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Vaccination: Key Considerations And Hepatitis B Vaccines

Vaccinations have become a hot-button issue during the coronavirus pandemic. There have been recent developments in vaccination for hepatitis B, with the Centers for Disease Control and Prevention (CDC) guidelines recommending hepatitis B vaccination for all adults between the ages of 19 to 59 years old. And, there is a two-dose hepatitis B vaccine as an alternative to the three-dose option that may improve adherence.

In addition to discussing changes in hepatitis B vaccination, participants at this HealthLeaders roundtable also addressed broad vaccination issues such as vaccine hesitancy and the climate surrounding vaccination in general.

Hepatitis B/Meningococcal Information

Meningococcal Fact Sheet

Fact:  Bacterial meningitis is very rare--the annual incidence in the United States is 1 case per 100,000 people.  But because meningococcal meningitis can cause grave illness and rapid progress to death, it requires early diagnosis and treatment.  In contrast to viral meningitis, persons who have had intimate contact with a case of bacterial meningitis require prophylactic therapy. 

Fact: This disease is caused by the Meningococcus bacteria, which can also cause meningococcemia.  The bacteria cannot survive outside the body for more than a few minutes.  The disease is spread by intimate person-to-person contact (oral secretions)  – kissing, sharing a drink, living in the same room.  It is not spread through the air. Even persons who shared a drinking glass with a person who had the disease would have only three chances in 1,000 of contracting the disease.

Fact:  Most college students have developed a natural immunity to bacterial meningitis.  Casual contact by those who lived in the same residence hall or corridor, attended class or ate in the same dining hall does not pose an increased risk.

Fact: Meningococcal disease is characterized by the abrupt onset of high fever, chills, nausea, muscle ache, severe headache, a bruise-like rash in the case of meningococcemia and, in the case of meningitis, a rigid neck (as opposed to merely a stiff or sore neck).

Fact:  Viral meningitis is more common than bacterial meningitis and can be spread through the air. Most cases of viral meningitis run a short, uneventful course.  Since the causative agent is a virus, antibiotics are not effective.  Persons who have had contact with a person with viral meningitis do not require any treatment.

Fact: One can reduce the risk of contracting meningococcal disease and other diseases by maximizing the body's own immune system through a lifestyle that include a balanced, healthy diet, adequate sleep, appropriate exercise and the avoidance of stress.  Avoiding upper respiratory infections and inhalation of tobacco smoke may also help to protect from invasive disease.  Everyone should be sensitive to other public health measures that decrease exposure to oral secretions, such as covering one's mouth when coughing or sneezing and washing hands after contact with oral secretions.

If you have questions or would like more information, please contact the Student Health Service at (513) 529-3000.

Meningococcal Disease and College Students

Meningococcal disease is a serious illness caused by bacteria. It is the leading cause of bacterial meningitis in children 2-18 years of age in the United States. Meningococcal bacteria can cause meningitis (inflammation of the lining of the brain and spinal cord) or sepsis (an infection of the bloodstream). Symptoms of meningitis include stiff neck, headache, fever, nausea, vomiting, confusion and drowsiness. Symptoms of sepsis include fever, shock and coma. Death from sepsis can occur within 12 hours of the beginning of the illness – meningococcal disease can be a rapid and overwhelming infectious disease. For these reasons, meningococcal infections that occur in childcare centers, elementary schools, high schools and colleges often cause panic in the community. Every year about 2,600 people in the United States are infected with meningococcus. Ten to fifteen percent of these people die, in spite of treatment with antibiotics. Of those who live, another ten percent lose their arms or legs, become deaf, have problems with their nervous systems, become mentally retarded or suffer seizures or strokes.

How do you catch a meningococcal infection?

Usually meningococcal infection is acquired after intimate contact with an infected person. Intimate contact includes kissing, sharing toothbrushes or eating utensils or frequently eating or sleeping in the same dwelling as an infected individual.

Who is at risk?

Anyone can get meningococcal disease, but it is most common in infants less than 1 year of age and in people with certain medical conditions. College freshmen, particularly those who live in dormitories, have a slightly increased risk of getting meningococcal disease. The risk for meningococcal disease among nonfreshman college students is similar to that for the general population; however, the vaccine is safe and effective and therefore can be provided to nonfreshmen undergraduates who want to reduce their risk for meningococcal disease.

What can be done to decrease risk?

The meningococcal vaccine can prevent four types of meningococcal disease. These include two of the three most common types in the United States. Meningococcal vaccine cannot prevent all types of the disease, but it does help to protect people who might become sick if they do not get the vaccine. The vaccine is available through a variety of settings including physician offices and university/college student health centers.

Hepatitis B and College Students

Hepatitis B is a serious disease

Hepatitis B is a virus that affects the liver. It is one of several hepatitis diseases (for example, hepatitis A and hepatitis C) that are caused by different viruses but are similar in that they all attack the liver. The hepatitis B virus (HBV) can cause a short-term (acute) illness that leads to loss of appetite, stomach pain, tiredness, diarrhea, vomiting, jaundice (yellow skin or eyes) and pain in muscles and joints. These symptoms can last for several weeks. It can also cause a long-term (chronic) illness from which people never recover. A person might not look or feel sick, but he or she carries the hepatitis B virus in their blood for the rest of their lives and can infect other people with HBV. Chronic hepatitis B may cause liver damage (cirrhosis), liver cancer and even death. About 1.25 million people in the United States have chronic HBV infection. Each year 80,000 more people, mostly young adults, get infected with HBV and 4,000 to 5,000 people die from chronic hepatitis B.

How do you catch hepatitis B?

HBV virus is spread through contact with blood or other body fluids of an infected  person. You can catch the virus by having unprotected sex, by sharing drug needles or by sharing personal items such as razors and toothbrushes with someone who is infected. Babies of chronic HBV mothers can become infected during birth. Children can be infected through exposure to blood and other body fluids from infected children or adults.

Who is at risk?

Anyone who participates in any of the behaviors listed above is at risk of acquiring hepatitis B.

What can be done?

There are hepatitis B vaccines available that can prevent infection with HBV. Many physicians offer the vaccine to patients seen in their offices. These are the first anti-cancer vaccines, because they can prevent a form of liver cancer that can develop in a person who gets a chronic hepatitis B infection.

What about the vaccine?

A vaccine, like any medicine, is capable of causing serious problems, such as allergic reactions. Most people who get hepatitis B vaccine do not have any problems with it. People who have ever had a life-threatening allergic reaction to baker's yeast (the kind used to make bread) or to a previous dose of hepatitis B vaccine should not get the vaccine. People who are moderately to severely ill at the time the shot is scheduled should usually wait until they recover before getting the vaccine. Hepatitis B vaccine is very safe and the risk of it causing serious harm is extremely small. Hepatitis is a serious disease and getting the vaccine is safer than getting the disease. College students and their parents should discuss the risks and the benefits of vaccination with their health care providers. For more information about the hepatitis vaccine, access the Vaccine Information Sheet at the Centers for Disease Control and Prevention Web site http://www.Cdc.Gov/nip/publications/VIS. If college students decide to be vaccinated against hepatitis B, they (or their parents if they are less than 18 years of age) should contact their health care provider or the university/college student health center where they will be attending to inquire about receiving the vaccine

In February 2005 the Advisory Committee on Immunization Practices (ACIP) to the CDC recommended the use of a newly licensed conjugate meningococcal vaccine for vaccination against meningococcal meningitis. The new vaccine was licensed by the US. Food and Drug Administration in January 2005 for use in people 11-55 years of age. This conjugate meningococcal vaccine is effective in preventing the same four types of meningococcal disease as the polysaccharide meningococcal vaccine. Although the need for revaccination with the conjugate meningococcal vaccine has not been determined, antibody levels decline in 6-8 years and if indications still exist for vaccination, revaccination may be considered 6-8 years after receipt of the first dose.

Adapted from CDC publications.

Pneumococcal Disease Can Impact Individuals Of All Backgrounds, But Specific Factors Elevate The Risk

Mumbai: Prof Charles Fieldman, Professor, Pulmonology, & Chief Physician, University of Witwatersrand, Johannesburg, South Africa, interacted with ETHealthworld's Prabhat Prakash on the difficulties in adult pneumococcal disease diagnosis, the importance of early immunisation for adults, the advantages it has in improving public health and reducing healthcare costs. Edited Excerpts.

What are the principal difficulties in adult pneumococcal disease diagnosis, and how do these difficulties affect the healthcare system?I have encountered several significant challenges when it comes to diagnosing adult pneumococcal disease, and these difficulties have far-reaching implications for our healthcare system.

First and foremost, one of the principal difficulties in diagnosing adult pneumococcal disease lies in the inconsistent and inadequate collection of patient samples. In many cases, samples may not be collected at all, and when they are, the collection process might be suboptimal. This results in only a few isolated samples containing the pathogen, making it difficult to confirm the diagnosis definitively.

Moreover, the laboratory infrastructure for pneumococcal disease diagnosis is often underdeveloped, which further complicates the detection process. The limitations in laboratory methods and infrastructure can lead to the risk of obtaining false-negative results, even when samples are collected, hampering accurate diagnosis and treatment.

The diagnostic challenges in adult pneumococcal disease have significant implications for our healthcare system, leading to increased hospitalisations, straining resources, and impacting patient outcomes. Streptococcus pneumoniae is a common cause of community-acquired pneumonia, contributing to a substantial healthcare burden. Although preventable through vaccination, limited vaccine coverage and high case fatality rates pose risks to healthcare professionals. Addressing these challenges is essential to reducing the burden on our healthcare system.

Why is early immunisation important for adults, especially those over 50 and those with chronic disorders like diabetes and cardiovascular diseases?I emphasise the critical importance of early immunisation for adults, particularly those over the age of 50 and individuals with chronic conditions like diabetes and cardiovascular diseases. Pneumococcal disease can impact individuals of all backgrounds, but specific factors elevate the risk. These factors include age, the presence of particular medical conditions such as chronic lung disease, chronic kidney disease, and diabetes, as well as exposure to lifestyle and occupational hazards. It is worth noting that adults aged 50 and older are at a heightened risk for pneumococcal disease due to several key factors, including the natural decline in immunity associated with ageing, the presence of chronic illnesses, the inadequacy of childhood vaccinations in providing long-term protection, and the dynamic nature of disease epidemiology with the emergence and re-emergence of specific diseases, such as tuberculosis and malaria. From a medical standpoint, this underscores the critical role of early immunisation to protect the health of individuals in these vulnerable groups.

Please give instances of particular vaccine-preventable infections that, if untreated, might worsen underlying disorders in at-risk individuals.

I'd like to highlight some vaccine-preventable infections that, if untreated, can worsen existing health conditions in at-risk individuals. These infections include pneumococcal diseases, influenza, Haemophilus influenzae type B, hepatitis A, hepatitis B, tetanus, diphtheria, pertussis, human papillomavirus (HPV2, HPV4, HPV9), measles, mumps, rubella (MMR), varicella (chickenpox, VAR), and meningococcal. It's crucial to emphasise the importance of vaccination, especially for those with underlying health issues, as untreated infections can significantly aggravate their conditions.

How can healthcare professionals persuade at-risk people to act by convincing them of the value of early vaccination?Encouraging at-risk individuals to see the value of early vaccination is vital. It starts with healthcare professionals assessing the vaccination status of these individuals, considering factors like age and specific health conditions. To be persuasive, it's all about consistently recommending vaccinations at every suitable opportunity, using the '4Rs' approach (recommend, repeat, remind, review) to drive home the importance of vaccinations.

In healthcare settings, we need to make sure getting vaccinated is easy, whether that means offering vaccines on-site or referring patients to specialists. Keeping accurate records of vaccine administrations, which are then shared with immunisation registries, is crucial for tracking and ensuring compliance. This comprehensive approach helps at-risk individuals grasp the value of early vaccination, ultimately leading to better health outcomes and disease prevention.

What part should the government, medical professionals, drug manufacturers, and community organisations play in creating this ecosystem?

In building a robust adult immunisation ecosystem, each stakeholder has a vital role to play. The government's responsibility lies in mainstreaming vaccination for all age groups through primary healthcare facilities and health & wellness centres, ensuring accessibility and affordability. Medical professionals are instrumental in educating patients and caregivers about the significance of adult vaccination, recommending and administering vaccines. Drug manufacturers, especially those in developing countries, have a critical duty to provide innovative vaccines globally, with an emphasis on affordability. Community organisations contribute by fostering community awareness, hosting immunisation programmes, and bridging the gap between healthcare providers and local communities. Collaboration among these stakeholders is key to overcoming challenges like cost and limited vaccination centres. Through collective efforts, adult vaccination centres can be established, leading to improved vaccine coverage and enhanced public health and well-being.

How can the creation of a thorough adult immunisation infrastructure take into account potential obstacles such as vaccine access, price, and awareness?In building a strong adult immunisation infrastructure, it's essential to address key factors such as vaccine access, pricing, and awareness. We can achieve this by ensuring widespread accessibility through mobile vaccination units and homecare nurses, making vaccines affordable with government programmes, educating healthcare professionals and the public, integrating technology for reminders and record-keeping, and implementing a system for monitoring vaccine coverage and effectiveness. By considering these factors, we create a comprehensive infrastructure that effectively overcomes challenges, ultimately promoting public health and preventing vaccine-preventable diseases.

What are the potential long-term advantages of improving public health and reducing healthcare costs if we are successful in creating a robust adult immunisation ecosystem?

As someone deeply entrenched in this field, I can't stress enough how a robust adult immunisation system, particularly for those 50 and above, can be a game-changer in multiple ways. It's not just about shots; it's about health, economics, and societal progress.

Health benefits: Vaccination isn't just preventive; it's a lifesaver. It reduces the risk of infectious diseases like the flu and pneumonia, potentially eradicating some diseases and preventing cancer. Fewer infections mean fewer complications and a safety net for those who can't get vaccines for medical reasons. It also helps in the fight against antibiotic resistance.

Economic benefits: Saving money is a bonus. Vaccinating older adults significantly cuts costs by reducing hospital stays and treatment expenses. It's a smart strategy for outbreak preparedness, stimulating vaccine development and lessening the economic and emotional impact on families. A healthier, vaccinated 50+ population is more productive, benefiting the workforce and economy.

Social benefits: It's not just about health; it's about equity and empowerment. Widespread vaccination ensures access to healthcare measures regardless of age. It empowers women, strengthens healthcare systems, and extends life expectancy, opening doors to healthier, longer lives.

Please share any best practices or suggestions for stakeholders who are interested in assisting with the creation of adult vaccination initiatives in India.The advancement of adult vaccination initiatives in India involves several key strategies and best practices. Industry-academia collaborations have shown significant promise, as demonstrated by many pharmaceutical companies who have collaborated with esteemed hospitals and medical institutions to establish a centre of excellence (CoE) dedicated to immunisation. These collaborations establish CoE dedicated to adult vaccination, creating comprehensive ecosystems that promote the adoption of adult vaccination and safeguard individuals against vaccine-preventable diseases (VPDs). Prioritising vaccination for high-risk groups, empowering healthcare professionals through specialised training, conducting awareness campaigns, engaging with government health authorities, and involving local communities are industry-driven best practices. By fostering such collaborations and embracing these strategies, stakeholders can contribute significantly to the success of adult vaccination programmes, ultimately enhancing public health and overall well-being.

Published On Nov 27, 2023 at 12:29 PM IST

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