Epidemiology Newsletter
Office of Epidemiology April 2002 Utah Department of Health
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Itís Always the Season to Vaccinate Against Pneumonia!

Streptococcus pneumoniae infections are among the leading causes of illness and death worldwide for young children, persons with underlying debilitating medical conditions, and the elderly. Pneumococcal disease is the most commonly identified cause of bacterial pneumonia. Each year in the United States, pneumococcal disease accounts for approximately 125,000 cases of pneumonia requiring hospitalization. The timing of treatment and type of antibiotic prescribed is critical and can either assist or complicate case outcomes. One of the complicating factors is resistance to penicillin and other antimicrobial agents that has spread rapidly in the United States in recent years. In some areas, more than 30% of pneumococcal isolates are not susceptible to penicillin. Despite appropriate antimicrobial therapy and intensive medical care, the overall case-fatality rate for pneumococcal bacteremia is 15-20% among adults. Among elderly patients, this rate is approximately 30-40%. Pneumococcal infections account for an estimated 40,000 deaths annually in the United States; more deaths than any other vaccine-preventable bacterial disease.

Approximately 50% of these deaths can be prevented through the use of the 23-valent pneumococcal polysaccharide vaccine (PPV), which includes 23 of the most common serotypes of S. pneumoniae and has been available since the early 1980s. Despite its availability, the vaccine is underutilized. Thousands of hospitalizations could be avoided and hundreds of lives could be saved in Utah every year, simply by vaccinating.

In Utah, the 7th overall leading cause of death is due to pneumonia and influenza. Among Utahís elderly, 65 and older, it is the 5th leading cause of death. In 1999, 70% of deaths reported for persons 65 and older were due to pneumonia. Utahís hospitals admitted 3,465 persons 65 and older with pneumonia in 2000. Approximately 10% of those who were admitted for pneumonia died from pneumonia. Provisional data from Utahís 2001 Behavioral Risk Factor Surveillance System indicate only 66.3% of persons 65 and older have been vaccinated against pneumonia. The trend is incrementally increasing, however, we have a long way to go.

COMMON QUESTIONS

Who should be vaccinated?

    All adults 65 years of age or older.

    Anyone over 2 years of age who has a long-term health problem such as:

-heart disease
-lung disease
-sickle cell disease 
-diabetes
-alcoholism
-cirrhosis
-leaks of cerebrospinal fluid
    Anyone over 2 years of age who has a disease or condition that lowers the bodyís resistance to infection, such as:
-Hodgkinís disease 
-lymphoma, leukemia
-kidney failure 
-multiple myeloma
-nephrotic syndrome 
-HIV infection or AIDS
-damaged spleen, or no spleen
-organ transplant
    Anyone over 2 years of age who is taking any drug or treatment that lowers the bodyís resistance to infection, such as:
-long-term steroids 
-certain cancer drugs
-radiation therapy
    Persons living in special environments or social settings:
-Long Term Care
-Alaska Natives and certain 
-American Indian populations.
How many doses are needed?

A single dose of pneumococcal vaccine is recommended for most persons aged 65 years or older. Some people who were younger than 65 when they received the pneumococcal vaccine may need one booster dose after 5 years. Detailed revaccination schedules can be found in the ACIP recommendations at:

http://www.cdc.gov/nip/vaccine/pneumo/default.htm#acip

A patient has an indication for pneumococcal vaccine, but doesnít have a record of receiving pneumococcal vaccine. What is recommended?

Providers should not withhold vaccination in the absence of an immunization record or complete record. For pneumococcal vaccine, the patientís verbal history can be used to determine vaccination status. Persons with uncertain or unknown vaccination status should be vaccinated.

A patient has had laboratory-confirmed pneumococcal pneumonia. Does he/she still need to be vaccinated?

Yes. If they have not had a PPV shot and meet the criteria. There are more than 80 known serotypes of pneumococcus (23 serotypes are in the current vaccine). Infection with one serotype does not necessarily produce immunity to other serotypes. As a result, if the person is a candidate for vaccination, he/she should receive it even after one or more episodes of invasive pneumococcal disease.

Should hospitalized patients >65 years be routinely immunized against pneumonia? 

Yes. Medicare patients hospitalized for any reason have triple the risk of future admissions for pneumonia. 38% of hospitalized Utah Medicare pneumonia patients had been admitted the previous year.

Should all nursing home patients 65 and over be vaccinated against pneumococcal disease?

Yes. Standing orders for vaccination of persons admitted to long term care facilities can help simplify the procedure. Providers should obtain immunization histories for facility residents and pneumococcal vaccination should be recommended and documented upon intake to the facility. 

Should influenza and pneumococcal vaccines be given simultaneously?

Pneumococcal vaccine can be given simultaneously with any inactivated vaccine, including influenza vaccine. It is often convenient to administer pneumococcal vaccine in conjunction with the influenza vaccine, but the pneumococcal vaccine can be administered any time of the year and should not be deferred if the need is indicated.

The pneumococcal vaccine is safe and effective in preventing illness and death due to pneumococcal disease. Some people have experienced mild side effects, but these are usually minor and last only a short time. When side effects do occur, the most common include swelling and soreness at the injection site. A few people experience fever and muscle pain. As with any medicine, there are very small risks that serious problems could occur after getting a vaccine. However, the potential risks associated with the pneumococcal disease are much greater than the potential risks associated with the pneumococcal vaccine. You cannot get pneumococcal disease from the vaccine.

If you have questions or need further clarification about the pneumococcal vaccine or other related issues you may visit the following websites:

Centers for Disease Control and Prevention (CDC) 
http://www.cdc.gov/nip/vaccine/pneumo/default.htm
http://www.cdc.gov/nip/recs/adult-schedule.htm
Immunization Action Coalition (IAC)
http://www.immunize.org/va
National Coalition for Adult Immunization (NCAI)
http://www.nfid.org/ncai
You may also call the Utah Immunization Program Hotline at 1-800-275-0659 for additional pneumococcal information.

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Planning a Trip Abroad?wpe1.jpg (7221 bytes)

Vaccine needs vary considerably from country to country but the best place to start is with the recommended vaccine schedules for children and adults. In Utah, some vaccinations are required for school entry. However, most of the vaccines that are routinely administered in childhood require periodic booster doses throughout life to maintain an effective level of immunity. Adults often neglect to keep up the recommended schedule of booster vaccinations, particularly if the risk of infection is low. Additionally, some adults have never been vaccinated at all. It is important to realize that diseases such as diphtheria and poliomyelitis, which no longer occur in most industrialized countries, many be present in those visited by travelers. Pre-travel precautions should include booster doses of routine vaccines if the regular schedule has not been followed, or a full course of primary immunization for people who have never been vaccinated.

Additional vaccines are advised on the basis of a travel risk assessment for the individual traveler. In deciding which vaccines are appropriate, the following factors should be considered for each vaccine:

    risk of exposure to the disease

    age, health status, vaccination history

    special risk factors

    reactions to previous vaccine doses, allergies

    risk of infecting others

    cost

Mandatory vaccination, as authorized by the International Health Regulations, now concerns only yellow fever. Yellow fever vaccination is carried out for two different reasons: 1) to protect the individual in areas where there is a risk of yellow fever infection, and 2) to protect vulnerable countries from importation of the yellow fever virus.

Travelers should therefore be vaccinated if they visit a country where there is a risk of exposure to yellow fever. They must be vaccinated if they visit a country that requires yellow fever vaccination as a condition of entry: this condition applies to all travelers who arrive from (including airport transit) a yellow fever endemic country.

Travelers should be provided with a written record of all vaccines administered (patient-retained record), preferably using the international vaccination certificate (which is required in the case of yellow fever vaccination).

To find out which immunizations are needed for the region being visited, you may go to the CDC Travel website at: http://www.cdc.gov/travel

You will find a wealth of travel information at this site. Food and water recommendations, disease outbreak areas, recommended precautions and much more. Itís a great place for travelers to start, when planning a trip.

Routine adult and childhood vaccine recommendations, required shots for LDS missionaries, a list of travel clinics throughout the state and other valuable travel information can be accessed through the Utah Immunization Program website: http://www.immunize-utah.org You may also call the Utah Immunization Program Hotline at 1-800-275-0659 for additional questions or information. 

For those planning to travel out of the country, make sure their immunization needs are assessed and their vaccinations completed in plenty of time to assure immunity. Most vaccines build immunity in approximately one week to ten days. However, immunizing against some diseases requires multiple vaccinations and may take six months or more to complete. Encourage travelers to determine which vaccines will be needed as soon as their travel plans are finalized. Remember that vaccine immunity may be the most important thing they take with them!  

Category
Vaccine/Chemoprophylaxis
Routine
vaccination
  • Diphtheria/tetanus/pertussis (DtaP) or tetanus/diphtheria for age 7+ (Td) 
  • Hepatitis B (HBV)
  • Haemophilus influenzae type b (HIB)
  • Measles, Mumps, Rubella (MMR)
  • Poliomyelitis (IPV)
Selective
vaccination/chemoprophylaxis determined by destination and risk factors
  • Cholera
  • Influenza
  • Hepatitis A (HAV)
  • Japanese encephalitis
  • Malaria
  • Meningococcal meningitis
  • Pneumococcal disease
  • Rabies 
  • Tick-bourne encephalitis
  • Tuberculosis (BCG)
  • Typhoid fever
  • Yellow fever (for individual protection)
Mandatory
vaccination
  • Yellow fever (for protection of vulnerable countries)
  • Meningococcal meningitis (for Hajj, Umra)

  •  

     

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Important Information

When Reporting a Communicable Disease:

Call (801)-538-6191 or 

Call toll free 
1-(888)-EPI UTAH (374-8824) 

Or you can Fax it to 
(801) 538-9923

AND AFTER HOURS 
In a Public Health emergency call 
(801)-241-1172 or
1-(888)-EPI-UTAH

The April 2002 Epidemiology Newsletter is the most current Newsletter online. 

For Information on Fact Sheets for Diseases or Annual Report Information, as well as The Epidemiology Newsletter, you can browse our website:

http://health.utah.gov/epi/

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Utah Department of Health, Office of Epidemiology
Monthly Morbidity Summary - April 2002 - Provisional Data

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The Epidemiology Newsletter is published monthly by the Utah Department of Health, Division of Epidemiology and Laboratory Services, Office of Epidemiology, to disseminate epidemiologic information to the health care professional and the general public.

Send comments to:
The Office of Epidemiology, Box 142104, Salt Lake City, UT 84114-2104 or call (801) 538-6191 

Approval 8000008: Appropriation 3705

Rod Betit, Executive Director, Utah Department of Health
Charles Brokopp, Dr.P.H., Director, Division of Epidemiology and Laboratory Services
Gerrie Dowdle, MSPH, Manager, Surveillance and Disease Control Program, Managing Editor
Connie Dean, Community Health Technician, Surveillance and Disease Control Program, Production Assistant

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