Health
Immunizing older adults with the tetanus-diphtheria-acellular-pertussis vaccine (Tdap) to prevent pertussis (more commonly referred to as whooping cough) was found to be as safe as immunizing them with the tetanus and diphtheria (Td) vaccine, according to a study by Kaiser Permanente published in the journal Clinical Infectious Diseases.
Researchers examined the electronic health records of nearly 120,000 people ages 65 and older at seven U.S. health systems between Jan. 1, 2006, and Dec. 31, 2010.
The study looked at a number of medical conditions following Tdap vaccination and found that although there is a small increased risk of injection site reactions 1-6 days following Tdap vaccination compared to other time periods, they are no more common than those following Td vaccination.
Researchers also found that patients who had received a tetanus- or diphtheria-containing vaccine within the prior five years did not have a higher rate of reaction from the Tdap vaccine.
“Published data on the safety of the Tdap vaccine in persons 65 years and older is limited as the vaccine was initially not licensed for this age group,” said study lead author Hung Fu Tseng, PhD, MPH from Kaiser Permanente Southern California’s Department of Research & Evaluation. “However, as the number of elderly individuals receiving Tdap increases, evaluation of the safety of the vaccine in this population becomes essential.”
The study provides empirical safety data suggesting that immunizing adults 65 years and older with Tdap should not have negative health impacts. All adults 65 and older should receive Tdap to reduce the risk of pertussis in the elderly and people they come in contact with.
“Recent outbreaks of whooping cough and infant deaths are a reminder of how serious these infections are and that pertussis immunization is important, particularly since one of the most common sources of pertussis in infants is their relatives, including their grandparents” said Tseng. “These findings should instill additional confidence for clinicians serving older adult populations in recommending the Tdap vaccine as a safe way to reduce the risk of pertussis infections.”
According to the Centers for Disease Control and Prevention, the most effective way to prevent pertussis is through immunization. Five doses of a diphtheria, tetanus, and pertussis vaccine (DtaP) are recommended for infants and children starting at two months of age.
Since protection from the childhood vaccine may fade over time, a Tdap vaccine is recommended for preteens, teens, and adults. Tdap is especially important for expectant mothers and those caring for infants.
Pertussis is a highly contagious bacterial disease that causes uncontrollable, violent coughing and can be deadly in infants, especially those under two months of age who are too young to be vaccinated.
In 1976, there were just over 1,000 reported cases of pertussis in the United States; by 2010, it climbed to nearly 28,000 cases – the largest number of cases reported in the U.S. since 1959 when 40,000 cases were reported.
Between 2000 and 2005 there were 140 deaths resulting from pertussis in the United States.
This study is part of the Vaccine Safety Datalink (VSD) project, a collaborative effort between the CDC’s Immunization Safety Office and 10 health systems including Kaiser Permanente.
The VSD project was established in 1990 to monitor immunization safety and address the gaps in scientific knowledge about rare and serious events following immunization.
The research is also part of Kaiser Permanente’s broader efforts to deliver transformational health research regarding the safety and effectiveness of vaccines.
Earlier this year, Kaiser Permanente researchers found that the herpes zoster vaccine, also known as the shingles vaccine, is generally safe and well tolerated.
Another Kaiser Permanente study from this year found that vaccines for measles were not associated with an increased risk of febrile seizures among 4-6 year olds during the six weeks after vaccination.
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Scientists at Columbia University and the National Center for Atmospheric Research have adapted techniques used in modern weather prediction to generate local forecasts of seasonal influenza outbreaks.
By predicting the timing and severity of the outbreaks, this pilot system can eventually help health officials and the general public better prepare for them.
The study, published this week in the Proceedings of the National Academy of Sciences, was funded by the National Institutes of Health and the Department of Homeland Security. NCAR’s sponsor is the National Science Foundation.
From year to year, and region to region, there is huge variability in the peak of flu season, which can arrive in temperate areas of the Northern Hemisphere as early as October or as late as April.
The new forecast system can provide “a window into what can happen week to week as flu prevalence rises and falls,” said lead author Jeffrey Shaman, an assistant professor of Environmental Health Sciences at Columbia’s Mailman School of Public Health.
In previous work, Shaman and colleagues had found that wintertime U.S. flu epidemics tended to occur following very dry weather.
Using a prediction model that incorporates this finding, Shaman and co-author Alicia Karspeck, an NCAR scientist, used Web-based estimates of flu-related sickness from the winters of 2003-04 to 2008-09 in New York City to retrospectively generate weekly flu forecasts.
They found that the technique could predict the peak timing of the outbreak more than seven weeks in advance of the actual peak.
“Analogous to weather prediction, this system can potentially be used to estimate the probability of regional outbreaks of the flu several weeks in advance,” Karspeck said. “One exciting element of this work is that we’ve applied quantitative forecasting techniques developed within the geosciences community to the challenge of real-time infectious disease prediction. This has been a tremendously fruitful cross-disciplinary collaboration.”
Up next: Your local flu forecast
In the future, such flu forecasts might conceivably be disseminated on the local television news along with the weather report, said Shaman. Like the weather, flu conditions vary from region to region; Atlanta might see its peak weeks ahead of Anchorage.
“Because we are all familiar with weather broadcasts, when we hear that there is an 80 percent chance of rain, we all have an intuitive sense of whether or not we should carry an umbrella,” Shaman said. “I expect we will develop a similar comfort level and confidence in flu forecasts and develop an intuition of what we should do to protect ourselves in response to different forecast outcomes.”
A flu forecast could prompt individuals to get a vaccine, exercise care around people sneezing and coughing, and better monitor how they feel. For health officials, it could inform decisions on how many vaccines and antiviral drugs to stockpile, and in the case of a virulent outbreak, whether other measures, like closing schools, is necessary.
“Flu forecasting has the potential to significantly improve our ability to prepare for and manage the seasonal flu outbreaks that strike each year,” said Irene Eckstrand of the National Institutes of Health’s National Institute of General Medical Sciences.
Worldwide, influenza kills an estimated 250,000 to 500,000 people each year. The U.S. annual death toll is about 35,000.
The seed of the new study was planted four years ago in a conversation between the two researchers, in which Shaman expressed an interest in using models to forecast influenza.
Karspeck “recommended incorporating some of the data assimilation techniques used in weather forecasting to build a skillful prediction system,” remembered Shaman.
In weather forecasting, real-time observational data are used to nudge a numerical model to conform with reality, thus reducing error.
Applying this method to flu forecasting, the researchers used near-real-time data from Google Flu Trends, which estimates outbreaks based on the number of flu-related search queries in a given region.
Going forward, Shaman will test the model in other localities across the country using up-to-date data.
“There is no guarantee that just because the method works in New York, it will work in Miami,” Shaman said.
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