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Pneumococcal Infections Spike During Flu Pandemic
Physicians Urged to Vaccinate Those Indicated to Receive PPSV
By News Staff
Influenza isn't the only serious respiratory illness physicians need to be thinking about when it comes to this busy flu season.
Anne Schuchat, M.D., director of the CDC's National Center for Immunization and Respiratory Diseases, said during a media briefing last month that the agency has seen an increase in serious pneumococcal infections across the country.
"We know that influenza infections can reduce the lining of the respiratory tract and really set somebody up for secondary pneumonia," Schuchat said. "Common bacterias can invade the lungs when there's a viral infection like influenza."
Denver, one of the CDC's active bacterial core surveillance sites, offers a prime example of those elevated numbers. The Mile High City has had a five-year average of 20 cases of invasive pneumococcal disease during the month of October, but in October 2009, Denver had 58 cases.
Schuchat said it is likely other U.S. cities that have less intense surveillance are experiencing similar increases.
In a typical year, the majority of invasive pneumococcal disease is seen in the elderly, but two-thirds of the Denver cases occurred in adults ages 20-59 years. The majority of patients had underlying health conditions, Schuchat said.
Schuchat said vaccination is the best way to protect against serious pneumococcal infections, but only one-fourth of high-risk adults younger than 65 have received the pneumococcal polysaccharide vaccine, or PPSV.
About 70 million Americans fall into at least one of several groups recommended to receive the vaccine. Those groups are:
"We know that influenza infections can reduce the lining of the respiratory tract and really set somebody up for secondary pneumonia," Schuchat said. "Common bacterias can invade the lungs when there's a viral infection like influenza."
Denver, one of the CDC's active bacterial core surveillance sites, offers a prime example of those elevated numbers. The Mile High City has had a five-year average of 20 cases of invasive pneumococcal disease during the month of October, but in October 2009, Denver had 58 cases.
Schuchat said it is likely other U.S. cities that have less intense surveillance are experiencing similar increases.
In a typical year, the majority of invasive pneumococcal disease is seen in the elderly, but two-thirds of the Denver cases occurred in adults ages 20-59 years. The majority of patients had underlying health conditions, Schuchat said.
Schuchat said vaccination is the best way to protect against serious pneumococcal infections, but only one-fourth of high-risk adults younger than 65 have received the pneumococcal polysaccharide vaccine, or PPSV.
About 70 million Americans fall into at least one of several groups recommended to receive the vaccine. Those groups are:
- adults ages 65 and older;
- people 2 years and older who have a chronic illness, such as
- cardiovascular disease or diabetes;
- people 2 years and older with a weakened immune system due to illnesses such as HIV infection or leukemia;
- those receiving immunosuppressive therapy;
- those who have had a splenectomy or whose spleen is dysfunctional;
- residents of long-term care facilities; and
- adults ages 19-64 who smoke cigarettes or have asthma.
AAFP Joins HHS, Other Groups to Emphasize Benefits of H1N1 Vaccination
The AAFP is one of more than 30 professional medical organizations that have signed on to a letter from HHS urging Americans to be vaccinated against the novel influenza A (H1N1) virus.
The letter, which was posted to the HHS Web site on Dec. 22, stresses the fact that the H1N1 vaccine is manufactured using the same processes used to produce seasonal flu vaccine and has been tested and monitored for safety.
The letter also highlights the need for people in high-risk groups, including pregnant women, young children and people with chronic medical conditions, to be vaccinated.
The letter also points out that although flu activity has waned in recent weeks, another wave is possible.
"If enough Americans get vaccinated, we could lessen the impact of, or perhaps even prevent, a third wave of H1N1 flu," says the letter. "Fighting the flu is a shared responsibility. We ask you to join us in the fight to protect yourself and your community by getting the H1N1 vaccine."
Anne Schuchat, M.D., director of the CDC's National Center for Immunization and Respiratory Diseases, said Dec. 22 that 111 million doses of H1N1 vaccine have been made available.
With vaccine supplies increasing, the CDC is encouraging physicians to offer vaccination to anyone who wants it as soon as the needs of their patients in the initial prioritized populations have been met.
The letter, which was posted to the HHS Web site on Dec. 22, stresses the fact that the H1N1 vaccine is manufactured using the same processes used to produce seasonal flu vaccine and has been tested and monitored for safety.
The letter also highlights the need for people in high-risk groups, including pregnant women, young children and people with chronic medical conditions, to be vaccinated.
The letter also points out that although flu activity has waned in recent weeks, another wave is possible.
"If enough Americans get vaccinated, we could lessen the impact of, or perhaps even prevent, a third wave of H1N1 flu," says the letter. "Fighting the flu is a shared responsibility. We ask you to join us in the fight to protect yourself and your community by getting the H1N1 vaccine."
Anne Schuchat, M.D., director of the CDC's National Center for Immunization and Respiratory Diseases, said Dec. 22 that 111 million doses of H1N1 vaccine have been made available.
With vaccine supplies increasing, the CDC is encouraging physicians to offer vaccination to anyone who wants it as soon as the needs of their patients in the initial prioritized populations have been met.
In September, the CDC released a Morbidity and Mortality Weekly Report that reported on 77 H1N1 fatalities. Twenty-two of those patients suffered from bacterial coinfections, including 10 cases of pneumococcal infection.
According to Schuchat, bacterial infection has been reported in about one-third of pediatric fatalities related to H1N1. She said that if a flu patient -- child or adult -- appears to be recovering but then worsens suddenly, that is a warning sign of secondary infection.
Concerns about coinfection prompted the CDC to issue a letter to physicians in November, urging them to immunize patients with indications for PPSV, especially those with high-risk conditions.
Meanwhile, a recent AAFP member survey found that 83.9 percent of respondents were reviewing patient records during office visits to assess the need for H1N1, seasonal flu and pneumocccocal vaccines.
Also troubling is a report (9-page PDF; About PDFs) released earlier this month that found the H1N1 virus can damage cells throughout the respiratory system, much like the flu viruses that caused pandemics in 1918 and 1957.
Researchers from the NIH and the New York City Office of Chief Medical Examiner reviewed autopsy reports and records from 34 people who died of H1N1 infection. A microscopic examination of tissues revealed that the virus caused damage primarily to the upper airway, but tissue damage in the lower airway, including deep in the lungs, also was present.
The researchers examined 33 of the 34 cases for pulmonary bacterial infections, and 18 of the cases had such infections.
According to Schuchat, bacterial infection has been reported in about one-third of pediatric fatalities related to H1N1. She said that if a flu patient -- child or adult -- appears to be recovering but then worsens suddenly, that is a warning sign of secondary infection.
Concerns about coinfection prompted the CDC to issue a letter to physicians in November, urging them to immunize patients with indications for PPSV, especially those with high-risk conditions.
Meanwhile, a recent AAFP member survey found that 83.9 percent of respondents were reviewing patient records during office visits to assess the need for H1N1, seasonal flu and pneumocccocal vaccines.
Also troubling is a report (9-page PDF; About PDFs) released earlier this month that found the H1N1 virus can damage cells throughout the respiratory system, much like the flu viruses that caused pandemics in 1918 and 1957.
Researchers from the NIH and the New York City Office of Chief Medical Examiner reviewed autopsy reports and records from 34 people who died of H1N1 infection. A microscopic examination of tissues revealed that the virus caused damage primarily to the upper airway, but tissue damage in the lower airway, including deep in the lungs, also was present.
The researchers examined 33 of the 34 cases for pulmonary bacterial infections, and 18 of the cases had such infections.
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