26 dic. 2016

Trump's Meeting With Wakefield Rattles Vaccine Supporters Was it a signal of new administration's attitude toward vaccines?


by 
  • Managing Editor, MedPage Today
Recent news reports disclosed that Donald Trump met during the summer with a group of anti-vaccine activists including the movement's most prominent leader, Andrew Wakefield, MBBS, whose now-retracted publications first linked vaccines to autism risk. Trump also made remarks during the campaign expressing doubt about vaccine safetyand effectiveness.
MedPage Today asked more than a dozen specialists in infectious disease and public health whether they thought the Wakefield meeting might signal a new, more skeptical attitude in Washington toward vaccines.

Some said it is a definite cause for worry.
"I think it is fair to say that everyone involved with vaccines (public health, pediatricians, family docs, patient advocacy groups, etc.) is very concerned!" said William Schaffner, MD, of Vanderbilt University, in an email. "This is potentially serious stuff."
Matthew Boulton, MD, MPH, of the University of Michigan, expanded on that theme. "The fact that [Trump] met with a doctor (Andrew Wakefield) to discuss vaccine policy who was shown to have blatantly falsified data in his study linking autism and vaccines and who has since been drummed out of the scientific and medical communities is rather astounding. I think the anti-vaccine crowd will definitely be emboldened with Trump in the White House."
Boulton added that he expects "the anti-vaccine community will grow more vocal and assertive because they perceive [Trump] as an ally."
Similarly, Anne Gershon, MD, of Columbia University, told MedPage Today that she was "horrified" to learn of the Wakefield encounter. "Given the appointment of Tom Price to head HHS and the planned attacks on the CDC, I strongly fear for control of infections by vaccines," she said in an email. "The failure to appreciate science... is frightening. If we can't control these falsehoods about vaccines, we are going to have epidemics of measles, rubella (and congenital rubella) and other 'childhood' infections that are even worse in adolescents than in children."

But other experts took more of a wait-and-see attitude.
"I think [Trump] is very unpredictable. ​I don't see him as science driven but as a practical economic issue vaccination makes sense," said John Sinnott, MD, of the University of South Florida in Tampa.
David Topham, PhD, of the University of Rochester, argued, too, that Trump is a pragmatist, not an ideologue. "It's one thing to engage with certain constituents during the election, and to imply support to win the greatest number of supporters, it is another thing entirely to face down overwhelming evidence that vaccines save lives and that they are not linked to autism."
"Optimistically," said Carol J. Baker, MD, of Baylor College of Medicine in Houston, "I would think Trump as a businessman and Price as a physician would clearly see the cost saving and great health benefit of vaccines to our population (real data not opinion) combined with the increasingly robust facts concerning safety."
And several respondents expect a much clearer signal of the new administration's approach to public health when Trump's pick to head the CDC is announced. "It is hard to know how concerned to be until we hear who is being considered for CDC director," said Emily Martin, PhD, MPH, of the University of Michigan.

That nomination has not yet been made and the Washington rumor mill has so far been silent about it.
Roger Sergel, Executive Producer, contributed reporting to this article. 






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    19 dic. 2016

    What is lumbar spondylosis?



    A:

    QUICK ANSWER

    Lumbar spondylosis refers to a degeneration of the discs in the lower spine, according to PubMed Health. These discs separate vertebrae and offer a cushion between the bones. Lumbar spondylosis is also often called degenerative disc disease. This condition causes lower back and leg pain.
    CONTINUE READING
    What is lumbar spondylosis?
    Credit: Michael Dorausch CC-BY-SA 2.0

    FULL ANSWER

    Lower back pain as a result of lumbar spondylosis can manifest at any age, even as early as a teenage years. PubMed Health explains that malalignment of the vertebral column or vertebral instability often results in cases of degenerative spinal diseases. Non-surgical treatment, or first-line treatment, includes drug therapy to aid in pain management as well as physical therapy, chiropractic adjustments, cortisone injection and massage therapy. Surgical procedures, such as vertebral fusions and disc replacement, are commonplace treatment options implemented after non-surgical treatment has failed to manage symptoms effectively.

    Sources:
     


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    What are some interesting facts about polio?


    QUICK ANSWER

    Polio is a virus that formerly ravaged populations the world over in widespread epidemics, but has in modern times, been nearly eradicated. The virus is transmitted via the fecal-oral route and primarily affects newborns and young children.
     CONTINUE READING
    What are some interesting facts about polio?
    Credit: AFP/Getty Images AFP Getty Images

    FULL ANSWER

    A visual symptom of the way polio attacks the body is by way of partial or total appendage paralysis, typically in the legs. Regardless, over 90 percent of people who carry the poliovirus show no symptoms of the disease. Polio is named after the Greek word for "gray," as in the gray matter of the central nervous system.
    Hundreds of thousands of polio cases were reported annually until the first polio vaccines were developed and perfected during the 1950s. Since the vaccine's widespread adoption, polio cases have plummeted down to only several hundred reported cases worldwide. Unfortunately, an anti-vaccine culture and poor hygiene led to worldwide breakouts of the disease reported in May of 2014 by the World Health Organization.
    According to the Disabled-World.com, one of the most famous faces of polio was Franklin Delano Roosevelt, the 32nd president of the United States. He contracted the illness at the age of 39, but it was largely hidden from the public view throughout his political career. Other well-known sufferers of polio to different degrees are author and futurist Arthur C. Clarke, musician Neil Young, actress Mia Farrow and golfer Jack Nicklaus.
    LEARN MORE ABOUT CONDITIONS & DISEASES

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    How do doctors treat post-polio syndrome?


    A:

    QUICK ANSWER


    Because symptoms vary, there is no one treatment for post-polio syndrome, according to the Mayo Clinic. A variety of treatments are implemented to help patients manage symptoms to be as comfortable and independent as possible.
     CONTINUE READING

    FULL ANSWER


    As of 2015, many medications have been studied to help alleviate post-polio syndrome, but none have been found to be very effective, Mayo Clinic reports. Currently, physicians recommend over-the-counter and prescription pain medications to help ease muscle and joint pain.
    Sleep apnea is common among post-polio syndrome patients, and sometimes doctors recommend treatment for the condition, Mayo Clinic states. Patients may need to wear a device to open their airways or refrain from sleeping on their backs.
    Physical therapy exercises may be prescribed, Mayo Clinic says. Most exercises are designed to strengthen muscles without creating muscle fatigue. It is important that patients with post-polio syndrome not over-exercise to the point of fatigue because it typically takes a lot of rest to recover. Sometimes speech therapy helps patients learn to overcome difficulty swallowing.
    Occupational therapy is very common because most post-polio syndrome patients must learn how to conserve energy, Mayo Clinic states. This involves learning how to pace oneself and rest periodically with the assistance of a cane, wheelchair or scooter. Occupational therapists also help patients make their homes safe and convenient as well as determine ways to perform household tasks while conserving energy.

    Sources:



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    14 dic. 2016

    How is it Possible ….Can Depression Be Faked?



    Faking Depression
    By Nancy Schimelpfening
    Question:  My co-worker has been missing a lot of work and she says it’s because she has depression.  The other day I was at the mall on my lunch break and saw her out shopping with her sister and not really looking all that depressed.  This makes me upset because I’ve been working overtime trying to take up the slack while she’s out from work.  I do have a lot of sympathy for people who have mental illness, but I don’t want to get taken advantage of either.
      I’m considering telling our boss what I saw.  Could it be that she is faking her depression?
    Answer:  I completely understand why you might feel upset about what you saw.  Going by external appearances only, it’s very easy to think that your friend might be faking her illness.  However, what we really have is only a moment in time.  What matters most in determining whether she has depression too severe to attend work is what her life is like overall.  Perhaps she had great difficulty falling asleep the night before and wasn’t able to get out of bed until just before you saw her? Maybe she was only at the mall because her sister dragged her along hoping to help her feel better.  It’s really impossible for us to know just based on seeing her for a few moments whether she is indeed depressed.
    What I can tell you is that depression tends to be an invisible illness.  Many of its symptoms are mental and emotional and its signs are not always obvious to the casual observer.
      People with depression often look completely normal on the outside because they become very good at pulling themselves together while out in public, putting on a false smile to hide the turmoil that they feel inside.  Then, when they are all alone, they fall apart.
    Even though depression can be difficult to detect, if you look really closely, you may be able to see some of its signs in your coworker.
      Does she ever:
    • Seem to have trouble thinking, remembering things or making decisions?
    • Seem really tired and lacking in energy?
    • Talk about feeling guilty, worthless or helpless?
    • Seem really hopeless or pessimistic about life?
    • Have problems getting good sleep?
    • Seem irritable or restless?
    • Seem to not be interested in things that she used to enjoy like hobbies?
    • Seem to be losing or gaining weight without trying?
    • Complain of pain, headaches or digestive problems that don’t seem to get better even with treatment?
    • Seem sad or anxious?
    • Talk about suicide or not wanting to be around anymore?
    If she seems to exhibit several of these signs, then it is quite possible that she really is telling the truth about her condition.  Perhaps the best thing you can do, rather than telling your boss what you saw, is to reach out to your co-worker and offer your support.  If she really is faking her depression then this will soon become clear.  If, however, she is genuinely depressed, the chances are good that she really could use a friend.
    SOURCE: verywell.com
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    13 dic. 2016

    If you haven't gotten your flu shot yet, get it now


    File photo of a person receiving a flu shot.
     
     LIONEL BONAVENTURE/AFP/GETTY IMAGES


    “The fact that flu activity hasn’t picked up dramatically yet means there is plenty of time for people to get vaccinated if they haven’t already,” said Lynnette Brammer, an epidemiologist with the U.S. Centers for Disease Control and Prevention.
    This year’s flu season is starting out much like last year, Brammer said. Currently, influenza H3N2 is the predominant strain, she said, although H1N1 is also circulating. Last year, the H3N2 virus started out as the dominant strain, only to be displaced by H1N1 as flu season hit full swing. “It ended up being an H1N1 season,” she said.
    “It’s similar to a lot of years right now,” Brammer added. “Things should start to pick up in the next few weeks, but we’ll see. Last year, things didn’t really pick up until the first of the year. Right now, there is nothing that’s really concerning.”
    Last year’s flu season was particularly hard on older people.
    In a typical flu season, flu complications -- including pneumonia -- send more than 200,000 Americans to the hospital. Death rates linked to flu vary annually, but have gone as high as 49,000 in a year, according to the CDC.
    Most of the time flu activity peaks between December and March but can last as late as May.
    This year’s vaccine contains the strains currently circulating, which makes it a good match, Brammer said. The vaccine supply is also good this year, with more than 131 million doses available, she said.
    How effective a vaccine is depends on how good a match it is to the strains of flu virus circulating that year. Most years, the vaccine is between 40 percent and 60 percent effective, according to the CDC.
    The CDC recommends that anyone 6 months of age and older get a flu shot. “You want to make extra sure for people at high risk -- including pregnant women, the elderly and anyone with a chronic medical condition,” Brammer said.
    Women with newborns also need to get their flu shot to help protect their infants, who can’t be vaccinated until they’re at least 6 months old. Also at risk are seniors and people with chronic health problems, such as lung and heart disease, the CDC said.
    Getting your flu shot soon is important because it can take several weeks to produce enough antibodies to give you maximum protection, officials noted.
    One change this year is that the CDC’s Advisory Committee on Immunization Practices does not recommend that the nasal spray vaccine be used by anyone, because it seems less effective than a shot, Brammer said.

    'It feels wonderful, actually': The polio survivor who has lived inside an iron lung for 60 YEARS


    Martha Ann Lillard's crippling illness has made her a prisoner in her own home for the last 60 years. 
    Paralyzed by polio at age five, the Oklahoma woman has spent most of her life encased in a 1940s respirator which breathes for her.
    But the 65-year-old couldn’t imagine life any other way.

    Martha Ann Lillard, 65, has lived inside an iron lung like this one since she was five-years-old



    Martha Ann Lillard, 65, has lived inside an iron lung like this one since she was five-years-old
    'Some people have said I’d rather die than leave my iron lung, and it makes it sound like I’m not trying to be modern, and it’s not like that at all,' she told NBC News. 
    'It feels wonderful, actually, if you’re not breathing well. When I was first put into it, it was such a relief. It makes all the difference when you’re not breathing.'
    Lillard has learned to live with her disease.
    She taught herself to walk again. While she can leave the 800-pound respirator, she prefers not to.
    Lillard lies on a goose down comforter inside a long metal cylinder in which she’s enclosed with an airtight seal. Her neck and head sticks out of a foam collar. 
    She lives with her three beagles, and a housemate who helps care for her. She stays in touch with friends by phone and internet.
    Lillard owns her iron lung, which runs on a fan belt motor that friends help patch together with car parts when it breaks. 
    She said it's a better option than portable positive pressure ventilators which most polio survivors use. They force air into the lungs, often through a tube in the throat.
    'If I use the positive pressure vent, I’m not as well rested,' she said.
    Martha told MailOnline about her experience. 'I was paralyzed all over except my face.I was unconscious & turning blue when they put me in the lung. I was in it for six month in hospital, during which time I learned to breathe for 30 seconds and longer on my own. It was terrifying.W hen you can't breathe much, you can't talk, cry or make a sound. Doctors said I wouldn't ever be out of the lung or walk. I was determined to do both!'
    She says that after the time she spent in hospital she regained 25% of her breathing and after a year of work she learned to walk. 
    'I would love to not need any vent & would like not to have the weakening that comes with Post-Poilo Syndrome. I can't use other types of ventilators because of inflammation that comes with Polio. I could be more rested if I stayed in the lung full time. But I choose to be up as much as possible.Get the vaccine!’


    This undated photo shows a woman lying inside an iron lung



    This undated photo shows a woman lying inside an iron lung
    Lillard considers herself an anomaly in a U.S. society that barely remembers the scourge of polio - a viral infection of the spinal cord that mainly affected young children.
    But with reports polio has reared its ugly head in Syria and Cameroon, Lillard wants to make sure that people never forget.
    'I think the word is to get your child vaccinated. Why would we let somebody have to go back through that again?' she said.
    'If my mother would have had the opportunity to give me the vaccine, she would have done that.'
    Lillard was a kindergartner in 1953 when she woke up with a sore throat that quickly progressed to poliovirus. The virus is transmitted through contaminated food and water. 
    'The night before I was paralyzed, the neighbor children ate out of the same bowl of pancake batter that I did,' Lillard said. 'They just had to pray that nobody got it.'
    The first known outbreak of polio in the U.S. was in 1894 in Vermont. In 1952, a record 57,628 cases of polio were reported in the U.S.
    Read more: http://www.dailymail.co.uk/news/article-2516222/It-feels-wonderful-actually-The-polio-survivor-lived-inside-iron-lung-60-YEARS.html#ixzz4SkVnU7ZD
    Follow us: @MailOnline on Twitter | DailyMail on Facebook


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    9 dic. 2016

    Polio and Vaccine-Associated Paralytic Poliomyelitis






    Polio
    Polio is an ancient disease.
    Although the first modern polio epidemic is thought to have occurred in 1887, when 44 cases were reported in Stockholm, Sweden, polio likely existed as far back as 1580 BC.
    A type of enterovirus, polio usually causes infections without symptoms or very mild symptoms, including a low-grade fever and sore throat.
    Other children can develop more worrisome polio symptoms, though, including those with:
    • nonparalytic aseptic meningitis – have a low-grade fever and sore throat with stiffness of the neck, back, and/or legs, and increased or abnormal sensations, which can last for 2 to 10 days
    • paralytic polio – have a low-grade fever and sore throat, and then 1 to 18 days later, they may develop increased deep tendon reflexes, severe muscle aches, and muscle spasms, followed by decreased deep tendon reflexes and flaccid paralysis. Some of these children have permanent weakness and paralysis and paralytic polio is fatal in at least 2 to 10% of cases.
    Polio hit its peak in the United States in 1952, when there were over 21,000 cases of paralytic polio.
    The United States has been polio-free since 1979. That last outbreak had been among an unvaccinated group of Amish in several states in the Midwest.

    Polio Vaccines

    Of course, it was the development of the first polio vaccines that stopped thepolio epidemics after 1952 and helped us eliminate the endemic spread of polio.
    The Salk vaccine, an inactivated polio vaccine, was licensed in 1955. This was followed by the introduction of the original Sabin vaccine, an oral, live polio vaccine, in 1961.
    Both polio vaccines had their strengths and weaknesses:
    • the Sabin vaccine provides lifelong immunity against polio, including intestinal immunity, and shedding of live weakened (attenuated) virus, which can help with community immunity, but the vaccine can also rarely cause vaccine-associated paralytic polio (VAPP) and vaccine-derived polio
    • the Salk vaccine provides great protection against polio after three doses, especially paralytic polio (intestinal immunity is not as good though), and since it isn’t a live virus vaccine, it can not cause vaccine-associated paralytic polio nor vaccine derived polio
    When a trivalent oral polio vaccine (protected against all three strains of the polio virus) was introduced in 1963, it replaced the Salk vaccine in the US.
    An enhanced version of the Salk vaccine was introduced in 1987 and it went on to replace the oral polio vaccine in many developed countries that had eliminated polio because of concerns about vaccine-associated paralytic polio (VAPP).
    When you look at the strengths of the oral polio vaccine, though, it is easy to see why it is used when you are still trying to get wild polio under control in an area. In general, the oral polio vaccine is also less expensive and much easier to give to children, since it doesn’t require a shot.

    Vaccine-Associated Paralytic Poliomyelitis

    Vaccine-associated paralytic poliomyelitis (VAPP) occurs when the weakened live poliovirus strain in the oral polio vaccine changes and causes someone ,or a very close contact, to develop symptoms of paralytic polio.
    The change occurs in the intestine of someone who has received the oral polio vaccine, typically after the first dose and most commonly in people with immune system problems

    Fortunately, VAPP does not lead to outbreaksof polio and it is very rare, only occurring after about 1 in 2.7 million doses of oral polio vaccine are given.
    Still, that ended up as 5 to 10 cases a year in the United States, and once polio was eliminated in the United States, the risk-benefit ratio no longer favored the oral polio vaccine. When the only kids getting polio were getting vaccine-associated paralytic poliomyelitis it became time to make a switch to the Salk vaccine.
    John Salamone became the advocate for that change. His son, David, developed VAPP after getting his oral polio vaccine in 1990. At the time, the live, oral polio vaccine was still a standard part of the childhood immunization schedule.
    As early as 1977, an IOM report “Evaluation of Poliomyelitis Vaccines” stated that “five major policy options were considered for the United States in the context of the 60-70 percent level of vaccination now reached.” These options including using only OPV, only IPV, and a combination of both vaccines, etc. Low vaccination rates seemed to be a big factor in influencing the recommendation to go with only OPV at the time.
    As time went by, it became clear that the switch to IPV was necessary, but fear of changing a program that had been working so well for so long and perhaps uncertainty that the switch, including a need to greatly increase the supply of the inactivated vaccine in a short amount of time, kept health experts from making it until 1997. The sequential IPV/OPV vaccine schedule was then formally changed to an all-IPV vaccine schedule in 2000.

    Vaccine-Derived Poliovirus

    Although it sounds similar to VAPP, vaccine-derived poliovirus strains are a little different.
    A vaccine-derived poliovirus (VDPV) strain also undergoes genetic changes from the weakened (attenuated) live poliovirus strain in the oral polio vaccine and can then cause paralytic symptoms, but it also develops the ability to continue circulating and cause outbreaks.
    These outbreak or circulating strains of vaccine-derived poliovirus (cVDPV) are fortunately very rare. When they occur, it is because a lot of people in the community aren’t vaccinated against polio, as high vaccination rates protect against cVDPV, just like they protect against wild poliovirus strains.
    The latest outbreaks of vaccine-derived poliovirus have occurred in:
    • Mali
    • Ukraine
    • Nigeria
    • Madagascar
    It is important to remember that although 580 polio cases occurred after 20 outbreaks of cVPDV around the world from 2000 to 2011 and there were 15,500 cases of wild paralytic polio during that time, the polio vaccine itself prevented over 5 million cases of paralytic polio!
    Sure, without polio vaccines, we wouldn’t have VAPP, VDPV, and cVDPV, but we would go back to the days when over 500,000 people a year developed paralytic polio.

    Post-Polio Syndrome

    Post-polio syndrome is another term to be familiar about when studying polio.
    Like children who recover from measles and then have a risk of developing subacute sclerosing panencephalitis (SSPE), a post-polio syndrome is a late complication of paralytic polio.
    About 25 to 40% of those who had paralytic polio can develop new symptoms 15 to 20 years later. Symptoms of post-polio syndrome can include new muscle pain, new muscle weakness, and even new paralysis. Or they may have worsening of previous muscle weakness.
    Post-polio syndrome does not occur after getting the live polio vaccine.

    What You Need to Know about Polio

    Other things to know about polio include that:
    • Improved hygiene and sanitation didn’t cause polio to disappear, as someanti-vaccine conspiracy theorists argue. Instead, polio changed from an endemic form, infecting most children when they were infants and still had protection from maternal antibodies, to an epidemic form, as fewer people were exposed and developed immunity when they were younger.
    • There are there different serotypes of wild poliovirus (WPV). Natural immunity provides lifelong immunity to the specific serotype of polio to which you were infected.
    • SV40 contamination in the original polio vaccines from 1955 to 1961 is not associated with an increased risk of cancer.
    • The standard vaccination schedule includes four doses of a polio vaccine at 2 months, 4 months, 6 to 18 months, and a booster dose at 4 to 6 years of age.
    • The Cutter Incident refers to a problem with polio vaccine manufactured by Cutter Laboratories which was not completely inactivated, causing paralytic polio in at least 200 children and 10 deaths in 1955.

    • There have been at least 73 cases of immunodeficiency-related vaccine-derived poliovirus (iVDPV), in which a person with a rare immune disorder continues to shed poliovirus after vaccination, typically for up to six months. Even though up to seven of these cases have been known to shed virus for more than five years, including one with common variable immunodeficiency (CVID) who has been shedding vaccine-derived poliovirus for 28 years, this is not thought to be a common way to spread the polio virus to others.
    • Because of VAPP and VDPV, there will eventually be a worldwide phase out of the oral polio vaccine and a switch to the inactivated polio vaccine until polio is completely eradicated. Countries are usually not switched to an all-IPV immunization schedule until they demonstrate high vaccination rates and the risk of importation of wild polio is low. And there will soon be aswitch to a bivalent oral polio vaccine (bOPV), removing the type 2 component of the vaccine, decreasing the risk of VAPP and cVDPV. By May 2016, the trivalent oral polio vaccine (tOPV) will no longer be used, as we will have switched to using IPV and bOPV.
    • There is no cure for polio.
    • In addition to polio, other types of acute flaccid paralysis include nonpolio enterovirus infections, rabies, Guillain-Barre syndrome, West Nile virus infections, acute transverse myelitis, and myasthenia gravis, etc. Many other causes of flaccid paralysis also include sensory signs and symptoms though or can be differentiated from polio in other ways.


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