CDC Updates Vaccine Guidelines for Flu, HPV and more

“Vaccine updates to keep in mind.”

— Dr. Dale

Roll up your sleeves, America. A national advisory panel of the U.S. Centers for Disease Control and Prevention has released its 2017 advisory for recommended shots affecting adults.

This year's advisory revises guidance on seasonal flu shots by eliminating nasal flu vaccines and modifying flu-shot advice for people with egg allergy. It also tweaks recommendations for vaccines against human papillomavirus (HPV), hepatitis B and meningococcal disease.

Doctors use the annually updated vaccine schedule to ensure that patients receive the right vaccines for their age, medical condition and other risk factors. The entire list includes 13 vaccinations.

"All adults need immunizations to help them prevent getting and spreading serious disease that could result in poor health, missed work, medical bills, and not being able to care for family," said the report's lead author, Dr. David Kim. He is deputy associate director for adult immunizations in the CDC's Immunization Services Division.

The CDC sets the adult immunization schedule based on recommendations from the Advisory Committee on Immunization Practices (ACIP), a group of medical and public health experts whose advice reflects the latest science.

Here are the major changes:

•No more nasal flu vaccine. Unlike traditional flu shots made from dead virus, the nasal flu vaccine, marketed as FluMist, is made from a weakened form of influenza virus. Studies have found it largely ineffective.

•Flu vaccine for people with egg allergy. The "major change" is that egg-allergic people, whether they have mild or more serious allergy, "can receive any age-appropriate" flu vaccine, said Dr. Sandra Fryhofer, the American College of Physicians' liaison to the ACIP.

Last year, people with more serious egg allergy were advised to stick with an egg-free flu vaccine, she explained.

The new guidance states that even people who develop symptoms like swelling, lightheadedness or breathing difficulties may get either type of flu shot. But they should get the shot under supervision of a health care provider who is able to recognize and manage severe allergic conditions, the committee advises.

•HPV vaccine for adolescents. Young people who receive their first dose of the HPV vaccine before age 15 and the second dose at least 5 months later may be vaccinated in just two doses, instead the three as was previously recommended.

The vaccine protects against cervical cancer and a number of other tumors linked to the human papillomavirus (HPV).

The American Cancer Society said it was supporting the new ACIP recommendation of a two-dose schedule for boys and girls who begin the vaccine regimen at ages 9 to 14.

"In the past several years, studies have shown the vaccine is even more effective than expected," explained Debbie Saslow, senior director of HPV-Related and Women's Cancers at the American Cancer Society (ACS). "This new two-dose regimen is easier to follow, and we now know is very effective in preventing HPV, which is linked to a half dozen types of cancer."

Both the ACS and the CDC advisory committee still recommend three doses of the HPV vaccine for young adults who were not immunized as adolescents. The vaccine may be given to women through age 26 and men through age 21.

•New advice for people who are HIV positive. Adults with HIV should receive a two-dose series of MenACWY. This combination meningococcal vaccine protects against a potentially deadly bacterial infection of the brain and spinal cord.

•Hepatitis B for adults with chronic liver disease. The new vaccine schedule adds people infected with the hepatitis C virus to the list of those with chronic liver disease who could benefit from a Hep B vaccine series. Others who should receive these shots are people with: cirrhosis (scarring of the liver); fatty liver disease; alcoholic liver disease; autoimmune hepatitis; and people with elevated levels of certain liver enzymes.

"Non-alcoholic fatty liver disease is the most common liver disorder in western industrialized countries," Fryhofer said. "If you're obese, you're more likely to have fat in your liver, which means that you would be on the list to get hepatitis B vaccination."

•Adult vaccination rates and barriers. U.S. adult immunization rates fall short of recommended levels, according to the ACIP.

According to the CDC's Kim, "Flu vaccine is especially important for people with chronic health conditions, pregnant women and older adults."

Also of concern, only 20 percent of adults 19 and older have had a Tdap vaccine, which protects against tetanus, diphtheria and pertussis (whooping cough), the report noted.

Fryhofer said insurance affects the likelihood of vaccination. "People who have insurance are two to five times more likely to be vaccinated, because the cost issue's a big barrier," she explained.

February is National Cancer Prevention Month

“The guidelines for cancer prevention.”

— Dr. Dale

From February is National Cancer Prevention Month

If your New Year’s fervor to get healthy is already losing steam, February -- National Cancer Prevention Month – is a great time to give yourself a second chance. 

AICR’s three Guidelines for Cancer Prevention can help you focus on what’s most important. 

1. Choose mostly plant foods, limit red meat and avoid processed meat.
2. Be physically active every day in any way for 30 minutes or more.
3. Aim to be a healthy weight throughout life.

Notice anything about them? Like, for example, how closely the advice for cutting cancer risk resembles advice for preventing other chronic diseases like heart disease and diabetes – not to mention for getting in shape? 

It’s true: these simple steps offer many different health benefits, and National Cancer Prevention Month is as good a time as any to start putting them into action. 

Let’s look at them one at a time:

Choose mostly plant foods, limit red meat and avoid processed meat.

You already know that limiting high-calorie treats is a good idea. But did you know that if you make an effort to prepare meals focused around vegetables, fruits, whole grains and beans, you’ll help fortify your body against cancer? 

That’s what AICR’s groundbreaking expert report concluded. The report also found a convincing scientific link between red and processed meats and colon cancer, so it’s a good idea to limit red meat to 18 ounces of lean cuts per week and avoid processed meats like ham, hot dogs, sausage and bacon.

Be physically active every day in any way for 30 minutes or more.

Remember: Every day – in any way. That means you don’t need a gym membership – you just need to get your heart pumping. 

Being physically active for at total of least 30 minutes a day -- whether you’re walking, vacuuming, dancing or scuba diving – will lower your risk for colon cancer and possibly several other cancers as well. 

You might need to get more than 30 minutes a day in order to prevent weight gain – which is very important -- but you don’t have to do it all at once. Try breaking your activity into several 15- or 20- minutes sessions to fit your schedule. 

Aim to be a healthy weight throughout life.

And what about that goal so many of us seek right after the holidays, a healthy weight? 

It’s the third key element that will help protect against chronic disease. In fact, carrying excess weight has been linked to six different types of cancer. 

The good news is that once you start following the first two guidelines about diet and physical activity, you’ll find it easier to accomplish this one.

So this month especially, keep these three guidelines in mind and remember: It’s never too early and never too late to start making choices that improve your chances for good health (and good looks!) for 2009 and beyond.

How Meditation Helps You Handle Stress Better

“An interesting read about what the practice of mindfulness can do for you.”

— Dr. Dale

From How Meditation Helps You Handle Stress Better

Stress is a modern mental bogeyman, keeping nearly half of Americans up at night, according to a recent survey from the American Psychological Association. Many say they don't do anything to combat it, yet it takes a toll; stress is linked to a higher risk of heart attack and stroke.

Now, there’s fresh evidence in favor of mindfulness practices—not just sitting cross-legged in meditation—to help ease stress and anxiety. In a new study published in the journal Psychiatry Research, anxious people who took a mindfulness course where they learned several different strategies reacted to stress better and had a lower hormonal and inflammatory response than people who didn't practice mindfulness.

“There’s been some real skepticism in the medical community about meditationand mindfulness meditation,” says lead author Dr. Elizabeth Hoge, associate professor of psychiatry at Georgetown University Medical Center. She and her team wanted to find out whether people merely felt better after meditating, or if doing so caused real, measurable changes in the body’s markers of stress.

They rounded up healthy adults with generalized anxiety disorder, marked by constant worry about the future. Half of the people in the study went through a mindfulness meditation training course called MBSR, short for mindfulness-based stress reduction. Half completed a stress management education course, with lectures on the importance of diet, exercise, sleep and time management. Both courses lasted eight weeks with an identical amount of class time and homework.

In the MBSR course, people were taught the elements of meditation that have the most scientific evidence behind them for helping stress. They learn to pay attention to the present moment without judgment through exercises like breath awareness, body scan meditations and gentle yoga. Though the practices have roots in Buddhism, MBSR is non-religious; “you don’t have to believe in anything or chant in another language,” Hoge says. The classes met weekly for 2.5 hours.

The real point of the course isn't to help someone relax in a group environment, however; it’s to steel a person against the ravages of in-the-moment stress, and the researchers tested just that. Before the courses started and right after they concluded, the researchers put the participants through a task that reliably stokes stress a stress response: eight minutes of public speaking, followed by a round of videotaped mental math in front of an audience of people in white lab coats with clipboards.

“The holy grail is to show that patients can do better under stress,” Hoge says.

Not only did the people who learned to meditate report feeling less stressed than people in the other class, but their blood measurements of ACTH, a stress hormone released in the brain and then into the bloodstream, were lower too, as well as markers of inflammation called pro-inflammatory cytokines. But in the control group, people were actually more stressed the second time they did the test, possibly because they knew and anticipated how bad the it would be.

“We have objective measures in the blood that they did better in a provoked situation,” says Hoge. “It really is strong evidence that mindfulness meditation not only makes them feel better, but helps them be more resilient to stress.”

The study adds to growing evidence that MBSR—which is becoming more popular in hospitals and cities across the country—may be a treatment for people with anxiety who don’t want to take medication or go through psychotherapy, Hoge says. But insurance companies don’t typically cover the course, which can cost more than $500.