Showing posts with label Vaccine. Show all posts
Showing posts with label Vaccine. Show all posts

December 4, 2019

Three HIV Vacs For 2021 *All You Need is One to Work and End Game for The Virus

By Tim Fitzsimons

The global fight against the human immunodeficiency virus is poised to make important advances thanks to three experimental HIV vaccines that are entering the final stages of testing at sites across the globe.
While any of these three late-stage HIV vaccine trials — known as HVTN 702, Imbokodo and Mosaico — could fail, scientists say they are more hopeful than at any time since 1984, when Secretary of Health and Human Services Margaret Heckler raised hopes by predicting that there would be a test-worthy HIV vaccine within two years.
This is “perhaps one of the most optimistic moments we have been in," said Dr. Susan Buchbinder, director of the Bridge HIV research program at the San Francisco Department of Public Health and a chair of both the Imbokodo and Mosaico trials.
“We have three vaccines currently being tested in efficacy trials," she said, "and it takes quite a bit to actually be promising enough in the earlier stages of trials to move you forward into an efficacy study."

HVTN 702

The oldest ongoing HIV vaccine trial, known as HVTN 702, is based on a prior vaccine candidate, RV144, that was effective, but not effective enough. In 2009, the RV144 clinical trial released findings showing that the vaccine lowered the rate of HIV infections by about 30 percent. To this day, RV144 remains the only HIV vaccine that has ever demonstrated any efficacy against the virus.
HVTN 702, launched in South Africa in 2016, was the first vaccine trial approved after the failure of RV144. According to the National Institute of Allergy and Infectious Diseases, the modified vaccination regime “aims to provide greater and more sustained protection than the RV144 regimen and has been adapted to the HIV subtype that predominates in southern Africa,” also known as HIV-1 clade C. While RV144, at 30 percent effective, did not suffice for global distribution, it pointed the way forward for vaccine researchers, who adapted RV144’s successes to create HVTN 702. Buchbinder said even a partially effective vaccine would be “a tremendous breakthrough,” and "would really have the power to change the trajectory of the epidemic.”
Dr. Anthony Fauci, director of NIAID and a longtime advocate for a vaccine that is at least 50 percent effective, said he feels “even more strongly now” that a partially effective vaccine would be worth deploying. He said that is because prevention strategies like pre-exposure prophylaxis (PrEP) and treatment as prevention (TasP) “are being so successfully used, even in the absence of a vaccine, that if one or more of these vaccines look good, have a 50-60 percent efficacy, I think that’s going to be the game-changer for turning the epidemic around.”
HVTN 702 completed enrollment this summer, and clinical results are expected in late 2020 or early 2021.

Imbokodo and Mosaico

Imbokodo, the second trial, began in five southern African nations in 2017 and completed enrollment of 2,600 women this summer. In southern African nations, heterosexual women are at extremely high risk of HIV infection.
“It’s almost unbelievable, but it’s true, women between the ages of 18 and 25 — the prevalence of infection is well over 50 percent,” Fauci said. “If ever you wanted to get a population that, if the vaccine works, you’re going to know pretty quickly, then you want to go in women.”
Unlike HVTN 702, Imbokodo uses “mosaic” immunogens, which are “vaccine components designed to induce immune responses against a wide variety of global HIV strains,” according to the National Institutes of Health.
“The presumption is that a mosaic is going to give you broader coverage,” Fauci said.
In November, the third vaccine trial, Mosaico, marked its informal start after the first study participant received an injection. Mosaico is based on Imbokodo’s unique mosaic immunogen approach.
Imbokodo and Mosaico are largely identical and consist of six injections, with slightly different vaccine formulations administered during the final two clinic visits. In addition, while Imbokodo is only being tested in African women, Mosaico will recruit 3,800 gay men and transgender people for its clinical trials at 57 sites in the United States, Latin America, and Europe. For any HIV vaccine, Fauci said there’s a need to prove it works in different at-risk populations.
Imbokodo completed enrollment of study participants this summer, marking the formal end of the recruitment process. Results from Imbokodo are expected in 2021, and results from Mosaico are expected in 2023.

Challenges ahead

Fauci noted that there has been a rapid pace of vaccine-related developments in recent years, with these three vaccine trials starting in 2016, 2017 and 2019.
“In all of these trials, intermittently the data and safety monitoring board takes a look at the data, and either says the data are so bad you have got to stop, or the data are so overwhelmingly good that you have got to stop,” Fauci said. So far, after several reviews of the data in HVTN 702 and Imbokodo, “there’s nothing there to say stop the study,” which happened in 2007 when a Merck vaccine trial was shut down after the monitoring board determined that it had no impact on prevention.
"None of these vaccines is a particularly simple regimen," Buchbinder said, "so it’s going to require quite a bit of effort to deploy.”
“They require multiple injections, and so each one would require a minimum of four different doses in its current configuration,” Buchbinder said. But an effective vaccine could be a “stepping off point” to potentially create a simpler and more effective vaccine in the future.
And if these vaccine trials all fail, public health officials, say enough tools currently exist to stop the spread of HIV — if only people would, or could, use them. PrEP, the daily pill that prevents HIV infection, is safe and effective, but not enough people are using it to slow HIV transmission and end the epidemic. And successful treatment of people living with HIV results in an undetectable viral load that they cannot transmit the virus via sexual activity, known as “treatment as prevention” or TasP.
“It goes exactly to what I have been saying for years and years — if you implement the tools that you have, you will definitely see an impact on the dynamics of the epidemic,” Fauci said. “I have been talking about this for well over a decade. If you implement, the incidence is going to go down. It happened dramatically in San Francisco, and it is happening right now in New York.”

Fauci said President Donald Trump’s Ending the HIV Epidemic plan, which Fauci played a central role in drafting, aims to lower new infections by 75 percent in five years and by 90 percent in 10 years “even in the absence of a vaccine.”
So, if one of the three vaccines currently being tested works, “that would be the endgame," she said.

November 13, 2019

He Opposed Vaccines Until His Son Was Struck Down By Polio in Nigeria

Adamu Misa used to chase health workers away from his home in northern Nigeria but now campaigns for vaccines after his son contracted polio.
His eight-year-old son Buhari went to bed one night healthy and strong. By morning, he had lost his ability to walk. 
Scared, his father took him to a traditional healer, who said an evil spirit had attacked his son, and applied some herbs.
It was not until a neighbor said he suspected Buhari had polio that he was taken to the hospital where an immediate medical intervention saved him from the full effects of the virus.
"He cannot open his fingers fully like me," said Mr. Misa as, five years later, he sits under a tree in their home outside Yola in Adamawa state, north-east Nigeria.

Adamu Misa
Image captionAdamu Misa's first two children were vaccinated while he was not around

He now campaigns for child vaccination, lending his voice and presence to local health workers who face stiff resistance from people against vaccines - or anti-vaxxers - in his community.
"I have seen it on my child so anybody who says anything against vaccination, I will show him practical example with my child," he told the BBC. 
He agreed that there are instances where the body's immune system is able to suppress certain viruses and bacteria, "but some of them may have fallen ill in the past without knowing what the actual cause was".
Polio graph

 Laureta Anaza trains volunteer health workers and believes the influence of religion and tradition is a major factor.
Her group engages in door-to-door advocacy, liaising with religious and traditional leaders to educate parents about the benefits of vaccinating their children.
Though they still encounter anti-vaxxers, they have the strong voice of people like Mr. Misa now supporting them.
"Now I realize my story is not like my father," he said.
"I have practical knowledge of vaccination so I can now tell those who are doubters.
The virus which causes polio is found in dirty water and generally unsanitary conditions. 
In parts of Nigeria, open defecation

practised in water channels that are a source of drinking water, and this is one way in which an unvaccinated child can get infected. 
That is why vaccinations are strongly encouraged. 

What is polio?

  • Polio, or poliomyelitis, mainly affects children aged under five
  • It is a highly infectious disease caused by a virus. It invades the nervous system and can cause total paralysis in a matter of hours
  • Initial symptoms include fever, fatigue, headache, vomiting, stiffness of the neck and pains in the limbs
  •  One in 200 infections leads to irreversible paralysis. Among those paralysed, 5% to 10% die when their breathing muscles become immobilised
  • Today, only two countries - Afghanistan and Pakistan - remain polio-endemic, down from more than 125 in 1988

Nigeria has not recorded any new cases of polio in the last three years and will be declared polio-free if it remains that way by mid-2020. But some people fear the disease may still be lingering on in remote areas where cases are not always officially recorded.
An ongoing struggle against a militant insurgency in the north-east of the country, not too far from Mr. Misa's home in Adamawa state, means that there are some communities that are "inaccessible to health workers", said Aliyu Shetima, a health worker with Unicef.
"I hope we achieve [polio-free status] but in the areas I have covered as a humanitarian worker, we still have a long way to go," he said.

May 16, 2019

These Are The Vaccines As an Adult You Should Have

Amid one of the largest measles outbreaks in the U.S. in recent history, vaccines are on the minds of many Americans.
The Centers for Disease Control and Prevention reported this week that the number of measles cases this year has climbed to 839 in 23 states, affecting mostly unvaccinated people. Most people in the U.S. are vaccinated against measles when they're children as part of the routine immunizations they get in primary care.
We're used to kids needing lots of shots to ward off lots of illnesses, but what about adults? The CDC recommends that adults get multiple vaccines for conditions ranging from tetanus to influenza to cervical cancer. The shots can be a bit trickier to keep track of, as many adults go to the doctor less frequently than kids do, but those vaccinations are equally important for staying healthy.
"Many adults are not aware of what vaccines they actually need," says Dr. Pamela Rockwell, an associate professor of family medicine at the University of Michigan who works with the CDC's Advisory Committee on Immunization Practices. "That is also balanced by physician unawareness of what vaccines they should be recommended. It's gotten very complicated, and it is difficult to keep up with all the changes." So we're here to answer some common questions about adult vaccines. Click on each topic to go to that section.
I was vaccinated against measles as a child, but the measles outbreak makes me worry that I'm no longer immune. Do I need to be revaccinated as an adult? 
If you received the standard two doses of the modern measles, mumps and rubella (MMR) vaccine, you're all set. You shouldn't need to be revaccinated, because you're considered immune for life.
And if you were born before 1957, doctors assume you were exposed to measles as a child and are already immune.
However, a version of the vaccine produced in the mid-to-late 1960s wasn't as effective as the current regimen, so if you were vaccinated before 1968, you should talk to your doctor about whether you need another shot. If you were born after 1957 but for some reason never got immunized, you should also get the MMR vaccine.
I've heard there's an effective vaccine for shingles, but my doctor's office doesn't have it and it's out of stock at the pharmacy. What's going on? 
Shingrix is a two-dose vaccine that is upward of 95 percent effective at preventing shingles, a painful rash that tends to affect older adults and immunocompromised people. The vaccine was approved in 2017 and requires two injections. It's more effective than Zostavax, an older shingles vaccine, so doctors will recommend Shingrix over Zostavax to most patients over age 50.
There has been a shortage of Shingrix for almost as long as it has been available because the demand for the vaccine has outpaced the supply. Its manufacturer, GlaxoSmithKline, told the CDC that it's working to step up its production schedule. But because every dose of Shingrix needs to undergo safety checks, GSK expects that shortages will continue at least through the end of the year.
"The demand was so great they literally couldn't keep up," Rockwell says.
If you get the first dose, do your best to get the second one within two to six months. If your local pharmacies don't have Shingrix in stock, don't worry — you can use the HealthMap Vaccine Finder to find out where it is available. If you wait more than six months to get the second dose, you don't need to repeat the first one, but it's possible the vaccine won't be quite as effective in preventing shingles.
What's the deal with tetanus shots? How often do I need them? 
Tetanus is a life-threatening disease of the nervous system that's caused by a toxin-producing bacterium usually found in soil. It can be prevented by a series of five childhood shots, including a booster between ages 11 and 12. Adults then need a booster shot every 10 years. It can be hard to keep track of this if you move or change doctors, so make a note in your calendar and don't be afraid to ask about it. If you get it early or a year or two late, it isn't harmful.
If you ever have an injury that might expose you to tetanus — such as stepping on a nail — your doctor will ask when your latest tetanus booster was and may give you another booster shot on the spot. If you're not up to date on your tetanus vaccines, you may need additional treatment to prevent the disease.
Childhood tetanus shots are combined with a vaccine for diphtheria, a dangerous infection that can affect kids, and one for pertussis, which is known as whooping cough. Your every-10-year tetanus and diphtheria boosters won't include pertussis, unless you're pregnant. But when you turn 65, you should again get the shot that protects against all three, which is known as Tdap.
I'm thinking about having a baby. What vaccines do I need? 
Make sure you and everyone around you is up to date on standard childhood and adolescent vaccines, including pertussis, since babies are vulnerable to this disease. You should also get a dose of Tdap during prenatal care, since it's safe in pregnancy.
Everyone also should get an annual flu shot, because pregnant women, who have weakened immune systems, are particularly susceptible to influenza and can get very sick or die from an infection.
Even if you got all the recommended vaccines as a kid, it's possible your immunity has waned when it comes to some of the vaccine-preventable diseases that can be passed from mom to baby. This is why prenatal doctors and midwives check to make sure pregnant women are immune to hepatitis B, varicella (chickenpox) and rubella.
If you find out you're not immune before you get pregnant, you should get vaccinated again. The hepatitis B vaccine is safe during pregnancy. But varicella and MMR (which includes rubella protection) vaccines are not safe for pregnant patients, so your doctor is likely to recommend that you get them after delivery.
I'm planning to visit my newborn nephew. What vaccines do I need? 
If you've gotten all your recommended vaccines and boosters, you're almost ready to meet the baby. Babies, like pregnant women, have weak immune systems, so an annual flu shot is important before interacting with a newborn. Adults over 65 should have gotten a pertussis booster (included in the Tdap shot).
What about if I'm visiting my hospitalized, elderly grandmother? 
Older, hospitalized adults are similar to newborns in that their immune systems are weak and particularly vulnerable to infections. Follow the same advice as if you're going to meet a new baby.
I was born before varicella (chickenpox) vaccine existed. Do I need it now?
The varicella vaccine was approved in 1995, so if you were born before then, there's a good chance you weren't vaccinated.
But even if you weren't vaccinated, you're probably already immune because there's a high likelihood you've had chickenpox. The CDC says adults born before 1980 don't need the vaccine and don't need testing to prove their immunity.
There are some occasions when doctors will want to order blood tests to make sure their patients are actually immune to varicella — for pregnant women and health care workers, for example. If you get tested and the blood test shows you're still susceptible, your doctor will recommend that you get the vaccine. But because the vaccine is so effective and the blood test isn't always accurate, getting tested isn't necessary for everyone.
What do I need to know about all the different hepatitis shots? 
Hepatitis means inflammation of the liver, but when we're talking about vaccines, we're referring to several types of viruses that infect liver cells and can cause lots of different and potentially life-threatening problems, ranging from diarrhea to liver failure to cancer. Routine childhood immunizations include vaccines for hepatitis A and hepatitis B, meaning virtually all kids in the U.S. are vaccinated against them.
Hepatitis B is transmitted through blood or sex. A vaccine for it has been available since the 1980s, but it's common for immunity to hepatitis B to decrease over time. If you work in health care or are thinking about becoming pregnant, your doctor might order a blood test that shows if you're still immune. If you're not, your doctor may recommend you get revaccinated as an adult.
Hepatitis A is transmitted through the fecal-oral route, meaning that if you eat something that has been contaminated with the feces of an infected person, you can get it. The vaccine for hepatitis A was approved in 1995. If you're not yet vaccinated and you fall into one of a few groups — including if you're a man who has sex with other men, you're traveling to a country where the virus is endemic, you live with a person who has had hepatitis A — you should get the shots.
Hepatitis C is another common viral infection that affects the liver. It's so common, in fact, that doctors routinely test people born between 1945 and 1965 for the virus. Unfortunately, there's no vaccine available for it, but it can be treated with oral medication. If you haven't been screened for it, ask your doctor if you need to be.
Who should get the HPV vaccine? What's it for? 
This is essentially a cancer vaccine.
The Food and Drug Administration initially approved the HPV vaccine for girls and young women in the early 2000s, but the range of people who should get it has since grown. The FDA recently approved its use for people up to age 45. FDA approval is different from CDC guidelines, however. The CDC still officially recommends that both boys and girls get their first shot by 11 or 12, up until age 26 for women and 21 for men. The CDC adds that men up to age 26 "may be vaccinated" based on a consult with a doctor. If you're older than 26 and haven't been vaccinated, again, talk to your doctor about whether you need it.
HPV stands for the human papillomaviruses, which cause a wide variety of conditions, ranging from common warts on hands and feet to cervical and anal cancer. The vaccine helps prevent infection from certain types of HPV, including the strains that are the most likely to cause cancer.
It's a series of two shots, six to 12 months apart, which is a change from when the vaccine was first approved — it used to require three shots. Children who are late getting the HPV vaccine and receive their first dose after age 15 will still need three doses.
And there's more.
You may also need vaccines for conditions such as pneumonia or meningitis. Ask your doctor. What your doctor recommends will depend on your medical history and your risk factors, so don't be afraid to speak up at your next appointment. You can use this CDC quiz to see what might be right for you.
Mara Gordon is a family physician in Washington, D.C., and a health and media fellow at NPR and Georgetown University School of Medicine.

May 9, 2019

He Sued to Not Get Vaccinated on Religious Grounds But Now No Need He Has Chicken Pox

                            Related image

By David K. Li

A northern Kentucky teenager banned from school for refusing the chickenpox vaccination due to his religious beliefs has come down with the childhood malady, his attorney said Wednesday.
Jerome Kunkel, a student at Our Lady of the Sacred Heart Assumption Academy, first started showing chickenpox symptoms last week and hopes to have recovered by next week, a lawyer for the 18-year-old told NBC News.
Kunkel and his family have no regrets about their decision to not be vaccinated.
"These are deeply held religious beliefs, they're sincerely held beliefs," family attorney Christopher Wiest said. "From their perspective, they always recognized they were running the risk of getting it, and they were OK with it."
 Some ultraconservative Catholics oppose chickenpox vaccinations because it was developed in the 1960s from cell lines of two aborted fetuses.
A chickenpox outbreak at Our Lady of the Sacred Heart Assumption Academy in March prompted state health officials to order unvaccinated students to stay away from school. Kunkel unsuccessfully challenged the state ban in court.
Now that Kunkel has had the chickenpox, and is thus immune to it, he hopes to be back in class soon for the first time since March 15.
Had state health officials not intervened, Wiest said, his client would have had the chickenpox earlier this year. "The ban was stupid," Wiest said. "He could have contracted this in March and been back to school by now."
Once the banned student can show that all of his chickenpox lesions have scabbed over, he'll be allowed to return to school, according to Doug Hogan, spokesman for Kentucky's Cabinet for Health and Family Services.
State health officials also lashed out at Wiest, accusing him of "downplaying the dangers of the chickenpox."
"Encouraging the spread of an acute infection disease in a community demonstrates a callous disregard for the health and safety of friends, family, neighbors and unsuspecting members of the general public," according to a statement by Laura Brinson, a spokeswoman for the Northern Kentucky Health Department.
Earlier this year, opponents of mandatory vaccinations seemed to pick up support from Kentucky Gov. Matt Bevin, who admitted he's exposed all nine of his children to chickenpox.
“We found a neighbor that had it, and I went and made sure every one of them got it. They were miserable for a few days and they all turned out fine," Bevin told WKCT, a radio station in Bowling Green, Kentucky, in March.
Despite his unorthodox actions, Bevin urged parents to get their kids vaccinated.

March 12, 2019

6 yrs old Boy Almost Died of Tetanus ($800,000.) Because Parents Kept Him Away From Vaccines

A nurse administers a measles vaccine to a teenager on Feb. 21, 2019.
A new federal report details the frightening, exhausting, and extremely expensive experience of one family whose child contracted a vaccine-preventable disease.


A 6-year-old boy who never got his childhood vaccinations spent nearly two months in a hospital and nearly died after contracting tetanus from a cut on his forehead, racking up more than $800,000 in medical expenses.

A new report from the Centers for Disease Control and Prevention details the exhausting and expensive fight the family had with a highly-preventable disease.

Tetanus is a bacterial infection usually transmitted by soil: think not wearing gloves while gardening and cutting your finger on a thorn or scraping your knee at the park. The bacteria then releases toxins that cause painful spasms and cause a person to lose control of their body, according to the CDC, and lead to broken bones, pneumonia, and difficulty breathing. About 10% of cases are fatal. 

"This case report reminds us that tetanus is severe and life-threatening illness," Dr. Judith Guzman-Cottrill, a pediatric infectious-disease specialist who co-authored the report and cared for the boy, told BuzzFeed News. "It was hard to see him suffer. Vaccinations can prevent these terrible diseases."

Last year, the 6-year-old boy was playing on his family’s farm in Oregon when he scraped his forehead. His family cleaned and sutured the wound, but six days later, his jaw started to clench and lock, and his arms and upper body spasmed uncontrollably. His whole body then began to experience seizures and he started arching his neck and back. Later that day, he struggled to breathe, the CDC said.

The boy's parents called for help and an emergency helicopter took him to a pediatric medical center. He craved water, but couldn’t drink it because he couldn’t open his mouth. Still barely able to breathe, physicians had to stick a tube down his windpipe.

Doctors diagnosed him with a tetanus infection, the first case seen in Oregon in about 30 years, and gave him several rounds of vaccines and a large dose of tetanus immune globulin, a common immunization that helps the body defend itself against diseases.

The boy, who was not identified, spent the next 47 days in intensive care, mostly in a dark room with ear plugs to minimize any stimulation, which intensified his spasms. He also remained hooked up to a breathing machine and was constantly medicated through an IV to help calm his muscles, pain, and blood pressure.

Still, according to the CDC, the boy continued to get worse. Five days later, doctors cut a hole in his neck and inserted a tube to help him breathe.

On the 44th day, he was finally able to sip some clear liquids and, two days later, he left the intensive care unit. After 50 days in the hospital, he was able to walk 20 feet, but still needed to spend 17 more days in a rehabilitation facility to regain the ability to move his legs and body, the CDC said.

When it was all said and done, the family had racked up a bill of $811,929 — nearly 72 times what it usually costs for an average child, the authors reported. His parents also have to pay for the emergency helicopter transport, rehabilitation, and follow-up visits.

One dose of DTaP, the tetanus vaccine, ranges from $24 to $30. Guzman-Cottrill said that about five rounds of the medication could have prevented his infection.

But even after the near-death experience, the family declined the second dose of the vaccine needed to be immunized against tetanus and other recommended immunizations, the CDC reported.

William Schaffner, a vaccine and infectious-disease specialist at Vanderbilt University, told BuzzFeed News that the boy's painful ordeal was "enormously problematic" because he contracted "a disease that we had eliminated virtually in the US."

"It's not by accident but intent that Oregon hasn't seen a case in 30 years and basically every other state could make that statement," he said. "It's a fierce illness. That's why this case is so enormously problematic."

And while the boy not receiving any vaccinations prior to the infection was "troubling," it was the parents' decision to again refuse to vaccinate the child that was hard to comprehend, Schaffner said.

As the boy was recovering, Guzman-Cottrill said she gave his parents educational materials explaining the benefits of all immunizations, but they still refused.

"He could get this again," Schaffner said. "Even though you had a case of tetanus you remain susceptible, so they could go through this whole experience again." 

A nurse administers a measles vaccine to a teenager on Feb. 21, 2019.
Nationwide, there’s been a 95% drop in tetanus infections over the past 80 years since child vaccinations and adult booster shots became more common, the CDC said. However, between 2009 and 2015, 16 people in the US have died from tetanus and doctors have recorded 197 infections.

The CDC report comes as the US is grappling with a growing anti-vaccination movement bolstered by the spread of misleading content social media platforms. Major tech companies like YouTube and Amazon have recently pulled and banned anti-vaxx ads and videos from their sites.

The US is also in the throes of one of the worst measles outbreaks since 1992. In Washington and Oregon, the preventable disease has sickened more than 75 people, many of them children, prompting a visit from the US surgeon general. In Clark County, Washington, parents had to keep more than 800 kids home from school because of exposure to the disease.

"There are many scary diseases of yesteryear, as we say, that could come out of the woodwork," Schaffner said. "The Oregon case is a terribly painful but absolutely vivid lesson and I hope that parents listen to this story."

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