From the infectious diseases meeting: What’s with the vaccine-o-phobia?

PHILADELPHIA – For the folks who promote vaccination, these are trying times. Recently, CNN hosted a segment titled: “Virus or Vaccine: Which is Worse?”

It’s enough to set Paul Offit to ranting, which he did this week at a meeting of the Infectious Diseases Society of America. Offit, a physician who heads the infectious disease division at Children’s Hospital of Philadelphia, has devoted a career to fighting illness. In his job, vaccines are often the most reliable weapon available, and cost-effective to boot. And although it’s astonishingly more dangerous to contract a disease than it is to get vaccinated for it, that message seems to have gotten lost somewhere along the way.

Offit traces this detour back to 1982, when DPT — the shot that prevents diphtheria, tetanus and pertussis – was (wrongly) linked to brain damage. “Three people believed their kids were harmed by the vaccine,” he says.

Offit has compassion for families who have a child who has suffered, whatever the cause may be, known or unknown. But since 1982, it’s been one accusation after another against vaccines. People tried to link the HIB vaccine to diabetes (no evidence), the hepatitis B vaccine to multiple sclerosis (all but one study found no link), and other vaccines to SIDS or autism. Recently, the HPV vaccine — which prevents cervical cancer – got linked to heart attacks and strokes (no proof).

And now the seasonal flu vaccine and H1N1 flu vaccine are being skipped by millions of people who somehow distrust the science that went into making them, even though the illnesses they cause can be fatal. Read more »

Male circumcision reduces risk of HIV transmission from women

In the study, published in the Feb. 15 issue of The Journal of Infectious Diseases, now available online, Jared Baeten and colleagues from the United States and Kenya collected detailed sexual data from a group of male Kenyan truckers and, using statistical models, developed infectivity measures that estimate the per-sexual-act probability of HIV transmission. The study is the first to calculate the probability of infection for men who have multiple, concurrent heterosexual partners, which was found to be significantly higher than infectivity rates calculated in the past from studies of monogamous couples. Their results may help explain the rapid spread of HIV in settings where circumcision is not common and multiple sexual partnerships are.

Between 1993 and 1997, 745 male employees of trucking companies based in Mombasa, Kenya were followed for the study. Initially they were evaluated for circumcision status and HIV-negativity. Over the length of the study the men were asked to give information concerning the number of sexual encounters with three different partner types–wives, casual partners, and prostitutes–and were screened for HIV and other sexually transmitted infections. At the end of the study the probability of infection was calculated using a statistical model that incorporated published data to estimate the rates of HIV infection among the three types of sexual partners.

For the men in the study, the overall probably of becoming HIV-infected following a single act of intercourse was calculated to be .0063, or one in 160. Uncircumcised men had a more than two-fold increased risk of infection per sexual act compared with circumcised men–one in 80 versus one in 200. Read more »

Tetanus

Background

The word tetanus comes from the Greek tetanos, which is derived from the term teinein, meaning to stretch. Tetanus appears in military medical documents throughout the ages. Slapping infected dung on the umbilical cords of newborns (ie, as part of ritualistic ceremonies) caused rampant tetanus neonatorum or trismus nascentium in the West Indies and in Africa. Osler’s textbook describes the “eight days sickness” caused by umbilical sepsis, which killed 84 of 125 children within a fortnight of birth in St. Kilda, Scotland. During World War I, tetanus occurred in 1.47 per 1000 British wounded and in 12.5 per 1000 persons involved in the Peninsular campaign. Nicolaier discovered the anaerobic bacillus Clostridium tetani in 1885. In 1889, Koch’s pupil, Kitasato, obtained the bacillus of tetanus in pure culture and associated the disease to animals.

Although rare, the disease has not been eradicated, and early diagnosis and intervention are life saving. Prevention is the ultimate management strategy for tetanus. The 4 clinical types of tetanus are generalized, local, cephalic, and neonatal.

Neonatal tetanus is a major cause of infant mortality in underdeveloped countries, but this form is rare in the United States. Infection results from cord contamination during unsanitary delivery conditions, coupled with a lack of maternal immunization. At the end of the first week of life, infected infants become irritable, feed poorly, and develop rigidity with spasms. This form of tetanus has a very poor prognosis for survival.

Cephalic tetanus is uncommon and usually occurs following head trauma or otitis media. Patients with this form present with cranial nerve palsies. The infection may be localized or may become generalized.

Patients with local tetanus present with persistent rigidity in the muscle group close to the injury site. The muscular rigidity is caused by a dysfunction in the interneurons that inhibit the alpha motor neurons of the affected muscles. No further CNS involvement occurs, and this form has very low mortality rates. Read more »

Typhus

Background

Typhus refers to a group of infectious diseases that are caused by rickettsial organisms and that result in an acute febrile illness. Arthropod vectors transmit the etiologic agents to humans. The principle diseases of this group are epidemic or louse-borne typhus and its recrudescent form known as Brill-Zinsser disease, murine typhus, and scrub typhus. (For more information on pediatric scrub typhus, see the eMedicine article Scrub Typhus in the Pediatric: General Medicine volume.)

Pathophysiology

Epidemic typhus is the prototypical infection of the typhus group of diseases, and the pathophysiology of this illness is representative of the entire category. The arthropod vector of epidemic typhus is the body louse (Pediculus corporis). This is the only vector of the typhus group in which humans are the usual host. Rickettsia prowazekii, which is the etiologic agent of typhus, lives in the alimentary tract of the louse. A Rickettsia- harboring louse bites a human to engage in a blood meal and causes a pruritic reaction on the host’s skin. The louse defecates as it eats; when the host scratches the site, the lice are crushed, and the Rickettsia- laden excrement is inoculated into the bite wound. The Rickettsia travel to the bloodstream and rickettsemia develops.

Rickettsia parasitize the endothelial cells of the small venous, arterial, and capillary vessels. The organisms proliferate and cause endothelial cellular enlargement with resultant multiorgan vasculitis. This process may cause thrombosis, and the deposition of leukocytes, macrophages, and platelets may result in small nodules. Thrombosis of supplying blood vessels may cause gangrene of the distal portions of the extremities, nose, ear lobes, and genitalia. This vasculitic process may also result in loss of intravascular colloid with subsequent hypovolemia and decreased tissue perfusion and, possibly, organ failure. Loss of electrolytes is common.

Some people with a history of typhus may develop a recrudescent type of typhus known as Brill-Zinsser disease. After a patient with typhus is treated with antibiotics and the disease appears to be cured, Rickettsia may linger in the body tissues. Months, years, or even decades after treatment, organisms may reemerge and cause a recurrence of typhus. How the Rickettsia organisms linger silently in a person and by what mechanism recrudescence is mediated are unknown. The presentation of Brill-Zinsser disease is less severe than epidemic typhus, and the associated mortality rate is much lower. Risk factors that may predispose to recrudescent typhus include improper or incomplete antibiotic therapy and malnutrition.

Murine typhus and scrub typhus share the same pathophysiology as epidemic typhus, although they are somewhat milder. The incubation period is approximately 12 days for the typhus group. Prior infection with Rickettsia typhi provides subsequent and long-lasting immunity to reinfection. Read more »

Medical Alert Companies Comparison – Medical Alert Monitoring Systems

When you compare medical alert companies, you are not comparing companies medical alert device companies but service provider companies. This makes comparison process little tricky. Let me use industry knowledge and experience to act as shopper and market researcher.

Think you are going out to stay at a hotel that you’ve never been to before. We will use this analogy to compare medical alert companies. The hotel may appear clean, have nice surrounding, and great amenities, but the wait staff may not be providing good service you are expecting you may have been better off asking a friend what their experience was like, read reviews by others online, or a review by a local travel critic. That’s where we come in.

Assume the hotel is type of the medical alert monitoring device that you will use. Does it have all of the physical features, functions, or the look and feel that you want?

What kinds of Medical Alert Companies are there?

• Full Service These medical alert companies provide the entire operation from sales, to equipment service, to central station monitoring, all themselves. They do not source-out the operations to any third parties.

• Reseller/Marketing Only These medical alert companies take care of the marketing only of the product and service. In today’s digital age, they typically have a website and place ads in magazines, on television, or through retail displays in their storefronts.

• Partial Service These medical alert companies typically take care of the sales and service, but hire out the central station monitoring to a third party. This is due to the very high costs of opening and maintaining a central monitoring station; especially if it is certified or listed by one or more agencies like Underwriters Laboratories (UL).

• The hostess is like the sales person you’ll be speaking with. Are they able to give you an accurate estimate of how long your wait time may be for a table? If they tell you they can accommodate your group size, or maybe a request for special accommodations for a handicapper or a child playing areas?

• The hotel staff is like the customer service representatives and central dispatch operators. These are the people that you or your loved one will spend the most of your time communicating with and get the most satisfaction from. Are they attentive, knowledgeable, friendly, and patient? Are they maintaining the highest standards available and required to have continual training to be sure they are?

Who are then actual Medical Alert Monitoring Companies?

That can sometimes be very difficult finding out who is really who. The full service companies can be easy as they will usually come right out and tell you! The partial service companies will usually tell you who will monitor your loved one typically after you come right out and ask. Very few are up front about it, but some are.

It is not easy to get correct information from some reseller companies. We try to uncover who these companies are, and let you know who is providing the monitoring services for them, so you can read about the actual medical alert company servicing your loved one.

Why You Should Care about Medical Alert Companies?

The full service medical alert companies have a much larger capital and human investment than the partial and marketing only companies. That gives them a vested interest in the quality and care provided to their customers from end-to-end.

The partial service companies have a much greater investment than the reseller/marketing only companies because they take care of the sales, customer service, equipment service, shipping, etc. themselves. They don’t handle the monitoring, but they do more than just market the service.

It is very important to find-out what type of medical alert company you are dealing with. The more services that are under one roof could mean higher customer satisfaction and better quality control.

If you can get a quality, full service, and highly rated company in the same price range as a marketing only or partial company, would you pick the full service company?