MMS Physician Focus: September 2010
By Alice Coombs, M.D.
With less fanfare and fear than last year, flu season has
arrived, and public health officials wasted no time in urging
health providers to go on the offensive: "Begin offering influenza
vaccine to people of all ages as soon as it becomes available" was
the key recommendation.
With the specter of the H1N1 pandemic fresh in everyone's mind,
the fight against the flu has expanded. The Centers for Disease
Control's annual guidelines contain important additions this year,
most notably a recommendation of 'universal' vaccination for
everyone six months of age and older, and this year's vaccine
protects against the H1N1 flu, precluding the need for a separate
shot.
Also new are updated dosing recommendations for children under 9
and the addition of American Indians/Alaska Natives and the
morbidly obese to the list of those at increased risk for
flu-related complications, bringing the number of groups in that
category to eight. Visit www.flu.gov or www.mass.gov/dph/flu for the
latest information on the 2010-2011 flu season.
The medical community spends huge amounts of time and energy
urging people to get flu shots, and rightfully so. The flu
contributes to thousands of deaths annually, especially in the
elderly population, and, depending on the severity of the outbreak,
can put enormous stress on our health care system, especially
emergency departments. So it makes sense to prepare and make flu
vaccination a sound part of preventive medicine.
But vaccinations should go far beyond annual flu shots. In its
most recent Health Care Trends Report, the American Medical
Association warns that "The lack of public awareness regarding the
importance of immunization, together with continuing suspicion by
some of the vaccines for children, poses a significant public
health risk for patients and their families." Some of the
indifference may stem from fears of side effects, but many people
simply forget or ignore the value of prevention.
The estimated numbers of annual deaths occurring from vaccine
preventable diseases are stunning. The U.S. Department of Health
and Human Services figures that more than 50,000 Americans die from
diseases such as flu, pneumonia, and hepatitis B; the World Health
Organization believes preventable diseases claim more than two
million children.
The growing resurgence of preventable diseases should make us
all pay attention to the importance of immunization, and plenty of
examples exist. California has experienced its biggest whooping
cough outbreak in nearly five decades, with more than 4,000 cases
as of mid-September, a seven-fold increase over 2009. The disease
has claimed at least nine infants, and public health officials
there attribute the outbreak to low immunization rates. Vermont is
also now reporting a rise in whooping cough cases.
Outbreaks of measles, a contagious disease with some 10 million
cases and 164,000 deaths worldwide annually, have been reported in
South Africa and the Philippines. An outbreak in California earlier
this year was unwittingly caused by a 7-year-old unvaccinated boy
who brought back the virus with him from a trip to Europe.
A mumps outbreak infected more than one thousand in New York and
New Jersey, caused by a young boy who likewise returned from
overseas with the disease. And while polio has all but disappeared
in this country, recent outbreaks have occurred in Tajikistan and
Russia. Those nations may seem far away, but distance no longer
offers the protection it once did. The CDC cautions that "The
United States can remain free of polio only by maintaining high
levels of population immunity and reducing or eliminating the risk
for poliovirus importation."
The lesson: experience shows us that an outbreak of disease can
be a single plane ride away.
While childhood diseases get the most attention for
immunization, infectious diseases know no age limits, and
immunization should be a regular part of medical care for all age
groups. The CDC at www.cdc.gov
has recommended schedules for children birth to 6 years,
adolescents 7 to 18, and adults over 18, and the National Network
for Immunization Information at www.immunizationinfo.org
contains information on specific vaccines and the diseases they
prevent.
So when you get your flu shot this year, check to see if you're
up to date on other immunizations. Vaccines are one of the greatest
achievements in medicine and public health. We should use them for
our ultimate benefit.
Alice Coombs, M.D., is president of the Massachusetts
Medical Society and a critical care specialist at South Shore
Hospital in Weymouth, Mass. Physician Focus is a public service of
the Massachusetts Medical Society. Readers should use their own
judgment when seeking medical care and consult with their physician
for treatment. Comments toPhysicianFocus@mms.org
.
