Tuesday, January 22, 2013

The Human Papillomavirus Vaccine (Gardasil)

This is an anti-cancer vaccine

It is a vaccine against a cancer-causing virus called the Human Papillomavirus (HPV).

This virus can cause cancers of the cervix, vagina and vulva, as well as anal, oral and throat cancers and genital warts in men and women. About 12,000 women develop cervical cancer each year in the U.S. and more than 10 women die of cervical cancer in this country every day (about 4000 per year).

The HPV vaccine can prevent about 70% of the cervical cancer in this country, as well as genital warts and the other types of cancer HPV causes, if given before there is any exposure to the virus. The virus is passed from men to women and women to men through sexual contact. About 50% of men and women are eventually exposed to this virus. 

The full benefit of the vaccine occurs only if given before exposure to the HPV. Therefore, the vaccine is recommended to be given at 11-12 years of age to both boys and girls. It can be given up to age 26 years of age but younger people are less likely to have already been exposed and have a better immune response to the vaccine.

The HPV vaccine has been used for the past 6 years around the world. It is very safe with few side effects.  The most frequent complaints from adolescents are that multiple shots are required over 6 months for full immunity and there is pain associated with the shot itself.  Pain occurs in about 80% of people but lasts for only a short time. Headache may occur in up to 33%. Redness or swelling at the site of the shot occurs in 25%. Mild fever (100 F) occurs in only 10% and fever of 102 F occurs in only 1.5%. 

PAP smears in women have greatly reduced the number of women who die of cervical cancer worldwide. These depend on detecting cancer cells early.  The HPV vaccine is an additional means to dramatically decrease the number of new cancer cases by preventing them in the first place.

Heritage Pediatrics, a member of PinnacleHealth Medical Group

Monday, January 14, 2013

New Year, New Flu!

Happy New Year! How many of you signed your holiday cards wishing everyone a happy, healthy new year for 2013? It's a pretty common sentiment. Maybe that came about because the new year comes in the midst of winter, the peak of sick season. This year is no different. We are deep into flu season for this year. It's a pretty rough one, too. The World Health Organization (WHO) has been predicting a doozy of a flu season for a while now.

We thought it was the Swine-Flu of 2009-2010 and that was bad. However, this year is also proving to be one of epidemic proportions. As I sit writing this, all but 3 states in the continental US are in epidemic peak flu season. Pennsylvania is no different. There was just a reported case of a death in York county in an older person. The very old and very young are especially susceptible not only to the flu, but to it's complications as well.

Remember back in October when we talked right here about how to avoid getting sick and how to protect yourself from the flu? Well, I strongly encouraged you all to get your flu shots and to wash your hands. That advice has not changed one iota. Frankly, if you heeded our call to get your flu shot back then, you are as protected as possible for this flu season. Yes, that's right. This year's flu shot was spot-on in predicting the strain of H3N2 influenza that is the predominant strain for this season. Simply stated, those of you who got the flu shot will be well protected against casual contact with the flu. If you are exposed to large amounts of flu virus, you may still get sick.

Yes, you may get the flu despite having had the flu shot. That is not a surprise to any of us. The difference is, when you've been immunized, your body has been warned and made aware that a particular virus is there to attack it. When it sees it, it responds more quickly, allowing your body to get ahead of the infection. I make an analogy: think of "wanted" posters for criminals. Seeing the poster won't keep the person in question from harming you, it just makes you more aware so when you encounter that person, you'll know to make haste to get out of their way. It's the same for anything we vaccinate against.  The body is introduced to the "bug" (either a virus or a bacteria) and knows it means harm, so when it sees it again, it knows right away to attack it. In many people, that is enough to keep from getting sick at all. In others, they get sick, just not as badly as they would have without the shot. We're seeing proof of this now. EVERY severe case of flu we've come across has something in common with the one before it; the person was not immunized. The mild cases are being noticed in those who have been vaccinated.

Is it too late to vaccinate? Well, no. It's not. Remember, the goal is to introduce your immune cells to the virus. If you've not had the flu, your body doesn't know what it doesn't know. So getting the shot can still help you. Is it ideal? No, it's not that either. It takes about 2 weeks to get full protection from the flu shot.  But knowing the shot is an accurate representation of the current strain, it's worth doing, even now.

Are there even any shots still around? Yes, there are. Do we have enough for everyone? Yes, we do. If I said no earlier to the flu shot, can I still get it? Yes, you may. As I tell my patients, it's not a one-time proposition. We want you protected and as healthy as possible. We welcome those who have changed their minds.

What else can you do? Well, an ounce of prevention is worth a pound of cure. So keep yourself from being in contact with someone who is suspected of having the flu. Wash your hands and take good care of yourself. A body that is stressed out cannot defend itself from outsiders; it's busy defending itself from, well, itself! Vitamin C and Zinc have been known to be immunity boosters, so taking extra amounts of that now may help.

If you think you have the flu, STAY HOME! Call your PinnacleHealth Medical Group medical home and ask what you should do. We'll ask you lots of questions to see where you are in the stages of the flu and if you have it at all. If it's the right timing and your other health conditions are such that you are at high risk, your provider may recommend a medication to fight the virus, shortening your illness by a day or so. Yes, I said if you have it at all. It is cold AND flu season, after all…not just flu. There is a fun virus going around too, the Norovirus, that is rather aggressive and makes you very ill but it is NOT the flu. The primary symptoms beyond fever with that one are "stomach bug" related. Dr. John Goldman, our own infectious disease specialist here at PinnacleHealth, was recently interviewed on ABC27 news talking about both of these, reminding us there is more out there now than just the flu (as if that wasn't enough on it's own!).

So, you have the flu--now what? STAY HOME!! You are contagious as long as you have a fever. You should not be around others until you are fever-free for 24 hours (but that's OFF the fever reducer medicines like ibuprofen (Motrin/Advil) and acetaminophen (Tylenol)). Be sure you read cold and flu medicine labels well, as many of them contain those ingredients beyond the stuffy nose/cough symptom relievers.

A few reminders about children: NEVER give a child with a fever aspirin and there is NO SAFE and effective cold medication for preschoolers (so avoid the temptation to give them something to make them feel better other than ibuprofen or acetaminophen). Call their PinnacleHealth Medical Group provider to see what is right for them. Don't guess the dose, ask your pharmacists or providers.

Well, I was feeling better and the fever went away but it's back again and I feel like I'm getting a second hit.  Is that normal? NO! It's not. Remember me talking about flu complications? Well, they often come along after the flu itself is controlled. People who have had the flu are more prone to pneumonia, ear infections, and sinus infections to name a few. That's definitely a red-flag warning and you should call your PinnacleHealth Medical Group provider to let them know. They'll likely want to see you to figure out what is going on.

Good luck to you all. Getting through the maze of flu and colds and sick season is not easy. The most important thing to remember is that you have a resource of information in your primary care doctor. We're where you should feel comfortable to go when you just don't know what to do. That's why we're here. So, go wash your hands and get some rest. You never know what will greet you tomorrow.

Heritage Family Medicine
Member, PinnacleHealth Medical Group