There are too many cooks in the health care kitchen This article is also from Dr. Kevin's blog. This is something which I have previously mentioned in a slightly different context.
I object to all the extraneous people costing patient money. There is no end to people populating medical entities all doing minor variations of the same job. Do we need to pay all those people a lavish salary? My contention is NO.
Do we need 40 or so different people roaming around and questioning us like a team of homicide investigators? I don't think so.
Do we need a different diagnosis from myriad people? Is it a game of 20 questions and we get to pick which diagnosis we wish to have? Of course not, the patient's job is to endure it all and then pay up. It's scandalous.
I got around it by having a patient advocate. One more person involved in my care, right? lol. The difference is that the patient advocate was MY employee. Her job was to make sure that the HOSPITAL workers remembered their place. Her job was to make sure that I was treated like a human being, not a slab of meat, there to be used for profit.
Whooping Cough Epidemic Hit Vaccinated Kids Hard
Researchers found Tdap vaccine effectiveness fell off after 2 to 4 years.
The 2012 pertussis epidemic in Washington state affected a surprising number of adolescents who were vaccinated on schedule, researchers reported.
Compared with over 1,200 controls, 450 adolescent cases of pertussis showed similar rates of having received five rounds of their vaccinations on the recommended schedule, but the vaccine's effectiveness rate dropped dramatically over time from 73% within 1 year to as low as 34% after 2 to 4 years from the last dose, Anna M. Acosta, MD, of the CDC, and colleagues, reported in Pediatrics.
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The pertussis vaccine and its schedule have been through several changes in the past 2 decades. Through 1997, children received five doses of a whole-cell vaccination. After 1997, those five doses were switched to an acellular pertussis vaccine. And in 2005, a sixth dose of the tetanus, diphtheria, acellular pertussis (Tdap) vaccine was recommended.
In 2012, Washington state experienced a pertussis epidemic with 2,520 cases reported by June of that year, a 1,300% increase over the previous year.
Acosta's team noticed an unexpectedly high rate of infection among older children and adolescents -- those potentially exposed to either a mix of whole-cell and acellular vaccines, or acellular vaccines only.
For this study, the researchers looked at Washington residents born from 1993 to 2000 in the seven Washington counties that reported more than 50 cases, and matched the adolescent pertussis cases with three controls based on vaccination records.
The participants were grouped by vaccination years, 1993-1997 for children who received five total vaccines in a mix of whole-cell or acellular form, or 1998-2000 for children who received five total vaccines in the acellular form only.
In order to be considered "complete and on schedule" for vaccination, the child had to have records indicating five total doses of diphtheria-tetanus toxoids-pertussis (DTP) or DTaP parsed as doses one-three before turning 1-year-old, dose four on or after the first birthday, and dose five on or after the fourth birthday, but before turning 7.
Within the seven counties, 959 cases of adolescent pertussis were reported. These cases represented 83% of all adolescent cases in the state, and 73% of all healthcare providers reporting cases of adolescent pertussis.
The primary analysis by Acosta's group included 450 cases and 1,246 age- and provider-matched controls with a median age of 14.
In the cohort, only 74% of cases and 75% of controls had proof of five vaccination doses, and only 60% of cases and 58% of controls received the five doses on schedule.
Tdap was given to 81% of the cases, and 90% of the controls, and overall, 84% of the cohort had been vaccinated again at 11 to 12 years of age.
The researchers estimated that Tdap demonstrated vaccine effectiveness at a rate of 63.9% (95% CI 49.7%-74.1%).
When stratified by time since Tdap vaccination, the effectiveness fell dramatically over time:
- Within 12 months, it was 73.1% (95% CI 60.3-81.8)
- At 12 to 23 months, the effectiveness rate dropped to 54.9% (95% CI 32.4-70.0)
- By 24 to 47 months, vaccine effectiveness was 34.2% (95% CI -0.03 to -58)
When Acosta's group performed subgroup analysis limited to confirmed cases of pertussis -- those with on-schedule only vaccinations -- or by excluding those with suspected cases, the results weren't much different from the findings in the primary analysis.
In the mixed group, 386 cases and 1,076 controls, the overall vaccine effectiveness was 51.5% (95% CI 26.1-68.1). But, the authors wrote, a direct comparison of the mixed group and the acellular only group wasn't possible due to differences in the age and time since vaccination between groups (P<0 .0001="" p="">
Although they could only confirm the vaccine brands, Boostrix by GlaxoSmithKline or Adacel by Sanofi, in 76% of study participants, the researchers found that Adacel was used more often in adolescents who caught pertussis (P=0.05), even though Adacel was used in only 17% of cases compared with 59% of cases vaccinated with Boostrix.
And regardless of vaccine group, Boostrix demonstrated slightly higher effectiveness when compared with Adacel. The estimated vaccine effectiveness for Boostrix was 60.1% (95% CI 47.7-69.6), and 48.8% (95% CI 28.8-63.2) for Adacel.
The study authors hazarded a few guesses as to why vaccine effectiveness fell short. One explanation could be suboptimal, post-vaccination, cell-mediated immunity with the acellular vaccine. Another could be that the vaccine prevented symptoms, but not infection and transmission. Also, there could have been genetic mutations in the pertussis strains that were not accounted for in the vaccine.
Study limitations include small sample size in comparison with the overall epidemic.
At first, we thought it was kind of funny. But as I learned more about what went on, it isn’t so ha-ha anymore. In fact, I’ve been drowning in alternating feelings of anger, embarrassment, and betrayal.
Mavis
/ 1 July, 2010