare spending. These cuts are likely to increase Medicare costs over time by forcing more seniors into nursing homes and hospitals, blocking preventative care, and causing more frequent visits to emergency rooms.

“Quality home medical equipment and services facilitate hospital discharges, reduce hospital readmissions and emergency room visits, and help to keep seniors and people with disabilities out of more expensive institutional settings. As Congress debates health care reforms, it is important that it keeps these facts in mind and recognizes home care as a partner in improving the quality of American health care and reducing overall health care costs.

“Most home medical equipment costs just dollars a day. The cost of providing the equipment and service for home oxygen, for example, is less than $7 per day under Medicare. Compare that to the average daily cost of about $200 for a nursing facility and more than $5,000 per day for a hospital stay under Medicare.

“According to a recent study in the New England Journal of Medicine, up to one-fifth of all Medicare patients are readmitted to hospitals within one month of being discharged. These unplanned visits cost Medicare an estimated $17 billion in 2004. One reason for the high readmission rates is the lack of continued interaction and guidance once patients are dismissed. Home medical equipment providers help to fill this gap by smoothing the transition from hospital to home with the equipment and services patients need.

“This year, Medicare payments for the most commonly prescribed home medical equipment categories have been cut by 9.5 percent, including complex rehabilitative power wheelchairs. Medical oxygen reimbursement has also been cut by 27 percent so far this year. Home oxygen is a critical, life-sustaining medical treatment prescribed to nearly 1.5 million Medicare patients each year who suffer from respiratory illnesses such as chronic obstructive pulmonary disease.

“Another measure aimed at cutting HME costs further has been labeled ‘competitive’ acquisition. A regulation enacted in the final hours of the Bush administration would selectively contract with a small number of home care providers based on a race to bid the lowest payment. Even among those who agree to new bid-determined payment rates, Medicare only allows a select few to provide the items, which will have the long-term result of reducing the number of companies competing to offer home care products.

“These cuts in reimbursement are having a negative impact on the quality of equipment and the level of services that providers are able to furnish to consumers who have severe disabilities and who are in greatest need of mobility products and services.

“Home medical equipment and service is already the most cost-effective slowest-growing portion of Medicare spending, increasing only 0.75 percent per year, according to the latest National Health Expenditures data from Medicare. That compares to more than 6 percent annual growth for Medicare spending overall. Moreover, home medical equipment represents only 1.6 percent of the Medicare budget.

“As Congress deliberates cuts to Medicare, they would do well to recognize that cuts to home medical equipment will increase long-term Medicare costs. The home medical equipment sector should be seen as a key element in reducing overall Medicare costs.”

Source: American Association for Homecare


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