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    <recommendedItem id="20100101_19_410"
                     title="Most Adults Are Not Getting Necessary Vaccinations"
                     score="0.013"
                     href="http://www.medpagetoday.com/InfectiousDisease/Pneumonia/tb/18317?impressionId=1265818273897"
                     
      &lt;p&gt;Public health experts say they&apos;re concerned about the low number of U.S. adults who receive recommended vaccinations  --  and in particular about seniors who aren&apos;t immunized against pneumonia.&lt;/p&gt;
&lt;p&gt;As of 2008, one-third of people 65 and older had not received the pneumococcal vaccine, according to a report issued by the Trust for America&apos;s Health (TFAH), the Infectious Diseases Society of America (IDSA), and the Robert Wood Johnson Foundation.&lt;/p&gt;
&lt;p&gt;In 36 states, 30% or more of their older residents had not received the vaccine.&lt;/p&gt;
&lt;p&gt;The worst coverage was in the District of Columbia, where 45.6% of seniors had not been vaccinated. Even in the best performing state, Oregon, more than a quarter (26.8%) of older people had not received the one-time shot.&lt;/p&gt;
&lt;p&gt;Among all adults, the investigators also found extremely low rates of immunization against tetanus, diphtheria, and pertussis (2.1%), shingles (&amp;lt;2%), human papillomavirus (10%), and seasonal influenza (36.1%).&lt;/p&gt;
&lt;p&gt;&quot;The vaccination efforts around the 2009 H1N1 outbreak actually showed how well our public health system can react to vaccinate millions of people in a very short amount of time,&quot; L.J. Tan, PhD, director of medicine and public health for the American Medical Association, told reporters in a conference call.&lt;/p&gt;
&lt;p&gt;&quot;But I think our response also clearly demonstrated that we do have a lack of a strategy and a system for vaccinating adults.&quot;&lt;/p&gt;
&lt;p&gt;Added Jeffrey Levi, PhD, executive director of TFAH, &quot;We need a national strategy to make vaccines a regular part of medical care and to educate Americans about the effectiveness and safety of vaccines.&quot;&lt;/p&gt;
&lt;p&gt;Doing so could avoid 40,000 to 50,000 deaths from vaccine-preventable illnesses and save about $10 billion in healthcare costs each year, he said.&lt;/p&gt;
&lt;p&gt;But, according to William Schaffner, MD, chair of IDSA&apos;s immunization working group and a co-author of the report, there are many obstacles to adult vaccination efforts.&lt;/p&gt;
&lt;p&gt;First, unlike children in school, adults lack widespread institutional access to immunizations nor is there a way to require most adults to undergo vaccination.&lt;/p&gt;
&lt;p&gt;In addition, there are limited interactions with the healthcare system because, also unlike in children, care in adults generally revolves around acute care and not well care visits.&lt;/p&gt;
&lt;p&gt;Insurance coverage also plays a major role in low vaccination rates among adults, and not just in the uninsured or underinsured.&lt;/p&gt;
&lt;p&gt;Most insurance plans do not cover routine vaccination, Schaffner said, a situation that would change under pending healthcare reform legislation in Congress. That would require insurers to pay for all vaccinations recommended by the CDC&apos;s Advisory Committee on Immunization Practices.&lt;/p&gt;
&lt;p&gt;Schaffner also cited what he called misunderstandings and misinformation regarding the safety and effectiveness of vaccines, and the limited support for research, development, and production of vaccines as reasons for low immunization rates among adults.&lt;/p&gt;
&lt;p&gt;&quot;It&apos;s a shame that we aren&apos;t focusing enough resources on the science to prevent disease and we don&apos;t have a system where we can better protect people by getting them all of the vaccines that are currently available,&quot; he said.&lt;/p&gt;
&lt;p&gt;Tan outlined several recommendations the report makes to increase adult vaccination rates, starting with the creation of a program to provide vaccine coverage to uninsured individuals.&lt;/p&gt;
&lt;p&gt;Also, he said, the CDC and local and state health departments should be given more funding to conduct public education campaigns to increase awareness about the importance of vaccination.&lt;/p&gt;
&lt;p&gt;For their part, physicians should adopt practices to enable them to offer their adult patients vaccines at appropriate visits, like general physicals and cancer screenings, and to make a review of vaccination history a part of standard care.&lt;/p&gt;

    </recommendedItem>
    <recommendedItem id="20090101_19_3815"
                     title="CDC Watching H1N1 Mutation, but No Cause for Alarm"
                     score="-0.005"
                     href="http://www.medpagetoday.com/Pulmonary/URIstheFlu/tb/17142?impressionId=1265818273897"
                     
      &lt;p&gt;The CDC is keeping a careful eye on a mutation in some strains of the pandemic H1N1 flu that Norwegian researchers isolated from three patients with severe disease.&lt;/p&gt;
&lt;p&gt;The mutation has been seen &quot;sporadically&quot; in the U.S., according to Anne Schuchat, MD, director of the CDC&apos;s National Center for Immunization and Respiratory Diseases.&lt;/p&gt;
&lt;p&gt;But in the U.S., the mutation has been associated with mild disease, she said, although the Norwegians isolated it from the first two patients who died of the disease in that country.&lt;/p&gt;
&lt;p&gt;The mutation was also found in a third patient who had severe disease, according to a statement from the Norwegian Institute of Public Health.&lt;/p&gt;
&lt;p&gt;Schuchat told reporters that there are &quot;theoretical reasons&quot; for thinking that the mutation might make it easier for the virus to penetrate to the lower lungs, leading to more severe disease.&lt;/p&gt;
&lt;p&gt;But she said in the U.S., patients have had severe lower respiratory infections caused by strains without the mutation, as well as mild disease caused by strains with the mutation.&lt;/p&gt;
&lt;p&gt;&quot;It&apos;s just too soon for us to say what this is going to mean long term,&quot; Schuchat said. &quot;It&apos;s an important finding for the influenza virologists, and they&apos;re looking into it.&quot;&lt;/p&gt;
&lt;p&gt;She added that the mutation &quot;has no implications for how good the match of the vaccine is and no implications for treatment with antiviral medicine.&quot;&lt;/p&gt;
&lt;p&gt;&quot;But it&apos;s important for us to continue to track influenza viruses and look for changes,&quot; she said.&lt;/p&gt;
&lt;p&gt;The agency will be watching to see if the mutation spreads and if it is more common in cases of severe disease, she added.&lt;/p&gt;
&lt;p&gt;Schuchat said influenza-like activity in the U.S. continues to be high, although the number of states reporting widespread disease has dropped slightly  --  to 43 states from 46 last week.&lt;/p&gt;
&lt;p&gt;At the same time, she said, some states  --  such as Maine and Hawaii  --  are reporting increased activity this week.&lt;/p&gt;
&lt;p&gt;Overall, flu activity is &quot;much greater than we would ever see at this time of the year,&quot; Schuchat said.&lt;/p&gt;
&lt;p&gt;The CDC has had reports this week of an additional 21 pediatric deaths associated with the flu, 15 of them confirmed to be H1N1. The other six could not be subtyped but were influenza A and probably H1N1, Schuchat said.&lt;/p&gt;
&lt;p&gt;Two-thirds of the 171 lab-confirmed H1N1 pediatric deaths have involved children with underlying conditions, such as asthma or cerebral palsy, she said.&lt;/p&gt;
&lt;p&gt;The vaccine supply is still less than the agency had hoped for, she said, but a total of 54.1 million doses have become available since the beginning of the season.&lt;/p&gt;
&lt;p&gt;Of those, Schuchat said, states have ordered 93%.&lt;/p&gt;
&lt;p&gt;She added that vaccine manufacturers have told the CDC that 94.5 million doses of the seasonal flu vaccine have been distributed.&lt;/p&gt;

    </recommendedItem>
    <recommendedItem id="20090101_19_1365"
                     title="IVW: Long Odds for a Universal Flu Vaccine"
                     score="-0.005"
                     href="http://www.medpagetoday.com/InfectiousDisease/URItheFlu/tb/14035?impressionId=1265818273897"
                     
      CANNES, France, May 4 -- A universal influenza vaccine that protects against multiple viruses, including unexpected strains like the 2009 H1N1 (swine) virus, is not likely to emerge soon -- if at all, according to researchers here.
              &lt;p&gt; 
              &lt;p&gt;Such a vaccine would eliminate the need to select different viruses each year for inclusion in the trivalent seasonal vaccine and would ideally protect against potential pandemic strains.
              &lt;p&gt; 
              &lt;p&gt;&quot;It&apos;s certainly the Holy Grail,&quot; Martin Meltzer, Ph.D., a senior health economist at the CDC in Atlanta, said at the conference on Influenza Vaccines for the World.
              &lt;p&gt; 
              &lt;p&gt;&quot;From my point of view, as an economist, you might say it&apos;s worthwhile putting some money in it,&quot; he said, &quot;but you have to be a little skeptical about how easy it is. I think it&apos;s not easy.&quot;
              &lt;p&gt; 
              &lt;p&gt;The longstanding problem in dealing with influenza is that the virus is constantly mutating.
              &lt;p&gt; 
              &lt;p&gt;Nancy Cox, Ph.D., director of  CDC&apos;s Influenza Division, noted at a press briefing Sunday that an influenza virus may swap genes with other strains that turn up in the same host, or with strains from birds and pigs.
              &lt;p&gt; 
              &lt;p&gt;The novel 2009 H1N1 had its genetic antecedents in swine flu strains, but until this weekend, it had only been confirmed in humans.
              &lt;p&gt; 
              &lt;p&gt;This constantly moving target makes researchers like John Oxford, Ph.D., scientific director of Retroscreen Virology and a professor of virology at St. Bartholomew&apos;s and the Royal London Hospital, pessimistic about the chances for a universal flu vaccine.
              &lt;p&gt; 
              &lt;p&gt;&quot;Instinctively, this looks like an unachievable goal,&quot; he said.
              &lt;p&gt; 
              &lt;p&gt;&quot;If you came to me and said, &apos;I&apos;ve got this experimental pig flu vaccine made in the normal way, and I&apos;ve got this really interesting thing to give you protection against everything, which one you gonna have?&apos; -- I&apos;d say, &apos;I&apos;ll have the swine one, thank you very much,&apos; &quot; he said.
              &lt;p&gt; 
              &lt;p&gt;He said he might consider taking the universal vaccine as well, but &quot;I wouldn&apos;t want to place my reliance on it.&quot;
              &lt;p&gt; 
              &lt;p&gt;Robert Webster, Ph.D., an influenza and vaccine researcher at St. Jude Children&apos;s Research Hospital in Memphis, Tenn., called the universal flu vaccine a &quot;pipe dream.&quot;
              &lt;p&gt; 
              &lt;p&gt;&quot;We don&apos;t have the knowledge that would allow us to think in this term,&quot; he said. &quot;If we can start manipulating [immune] responses to our needs to head off the virus, maybe we can, but we don&apos;t have the skills to do that yet.&quot;
              &lt;p&gt; 
              &lt;p&gt;Despite the odds, several studies presented at the conference showed that investigators are working on a universal flu vaccine. But they&apos;re still in the early stages.
              &lt;p&gt; 
              &lt;p&gt;Melissa Malhame, director of marketing and project management at Dynavax Technologies in Berkeley, Calif., reported promising results from animal studies. The company expects to begin a phase I trial of its universal vaccine early next year.
              &lt;p&gt; 
              &lt;p&gt;The goal, she said, is to &quot;cut down on transmission of divergent strains and potentially create background immunity against strains that might emerge unexpectedly.&quot;
              &lt;p&gt; 
              &lt;p&gt;Tammy Ben-Yedidia, Ph.D., of BiondVax Pharmaceuticals in Ness Ziona, Israel, reported preliminary animal data on another type of universal vaccine.
              &lt;p&gt; 
              &lt;p&gt;Such a product, she said, would eliminate the annual guessing game officials play when they decide what strains to include in the next year&apos;s seasonal flu vaccine -- a decision complicated this spring by the unexpected emergence of an H1N1 strain that has infected almost 1,000 people worldwide.
              &lt;p&gt; 
              &lt;p&gt;BiondVax expects to initiate a phase I trial later this year.
              &lt;p&gt; 
              &lt;p&gt;But David Fedson, M.D., retired from the University of Virginia School of Medicine and Aventis Pasteur MSD, tempered expectations for a universal vaccine.
              &lt;p&gt; 
              &lt;p&gt;&quot;They&apos;re obviously very, very important long-term targets for prevention,&quot; he said, &quot;but in terms of whether they will have a meaningful impact on what we are able to do for our fellow human beings in the next five years, the chances of that happening are very small.&quot;
            
    </recommendedItem>
    <recommendedItem id="20090101_19_2410"
                     title="Those Under 25 and Pregnant Women to Get Swine Flu Vaccine First"
                     score="-0.005"
                     href="http://www.medpagetoday.com/InfectiousDisease/SwineFlu/tb/15324?impressionId=1265818273897"
                     
      ATLANTA, July 30 -- A CDC advisory committee has released a list of groups to receive priority vaccination against the 2009 H1N1 (swine flu) virus so broad it covers just over half the population. 
              &lt;p&gt;
              &lt;p&gt;Included on the list are pregnant women, children and adults younger than 25, healthcare and emergency medical services personnel, household and caregiver contacts of children younger than 6 months, and adults younger than 65 with preexisting medical conditions that increase the risk for flu-related complications. 
              &lt;p&gt;
              &lt;p&gt;That would total about 159 million people, according to Anthony Fiore, MD, MPH, of the influenza division of CDC&apos;s National Center for Immunization and Respiratory Diseases. 
              &lt;p&gt;
              &lt;p&gt;Dr. Fiore participated in the workgroup that crafted the recommendations for the Advisory Committee on Immunization Practices. 
              &lt;p&gt;
              &lt;p&gt;Committee member Kathleen Neuzil, MD, MPH, of the University of Washington in Seattle, said the anticipated supply of H1N1 vaccine -- 120 million doses by the end of October -- should cover the initial target group because coverage rates likely won&apos;t approach 100%. Seasonal vaccine coverage is only about 20% to 50% in these groups. 
              &lt;p&gt;
              &lt;p&gt;The committee purposely chose a large initial group for coverage because past attempts at choosing groups that were too small resulted in drops in vaccine coverage. 
              &lt;p&gt;
              &lt;p&gt;Only if there isn&apos;t enough vaccine to meet demand in the initial stages of a vaccination program would further stratification occur, said Anne Schuchat, MD, director of the CDC&apos;s National Center for Immunization and Respiratory Diseases. 
              &lt;p&gt;
              &lt;p&gt;ACIP members unanimously adopted a recommendation that pregnant women, household and caregiver contacts of children younger than 6 months, healthcare and EMS personnel, children 6 months through 4 years, and children younger than 19 with chronic medical conditions receive preference should that happen. 
              &lt;p&gt;
              &lt;p&gt;The recommendations were made on the basis of epidemiological data that continue to show a disproportionate effect of the new H1N1 virus on younger individuals. 
              &lt;p&gt;
              &lt;p&gt;About 61% of confirmed cases and 53% of hospitalizations are in individuals younger than 25. 
              &lt;p&gt;
              &lt;p&gt;Children younger than 5 have the highest hospitalization rate -- at 4.5 per 100,000 population -- followed by individuals 5 to 24 years old, with a rate of 2.1 per 100,000. 
              &lt;p&gt;
              &lt;p&gt;Just 1% of confirmed cases were in individuals 65 and older, and there have been no reports of outbreaks in long-term care facilities, suggesting a lower risk for infection among that group, according to Dr. Fiore. 
              &lt;p&gt;
              &lt;p&gt;The committee agreed that older individuals would be vaccinated last, after demand had been met for the initial target group and all other individuals younger than 65. 
              &lt;p&gt;
              &lt;p&gt;The recommendation stated, however, that older individuals should receive the seasonal flu vaccine as soon as it&apos;s available. 
              &lt;p&gt;
              &lt;p&gt;Pregnant women were included in the initial priority group because they, like young people, have also been disproportionately affected. 
              &lt;p&gt;
              &lt;p&gt;Pregnant women account for about 6% of H1N1 cases, compared with just 1% of the general population, according to Dr. Schuchat. 
              &lt;p&gt;
              &lt;p&gt;A recent paper in &lt;em&gt;The Lancet&lt;/em&gt; showed that pregnant women were also more likely to have severe disease and complications from the new virus. (See &lt;a href=&quot;http://www.medpagetoday.com/InfectiousDisease/SwineFlu/15284&quot; target=&quot;blank&quot;&gt;Pregnancy Increases Risk of Severe H1N1 Disease&lt;/a&gt;) 
              &lt;p&gt;
              &lt;p&gt;Dr. Schuchat said the pandemic could present an opportunity to substantially increase flu vaccination rates among pregnant women, which historically have been very low. 
              &lt;p&gt;
              &lt;p&gt;&quot;In contrast to seasonal influenza, this H1N1 situation has given the unfortunate opportunity of being able to highlight some of the really horrible outcomes that pregnant women are suffering,&quot; she said. 
              &lt;p&gt;
              &lt;p&gt;Additional recommendations accepted by the committee included guidance not to keep vaccine in reserve for second doses, anticipating that the pandemic vaccine supply would increase rapidly after initial distribution. 
              &lt;p&gt;
              &lt;p&gt;In addition, the committee said, individuals currently recommended for seasonal flu vaccine should get it as soon as it is available. 
              &lt;p&gt;
              &lt;p&gt;Robert Field, PhD, MPH, JD, of the University of the Sciences in Philadelphia, noted stark differences between the collective recommendations and those drafted by the Department of Health and Human Services as part of prepandemic planning. 
              &lt;p&gt;
              &lt;p&gt;&quot;That document focused on protecting personnel involved in key infrastructure, including homeland security, national defense, government, public health, and key industries,&quot; he said. 
              &lt;p&gt;
              &lt;p&gt;&quot;The present recommendations focus on protecting those who are most vulnerable. It is not clear whether this represents a different philosophy or a response to a different kind of pandemic that is expected to be less lethal than avian flu,&quot; he said. 
            
    </recommendedItem>
    <recommendedItem id="20090101_19_3482"
                     title="High Potential for False Safety Concerns with H1N1 Vaccine (CME/CE)"
                     score="-0.005"
                     href="http://www.medpagetoday.com/InfectiousDisease/URItheFlu/tb/16726?impressionId=1265818273897"
                     
      &lt;p&gt;Failure to account for background rates when considering adverse events from pandemic H1N1 flu vaccination could spark public panic, researchers cautioned.&lt;/p&gt;
&lt;p&gt;Coincidental cases of dramatic events including sudden death, Guillain-Barr&amp;#233; syndrome, and spontaneous abortion can be expected to boost the true incidence of adverse events after immunization, said Steven Black, of Cincinnati Children&apos;s Hospital, and colleagues online in &lt;em&gt;The Lancet&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;&quot;The public will need frequent reassurance of vaccine safety when events that are temporally associated with vaccination are identified, even when these events have other causes and occur at the expected background rate,&quot; they said.&lt;/p&gt;
&lt;p&gt;Widespread belief in spurious associations can disrupt immunization programs, the researchers noted.&lt;/p&gt;
&lt;p&gt;They cited the example of four deaths that occurred within 24 hours of seasonal flu vaccination in 2006 in Israel that derailed the program there, even though these were high-risk patients to begin with and the number of deaths was actually lower than expected from chance alone.&lt;/p&gt;
&lt;p&gt;The risk is high for a similar situation with the mass vaccination programs underway for H1N1 influenza, they said.&lt;/p&gt;
&lt;p&gt;A vaccination campaign in 1976-1977 against &quot;swine&quot; flu was associated with elevated rates of the autoimmune disease Guillain-Barr&amp;#233; syndrome.&lt;/p&gt;
&lt;p&gt;Since one or two diagnoses of the syndrome per 1 million people would be expected every month, 200 or more cases of Guillain-Barr&amp;#233; will occur as background, coincidental events during the current vaccination campaign if 100 million people in the U.S. are immunized.&lt;/p&gt;
&lt;p&gt;&quot;The reporting of even a fraction of such a large number of cases as adverse events after immunization, with attendant media coverage, would probably give rise to intense public concern, even though the occurrence of such cases was completely predictable and would have happened in the absence of a mass campaign,&quot; Black&apos;s group wrote.&lt;/p&gt;
&lt;p&gt;So, the investigators looked into background rates of some events that are most likely to raise concerns with the pandemic vaccination campaign.&lt;/p&gt;
&lt;p&gt;A review of data from prior studies and from hospital databases showed that rates varied by year, country, age, and sex.&lt;/p&gt;
&lt;p&gt;Overall, 3.58 cases of Guillain-Barr&amp;#233; syndrome would be expected as background events within seven days per 10 million individuals vaccinated and 21.50 per 10 million within six weeks.&lt;/p&gt;
&lt;p&gt;Coincident sudden death would be expected to strike 0.98 people per 10 million vaccinated people within seven days of vaccination and 5.75 cases would be expected to occur within six weeks as background events.&lt;/p&gt;
&lt;p&gt;Among women, 14.40 cases of optic neuritis would be expected for every 10 million vaccinated within seven days and 86.30 could be expected for the same population within six weeks.&lt;/p&gt;
&lt;p&gt;For pregnant women, 397 spontaneous abortions within one day of vaccination would occur as coincidental, background events for every 1 million vaccinated.&lt;/p&gt;
&lt;p&gt;However, the researchers cautioned that the miscarriage rate may have been an overestimate given that vaccination rates are not uniform throughout trimesters of pregnancy.&lt;/p&gt;
&lt;p&gt;But given the large number of events that could potentially be misinterpreted as caused by vaccination, Black&apos;s group recommended &quot;timely and thorough analysis of safety concerns,&quot; taking into account the chance of temporal and geographical clustering.&lt;/p&gt;
&lt;p&gt;For example, about 2% of practices will likely have a seemingly elevated rate  --  more than two standard deviations above average  --  of postvaccination spontaneous abortion based on the normal distribution.&lt;/p&gt;
&lt;p&gt;Although this could lead to suspicions of a link to vaccination or a specific manufacturer&apos;s vaccine, the investigators warned that &quot;even random events can appear to have patterns.&quot;&lt;/p&gt;
&lt;p&gt;The number of cases sent to passive reporting systems alone is not an appropriate method on which to rely because the &quot;denominator&quot;  --  the number vaccinated  --  is usually not known, they cautioned.&lt;/p&gt;
&lt;p&gt;Comparing observed and expected rates is a better method, although that is still subject to uncertainty and differences in populations, the researchers said.&lt;/p&gt;
&lt;p&gt;In the U.S., the voluntary Vaccine Adverse Event Reporting System has beefed up outreach efforts, and a new Web-based active surveillance system has been implemented along with population-based, computerized database monitoring, according to an accompanying commentary in &lt;em&gt;The Lancet&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;The CDC&apos;s Frank DeStefano, MD, MPH, and Jerome Tokars, MD, MPH, wrote that other countries have mounted similarly intensive monitoring for the safety of the H1N1 vaccine, which should serve as a model for tracking safety of all vaccines in the future.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;Black reported serving on the data monitoring safety board for pneumoccocal conjugate vaccine for GlaxoSmithKline and receiving honoraria for participation in scientific advisory boards for Novartis. Co-authors reported conflicts of interest with the CDC, Merck, Novartis, Wyeth, and Sanofi Pasteur.&lt;/p&gt;&lt;p&gt;DeStefano and Tokars reported no conflicts of interest.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
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