Category: Vaccine

CHARLESTON, W.Va. Health Officer at the Kanawha-Charleston Health Department, Dr. Steven Eshenaur, says the passage of a bill allowing parents to choose whether they vaccinate their children against infectious diseases is very much a concern.

HB5105, or the vaccine bill, pertaining to the elimination of requirements to prevent and control diseases such as measles, mumps, tetanus, meningitis, and polio, and the compulsory immunization of school children, passed during the 60-day legislative session that just wrapped up at the state capitol.

Eshenaur told MetroNews that he testified against the bill in both the House of Delegates and the state Senate, because, up until this point, West Virginias immunization regulations for students have proven to be both safe and effective at keeping those diseases out of schools.

That system, those laws have kept our children safe, Eshenaur said. This bill weakens those laws.

Eshenaur said the bill specifically allows for parents of children attending private and parochial schools in the state to sign a religious exemption form to prevent their child from getting vaccinations that were once mandatory for all students.

He said this still allows those children deemed exempt from getting immunizations to interact with other children and potentially expose them to such diseases, as well.

Eshenaur said this poses a potential risk for the entire population, because, in order to keep herd immunity in place and infectious diseases at bay, a 95% immunization rate across the state must be maintained. He said while that 95% immunization rate can still be maintained when taking into account of those who are legitimately medically-exempt from getting vaccines, this bill creates the risk of decreasing that rate by exempting those who may otherwise safely receive immunizations.

When we drop below that threshold, then we will become like our neighbors in Ohio, Pennsylvania, Virginia, Maryland, etc. that have now had measles outbreaks just this year, he said.

Eshenaur said while it wont happen immediately, the lower immunization rates this policy change could lead to could even open the door up to a relatively longtime dormant disease in the country polio. He said West Virginia hasnt had a case of polio since 1970.

Eshenaur said a polio case was, however, reported for the first time in many years in the U.S. in New York back in 2022 from someone who was unimmunized.

He said if it could break out there again, it could just as easily spark an outbreak here.

Polio still exists in the world, it has never gone away, but we have been able to keep it from infecting our population, because weve had strong immunization programs to prevent polio from infecting our children, he said.

He said as an emergency physician who has been all over the world treating these diseases in first-world countries, he saw the affects of what the lack of accessibility of vaccinations can do.

Eshenaur urges parents to continue to protect their children by getting them these safe and effective vaccines which doctors have been utilizing in West Virginia for many years.

Our immunization laws are almost 90 years old, they have evolved overtime with new immunization that we have developed and we have now effectively eliminated as a scourge a number of childhood diseases that our grandparents and great-grandparents had to experience, said Eshenaur.

Eshenaur is now submitting a letter to Governor Jim Justice urging him to veto HB5105 immediately. He said if Justice decides not to veto the bill, the legislation will turn the clock back nearly 100 years in immunization protection.

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Health officer says recently-passed vaccine bill is deeply concerning and weakens immunization protection - West Virginia MetroNews

The early identification of thrombocytopenia and thrombosis (VITT) and immune thrombocytopenia (ITP) after vaccination against COVID-19 were crucial for successfully caring for patients presenting with thrombocytopenia, according to a recent study published in Research and Practice in Thrombosis and Haemostasis.1

Blood Clot Model | image credit: Matthieu - stock.adobe.com

The study authors reflected on emerging evidence of thrombocytopenic and thrombotic events in some patients after receiving a COVID-19 vaccination. While rare, VITT and ITP following vaccination require urgent evaluation and therapy initiation.2

Despite emerging data on the occurrence of VITT and ITP following vaccination, there is insufficient information available pertaining to the long-term management of these events, the authors explained.1

To better understand these adverse hemolytic events, treatment approaches, the diagnostic process, and to address the shortcomings in literature, the researchers reported on patients at a tertiary care center in Canada who presented with thrombocytopenia following their COVID-19 vaccine.

Nine adult patients with new-onset thrombocytopenia at The Ottawa Hospital between April 1, 2021, and May 31, 2021, were retrospectively reported on. These presentations of thrombocytopenia began between 4 and 42 days after receiving a COVID-19 vaccine, which included the Pfizer-BioNTech mRNA, Moderna mRNA, and Astra Zeneca adenovirus vector-based vaccines.

The treatment regimens for VITT and ITP included a corticosteroid approach with daily prednisone at a dose of 1 mg/kg over the initial few days before tapering over the next 2-3 months. For VITT, it was also recommended to administer non-heparin anticoagulation; some cases can necessitate intravenous immunoglobulin (IVIG).

Additionally, 4-42 days prior to patients symptom onset, heparin-induced thrombocytopenia (HIT) testing was sent for individuals with a COVID-19 vaccination record and a platelet count under 150. This testing utilized the Immucor PF4 Enhanced enzyme-linked immunosorbent assay (ELISA) to assess for anti-PF4 autoantibodies. If a patient registered a positive PF4 binding assay, the serotonin release assay (SRA) was performed as a confirmation test for VITT.

The 9 included patients had an average age of 55 years, with a close-to-equal gender distribution. The majority of patients received the Astra Zeneca vaccine (n = 7) while the others received Pfizer (n = 2). No one had been exposed to heparin and all patients were negative for COVID-19 infection.

Positive results from the HIT ELISA tests came back for 3 patients and further testing with SRA diagnosed VITT in a 4th patient. There were 5 patients who went on to develop ITP4 of whom did not have an associated thrombosis. The fifth patient had a history of ITP and was diagnosed with deep vein thrombosis.

All patients who developed VITT stayed oral anticoagulation treatment following 9 months of treatment. Three of the 4 patients with VITT were admitted to the hospital and subsequently treated with corticosteroids, non-heparin parenteral anticoagulation, and IVIG. The authors observed that patient 1 had a good response to treatment; however, this was not the case in patients 2 or 3. Patient 2 endured recurrent thrombocytopenia throughout their steroid taper and needed to be readmitted for steroids and IVIG. The third patient experienced 2 incidences of cerebral venous sinus thrombosis (CVST) progression and refractory thrombocytopenia. Their hospital stay lasted 15 days and their complications required 7 treatments of plasma exchange. While patient 4 was not admitted to the hospital, they did receive outpatient treatment with a DOAC for pulmonary emboli, to which they responded well.

Of the 5 patients who went on to develop ITP, 1 experienced success treating their condition with eltrombopag and apixaban as an outpatient, but the remaining 4 were admitted to the hospital.

Patients with VITT all continued to get their next round of the COVID-19 mRNA vaccine, whereas all patients except for 2 who had ITP continued with the next vaccine round. Of the 2 who did not have their next dose, 1 declined because of their experience with adverse hematologic events and the other was not recommended to continue because of their history of thrombocytopenia following their previous vaccine doses.

Early identification was key to the successful management of VITT and ITP events following COVID-19 vaccination. The patient cases described in our study add to the currently limited literature on long-term management of VITT and ITP, particularly in refractory cases, and provides guidance around future COVID-19 vaccinations, the authors concluded.

Reference

1. Ge M, Ladha D, Lymer J, et al. Thrombocytopenia with and without thrombosis following covid-19 vaccination: long-term management. Res Pract Thromb Haemost. Published online February 29, 2024. doi: 10.1016/j.rpth.2024.102357

2. Vaccine-induced immune thrombotic thrombocytopenia. American Society of Hematology. Updated May 9, 2022. Accessed March 12, 2024. https://www.hematology.org/covid-19/vaccine-induced-immune-thrombotic-thrombocytopenia

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Managing Rare Thrombotic Events Following COVID-19 Vaccination - AJMC.com Managed Markets Network

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Largest COVID vaccine study yet finds links to health conditions - wenatcheeworld.com

Neil Young is back on Spotify after boycotting the platform over two years ago, he said in a new blog post. The Canadian singer ditched the platform over vaccine misinformation on the Joe Rogan podcast, later saying he was fed up with Spotifys "shitty" sound quality anyway.

Young returned because Rogan's podcast is no longer exclusive on Spotify. "My decision comes as music services Apple and Amazon have started serving the same disinformation podcast features I had opposed at Spotify," he said, without specifically mentioning the Joe Rogan Experience.

There's no way he could also pull his catalog from Apple Music and Amazon as well, he added, "because my music would have very little streaming outlet to music lovers at all" if he did. Young also expressed hope that Spotify would improve its sound quality, while shouting out Quobuz and Tidal for presenting his songs in high-res.

"Spotify, you can do it! Really be #1 in all ways. You have the music and listeners!!!! Start with a limited Hi res tier and build from there!" he wrote. (Spotify did announce that it would launch a HiFi tier way back in early 2021, but it has yet to actually do so.)

Fellow Canadian Joni Mitchell joined Young in the boycott, and her music is still missing from the platform. Both had reason to be incensed about the vaccine misinformation on Rogan's show as both were victims of polio a disease that was wiped out in North America thanks to vaccines.

It's hard to say how Young's boycott affected Spotify, but it certainly impacted his finances. Last year, Billboard estimated that pulling his songs from Spotify cost him roughly $300,000 in lost recorded music and publishing royalties.

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Neil Young is returning to Spotify after boycotting it over Joe Rogan's vaccine comments - Engadget

Fair Access

It has taken 18 years for India to produce its own affordable version to tackle the countrys second-biggest cause of cancer deaths among women

Tue 12 Mar 2024 05.00 EDT

It is a Wednesday morning and Sneha Neurgaonkar sits on a gurney in a private hospital in Pune, India. The 14-year-old is at the Lalwani mother and child care hospital to receive the first Indian-made human papillomavirus (HPV) vaccine, which prevents cervical cancer.

Unlike the 10-year-old girl who was given the vaccine before her, Sneha knows what cervical cancer is and the damage it is doing to women in her country.

I researched cervical cancer on Google and its bad, she says. Protection is very important because females are the leaders of the future generation and without them, there is no world.

Cervical cancer is the second biggest cause of cancer deaths among women in India, killing an estimated 70,000 a year a quarter of the global burden of the disease. According to the World Health Organization (WHO), cervical cancer is the fourth most common cancer in women worldwide, with about 90% of deaths from the disease occuring in low- and middle-income countries.

Nearly all cervical cancers are caused by an infection from certain types of HPV. It takes 15 to 20 years for the disease to develop.

The HPV vaccine has been shown to significantly reduce cases, but access to the vaccine in India has been extremely limited because the existing doses, sold by foreign pharmaceutical companies Merck and GSK, are expensive.

Developed as a joint initiative between the Indian government and the Serum Institute of India (SII) the worlds largest vaccine manufacturer by dose Cervavac is the first vaccine manufactured in the country to receive approval from its drugs controller general.

Last month, the government announced it would include the vaccine in the countrys immunisation programme, meaning it will be distributed for free to girls between nine and 14.

Until this month it was only available in private healthcare settings at a cost of 2,000 rupees (19) for three doses. From March 8 it was offered at the hospital at the price of 1,500 rupees to those who had registered in advance. Adar Poonawalla, SIIs chief executive, says the vaccine will be available by December to the government at a cost of 300-400 rupees a dose.

The SII, based in Pune, can currently manufacture 70m doses of the vaccine annually, but aims to at least double that by 2026. About 25 million children are born in India every year.

Once demand in India has been satisfied, Poonawalla wants to export the vaccine. Well start with African countries, the Indian subcontinent, maybe South America, he says. Europe and the US probably wont be seeing this vaccine because theyre used to the 9-valent [vaccine]. Maybe in five or six years, well make the 9-valent and go to these countries.

Umesh Shaligram, an executive director at SII, says the new HPV vaccine will have a huge impact.

I always had a feeling that women in low- and middle-income countries are not well treated, he says. Its a mother who gives you energy and power. In Indian spirituality we have prayers, we have goddesses everywhere. If you ask me whether we pass on that respect, probably not. I always felt that lack. I was very happy we could do something for that particular aspect of life.

This vaccine comes almost two decades after the first HPV vaccine was developed in 2006. Shaligram blames Covid for the delay in production, but some have criticised the delay.

At some point it has to stop being an achievement when we get a low-cost indigenous vaccine that we can afford 18 years after one in the west, says Achal Prabhala, coordinator of the AccessIBSA project, which campaigns for access to medicines in India, Brazil and South Africa. Why cant SII challenge the environment to produce vaccines simultaneously to those in the west?

Back at Lalwani, Sneha and her mother, Sonia, are happy she has been vaccinated with an Indian-made vaccine. If it is made in India, we have more trust, says Sonia.

Sneha says she has been telling her friends about the vaccine. She doesnt think many of them know about cervical cancer. Currently theres not much awareness, she says. We have not been taught about it in school. Period awareness is now being implemented, but before it was considered taboo.

Her doctor, Sunita Lalwani, a consultant gynaecologist and obstetrician, agrees: I dont think the government or families used to spend money on womens health. It was only in [childbirth] or if the lady really fell ill where women were taken care of. Vaccination was never considered. Womens health was very taboo.

Despite the WHOs recommendation that all women over 30 attend a cervical cancer screening every five to 10 years, less than 2% of women in India aged 30 to 49 years have been screened.

Lalwani faces problems in convincing women to attend appointments for cervical smears, a procedure in which a small brush is used to gently remove cells from the surface of the cervix and the area around it so they can be checked for cancer.

Pap smears have always been available but where are the takers? I have to ring up my patients and send them SMS. Let me tell you, many dont turn up.

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India gets its own HPV vaccine to stop 70,000 women dying of cervical cancer a year - The Guardian

While HPV vaccine is cost effective, affordability can still be a challenge, especially for middle-income countries that are no longer eligible for subsidized pricing via Gavi, the Vaccine Alliance. For instance, Kenya may soon transition away from Gavi support and see its vaccination program costs increaseexceeding US$10 million per year for HPV, the study demonstrated. Moreover, countries face competing health needs and may sometimes need to prioritize one intervention over anothermeaning, even a cost-effective vaccination program may get skipped due to affordability limitations.

It's important to reassess cost-effectiveness as the HPV vaccine landscape and country circumstances change. Gavi transitions can impact affordability and vaccine pricing can change. New vaccines can enter the global market; for instance, Cecolin, a lower priced HPV vaccine, received WHO prequalification in 202111 years after the first HPV vaccines were prequalified. And vaccination recommendations can evolve; in 2022 the WHOs Strategic Advisory Group of Experts on Immunization endorsed a single-dose HPV vaccination schedule as an alternative to the two-dose schedule, which impacts how much vaccine a country needs to procure to protect girls and women. HPV vaccination programs in Kenya and the Philippines, for instance, predate Cecolins approval and the single-dose endorsementand our research shows that a product or schedule switch could be more cost effective or even cost saving in these countries.

Product choice in particular influences the degree of cost effectiveness. Pricing is of course a concernGARDASIL 9, for instance, which at the time of study cost more than other vaccine options and isnt supported by Gavi, generally wasnt cost effective for the countries studied. But in addition to price variations, the virus types the vaccine protects against matter. The currently available vaccines directly protect against the two major virus types that cause cancer, and some potentially offer cross-protection against additional virus types not included in the vaccine. Type of protection offered impacts health outcomes, which in turn impacts cost effectiveness.

For instance, our research showed that in Mongolia, Cervarix may offer better value for money than GARDASIL even though Cervarix was priced higher at the time of study. This is because Cervarix has shown cross protection against some virus types not included in the vaccine but that were prevalent in a notable percentage of cervical cancer cases in Mongolia. Similarly, the study in Kenya showed that Cecolin provides better value for money when cross-protection is not considered, whereas Cervarix is the most cost-effective choice when it is considered.

Vaccines are one of the best buys in public health but that doesnt mean countries should say yes to every new vaccine or schedule change that comes along, said Clint Pecenka, PhD, Director of Health Economics at PATH. HPV vaccination saves lives and improves healthand health economic assessments like cost-effectiveness analyses can help ensure it makes good financial sense, too. In the case of HPV vaccination, research shows that vaccination is often a wise economic choice for countries.

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Is HPV vaccination cost effective? - PATH

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Antigen identification strategies and preclinical evaluation models for advancing tuberculosis vaccine development ... - Nature.com

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'Turning back the clock': Kanawha health officer speaks out against vaccine exemption bill

{p}Kanawha Countys leading health official released a statement Monday expressing his concern after state lawmakers passed legislation over the weekend that would allow for vaccine exemptions in schools. (WCHS){/p}

KANAWHA COUNTY, W.Va. (WCHS)

Kanawha Countys leading health official released a statement Monday expressing his concern after state lawmakers passed legislation over the weekend that would allow for vaccine exemptions in schools.

Dr. Steven Eshenaur, health officer at the Kanawha-Charleston Health Department, has been vocal in his opposition to the bill, saying the consequences of the legislation could have wide-reaching effects.

"By allowing philosophical exemptions to the law, we are weakening the publics ability to prevent measles, mumps, tetanus, meningitis and polio, Eshenaur said in the statement. Make no mistake, these are debilitating and deadly diseases for which immunizations have been proven to be safe and effective.

Childhood vaccines have kept the Mountain State free from Polio since 1970.

House Bill 5105, which originally just stripped vaccination requirements for students in virtual school, was amended to allow private schools to make their own requirements and then added a religious exemption.

The highly-debated bill was passed Saturday and now heads to the governors office.

Eshenaur called on Justice, who he said he knows cares a lot about children, to veto the legislation.

If Governor Justice signs this bill into law, he will join the legislature in turning the clock back nearly 100 years in immunization protection for our children, Eshenaur said. I pray he vetoes HB5105. Lets all pray he does.

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'Turning back the clock': Kanawha health officer speaks out against vaccine exemption bill - WCHS

A new analysis of all-cause mortality of Hispanic and Latino adults published in Annals of Internal Medicine shows Mexicans and Central Americans were most affected by the pandemic.

The study was based on trends seen among 15,568 adults aged 18 to 74 years who participated in the HCHS/SOL (Hispanic Community Health Study/Study of Latinos). Baseline mortality trends from 2008 through 2011 were compared to trends seen in 2020 and 2021.

Participants were recruited from the Bronx, New York City; Chicago; Miami; and San Diego and were of Central American, Cuban, Dominican, Mexican, Puerto Rican, and South American backgrounds.

Prior to the pandemic, cumulative mortality risks were higher in the Puerto Rican and Cuban groups (6.3% and 5.9%, respectively) and lowest in the South American group (2.3%). Mortality was higher among those born in the United States and lower among immigrants, and the increased mortality risk among Puerto Ricans and Cubans was most often associated with lifestyle factors, including diet.

"During the pandemic, marginal 2-year cumulative mortality risks adjusted for age ranged from 1.1% (South American) to 2.0% (Central American), and CIs [confidence intervals] overlapped across all groups," the authors wrote. "Our findings (based on 2 years of follow-up) suggest that mortality risks varied during the pandemic after adjustment for lifestyle and clinical factorsthat is, risks were somewhat higher for persons of Central American and Mexican backgrounds than for those of Puerto Rican and Cuban backgrounds."

Risks were somewhat higher for persons of Central American and Mexican backgrounds than for those of Puerto Rican and Cuban backgrounds

Lifestyle factors were second to socioeconomic factors in contributing to mortality, the authors wrote, as the pandemic emphasized discrepancies among Latino groups. For example, according to the 2020 census, 20.3% of Mexican Latinos had no insurance, compared with 8% of Puerto Rican Latinos.

In an editorial on the study, authors write the HCHS/SOL, "holds great promise for the further development of theoretical models and frameworks on Latino mortality and health," an area of study missing in US public health research.

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