Travel to India, China, Indonesia in your future? Think Japanese Encephalitis Vaccine!

From the Center for Disease Control recently....

Japanese encephalitis vaccine is recommended for travelers to Asia who:

plan to spend at least a month in areas where JE occurs
are traveling to these areas for less than a month but plan to visit rural areas or engage in outdoor activities.
go to areas where there is a JE outbreak or are not sure of their travel plans.
Laboratory workers at risk for exposure to JE virus should also get JE vaccine.
JE vaccine is approved only for people 17 years of age and older. Younger people needing protection from Japanese encaphalitis should talk with their doctor.
The vaccine is given as a 2-dose series, with the doses spaced 28 days apart. The second dose should be given at least 1 week before travel.

A booster dose of JE vaccine may be given to anyone who was vaccinated more than one year ago and is still at risk of exposure, or might be re-exposed. Your doctor can give more information.

See; CDC / Japanese encephalitis vaccine

Why Hepatitis B vaccine highly recommended for those with diabetes

Hepatitis B Vaccine Recommended for Diabetics

As you’re probably aware, more and more Americans are being diagnosed with diabetes. The reasons include more obesity, less physical exercise, and genetics.

You’re probably also aware of hepatitis B, a potentially serious and sometimes fatal infection of the liver caused by hepatitis B virus. We don’t usually think of diabetes and hepatitis as being related, but there is an increased risk of becoming infected with hepatitis B if you’re a diabetic. The risk is present whether one has type 1 or type 2 diabetes.

Since the early 1990s newborns and infants in the United States have routinely been vaccinated against hepatitis B, so most children and teenagers in the U.S. are now protected against this infection. Most adults are not.

This past fall the influential ACIP (Advisory Committee on Immunization Practices) recommended that all previously unvaccinated adult diabetics from 19 through 59 years of age be vaccinated with the hepatitis B vaccine “as soon as possible after a diagnosis of diabetes is made.” The recommendation was given an “A” category rating, its highest endorsement, based on the strength of the data. In late December 2011 the CDC (Centers for Disease Control and Prevention) published this recommendation in its weekly report.

For those who like figures, here are the benefits according to the CDC if 10% of unvaccinated adult diabetics in the U.S. got vaccinated against hepatitis B: 4271 fewer hepatitis B infections, 467 fewer hospitalizations, 33 cases of liver cancer prevented, 13 liver transplants avoided, and 130 fewer deaths. And that’s if only 10% of those eligible got vaccinated.

For diabetics 60 and older, the evidence supporting vaccination isn’t as strong. Part of the reason has to do with immune response in seniors. The younger one is when vaccinated, the better the vaccine works. (I wouldn’t be surprised if that recommendation were to change to a full endorsement of hepatitis B vaccination for seniors with diabetes in the not-too-distant future.)

For now, the vaccine is strongly “recommended” for adult diabetics 19-59 which means that your health insurance will likely cover its cost for you if you’re in this category. Millions of American adults are.

Brad Gascoigne, M.D.
Smart Readers Health Column

Yellow Fever spreads in Brazil...get your vaccine before travel.

CDC / Yellow Fever in Brazil
Center for Disease Control and Prevention: update December 19, 2011

Current Situation

Yellow fever is a risk for travelers to most areas of Brazil, except coastal regions. During 2009, an outbreak of yellow fever, including a number of deaths, occurred in parts of southeastern Brazil that had not been affected by yellow fever for many years.

In response, the Brazil Ministry of Health has gradually expanded the list of municipalities for which yellow fever vaccination is recommended in the four southeastern states of São Paulo, Paraná, Santa Catarina, and Rio Grande do Sul
.
Globally, yellow fever occurs in sub-Saharan Africa and tropical South America and is spread to people through the bite of infected mosquitoes. Symptoms can include sudden onset of fever, chills, headache, backache, nausea, and vomiting.

Yellow Fever Risk Areas in Brazil
Currently, Brazil and CDC recommend yellow fever vaccination for travelers to the following states:

All areas of Acre, Amapá, Amazonas, Distrito Federal (including the capital city of Brasília), Goiás, Maranhão, Mato Grosso, Mato Grosso do Sul, Minas Gerais, Pará, Rondônia, Roraima, and Tocantins.
Other designated areas of the following states: Bahia, Paraná, Piauí, Rio Grande do Sul, Santa Catarina, and São Paulo. Vaccination is also recommended for travelers visiting Iguassu Falls.

Source: CDC / Yellow Fever in Brazil, update

A Doctor's Vaccine Christmas Wish List

Christmas Wish List

Wouldn’t it be wonderful if we had a vaccine to prevent tooth cavities? That possibility isn’t as far-fetched as you might think. For cavities to occur, they need sugar, plaque and bacteria, and the bacteria responsible for cavities in humans are lactobacillus and a type of streptococcus. I checked this week with three of my favorite dentists to confirm that there has been a lot of effort expended towards developing a vaccine that would protect us from ever getting cavities.

How about a vaccine against acne? The germ responsible for pimples and scars is propionibacterium acnes. It’s a bacteria against which we have antibiotics such as tetracycline and erythromycin. A vaccine which prevented acne would be welcome news for the complexions of millions of teenagers and young adults.

Here are a few others on my wish list. We currently have great vaccines against hepatitis A and hepatitis B. Whoever invents a vaccine against hepatitis C will be a rich man or woman.

Some day we’ll likely have a herpes vaccine. It’s a bit complicated, however, because there’s genital herpes and oral herpes and a few other cousins. A herpes vaccine might not help the more than 80 million Americans already infected with this virus, but it would be a boon for those in the future.

In many parts of the world, malaria is an everyday threat. An effective malaria vaccine could prevent an estimated 300-500 million infections per year.

It’s been more than twenty years since AIDS was first recognized as a new disease and HIV was identified as the virus responsible. Many thought that we would have a vaccine against HIV by the mid-1990s. Unfortunately, this virus has proven to be exceedingly resistant thus far to researchers’ efforts to come up with a safe and effective vaccine.

Lastly, MRSA (methicillin-resistant staphylococcus aureus) is a miserable bacteria that’s responsible for pneumonia and bloodstream infections, both in hospitals and in our communities. My Dad died as a result of an overwhelming staph infection, so I’ve always had a healthy respect for this particular bacteria. Selfishly, a vaccine against staph is at the top of my list.




Brad Gascoigne, M.D.
Smart Readers Health Column

Better Hearing and Speech Month

May is “Better Hearing and Speech Month,” and in the fall we have “National Protect Your Hearing Month.” Both of these designations help remind us that good hearing is
not something we should take for granted.

The American Audiology Association (www.audiology.com) provides a helpful chart of levels of noise. Faint noises, like leaves rustling, are in the 20 decibel (dB) range. At the other end of the spectrum are “Painful & Dangerous” noises, e.g. fireworks and jackhammers, in the 130-140 dB range. Here’s a more complete listing:
20 dB leaves rustling
30 dB whispers
40 dB quiet library
50 dB moderate rainfall
60 dB normal conversation
70 dB traffic, vacuums
80 dB alarm clocks
90 dB lawnmowers, power tools, hair dryers
100 dB snowmobiles, MP3 players at full volume
110 dB concerts, car horns, sporting events
120 dB jet planes during take off
130 dB jackhammers, ambulances
140 dB fireworks, gun shots, custom car stereos at full volume

A large study released last summer reported that the prevalence of hearing loss in adolescents in the U.S. has increased in recent years. However, as the list above suggests, it’s not just teenagers who are being exposed to a myriad of loud noises.

Exposure to any noise over 85 decibels for a period of 30 minutes or longer is considered dangerous and can result in permanent hearing loss. Noise at 120 dB and above can damage one’s hearing in 30 seconds or less.

I recently asked Dr. Gail Murray, Director of Audiology Services at University Hospitals Case Medical Center in Cleveland, for her advice. She said that she had ear plugs form- fitted for her ears and that she carries them with her to use when she finds herself exposed to unavoidable loud noise.

What have you done lately to protect your hearing?



Brad Gascoigne, M.D.
Smart Readers Health Column

Try Adding Up Your Calcium Intake

Much has been written over the past couple of years about the important role vitamin D plays in our overall metabolism and the health of our bones. Overlooked to some degree, perhaps, has been the fact that it’s calcium which is the real key when it comes to maintaining bone strength.

The Institute of Medicine early this year updated its recommendations regarding calcium. For the first time ever the recommendations cover both the lower limits (RDA or Recommended Daily Allowances) as well as safe upper limits. In regards to calcium intake, how do you fare?

Think back over the past 24 hours and try to recall how much calcium you’ve consumed. Here are some common calcium sources:

______ 8 ounce glass of milk (300 mg)
______ 6 ounce serving of yogurt (about 200 mg)
______ 6 ounce glass of calcium-fortified juice (200 mg)
______ 1 ounce of hard cheese (200 mg)
______ salmon, tuna or sardines (varies) (about 200 mg)
______ 1/2 cup of turnip greens (100 mg)
______ 1/4 cup of almonds (100 mg)
______ 1 cup of beans or chickpeas (about 100 mg)
______ adult daily multiple vitamin (100-500 mg)
______ calcium supplement (e.g. TUMS) (200-600 mg)

Now add up your past-24-hour calcium intake. Teens are supposed to get 1300 mg/day. Men need 1000 mg till age 70 and then 1200 mg per day thereafter. Women are advised to take in 1000 mg/day till age 50 and then 1200 mg/day. How close are you to the new RDAs?

Intakes over 2000 mg per day might put you at risk for kidney stones or other problems, so check with your physician if you think you might be consuming too much calcium. Most of us, however, have the opposite problem: too little daily calcium. If you’re falling short of your body’s calcium requirements, drink an extra glass of milk this evening. When you get older, your bones will thank you.

Brad Gascoigne, M.D.
Smart Readers Health Column

Super-Flu Shots for Seniors

Two autumns ago Americans were anxiously awaiting the arrival of what had first been called “swine flu” and then officially became known as novel H1N1 influenza. In June 2009 the World Health Organization had issued its warning about an official “world pandemic.” By the end of the 2009-2010 winter flu season, millions of Americans had come down with the flu and between 10,000 and 20,000 had died from flu-related illnesses. A surprisingly large percentage of those who died were teenagers and young adults who had previously been in the prime of health.

Last winter’s flu season was comparatively mild. The peak of the flu season didn’t arrive until February, and numbers of flu cases were down in all regions of the country.

What can we expect this fall and winter? It’s reasonable to assume that our flu season won’t be as mild as last year’s was, as viruses have a way of mutating over time and becoming more infectious. On the other hand, it’s also not likely that we’ll see a flu season as bad as we had two years ago, since no dramatically new flu strains have appeared thus far in the Southern Hemisphere where it’s been winter south of the equator.

Flu vaccination will continue to be recommended for just about everyone 6 months of age and older. Those for whom flu vaccination is especially important are seniors, infants and young children, pregnant women, and health care workers. And for anyone else not wishing to miss a week or more of work or school.

This year there is now available a “senior strength” flu virus vaccine with the brand name “Fluzone High-Dose.” It was actually licensed by the Food and Drug Administration a year ago, and it will be more widely marketed by its producer Sanofi Pasteur this year. It has been known for many years that those 65 and older don’t produce as high an antibody response to the flu vaccine components (known as antigens) as do younger adults. The new higher-dose vaccine has 4 times the amount of antigen in it and produces approximately 40% higher antibody levels than does the standard flu vaccine. The new vaccine has been shown to be safe in clinical trials, but it has not yet been proven that higher antibody levels will necessarily result in less flu.

The cost of Fluzone High-Dose is covered for those with Medicare Part B. It will be interesting to learn over the coming one to two flu seasons whether this senior-strength vaccine is as great a value as is the usual flu vaccine.

Brad Gascoigne, M.D.