By Helen K. Kelley
While some diseases are becoming rare due to vaccinations, it’s important to acknowledge that they haven’t been completely eradicated. The viruses and bacteria that cause measles, mumps, chicken pox, flu, HPV and other illnesses still exist – and can easily be spread by people who have not been immunized.
We recently spoke with two Atlanta-area physicians who discussed the importance of immunizations for children and adults, improvements in vaccines and the challenges physicians face in ensuring that their patients know and understand the significance of receiving appropriate immunizations.
Advocacy for Pediatric Immunizations
Sam Gold, M.D., chair for pediatrics for WellStar Medical Group, began his career when new vaccines were just coming on the market for many common childhood diseases.
“I remember taking care of children who were in the intensive care unit for pneumococcal meningitis. We saw that scenario often, along with chicken pox and other diseases,” he says. “Seeing the big changes that were brought about by vaccines was exciting to me, and I became an advocate for children’s immunizations.”
Citing a resistance toward immunizations by many parents in the last 15-20 years, Gold says that he and his colleagues on WellStar’s pediatrics leadership team saw the need for improved communication, education and advocacy. This led to the creation of policies that standardize how WellStar pediatricians address the subject of immunizations with parents and deliver them to patients.
“In the past, each office determined how it handled the issue. Some offices allowed for parents who didn’t want to immunize their children, but that created problems with scheduling,” Gold says. “Choosing not to immunize creates risks not only for those kids, but also for others, especially infants who haven’t yet been vaccinated and children with nonfunctioning immune systems. Additionally, some parents would say they wanted to exclude only one particular vaccine.
“But our physicians have found that all childhood vaccines are important,” he adds. “Therefore, we require our patients to have all of the immunizations recommended by the Georgia Department of Health. Also, we have standardized, across the WellStar system, the manufacturers that supply our vaccines. This has helped reduce the potential for errors in efficacy of the vaccines.”
Gold adds that educating the public about immunizations is an important, albeit challenging, part of the advocacy puzzle.
“It is extremely difficult to get the true message out. With the rise of social media, there are many people who, even though they are not experts, can make claims to a large audience. It’s a pushback to science and hard to refute with expert proof,” he says. “We’re seeing a lack of understanding among parents because global health has improved so dramatically in the 20th century due to immunizations. Because they were immunized as children, parents today didn’t experiences measles and mumps and aren’t familiar with those diseases. It’s a double-edged sword. The vaccines have been so effective that they’ve made the reasons for having them seem so remote.”
Immunizations Important for Adults, Too
Sandra Fryhofer, M.D., agrees that education is the key to getting adult patients on board with the immunizations they need to stay healthy.
“Every year, thousands of adult Americans die of diseases that could have been prevented by vaccines. But some people are resistant to getting immunizations, often because they lack information,” she says. “That’s why a recommendation from a physician can go a long way toward helping patients understand why vaccination is important.”
Fryhofer, an internal medicine practitioner, says she includes a discussion of vaccines as a regular part of each patient’s annual physical exam.
“I might mention a particular vaccine and then let the patient read the vaccination statement about why they need it and what the possible risks are, so they can make an informed decision,” she says.
In addition to discussing standard vaccines such as flu, hepatitis B, HPV and pneumococcal pneumonia, Fryhofer counsels patients who are planning international travel about the immunizations they’ll need.
“I routinely ask patients about their travel plans, because talking to a doctor about their trip probably isn’t on their radar,” she says. “Because we live in a developed country with clean water and food, most people haven’t considered the medical dangers of traveling abroad where resources are not as reliable. They also haven’t considered the possibility of bringing some diseases, like measles, back into the U.S., where they can be transmitted to other people.”
Fryhofer encourages those who are planning to travel out of the country to make sure they are up-to-date on basic immunizations like tetanus, Tdap and MMR and to be prepared if they are going to countries where they will need to be immunized against diseases like cholera and yellow fever.
“It’s important to know what you need well in advance. For example, right now there is actually a shortage of YF-VAX, the vaccine for yellow fever, due to a delay in the manufacturing process,” she says. “The good news is, the FDA is allowing the importation of Stamaril, a yellow fever vaccine made in Europe. It’s available only at a limited number of locations, though, so people will have to consult the travel page on the CDC’s website to find those clinics. The best advice physicians can give their patients who are planning to travel abroad is to be informed and not wait until the last minute to get what they need.”
Fryhofer adds that doctors can help their patients and their peers by entering vaccine information into the Georgia Registry of Immunization Transactions and Services (GRITS) database.
“Keeping track of immunization information can be a challenge. When a physician administers a vaccine and enters the information into GRITS, other physicians and public health officials can access it,” she says. “It’s a helpful tool, ensuring that patients are up to date on the immunizations they need to stay healthy.”
New Microneedle Patch for Flu Vaccination
A National Institutes of Health-funded study led by a team from the Georgia Institute of Technology and Emory University has shown that an influenza vaccine can produce robust immune responses and be administered safely with an experimental patch of dissolving microneedles. The method is an alternative to needle-and-syringe immunization; with further development, it could eliminate the discomfort of an injection as well as the inconvenience and expense of visiting a flu clinic.
“This bandage-strip sized patch of painless and dissolvable needles can transform how we get vaccinated,” says Roderic I. Pettigrew, Ph.D., M.D., director of the National Institute of Biomedical Imaging and Bioengineering (NIBIB), which funded the study. “A particularly attractive feature is that this vaccination patch could be delivered in the mail and self-administered. In addition, this technology holds promise for delivering other vaccines in the future.”
The vaccine patch consists of 100 solid, water-soluble needles that are just long enough to penetrate the skin. Adhesive helps the patch grip the skin during the administration of the vaccine, which is encapsulated in the needles and is released as the needle tips dissolve, within minutes. The patch is peeled away and discarded like a used bandage strip.
The researchers enrolled 100 adult participants, dividing them into four random groups: vaccination with microneedle patch given by a healthcare provider; vaccination with microneedle patch self-administered by the study participant; vaccination with intramuscular injection given by a healthcare provider; and placebo microneedle patch given by a healthcare provider. The researchers used an inactivated influenza vaccine formulated for the 2014-15 flu season to inoculate participants other than those in the placebo group.
The researchers found that vaccination with the microneedle patches was safe, with no serious related adverse events reported. Some participants developed local skin reactions to the patches, described as faint redness and mild itching that lasted two to three days.
The results also showed that antibody responses generated by the vaccine, as measured through analysis of blood samples, were similar in the groups vaccinated using patches and those receiving intramuscular injection, and these immune responses were still present after six months. More than 70 percent of patch recipients reported they would prefer patch vaccination over injection or intranasal vaccination for future vaccinations.
The prospective vaccine technology could offer economic and manufacturing advantages. The manufacturing cost for the patch is expected to be competitive with prefilled syringe costs. The patch, however, can dramatically reduce the cost of vaccination, since self-administration can eliminate the need to have health workers oversee the process. It can be easily packaged for transportation, requires no refrigeration and is stable.
The team plans to conduct further clinical trials to pursue the technology’s ultimate availability to patients. They also are working to develop microneedle patches for use with other vaccines, including measles, rubella and polio.