HEALTH: NOVEMBER 2008
Adults should consider reviewing
their vaccination history, report says
When you think of serious threats to your health, heart disease, cancer, or maybe even serious injuries might come to mind. However, you probably don’t think about infectious diseases. Often underestimated, infectious diseases can be overlooked, but are a leading killer in the United States and worldwide.
You’ve probably been vaccinated against a number of infectious illnesses. In the United States, vaccination is required for entry to schools, many camps, colleges, and some occupations. However, it is important for adults to review their vaccination status. There are a number of reasons adults need vaccination:
• You may not have received any or all vaccines as a child;
• Newer vaccines may not have been available when you were a child;
• Immunity can wane over time;
• As you age, you become more susceptible to serious disease caused by common infections;
• You may travel to areas where rare infectious diseases are much more common;
• You may interact with people who have been exposed to unusual infectious diseases.
The FDA is understandably cautious and demanding before it will license a new vaccine. Most recently, it has licensed several new vaccines: human papillomavirus (HPV), varicella-zoster virus, and meningococcus (a second meningococcal vaccine). The FDA has also approved a preliminary bird flu vaccine in case of a bird flu pandemic.
Do you need the HPV vaccine? The HPV vaccine was licensed in June 2006 and is recommended for females beginning at age 11 or 12 through age 26, although it can be administered to girls as young as 9. This vaccine protects against the four most common HPV strains, which are responsible for 70 percent of cervical cancers and 90 percent of genital warts. Ideally, girls should receive the vaccine before they become sexually active.
Studies that included 11,000 girls and women, ages nine to 26, showed that the vaccine was safe and had no serious side effects. However, no vaccine is 100% protective. Because the vaccine doesn’t protect against all viruses that can lead to cervical cancer, women should continue to have regular Pap smears. Although males are also carriers of HPV, currently there are no recommendations to vaccinate boys or men.
Do you need the varicella-zoster vaccine? The FDA licensed the varicella-zoster virus vaccine for shingles in 2006. (Shingles is caused by the chickenpox virus, which remains in the body after an initial bout of chickenpox and may emerge many years later to cause the painful condition known as shingles.) The Centers for Disease Control and Prevention (CDC) recommends the varicella-zoster virus vaccine for people over age 60 to prevent shingles and to reduce shingles-associated pain.
Do you need the hepatitis A vaccine? Children are routinely vaccinated for hepatitis A but many adults have not been vaccinated because the vaccine is relatively new. The Advisory Committee on Immunization Practices (ACIP) recommends it for all people and especially for those with chronic liver disease, people who receive clotting factor concentrates, individuals traveling to countries where hepatitis A is common, men who have sex with men, or people in occupations that might expose them to the virus.
Do you need the meningococcus vaccine? A further addition to the existing vaccine arsenal is the meningococcal conjugate vaccine (MCV4), which was licensed in 2005 to combat bacterial meningitis. This vaccine is recommended for adolescents and some adults, including students entering college and people traveling to areas where they are likely to be exposed.
What about bird flu? The bird flu vaccines will not be available to the public except in case of a pandemic. Although the number of human deaths attributable to bird influenza strains has been low thus far, there remains the very real fear of a pandemic should the viral strains mutate sufficiently to pass easily from person to person.
What about smallpox? Smallpox vaccine is routinely given to health workers, military personnel, and other persons in professions where the unlikely threat of bioterrorism employing the smallpox virus may put them on the front line of exposure. If you think you fall in this category, check with your clinician about vaccination.
Other vaccines you may need. Even if you have received all your childhood vaccinations, ask your doctor whether you need any booster shots, for example:
• The tetanus shot should be repeated every 10 years;
• Get a flu shot each year;
• If you have never had chickenpox and have never been vaccinated, now is the time;
• Check whether you need a booster for measles, mumps, and rubella;
• If you travel, make sure to check for needed immunizations;
• Adults over age 65 need the vaccine for bacterial pneumonia;
• Those age 60 and up need the zoster vaccine against shingles.
Reprinted from “Viruses and Infectious Diseases: Protecting Yourself from the Invisible Enemy — A Special Health Report from Harvard Medical School,” Copyright © 2008 by Harvard University. All rights reserved.
Teen vaccination rates increase, but fall below goals for 2010
The nation’s immunization coverage rates for preteens and teens are increasing for routinely recommended vaccines, but most still do not have all of the recommended immunizations, according to 2007 estimates released in early October by the Centers for Disease Control and Prevention.
“The overall trends are good news,” said Dr. Lance Rodewald, director of the Division of Immunization Services at the CDC’s National Center for Immunization and Respiratory Diseases.
“We are seeing more preteens and teenagers being protected against serious, sometimes deadly diseases. But we remain short of our goals – for almost all of these vaccines we want at least 90 percent of adolescents to be fully immunized. As such, we have much work to do to get many more adolescents protected.”
The survey provides estimates for three vaccines recommended at 11 or 12 years of age: the tetanus-diphtheria-acellular pertussis (Tdap) vaccine, the meningococcal conjugate vaccine (MCV4), and the human papillomavirus (HPV4) vaccine for girls and young women. It also includes estimates of the percentage of 13- through 17-year-old teens who should have received the recommended immunizations for measles, mumps and rubella vaccine (MMR), hepatitis B (HepB) vaccine, and varicella vaccine (VAR) earlier in life.
According to Rodewald, the nation’s “Healthy People 2010” goals for preteens and teens ages 13-15 years are not being met for any of the vaccines for which goals were set. The “Healthy People 2010” goals are for 90 percent coverage for preteens and teens 13 to 15 years of age with three doses of hepatitis B vaccine, two doses of measles, mumps and rubella vaccine, one dose of either tetanus-diphtheria or tetanus, diphtheria and acellular pertussis vaccine, and one dose of varicella vaccine for those who have not previously had chickenpox. There is not a “Healthy People 2010” goal for HPV vaccination, which was first licensed and recommended in 2006.
The survey found that, compared to 2006, there was a substantial increase in the percentage of preteens and teens that had received the recommended vaccinations. Specific findings included:
• (HepB) and two or more doses of measles, mumps and rubella vaccine (MMR) were over 80 percent;
• Coverage with one dose of varicella vaccine (VAR) was high at 75.7 percent but coverage with two doses was low at 18.8 percent among preteens and teens without a previous history of disease;
• 32.4 percent of preteens and teens surveyed had received MCV4 vaccination, up from 11.7 percent in 2006 (a 20.7 percentage point increase);
• 30.4 percent had received Tdap vaccination, up from 10.8 percent in 2006 (a 19.6 percentage point increase);
• 25.1 percent of adolescent females had received at least one dose of HPV vaccine.
Rodewald encourages parents to take their preteens and teenagers for routine medical checkups as a way to ensure they receive the recommended vaccinations.
Additional background information – The meningococcal conjugate vaccine (MCV4) vaccine protects against meningococcal meningitis, the tetanus-diphtheria-acellular pertussis (Tdap) vaccine protects against pertussis, also known as whooping cough, and the human papillomavirus (HPV) vaccine protects girls against cervical cancer.
The recommended series consists of one dose of Tdap vaccine, one dose of the MCV4 vaccine, and three doses of the HPV4 vaccine.
CDC has conducted the National Immunization Survey for teens since 2006. It is similar to the standard NIS that began in 1994, that collects immunization information among children 19 through 35 months old. It is a random digit-dialed telephone survey.
For more information, visit http://www/cdc.gov/vaccines/default.htm.
Ursuline Center sets
Nov. 7 grief session
Catholic Charities Regional Agency and the Ursuline Center will co-sponsor a holiday grief workshop from 11 a.m. to noon on Friday, Nov. 7 at the Ursuline Center,4280 Shields Road. Sister Pauline Dalpe, M.ED., LPC and Marlene Hanisko, LPCC will present the workshop. The donation for the grief workshop is $5. The fee includes the workshop, soup and salad. Hanisko is a licensed counselor at Catholic Charities Regional Agency, 2401 Belmont Ave. in Youngstown. For more information and to register, call 330-744-3320 or 330-799-4941.
Safety Council: Keep drinking age at 21
The National Safety Council and the Northern Ohio Chapter last month reaffirmed their public policy to support a national 21-year-old minimum legal drinking age. The policy was reaffirmed by representatives of the National Safety Council’s 50,000 member organizations at their annual meeting in Anaheim, Calif.
A key statement emerged from the meeting. It reads: “The National Safety Council supports the minimum drinking age of 21 and opposes any attempt to lower this age and reaffirms the need for Federal sanctions for states that violate this provision.”
The National Safety Council first adopted its policy supporting the 21-year-old minimal legal drinking age in 1984, preceding federal establishment of it that year. (The full policy, “Under 21 Drinking and Driving,” will be posted on the Northern Ohio Chapter and National Safety Council Web sites.)
“After 24 years of saving young lives with a higher drinking age in this nation, there is absolutely no reason to go back to the 1970s and early 80s which produced more injuries and deaths related to alcohol,” said Larry Kingston, executive director of the National Safety Council’s Northern Ohio Chapter.
Mothers Against Drunk Driving (MADD), a National Safety Council partner in the Support 21 Coalition, supported the policy reaffirmation.
“The 21 minimum legal drinking age law is proven to be one of the nation’s most important and lifesaving laws to protect youth. There is overwhelming support for this law, including that of national health and safety leaders, enforcement, legislators and the American public,” said MADD National President Laura Dean-Mooney.
Compiled from local reports.
High blood pressure
Helpful tips to control a deadly, ‘silent killer’
From Harvard Medical School
Because high blood pressure (hypertension) has no symptoms or warning signs, 30 percent of the people who have it don’t realize it. That lack of knowledge can be deadly.
Over the years, untreated high blood pressure quietly damages your organs and sets you on a course for several life-threatening diseases, including stroke and heart disease. This special health report gives you the crucial information to help you identify a blood pressure problem and get it under control sooner rather than later.
Checking blood pressure: Do try this at home. Your blood pressure changes from hour to hour, sometimes even minute to minute.
Standing up, watching an exciting sports event, eating a meal, even the time of day influence your blood pressure. It jumps around so much that you are more likely to get a “normal” reading if you check it at home rather than in the doctor’s office.
That idea underlies a recommendation from the American Heart Association, American Society of Hypertension, and Preventive Cardiovascular Nurses Association. They urge individuals with high blood pressure, or at high risk for developing it, to become blood pressure do-it-yourselfers. There are many good reasons to follow their advice:
Find your real blood pressure. The measurement your doctor or nurse takes is just a just single frame from an ongoing movie. In some individuals, that snapshot is an excellent approximation of their usual blood pressure. In others, it isn’t. Up to 20 percent of people diagnosed with high blood pressure have white-coat hypertension. This is a temporary spike in blood pressure brought on by the stress of seeing a doctor. Still others have what’s called masked hypertension – normal blood pressure in the doctor’s office but high blood pressure everywhere else.
Improve your control. People who check their blood pressure at home tend to be more successful at keeping it under control. Instead of a getting a blood-pressure reading once every few months in a doctor’s office, you can get a reading every week or so at home. Being more involved by taking the measurements yourself also helps. People who actively participate in their care generally do better than those who take a hands-off, let-the-doctor-do-it approach.
Track your progress. You can’t feel your blood pressure improve – or get worse. Measuring it at home can tell you whether your life-style changes and the medications you are taking are having their desired effects.
Save time and medications. Monitoring your blood pressure at home may mean fewer trips to the doctor’s office. If you have white-coat hypertension, it may also mean taking fewer, or no, blood pressure medicines.
Run with the right crowd. Of every 100 people with high blood pressure, 70 or more don’t have it under control. A study shows that people who checked their blood pressure at home and e-mailed the results to a pharmacist who offered advice were far more likely to keep their blood pressure in check than those who merely measured it at home or those who had it taken by a doctor every now and then.
Key points – If you have high blood pressure, it’s a good idea to check your blood pressure at home.
• Use an automatic monitor with a cuff that fits around your arm and that keeps track of your readings.
• Check your blood pressure once in the morning and once in the evening for a week, then one or two days a month after that.
• Picking the right machine – There are dozens of different home blood pressure monitors on the market. For best accuracy and ease of use, buy one with a cuff for the upper arm that automatically inflates and that automatically records the pressure. The AHA doesn’t recommend wrist or finger home blood pressure monitors. The September 2008 issue of Consumer Reports compares home blood pressure and blood sugar monitors.
Do it right – Technique matters when it comes to measuring blood pressure. Doing it wrong can give you a reading that’s too high or too low. (To see a brief video on using a home blood pressure monitor, visit health.harvard.edu/128.)
There are two things to do before you start. First, check your machine against the one in your doctor’s office. Second, make sure you have the right size cuff — the inflatable part should encircle at least 80 percent of your upper arm.
When you first start to check your blood pressure at home, measure it early in the morning, before you have taken your blood pressure pills, and again in the evening, every day for a week. After that, follow the plan your doctor recommends, or check it one or two days a month. Each time you take a reading:
• Avoid caffeinated or alcoholic beverages, and don’t smoke, during the 30 minutes before the test;
• Sit quietly for five minutes with your back supported and feet on the floor;
• When making the measurement, support your arm so your elbow is at the level of your heart;
• Push your sleeves out of the way and wrap the cuff over bare skin. Measure your blood pressure according to the machine’s instructions. Leave the deflated cuff in place, wait a minute, then take a second reading. If the readings are close, average them. If not, repeat again and average the three readings;
• Don’t panic if a reading is high. Relax for a few minutes and try again;
• Keep a record of your readings and the time of day they are made.
Checking blood pressure at home won’t cure hypertension, but it will help control the most common cause of stroke and a big contributor to heart attack, heart failure, and premature death.
For more information on diagnosing and treating high blood pressure, order “Special Health Report, Hypertension: Controlling the ‘silent killer,’ ” at www. health.harvard.edu/HT.
