 | | | | Medical Health Encyclopedia | | Other adults who should consider influenza vaccinations include: - People at risk for complications for influenza and who are traveling to the tropics at any time or to the Southern Hemisphere between April and September.
- Pregnant women who are at risk for complications of influenza and who will be in their second or third trimester during flu season. (Vaccinations should usually be given after the first trimester. Exceptions may be women who are in their first trimester during flu season and their risk from complications of the flu is higher than any theoretical risk to the baby from the vaccine.)
- People such as firemen or policemen who are critical for public safety.
Negative Effects. Possible negative responses include: - Allergic Reaction. Newer vaccines contain very little egg protein, but an allergic reaction still may occur in people with strong allergies to eggs.
- Soreness at the Injection Site. Up to two thirds of people who receive the influenza vaccine develop redness or soreness at the injection site for one or two days afterward.
- Flu-like Symptoms. Some people actually experience flu-like symptoms, called oculo-respiratory syndrome, which include cough, wheeze, tightness in the chest, sore throat, or a combination. Such symptoms tend to occur between 2 and 24 hours after the vaccination and generally last up to 2 days. These symptoms are not influenza itself but an immune response to the virus proteins in the vaccine. (Anyone with a fever at the time the vaccination is scheduled, however, should wait to be immunized until the ailment has subsided.)
- Guillain-Barre Syndrome. Isolated cases of a paralytic illness known as Guillain-Barre syndrome occurred in about one of every 100,000 people vaccinated with the swine-flu vaccine in 1976, but it has not been a problem with subsequent vaccines.
Pneumococcal VaccinesThe pneumococcal vaccine protects against S. pneumoniae (also called pneumococcal) bacteria, the most common cause of respiratory infections. There are two effective vaccines available, one called a 23-valent polysaccharide vaccine (Pneumovax, Pnu-Immune) for adults and a 7-valent conjugate vaccine (Prevnar or PCV7) for infants and young children. Experts are now recommending that more people, including healthy elderly people, be given the pneumococcal vaccine, particularly in light of the increase in antibiotic-resistant bacteria. This has created a great sense of urgency in the medical community to find effective measures for preventing infection. Text Continues Below
Pneumococcal Vaccine in Young Children. The pneumococcal vaccine (Prevnar or PCV7) is very effective in children. Evidence suggests that this vaccination, plus the vaccination against Haemophilus influenzae (an important cause of meningitis), has led to 25,000 fewer cases of serious bacterial infections each year. The pneumococcal vaccine is now recommended by many experts for the following groups: - All children up to age 2 years old. The pneumococcal vaccine (Prevnar or PCV7) has now been added to the Recommended Childhood Immunization Schedule. The pneumococcal vaccine (Prevnar or PCV7) is very effective in children. Studies are suggesting that it prevents common ear infections as well as serious infections, such as pneumonia. In one study, a similar vaccine under investigation protected not only children in day care from serious respiratory infections, but their younger unvaccinated siblings had fewer infections as well.
- Children up to age five who are at risk for pneumonia or complications of influenza, such as children with sickle disease, those with immune deficiencies, or children with chronic medical conditions.
- Other children age 2 to 5 years old who are higher risk for serious pneumococcal infections should be considered for vaccinations. They include African or Native Americans, children in group child care, socially or economically disadvantaged children, or those who have had frequent or complicated acute middle ear infections within the past year. (In one study, the vaccine reduced the number of ear infections episodes by 6%.)
The recommended schedule of immunization for Prevnar (PCV7) is four doses, given at 2, 4, 6, and 12 to 15 months of age. Infants starting immunization between 7 and 11 months should have three doses. Children starting their vaccinations between 12 and 23 months only need two doses. And those who are over 2 years old need only one dose. Pneumococcal Vaccine in Older Children and Adults. The vaccine is proving to be effective in reducing the rate of pneumonia in young adults, although not to the degree that it protects young children. Its benefits for the elderly--other than protection against bloodstream infection--is unclear. Still, pneumonia is declining among adults, which may be due to fewer infections being transmitted from vaccinated young children. Many experts now recommend the vaccine for the following older children or adults: - All people over 65 years old. (Anyone who received the vaccine more than 5 years ago should be revaccinated.) Of note, the vaccination is protective against pneumococcal bacteremia (invasive infection) in this group, but it does not appear to protect against community-acquired pneumonia itself.
- Adults with any chronic condition that increases the risk for pneumonia. This includes patients with heart disease (e.g., congestive heart failure, cardiomyopathies), chronic lung disease (COPD or emphysema, but not asthma), or diabetes.
- Individuals with immune deficiencies (e.g., HIV) or those undergoing treatments to suppress the immune system.
- Patients with autoimmune diseases, such as rheumatoid arthritis and lupus. Unfortunately, studies suggest the vaccine may not be as effective in these patients as those with healthy immune systems. Nevertheless they are at high risk for serious respiratory infections and should be vaccinated.
- Patients with kidney disease or kidney transplants. Older people who have had transplant operations or those with kidney disease may require a revaccination after 6 years.
- Patients with problems in the spleen should be vaccinized.
- Alcoholics (especially those with cirrhosis) should receive a pneumoccocal vaccine.
- People living in long-term care facilities should be vaccinized.
- Alaska Natives or American Indians, who may be at increased risk for pneumonia, also should receive this vaccine.
Because the vaccine is inactive, it is safe for pregnant women and people with immune deficiencies. In fact, when the vaccine is administered to pregnant women, it may actually protect their infants against certain respiratory infections. Protection lasts for over 6 years in most people, although the protective value may be lost at a faster rate in elderly people than in younger adults. Anyone at risk for serious pneumonia should be revaccinated 6 years after the first dose, including those who were vaccinated before age 65. Subsequent booster doses, however, are not recommended. Side Effects of the Pneumococcal Pneumonia Vaccine. Side effects include pain and redness at the injection site, fever, and joint aches. Children are more likely to have fever within 48 hours if they receive other vaccines at the same time and also after the second dose. Rarely, such local reactions can be severe. Even if a person is mistakenly re-vaccinated before the effects of the first vaccination have worn off, the risk for severe side effects is very low. Allergic reactions are very rare. Antibiotic ResistanceThe intense and widespread use of antibiotics is leading to a serious global problem of antibiotic resistance. According to 2001-2002 reports, between 30 - 40% of S. pneumoniae strains no longer responded to penicillin in the U.S. The problem is much worse in Hong Kong, where 70 - 80% of strains no longer respond to penicillin. High rates of resistance strains are even being observed in infants. High-Risk Regions. In general, regions and institutions with the highest rate of resistance are those in which antibiotics are heavily prescribed. The inappropriate use of powerful newer antibiotics for conditions, such colds or sore throats, poses a particular risk for resistant strains of bacteria. In a 2003 study, of adult patients with upper respiratory infections, such antibiotics were prescribed in 33% of antibiotic prescriptions for sore throats and 65% for ear infections. Patients who lived in the Northeast and South were more likely to be given the potent antibiotics than those in the Midwest and West. When Antibiotics Are Needed for Upper Respiratory Infections. Antibiotics do not affect viruses and, in healthy individuals, these agents are almost never necessary or helpful for influenza or colds, even with persistent cough and thick, green mucus. In one disturbing study, antibiotics were prescribed for nearly half of children who went to the doctor for a common cold. Antibiotics may be required for upper respiratory tract infections only under certain situations, such as the following: - Patients, particularly small children or the elderly, who have medical conditions that put them at high risk for complications from any respiratory tract infections should usually be given antibiotics.
- Patients with severe sinusitis that does not clear up within seven days (some experts say 10 days) and symptoms include one or more of the following: green and thick nasal discharge, facial pain, or tooth pain or tenderness.
- Some children with middle ear infections, although experts differ on which ones will benefit. Some experts recommend that only children under the age of 2 years should be treated with antibiotics, and children over 2 years should be treated on a case by case basis.
- Patients with strep throat (which is caused by the Streptococcal bacteria) or severe sore throat that involves fever, swollen lymph nodes, and absence of cough. (Strep throat makes up only about 12% of all sore throat cases.)
- Patients who have an acute cough that is caused by pneumonia (but in few other cases, regardless of the duration of the cough). Experts estimate that, outside the hospital setting, less than 20% of prescriptions for persistent coughing are necessary.
Patients at Highest Risk for Infection with Resistant-Bacteria Strains. As of yet, the average person is not endangered by this problem. Some patients are at greater risk for developing an infection resistant to common antibiotics. Risk factors include: - Very old or very young age
- Exposure to patients with drug-resistant infection
- Hospitalization in intensive care
- History of an invasive surgical procedure
- Staying in the hospital
- Prolonged course of antibiotics, particularly within the past 4 to 6 weeks
- Serious wounds
- Tubes down the throat, catheters, or intravenous (I.V.) lines
- Immunosuppression
In children, those at higher risk are those who attend day care, who are exposed to cigarette smoke, who were bottle-fed, who had siblings with recurrent ear infections. On a positive note, a small study in Israeli suggested that antibiotic-resistant pneumococcal strains carried by children in a day care center were not passed on to the adults in their household. What the Health Care Community Is Doing. Prescribing antibiotics only when necessary is most important step in restoring bacterial strains that are susceptible to antibiotics. Encouraging studies are reporting that inappropriate antibiotic prescriptions are on the decline. In one study, there was a 47% reduction in prescriptions for otitis media since 1989. Prescriptions for other common respiratory infections also decreased for sore throat, acute bronchitis, and colds and flus. Rates for sinusitis were unchanged. What Patients and Parents Can Do. Patients and parents can also help with the following tips: - Use home or over-the-counter remedies to relieve symptoms of mild upper respiratory tract infections.
- Realize that antibiotics will not shorten the course of a viral infection. It is important for patients and parents to understand that although antibiotics may bring a sense of security, they provide no significant benefit for a person with viral infection, and overuse can contribute to the growing problem of resistant bacteria.
- Don't pressure a doctor into prescribing an antibiotic if it is clearly inappropriate. The doctor very often will give in.
- If a child needs an antibiotic, ask the doctor whether it is appropriate to use high-dose short-term antibiotics, which may lower the risk for developing resistant strains.
- If an antibiotic is prescribed, take the full course.
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