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Opening Remarks - Adult Immunisation: Some Thoughts
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13th International Congress on Infectious Diseases Abstracts (Invited Papers)
deprivation, school and work disruptions, rib fractures, and pneumonia. Adolescents and adults not only experience substantial morbidity and complications from pertussis, they play an important role in transmission of Bordetella pertussis to children. Multiple studies have documented that parents and other family members are the main source of pertussis infection in infants. Of particular concern are very young infants, who are at greatest risk for hospitalization and mortality from pertussis, and who are either incompletely vaccinated or unvaccinated. To address these concerns, adolescent/adult-formulation tetanus-diphtheria-acellular pertussis (Tdap) vaccines, sometimes combined with injectable polio vaccine, have been developed. These Tdap vaccines have been shown in clinical trials to be safe and at least as immunogenic against pertussis as their analogous pediatric vaccines. In Canada and the US, Tdap vaccination is recommended for all adolescents and adults < 64 years of age. Emphasis is placed on vaccinating young adolescents and on vaccinating adults (eg, new parents, child-care workers, and certain healthcare-personnel) who have close contact with infants. Canadian experience suggests that Tdap vaccine usage has contributed to further decreases in pertussis. Full control of this disease, however, may require decennial boosting with Tdap vaccine, which is currently under study. doi:10.1016/j.ijid.2008.05.065 New Perspectives on Vaccine-preventable Diseases in Adults: Pneumococcal Disease and Herpes Zoster (invited) 11.001 Opening Remarks - Adult Immunisation: Some Thoughts J. Hanna Communicable Disease Control, Tropical Population Health Unit Network, Queensland Health, Cairns, Australia Adult immunisation can be categorised in several ways:immunisation for travel - immunisation for certain occupations (eg. health-care and child-care workers)- immunisation for those with certain medical conditions (eg. asplenia), immunisation for the elderly. Immunisation for the elderly, in particular, is gaining greater recognition and greater credibility. Ageing populations, the increasing prevalence of certain medical conditions in the aged, and a desire to keep the aged in optimal health, all have contributed to this recognition of the need for vaccines for, and for the delivery of these vaccines to, the aged. However, this greater recognition of the need has not yet been matched by greater uptake of vaccines by the elderly, even in affluent industrialised countries. For example, uptake of the annual influenza vaccine in those aged ≥65 years in the United States increased from 33% to 66% in the 1990s, but has not increased since. Other countries do not even have mechanisms in place to determine the coverage of vaccines in the elderly; in Australia, for example, although influenza and pneumococcal polysaccharide vaccines are provided free to those aged ≥65 years, there is not yet a mechanism to determine uptake of these vaccines.
Perhaps the main reasons for this disconnection between intent and outcome are that ‘‘adult immunisation is not yet an essential element within the culture of adult medicine nor is it a health care priority in the minds of the public’’. This suggests that increasing demand for adult immunisation by improving professional and public awareness should be given greater priority; indeed this need for greater awareness has been given priority in a recent policy statement on adult immunisation from the Infectious Diseases Society of America. doi:10.1016/j.ijid.2008.05.066 11.003 A Vaccine for the Prevention of Herpes Zoster and Its Complications M. Levin University of Colorado School of Medicine, Denver, CO, USA Varicella (chickenpox) is associated with a viremia that results in a life-long association of the varicella-zoster virus (VZV) with neurons in sensory ganglia. VZV remains in a clinically inapparent (latent) form in these neurons because of the presence of VZV-specific immune responses that appear at the time of the childhood varicella infection. However, when these responses decline, as occurs with immune suppression, the latent VZV reactivates and causes herpes zoster (HZ). These same protective responses also decline naturally as part of the aging process. This explains why HZ occurs in approximately one-quarter of all people in their lifetime; 20% of cases occur in those who are 50—59 years old and 60% occur in older people (incidence is 1/100 persons per year for those ≥60 years). Not only does the incidence of HZ increase with aging, but the duration and severity of this painful disease increases with aging, as does its main complication - prolonged pain (post-herpetic neuralgia; PHN). Since HZ is the consequence of declining VZV-specific immunity, it was suggested that boosting this immunity in older people would prevent HZ and/or lessen its severity. A double-blinded, placebo-controlled, trial of a live, attenuated, HZ vaccine has proven this hypothesis to be correct. The HZ vaccine reduced the frequency of HZ (by 50%) and it reduced the pain and suffering (including PHN) by ∼65%, and as a consequence, is recommended in the United States for routine use in people ≥60 years of age. The details of the clinical trial and potential issues raised by its use will be discussed. doi:10.1016/j.ijid.2008.05.067 11.004 Herpes Zoster and Post Herpetic Neuralgia (PHN) - The Taiwan Perspective C.C. Yang Department of Neurology, National Taiwan University, College of Medicine, Taipei, Taiwan The objective of this study is to estimate the incidence of HZ among the Taiwanese population, and investigate the disease burden of HZ by analyzing the utilization of health
13th International Congress on Infectious Diseases Abstracts (Invited Papers)
deprivation, school and work disruptions, rib fractures, and pneumonia. Adolescents and adults not only experience substantial morbidity and complications from pertussis, they play an important role in transmission of Bordetella pertussis to children. Multiple studies have documented that parents and other family members are the main source of pertussis infection in infants. Of particular concern are very young infants, who are at greatest risk for hospitalization and mortality from pertussis, and who are either incompletely vaccinated or unvaccinated. To address these concerns, adolescent/adult-formulation tetanus-diphtheria-acellular pertussis (Tdap) vaccines, sometimes combined with injectable polio vaccine, have been developed. These Tdap vaccines have been shown in clinical trials to be safe and at least as immunogenic against pertussis as their analogous pediatric vaccines. In Canada and the US, Tdap vaccination is recommended for all adolescents and adults < 64 years of age. Emphasis is placed on vaccinating young adolescents and on vaccinating adults (eg, new parents, child-care workers, and certain healthcare-personnel) who have close contact with infants. Canadian experience suggests that Tdap vaccine usage has contributed to further decreases in pertussis. Full control of this disease, however, may require decennial boosting with Tdap vaccine, which is currently under study. doi:10.1016/j.ijid.2008.05.065 New Perspectives on Vaccine-preventable Diseases in Adults: Pneumococcal Disease and Herpes Zoster (invited) 11.001 Opening Remarks - Adult Immunisation: Some Thoughts J. Hanna Communicable Disease Control, Tropical Population Health Unit Network, Queensland Health, Cairns, Australia Adult immunisation can be categorised in several ways:immunisation for travel - immunisation for certain occupations (eg. health-care and child-care workers)- immunisation for those with certain medical conditions (eg. asplenia), immunisation for the elderly. Immunisation for the elderly, in particular, is gaining greater recognition and greater credibility. Ageing populations, the increasing prevalence of certain medical conditions in the aged, and a desire to keep the aged in optimal health, all have contributed to this recognition of the need for vaccines for, and for the delivery of these vaccines to, the aged. However, this greater recognition of the need has not yet been matched by greater uptake of vaccines by the elderly, even in affluent industrialised countries. For example, uptake of the annual influenza vaccine in those aged ≥65 years in the United States increased from 33% to 66% in the 1990s, but has not increased since. Other countries do not even have mechanisms in place to determine the coverage of vaccines in the elderly; in Australia, for example, although influenza and pneumococcal polysaccharide vaccines are provided free to those aged ≥65 years, there is not yet a mechanism to determine uptake of these vaccines.
Perhaps the main reasons for this disconnection between intent and outcome are that ‘‘adult immunisation is not yet an essential element within the culture of adult medicine nor is it a health care priority in the minds of the public’’. This suggests that increasing demand for adult immunisation by improving professional and public awareness should be given greater priority; indeed this need for greater awareness has been given priority in a recent policy statement on adult immunisation from the Infectious Diseases Society of America. doi:10.1016/j.ijid.2008.05.066 11.003 A Vaccine for the Prevention of Herpes Zoster and Its Complications M. Levin University of Colorado School of Medicine, Denver, CO, USA Varicella (chickenpox) is associated with a viremia that results in a life-long association of the varicella-zoster virus (VZV) with neurons in sensory ganglia. VZV remains in a clinically inapparent (latent) form in these neurons because of the presence of VZV-specific immune responses that appear at the time of the childhood varicella infection. However, when these responses decline, as occurs with immune suppression, the latent VZV reactivates and causes herpes zoster (HZ). These same protective responses also decline naturally as part of the aging process. This explains why HZ occurs in approximately one-quarter of all people in their lifetime; 20% of cases occur in those who are 50—59 years old and 60% occur in older people (incidence is 1/100 persons per year for those ≥60 years). Not only does the incidence of HZ increase with aging, but the duration and severity of this painful disease increases with aging, as does its main complication - prolonged pain (post-herpetic neuralgia; PHN). Since HZ is the consequence of declining VZV-specific immunity, it was suggested that boosting this immunity in older people would prevent HZ and/or lessen its severity. A double-blinded, placebo-controlled, trial of a live, attenuated, HZ vaccine has proven this hypothesis to be correct. The HZ vaccine reduced the frequency of HZ (by 50%) and it reduced the pain and suffering (including PHN) by ∼65%, and as a consequence, is recommended in the United States for routine use in people ≥60 years of age. The details of the clinical trial and potential issues raised by its use will be discussed. doi:10.1016/j.ijid.2008.05.067 11.004 Herpes Zoster and Post Herpetic Neuralgia (PHN) - The Taiwan Perspective C.C. Yang Department of Neurology, National Taiwan University, College of Medicine, Taipei, Taiwan The objective of this study is to estimate the incidence of HZ among the Taiwanese population, and investigate the disease burden of HZ by analyzing the utilization of health