Global Hib vaccination: reasons to cheer and fear

Haemophilus influenza Type B (HiB) is one of the emerging vaccinations that has been discovered in the past several decades. This particular strain of influenza is known to affect children under the age of 5. The findings of this strain began in early 1930’s when research figured out that this was an secondary infection and the primary infection was the influenza virus itself. The secondary infection in children caused bacterial infections which caused severe fatalities. But developments and findings of different strains of Haemophilus influenza have shown that it can be contained as it affects different parts of the body. This particular type B influenza affects the CSF and blood in an infant’s body, and since then there has been research done to prevent this virus from having its effect on the body.

The vaccine for HiB was recently discovered in the last several decades and had a specific dosing regimen of 3 shots at an early age. Conjugated vaccines were made to help the low-income countries to eliminate the onset of this HiB in children. Since then, 90% of the countries have been using this conjugated vaccine in children. Globally, this vaccine is required to be taken 3 times at an early age, but due to resurgence in the disease in UK and Ireland, a booster shot was implemented in early 2000s. Since then the following question has arose: should a booster shot be required in the third-world countries that find it hard to pay for these vaccinations? Or should there be more research done on whether the resurgence of the disease occurs only in certain types of children, therefore not everyone will need the booster shot?

 

Howie, S. R. (2016). Global Hib vaccination: Reasons to cheer and fear. The Lancet Global Health, 4(3). Retrieved February 26, 2016. http://www.thelancet.com/journals/langlo/article/PIIS2214-109X(16)00006-1/fulltext

Pharmacist Role in Counseling on Preconception Health

As accessible health care providers, pharmacists have a unique opportunity to improve preconception health in women which can lead to overall improved pregnancy outcomes. If women are thinking about conceiving a baby, it is important that they are counseled on prenatal supplementation and vaccinations. The information that a pharmacist can provide can help the woman make informed decisions about their lifestyle.

Screening for immunizations for measles, mumps, rubella, varicella, human papillomavirus, hepatitis A, and hepatitis B should all be recommended for women thinking about conceiving since they may have harmful effects on the developing fetus after conception. Not all vaccinations are off limits however. Inactivated influenza virus and tetanus, diphtheria, and pertussis vaccinations are recommended) even if the woman is pregnant (regardless of trimester) and should not pose a risk to the fetus. Moreover, contraction of influenza may cause problems for the baby. Influenza contraction in the first trimester gives rise to higher incidence of schizophrenia in the child. Contraction of the virus in the second and third trimesters poses more risk for the mother as breathing is impaired and the fetus is applying pressure on the mother’s diaphragm and lungs.

Counseling the woman on supplementation of folic acid may also lead to improved pregnancy outcomes as this B vitamin has been shown to improve optimal birth outcomes and neural tube development. Deficiency of this vitamin may result in spina bifida, a condition in which the spine does not close properly which can result in paralysis or mental retardation. It can also result in anencephaly or the case in which the brain does not form altogether. Since these events occur in the developing fetus within the first 28 days, it is important that the woman supplements this ahead of time.

Pharmacists have a role in helping educate people about medication day to day. However this role may be all the more important when discussing good preconception habits with women. This is a situation that there is a good chance that they have not been in before and since the development of the fetus is so fragile, it is important to make sure that they are getting all of the information correct in order to improve the likelihood of optimal birth outcomes.

Reference

El-Ibiary S, Raney E, Moos M. The pharmacist’s role in preconception health. J Am Pharm Assoc. 2014; 54(5): 288-303

J Am Pharm Assoc. 2014; 54(5): 288-303

The Efficacy of High-Dose vs. Standard-Dose Influenza Vaccinations for Older Adults

Older adults are known to suffer from more severe complications caused by the flu. 90% of deaths due to influenza are experienced by adults aged 65 and older. In 2009, the FDA licensed the high-dose influenza vaccination with 4 times more influenza haemagglutinin than the standard-dose. It was passed according to accelerated approval regulations. However, more research needs to be conducted to gather additional data beyond what was done prior to the high-dose vaccination’s approval to assess the effectiveness of the high-dose.

This article discusses a retrospective cohort analysis that studies the effectiveness of the high-dose versus the standard-dose influenza vaccinations in adults aged 65 and older. Influenza vaccination and infection rates were gathered from the US Medicare Program. The participants were thus enrolled in Medicare and had a Healthcare Common Procedure Coding System or Current Procedural Terminology code for either the high-dose or low-dose influenza vaccines between August 2012 and January 2013. The vaccinations were received in community pharmacy settings. If a participant had influenza before receiving the vaccination or received both the high-dose and standard-dose, he or she was excluded from the study.

Of the 12.5 million Medicare beneficiaries received influenza vaccinations within the set time frame, 19% received high-dose vaccinations and 81% received standard-dose vaccinations. The participants were said to be similar in age and medical condition. The high-dose vaccination was more effective in participants between the ages of 65 to 85 years old. There was a 22% reduction in influenza diagnosis in the group that received the high-dose vaccine. The high-dose vaccine was also more effective in preventing hospital and community setting influenza-related outcomes.

 

 

Lancet Infect Dis. 2015; 15(3): 293-300.

 

Because pharmacists have recently been given the responsibility of providing immunizations, the next step is to ensure that the most effective vaccines are being distributed to the population. At my Community Health site, almost all the older adults tell me that they have received their ‘flu shot’ at their community pharmacy. The results found in this study include evidence that can potentially lead to preventing the flu in these older adults who now come to the pharmacy for their influenza vaccination. Do you agree that pharmacists’ roles go beyond striving for positive health outcomes from medications to now including positive health outcomes from vaccinations?