New rule says Ky. students need two-dose Hepatitis A vaccine before school starts; the first dose is needed now for compliance

By Melissa Patrick
Kentucky Health News

A new state regulation says Kentucky students must prove that they have had the two-dose hepatitis A vaccine by the first day of school, so it's time to get the first dose, because the shots are given six months apart. Most schools start in August.

The regulation also applies to children entering day-care centers, certified family child-care homes and pre-school programs, as well as public and private primary and secondary schools. It also requires home-schooled students who participate in any public or private school activities to be vaccinated.

Because the hepatitis A vaccine is recommended for infants at 12 and 18 months, many Kentucky students may have already received the two-dose vaccine. They would simply need to have their immunization records updated.

In addition to the hepatitis A vaccine, students 16 and older are required to get a meningitis booster, called the Meningococcal ACWY vaccine.

Parents can seek exemptions from immunizations only for religious and medical reasons in Kentucky. A health official at the hearing on this regulation last summer said that less than 2 percent of Kentucky's students have a religious exemption for vaccinations.

The same regulation that added the new vaccine requirements also provided for a new process to obtain a religious exemption form that allows parents to obtain the form online, check the immunizations they object to on religious grounds, and sign the form before a notary public.

Hepatitis A is a highly contagious liver disease caused by a virus. Symptoms can range from mild to severe, and include fever, fatigue, loss of appetite, nausea, vomiting, joint pain, stomach pain and diarrhea, or jaundice. In the most severe cases, liver failure and/or death can occur.

The virus spreads primarily when an uninfected person ingests the virus from objects, food or drinks contaminated by small, undetected amounts of stool from an infected person, according to the Centers for Disease Control and Prevention. There is no medicine to treat hepatitis A.

In late November, the state Department for Public Health declared an outbreak of acute hepatitis A in the state. Since January 2017, Kentucky has had 86 confirmed cases of the disease, with the largest number among the homeless and intravenous drug users. Thirteen cases have been reported this year. The average number of cases over the past 10 years has been 20, according to the health department.

Form for religious exemption from vaccination can now be obtained online, with no role for any health-care provider

By Melissa Patrick
Kentucky Health News

Kentucky parents who don't want their children vaccinated for religious reasons can now get the religious exemption form online, have it notarized and submit it to their school upon enrollment -- instead of having to obtain it from their health-care provider along with their signature.

Laura Begin (pronounced buh-GEEN), health coordinator for the Cabinet for Health and Family Services Office of Policy and Budget, told the legislature's interim joint health committee that the changes had been in the works for several years, in response to complaints that a medical entity should not have authority over a religious exemption; that a co-payment was often required to get a provider's signature; and that parents and guardians were having trouble finding providers to sign the forms.

"It's still not a perfect form. I feel like it still exceeds the law's requirement. The law simply requires a signed, sworn statement to exempt yourself religiously from vaccines -- that's it," said Erika Calihan of Lexington, who said she was a representative for a "whole lot of moms" who believed in religious liberty. "This is like a thousand times more, but it's better and it's improved and that is because of voices in the community speaking out and standing up for religious beliefs."

Begin said that fewer than 2 percent of Kentucky's children have a religious exemption for vaccinations. In 2016, of the 99,805 students enrolled in Kentucky's schools, there were 202 medical exemptions and 521 religious exemptions.

The new form also includes educational information about the symptoms and effects of the communicable diseases that are prevented by immunization.

In response to public comments on the proposal, the cabinet changed the wording on the form to say "according to the CDC and KDPH," when describing the symptoms and effects of each disease, instead of "I acknowledge that there are increased risks associated if exposed to this disease." Those are acronyms for the federal Centers for Disease Control and Prevention and the Kentucky Department of Public Health. 

After the meeting, Eric Clark, legislative director for the cabinet, said the health department  is "compelled under the law" to share this educational information.

"The decision whether or not to immunize a child is a medical decision, with a vested public-health interest at stake. If an individual can make that decision on a form available online, rather than through the consultation and discussion of a health-care provider, it is the role of the Kentucky Department of Public Health to share information with the public on the risk and symptoms associated with diseases," Clark said.

Dr. Patty Swiney, former president of the Kentucky Academy of Family Physicians, told the committee that the religious decision to not immunize a child should be an informed decision based on "good information and evidence" and not on "fears and misinformation."

Research has disproven any relationship between vaccines and autism, a common concern among those who choose not to vaccinate. The 1998 study that claimed there was a link between the measles, mumps and rubella vaccine and autism has been declared fraudulent and been retracted.

"The best way to treat disease is to prevent it and that is what immunizations do," Swiney said. She added that we no longer have smallpox or polio, and that cases of chicken pox, measles and mumps are rare because of immunizations. But she also said, "We do have epidemic of these preventable illnesses because of children and patients that are not vaccinated."

In 2016, there were 70 confirmed cases of measles across the U.S., and most of those who contracted the disease were not vaccinated, according to the CDC. As of June 17, that number is already up to 108, with 78 of the cases in Minnesota, mostly in children who were not vaccinated, according to the Minnesota Department of Health.

Swiney also spoke to the dangers of meningitis, noting that 10 to 15 percent of people who get meningitis will die and of those who do survive, 20 percent will have a permanent disability.

"Your individual right only goes so far as it affects the public rights to health, and that is why I'm here standing up for this immunization policy," she said.

People who aren't eligible for certain vaccines, like infants, pregnant women and immuno-compromised individuals, depend on others to be vaccinated for protection, a concept called "herd immunity."

Calihan told the committee that the amendment wasn't about immunizations, but instead about religious liberty. "If a parent decides that it is against their religious beliefs to vaccinate  their child under state law we have a right and that is all there is to it," she said. "So it doesn't really matter what physicians say at this point because you are going to find physicians on both sides of the issue."

Calihan said many vaccines have "aborted fetal tissue, among other things that I find objectionable morally." However, the Children's Hospital of Philadelphia says: "Fetal cells are used to make five vaccines: rubella, chickenpox, hepatitis A, shingles and rabies. Fetal cells used to grow the vaccine viruses were isolated from two elective abortions performed in Sweden and England in the early 1960s. Further abortions are not necessary as the cells isolated in the 1960s continue to be maintained in laboratory cultures."

The updated immunization regulation requires a meningitis booster before 11th grade and a hepatitis A vaccine; consolidates the immunization certificate and medical exemption form; and requires home-schooled children who participate in school-sponsored activities to attend in-school classes to provide proof of immunization or an exemption.

It also adds meningitis B to the list of recommended, but not required, immunizations. Meningitis B is responsible for nearly 50 percent of all cases of bacterial meningitis.

The cabinet removed a requirement in the proposal that would require health-care providers to use the Kentucky Immunization Registry by July 1, 2018 in response to comments received.

The Interim Joint Committee on Health and Welfare and Family Services approved the religious exemption form as part of the updated immunization regulation June 21. It will go into effect July 1, 2018 for the 2018-2019 school year. The religious exemption form can be downloaded on the Kentucky Department of Education website and the CHFS and DPH websites.

Lexington will host two health conferences in November: one on immunization, one on health-care associated infections

Lexington will host two health conferences in November, one focusing on immunizations and the other on health-care transparency and patient advocacy.

The 2016 Kentucky Immunization Conference, titled "Educate, Immunize, Protect: Kentucky's Immunization Trifecta," will be held Nov. 2-4 at the Embassy Suites in Lexington.

This conference will feature nationally known speakers who will discuss all areas of immunization from infants to adolescents to adults.

A keynote speaker for this event is Dr. Ari Brown, a pediatrician, childcare advocate and author of the bestselling "411" parenting books. Brown also serves as a medical advisor for Parents magazine and a spokeswoman for the American Academy of Pediatrics.

Another keynoter, Rayna DuBose, is a meningitis survivor who will share her story about overcoming adversity and talk about the importance of vaccination.

This conference is sponsored by the Kentucky Rural Health Association in collaboration with the Kentucky Immunization Program. The cost is $100 through Oct. 15, when it will increase to $150. Continuing education credits will be offered. Click here to register.

Health Watch USA Conference

The annual Health Watch USA Conference for Healthcare Transparency and Patient Advocacy will be held Nov. 4 at the Four Points Sheraton in Lexington. This year's conference is titled, "Full Disclosure and Healthcare Associated Infections."

This conference will focus on the impact and magnitude of adverse events in health care, the importance of creating cultures of safety, patient advocacy, medical device patient safety issues and healthcare associated infections.

Keynote speakers include Dr. Jim Bailey, a fellow in the American College of Physicians and professor of medicine and preventive medicine at the University of Tennessee Health Science Center in Memphis; Dr. Lars Aanning, a medical/surgical consultant; and Dr. Mark Davis, an operating-room safety consultant specializing in reducing injuries from sharps and exposure to blood.

The conference is paid for in part by a grant from the Foundation for a Healthy Kentucky. Click here or call 606-425-7278 to register. The cost to attend is $48. Continuing educations credits are offered.

Vaccinations aren't just for children; coalition encourages shots for college students

Photo from southtexasmed.com

By Danielle Ray
Kentucky Health News

"Getting your shots" is part of starting to school, but it's also supposed to be part of the drill at the University of Kentucky, the University of Louisville and Kentucky State University.

The Kentucky Immunization Coalition, a public-private partnership, has mounted an effort to make sure students at those and other schools get immunized.

U of L began requiring all incoming freshmen to be vaccinated for diseases including hepatitis B, tuberculosis and meningitis in 2014.

UK requires only the meningitis vaccine for incoming freshmen living in campus housing. However, university health officials strongly recommend all other routine childhood vaccines, including those that protect against illnesses such as measles, mumps, rubella, chicken pox, polio, diphtheria, tetanus, pertussis, hepatitis B, hepatitis A and human papillomavirus.

Students in health-profession colleges at UK who train and work in hospital settings must have additional vaccinations, including those that protect against hepatitis B, chicken pox and season flu.

Phillip Bressoud, executive director of campus health services at U of L, said the ultimate goal is effective outbreak management.

"Over several years, we'd had situations where we'd had either an outbreak of tuberculosis or chicken pox, and when that happens it's really difficult to assess who is vaccinated or unvaccinated, and who we need to notify," Bressoud told Lisa Gillespie, of WFPL in Louisville.

Bressoud says managing an outbreak includes telling unvaccinated students what to avoid in order to keep it contained.

Potentially toxic ingredients from formaldehyde to aluminum can produce adverse effects in vaccines, especially if a person is allergic to an ingredient used in the vaccine. Any vaccine can cause side effects. For the most part, though, side effects are minor, such as a sore arm or low-grade fever, and they typically go away within a few days, according to the federal Centers for Disease Control and Prevention.

Summer is a good time to make sure your teenagers or preteens get their four recommended vaccinations

Vaccines aren't just for babies. Preteens and teens also fall into an age group that has both required immunizations for school and recommended vaccines that can save their lives.

Summer is a great time to take care of getting caught up on these vaccinations, because many pre-teens and teens see their primary-care provider anyway for sport and camp physicals. Taking care of them in the summer also helps to miss the back-to-school rush that typically happens as August approaches.

Four vaccines are recommended for preteens and teens, according to the federal Centers for Disease Control and Prevention. The flu vaccine is recommended yearly for teens, but three less familiar vaccines and boosters are also recommended. Also, it is recommended that during a vaccination visit, you make sure your child is up to date on all of the vaccinations they should have received when they were younger.

Click here more details.

The CDC's Advisory Committee on Immunization Practices, the American Academy of Pediatrics, the American Academy of Family Physicians and other medical societies recommend these vaccines:

Meningococcal vaccine: This vaccine protects against some of the bacteria that causes meningitis and sepsis, which are very serious and sometimes fatal. It is recommended at 11 or 12 years old and a booster shot is recommended at age 16. Even if your child got the meningococcal vaccine at 12, 14 or 15, the booster is recommended. Older teens who haven't gotten this vaccine should get one as soon as possible.

HPV vaccine: This vaccine protects against the many cancers caused by the human papillomavirus, including cervical cancer in girls, and anal cancer and genital warts in both girls and boys. HPV vaccines are given in a three-dose series that should be started and finished when the boy or girl is 11 and 12. Pre-teens and teens who have not gotten this vaccine series should ask their primary care provider about getting them.

TDAP vaccine: This vaccine protects against three serious diseases: tetanus, diphtheria and pertussis, which is commonly called whooping cough. Preteens should get Tdap at 11 or 12. If your teenager didn't get a TDAP shot as a preteen, he or she should get it as soon as possible. This vaccine takes the place of what used to be called the tetanus booster.

Flu vaccine: Preteens and teens should get the flu vaccine every year as soon as it's available, usually in the fall. It is especially important for preteens and teens with chronic conditions like asthma or diabetes to get the flu shot.

"The vaccines for preteens are very safe," says the CDC. Side effects for these vaccines are usually mild and include redness and soreness at the site of the injection, or fainting from the medical procedure.

"Most side effects from vaccines are very minor, especially compared with the serious diseases that these vaccines prevent," says the CDC.

If you don't have insurance or if your plan does not cover vaccines, the Vaccines for Children Program provides vaccines for children ages 18 and younger, who are not insured or are under-insured. Vaccinations are covered on all plans purchased through the Patient Protection and Affordable Care Act.

Three or four more cases of fungal meningitis found in southern Pennyrile region -- two of those in Todd County

Kentucky now has five confirmed reports of fungal meningitis, and the Kentucky New Era reports that three or four have occurred in the southern Pennyrile region. The New Era's Nick Tabor writes that while no facilities in Kentucky have received the steroid responsible for the outbreak, the Centers for Disease Control confirms that the Saint Thomas Outpatient Neurosurgery Center in Nashville, Tenn., and two separate facilities in Crossville and Knoxville have distributed the steroid in injection form. All five Kentuckians who contracted the illness received medical care in Tennessee, the state reported.

The state’s Department for Public Health was notified this weekend of two cases in Todd County. One is Bill Johnson Sr., whose son ran against Rand Paul for U.S. Senate and Alison Lundergan Grimes for Kentucky Secretary of State. Carolyn Bland, director of the Trigg County Senior Center, was hospitalized Oct. 3 for meningitis, said her daughter, Beth Taylor. Eddie Lovelace, a longtime circuit judge from Clinton County, died of meningitis last month. He was being treated at St. Thomas when he died. 

As of Tuesday, health officials have reported 119 infections and 11 deaths across the nation, and six of those deaths were in Tennessee.

For the CDC’s complete list of the facilities that received the steroid, broken down by state, go here. 

Southern Kentucky circuit judge was probably the first to die in Tenn. from fungal meningitis outbreak stemming from tainted steroids

Judge Eddie C. Lovelace

The first person to die in Tennessee from the nine-state meningitis outbreak liked to bad steroids was most likely Kentucky Circuit Judge Eddie C. Lovelace of Albany, 78, who died at Vanderbilt University Medical Center Sept. 17. John Dreyzehner, Tennessee's commissioner of health, said Friday that the number of Tennesseans affected by the meningitis outbreak has now risen to 29. The number of deaths is unchanged at three. The search for more affected patients will continue "for some time," he said. Investigators haven't found evidence that the clinics or clinicians in Tennessee did anything to cause the outbreak, which has been reported in other states.

In July and August, Lovelace received three rounds of the pain-relieving steroid injections suspected of causing the outbreak of the rare disease, Joyce Lovelace, his wife of 55 years, told Adam Tamburin of The Tennessean. Representatives of the Saint Thomas Hospital Outpatient Neurosurgery Center, where he received the injections, are reported to have called Joyce Lovelace twice after his death to discuss his condition. They did not mention the outbreak, she said, nor have they confirmed that that was his cause of death.

Vanderbilt spokespeople have confirmed to the newspaper that "the first reported casualty of the outbreak was a 78-year-old man who died there on Sept. 17." Doctors told his family that his unexpected death was likely caused by a stroke, which is common among critically ill meningitis patients. His symptoms -- slurred speech, trouble walking and numbness -- are consistent with symptoms of fungal meningitis.

Lovelace had been a circuit court judge for two decades, and commonwealth's attorney and county attorney before that. “He always wanted to be known as a judge who knew the law, and he certainly was.” Joyce Lovelace said. “His career was not over. He had years yet to work.” (Read more) Democratic Gov. Steve Beshear may fill Lovelace's nonpartisan vacancy with state Sen. David Williams of Burkesville, who has been president of the Senate since Republicans took formal control of the chamber in 2000.

UPDATE, Oct. 6: The New York Times reports that nine states have reported meningitis cases connected to the steroids made by a Massachusetts company, which shipped the steroids to 14 other states. "Some doctors and clinics have turned away from major drug manufacturers and have taken their business to so-called compounding pharmacies, like New England Compounding, which mix up batches of drugs on their own, often for much lower prices than major manufacturers charge — and with little of the federal oversight of drug safety and quality that is routine for the big companies." (Read more) New England Compounding has recalled the steroids, The Tennessean reports.