By Dave Gardner
Regulatory changes and a big push on scientific education mark the world in which health care providers must function, especially regarding patient immunization.
Immunization clearly is big business and, according to The Atlantic, the vaccine business has become a $24 billion annual market. This comprises no more than 3 percent of the trillion-dollar worldwide pharmaceutical industry, but creates a renewable market as group after group of children must be vaccinated every year before starting school.
Joanna Kraynak-Appel, D.O., family physician with the Geisinger Bloomsburg Clinic, explained that she and her peers frequently must debunk myths and rumors about immunization created by the authors of pseudo-science. All available data indicates immunization has been tremendously successful at preventing diseases that can cause death or inflict life-long side effects.
To combat this pseudo-science, Dr. Kraynak-Appel and her peers must educate patients with genuine scientific data about immunization. She said vaccine additives and fillers are not harmful, and vaccines, such as that used against polio, have scored tremendous wins in the prevention of human suffering.
“People must not just Google a subject such as immunizations and then accept what they read,” said Dr. Kraynak-Appel. “They also need to be aware that California has had mumps and measles outbreaks, and mumps also surfaced in Bloomsburg. These diseases are still out there.”
Family physicians are now facing several changes in vaccine administration in teens and adults.
A standard vaccine, now recommended to be given at ages 11 to 12 and re-administered at age 16 to 17, can protect against bacterial meningitis. Other common vaccines such as measles, mumps and rubella (MMR), chicken pox and flu shots can help to prevent viral meningitis as these are the diseases’ common causes.
A big push is also on in the battle against the human papillomavirus (HPV) which has been strongly implicated in cervical cancer onset. According to Dr. Kraynak-Appel, the risk for HPV contraction increases with every sexual exposure, making the best defense vaccination before any sexual encounter occurs.
Recommendations now are for a two-shot series if they are begun before age 14. If the initial immunization against HPV occurs after age 14, a triple-shot series is recommended, and in both cases immunity is lifelong requiring no follow-up injections.
In the battle against the agony of shingles, which actually is an encore of the chicken pox virus, adult vaccination is desirable because shingles can have long-lasting effects through a nasty complication known as post-herpetic neuralgia that can inflict pain and exhaustion. This is true only for a person who once contracted chicken pox, but Dr. Kraynak-Appel advised that people who never seemed to deal with chicken pox could have had a subclinical case without overt symptoms, thereby making them ripe for shingles.
“Post-herpetic neuralgia from shingles can last a lifetime,” warned Dr. Kraynak-Appel. “Pregnant women should also never be exposed to shingles.”
Vaccines and cancer prevention are increasingly making the news, but according to Dr. Kraynak-Appel, no magic immunization bullet is on the scientific horizon. These vaccines actually pinpoint drivers for cancer and attack them, such as HPV and cervical cancer, but do not directly prevent the cancer itself.
“These still is no Lyme disease vaccination for humans,” said Dr. Kraynak-Appel. “There was one in the early 2000s but it was pulled off the market by the FDA. This is a hot topic that’s being studied, but there’s nothing available now.”
Allyson Favuzza, CRNP with The Wright Center for Graduate Medical Education, noted that the Pennsylvania Department of Health, with guidance from the Centers for Disease Control and Prevention, calls the “shots” for child immunization. A new state regulation allows a grace period of only five days for kids to receive required immunization after school starts, such as for kindergarten and inoculation against hepatitis B, diphtheria, tetanus and whopping cough (DTP), polio, measles, mumps and rubella (MMR) and chicken pox.
“In the past, students had eight months to be fully inoculated before being sent home, which created a loophole parents could use to drag out year after year,” said Favuzza. “Schools now have the power to almost immediately send noncompliant students home.”
Favuzza noted that, despite all of the scientific data about immunization, some parents still resist. Providers are also struggling, in many cases, to have the manpower to immunize large numbers of children, with immunization of many uninsured children vaccinated in clinics and paid for by vaccine manufacturers, Harrisburg’s Vaccines and Children Program and Medicaid.
HPV, according to Favuzza, is presenting a special immunization problem. Rates of immunization in Pennsylvania are still lagging behind other groups, especially among teens, even though states such as Rhode Island now require mandatory immunization leading to higher compliance rates.
“Some parents can be particularly resistant to vaccination, particularly with HPV, making education for the family the best alternative,” said Favuzza. “We ask if these parents have ever heard of HPV and the possible side effects of it, and we may have to debunk false science. The most educated parents can sometimes be the most resistant.”
In the world of adult immunization, insurance carriers also can refuse to allow certain providers or pharmacies to administer select vaccines. While this may upset those desiring a vaccine, Favuzza pointed out that there is logic behind the tactic, particularly with older patients.
“In some cases, insurance carriers may avoid double vaccination for adults by restriction of where the inoculation can be administered,” Favuzza said.