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CDC Frets Over Further Dip in Kindergarten Vaccination Rates

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The percentage of kindergarteners in the United States who have received routine vaccines to protect against illnesses such as measles, whooping cough, and polio has declined for 2 straight years, a new study has found.

Drops in vaccine coverage leave communities more susceptible to outbreaks of vaccine-preventable diseases, such as those that occurred in 2022, public health officials said.

Coverage for four vaccines ― against measles, mumps, and rubella (MMR); diphtheria, tetanus, and acellular pertussis (DTaP); poliovirus (polio); and varicella (chickenpox) ― among kindergarten students was about 95% in 2019–2020.

The rate fell to 94% the following year.

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For the 2021–2022 school year, coverage dropped another point, to 93%, according to the report, published online January 12 in Morbidity and Mortality Weekly Report (MMWR).

The rate of vaccination overall remains high, but about 250,000 kindergarten students may not be protected against measles, the researchers estimate. Measles, which is highly infectious, can lead to serious illness and even death in children who have not been vaccinated against the virus.

“In 2022, two communities in the United States responded to outbreaks of measles where children have been hospitalized,” Georgina Peacock, MD, MPH, director of the immunization services division of the Centers for Disease Control and Prevention (CDC), said in a media briefing about the report. “One community reported a case of paralytic polio in an unvaccinated person. These outbreaks were preventable. The best way to prevent these diseases and their devastating impact on children is through vaccination.”

Exemptions Steady

For the new study, Ranee Seither, MPH, with the CDC’s National Center for Immunization and Respiratory Diseases, and her colleagues analyzed data reported by states to estimate nationwide coverage for the four routine vaccines.

The number of students with exemptions remained low, at 2.6%, but another 3.9% who were without exemptions were not up to date with the MMR vaccine, the investigators report.

In a separate study, researchers found that vaccination coverage for 2-year-olds has increased. Approximately 70% of children were up to date with a seven-vaccine series by age 24 months. The coverage rate was higher for children born during 2018–2019 than for those born during 2016–2017.

Although the COVID-19 pandemic was not associated with decreased vaccination rates in this younger age group overall, coverage fell by 4 to 5 percentage points for children living below the poverty level or in rural areas, according to the study.

In addition, uninsured children were eight times more likely than those with private insurance to not be vaccinated by their second birthday, the researchers found.

Strategies to increase vaccination coverage include enforcing school vaccination requirements and holding vaccination clinics at schools, the CDC said.

“Providers should review children’s histories and recommend needed vaccinations during every clinical encounter and address parental hesitancy to help reduce disparities and ensure that all children are protected from vaccine-preventable diseases,” the agency said.

To that end, the agency launched an initiative this week called Let’s RISE (Routine Immunizations on Schedule for Everyone) to provide clinicians with resources to help patients get on track with their immunizations.

Hundreds of Thousands Unprotected

MMR vaccination coverage for kindergartners is the lowest it has been in over a decade, Peacock noted. Decreased coverage for kindergarten students might be tied to pandemic-related disruptions in healthcare systems and schools, she said. School administrators and parents may have been less focused on routine vaccination paperwork amid the return to in-person learning, for instance.

Hesitancy about COVID vaccines could be affecting routine vaccinations. “That’s something that we are watching very closely,” Peacock said.

The two-point decrease in vaccination coverage “translates to hundreds of thousands of children starting school without being fully protected” against preventable diseases that can spread easily in classrooms, Sean O’Leary, MD, chair of the American Academy of Pediatrics’ Committee on Infectious Diseases, said.

Despite the drop in coverage, O’Leary said he saw some encouraging signs in the data: Nonmedical exemptions for kindergarten students have not increased. And the vast majority of parents are still having their children vaccinated. At the same time, the reports highlight a need to address child poverty and improve vaccine access in rural areas, he said.

 

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Good Dental Health Essential in Sickle Cell Anemia, Study Finds |… – Sickle Cell Anemia News

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Good oral health is essential in people with sickle cell anemia (SCA), according to a new study from Saudi Arabia that found that several disease-causing bacteria species — including Enterobacteriaceae — were significantly more abundant in a group of patients with poorer dental health than in those with better oral care.

“A healthy mouth has a balance of bacteria, but inadequate oral health narrows the range of bacteria, resulting in oral dysbiosis, a state in which beneficial bacteria decrease and potentially pathogenic [disease-causing] bacteria increase,” the researchers wrote.

The findings also indicated that patients with low levels of hemoglobin F — a type of hemoglobin normally produced during fetal development — had a significantly higher prevalence of harmful bacteria species than those who had higher levels of the protein.

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“Our data further emphasise the importance of routine oral hygiene visits for patients with SCA,” the team wrote, adding, “This is especially important for patients with SCA and low [hemoglobin F], who have a higher probability of hospitalisation and clinical complications compared to patients with SCA and high [hemoglobin F].”

The research’s findings were reported in “Oral microbiota analyses of Saudi sickle cell anemics with dental caries,” a study published in the International Dental Journal

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Examining good versus poor dental health in SCA

Sickle cell disease (SCD) is caused by mutations in the HBB gene that lead to the production of a faulty version of hemoglobin, the protein in red blood cells that is responsible for carrying oxygen through the body. This faulty version is called hemoglobin S.

People with sickle cell anemia or SCA, the most common and often the most severe form of SCD, have two faulty gene copies encoding hemoglobin S.

Complications of dental caries or tooth decay, including acute pain, are often observed in patients with SCA — and have been associated with poor quality of life.

In a healthy mouth, different bacteria species co-exist in a balanced ratio. However, in cases of inadequate oral health, the number of beneficial bacteria decreases, while that of potentially harmful ones increases. This can lead to dental caries, which often result in cavities and other oral health problems.

“Although ample evidence indicates a causative correlation between the disruption of the oral [bacteria] and dental caries, the effect in SCA has not been investigated,” the researchers wrote.

Now, a team from the Netherlands and Saudi Arabia conducted a study to examine oral bacteria composition in people with SCA. Their aim was to compare bacteria species in patients with a high decayed, missing, and filled permanent teeth (DMTF) index — a measure of dental health — compared with others who had a low index.

In addition, they evaluated the effect of hemoglobin F levels on bacterial composition by comparing the profiles of patients with low and high levels of the protein. Fetal hemoglobin or hemoglobin F is considered a major modulator of disease severity in SCA.

This type of hemoglobin normally is found in fetuses and newborn babies, but is typically replaced by another hemoglobin variant after birth. However, hemoglobin F is more effective at transporting oxygen than its adult counterpart, and may, therefore, help to counteract the harmful effects of hemoglobin S on blood flow and oxygen transport.

In some individuals, the levels of hemoglobin F remain relatively high during childhood, and only start to decline later on in life, rather than immediately after birth.

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hygiene, self-care

High levels of Enterobacteriaceae bacteria found

This new study was conducted in the Eastern Province of Saudi Arabia, where the disease is highly prevalent. It included 100 patients, ages 5–12, from whom saliva was collected.

Among the patients, 27 had high dental caries — reflected by a high DMTF index of five points or more — and 73 had low dental caries, indicated by a low DMTF index of four points or fewer.

The research team identified 416 bacteria species in the patients’ samples. When analyzing their prevalence, seven were found to be significantly more abundant in patients with a high DMTF index than in those with a low index.

In addition, eight bacteria species were found to be significantly more prevalent in patients with low hemoglobin F levels compared with those with high levels of the protein.

In particular, the Enterobacteriaceae bacteria species, which have been associated with severe infections and high rates of antibiotic resistance, were found in great abundance in both patient groups, being the most significantly abundant bacteria species among those with low levels of hemoglobin F. 

“It has been suggested that the presence of the Enterobacteriaceae species in the oral cavity is favoured when an individual’s immunity is compromised,” the researchers wrote, adding that “patients with SCA are immunocompromised.”

Overall, these findings indicate that Saudi SCA patients with poorer dental health and low levels of hemoglobin F have a higher predominance of harmful bacteria in their mouth.

Our data further emphasise the importance of routine oral hygiene visits for patients with SCA.

“Our results provide a valuable addition to the global microbiome reference data set in an underexamined community,” the researchers wrote, adding, “These efforts are essential and warranted given the scarcity of [bacteria composition] data in Middle Eastern populations.”

Nevertheless, a study with a large sample size evaluating how oral bacterial species can relate to dental caries in SCA patients is required, the team noted.

The researchers said their findings indicate the important of good dental health in people with sickle cell anemia, given that the bacteria species otherwise found “are thought to drive the development and progression of dental caries.”

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Good Oral Health Crucial in People with Sickle Cell Anemia, Study Finds – Oral Health

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A new study from Saudi Arabia found that good dental health is vital for people with sickle cell anemia (SCA). The findings observed that multiple disease-causing bacteria were seen much more in the patients with poorer oral health than those with better oral health.

Patricia Valerio, PhD, noted, “The findings also indicated that patients with low levels of hemoglobin F – a type of hemoglobin normally produced during fetal development – had a significantly higher prevalence of harmful bacteria species than those who had higher levels of the protein.”

This research shows how important good oral hygiene is for patients with SCA and low hemoglobin F.

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Read more about this study from Sickle Cell Disease News.


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Respiratory viruses on decline: Province – Brandon Sun – The Brandon Sun

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Hospitalizations due to influenza, COVID-19 and respiratory syncytial virus (RSV) have all decreased in Manitoba, according to the province’s latest epidemiological respiratory virus surveillance report.

Data for the week of Jan. 15 to Jan. 21 indicates this respiratory virus season may finally be nearing its end, after it began earlier than usual and caused surges of severe illness and hospitalizations, particularly among babies and toddlers.

There were two flu-related hospital admissions that week, none requiring intensive care, while the Influenza A test positivity rate fell to 0.8 per cent, compared with 1.9 per cent the previous week. No cases of Influenza B have been detected provincially yet this season.

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There were 105 detected cases of RSV, with a weekly RSV test positivity rate of 8.3 per cent. The previous week, the test positivity rate for RSV was 8.7 per cent.

There were seven patients with COVID-19 in hospital, as well as three in intensive care. No new COVID deaths were reported, but the province retroactively updated its COVID-19 death toll. There were 15 deaths added to the total count last week, for an overall number of 316 Manitobans who lost their lives to COVID since this fall.

» Winnipeg Free Press

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