Five Children in Minnesota Reported With Invasive HIB Disease 2008--pneumonia, meningitis, & epoglotitis (bacterial croup)

(picture of HIB bacteria cultured on a blood agar plate)

I just read this story in the MMWR (Morbidity and Mortality Weekly Report) which discusses infectious disease as it relates to events in the US.  This report is put out by the Centers for Disease Control and is free to anyone interested. Click the link above to check it out.

This time the report describes something that causes me to worry.  A group of underimmunized children who contracted invasive HIB disease.  This disease affects children the most, and has been nearly a non-issue since the HIB vaccine became available in the US.  The bacteria, Haemophilus influenza type B (which is actually misnamed since it doesn't cause the flu at all), causes respiratory infections including ear infections.  It can also cause bacterial pneumonia, meningitis, and epiglotitis (deadly bacterial croup that strikes fear into the heart of folks like me trained in the 80's because it can cause the throat to swell shut suddenly and kill a child very quickly).

So, in December 2007, several lots of HIB vaccine made by Merck company were recalled and the plant that made the vaccine was closed.  This resulted in a shortage of HIB vaccine in the US because it left only one manufacturer, Sanofi Pasteur.  We're still experiencing that shortage in the US.

Because of the shortage, the CDC has advised health care providers to give only the initial 3 doses of HIB vaccine to infants, and to skip the 4th dose usually given after 1 year of age.  Health care providers and the CDC worry that rationing the vaccine like this could cause an increase in invasive HIB disease in the US.  So far, we've managed to be lucky.

However, in Minnesota there were 5 cases of invasive HIB during 2008.  None of the cases were associated in any way--the families involved lived in different counties and had no relationship to one another.  The kids were ages 5 months to 3 years of age.  One died. 

The one thing they had in common was that they had not completed the first 3 doses of HIB vaccine (so in other words, this could have happened even without a HIB shortage).  Three of the children were unimmunized because their parents refused immunizations.  One of these children died of their HIB disease. Two of the children only had two doses of HIB.  One of those children also had an immunodeficiency condition.

Infectious disease specialists believe that these cases represent an increase in numbers of children who are carriers of the disease.  This means that children who are not immunized, or underimmunized, are at greater risk of contracting invasive HIB disease because we are experiencing a breakdown of "herd immunity."  If the herd is not completely immunized, more members will be carriers (they harbor the disease but either aren't sick or have milder illness).  The unimmunized are then at greater risk of contracting the illness.  With no immunity, they have a greater risk of severe illness and death.

Washington State has a large number of unimmunized people, and depending on "herd immunity" has never been a sure bet out here.  Shortages like the one we are experiencing with HIB vaccine are a serious threat to the health of our children.  We need to consider the implications of the limited supply chain for critical public health infrastructure like vaccines.  We can't afford to allow this to happen in the USA.  It's actually scandalous, and I'm shocked that there has not been public outcry.  I don't think I've even heard it in the news at all.

So, go forth after reading this and let our president know that our children can't be put at risk because of vaccine shortages in the US.  Contact your legislators.  Spread the word.  How can we call our country great if it can't even ensure enough vaccine for the children who need them?

Read more:  http://en.wikipedia.org/wiki/Hib_vaccine

and be sure to check the references cited there as well.

Michigan, Ohio, Wisconsin recalls

Nash Finch, the operator of stores named: SunMart Foods, Econofoods (excluding Wisconsin stores in Sturgeon Bay, Clintonville, Marquette, Holton and Iron Mountain), Prairie Market, Avanza Supermarket, Food Bonanza, Wholesale Food Outlet, Family Fresh Market, Family Thrift Center, and Pick'n Save (Ohio stores in Van Wert and Ironton only) is taking the precautionary measure of voluntarily recalling the following products made in the bakery departments of its corporate operated stores because they contain peanut butter that was supplied by Peanut Corporation of America (PCA) and has the potential to be contaminated with salmonella: Peanut Butter Cookies, Peanut Butter Chocolate Chip Cookies, Mini Peanut Butter Cookies, Monster Cookies, Peanut Butter Grand Brownies, Peanut Butter Blossom Cookies, Puppy Chow snack mix, Peanut Butter Rolls, Peanut Butter Rice Crisp Bar, Special K-Bar, Scotcheroos, Rolls and Cakes Iced with Peanut Butter Cream. All sell-by dates are included in this recall.

Salmonella Outbreak Summary

As of January 6, 2009, 474 people have become ill because of infection with Salmonella Typhimurium associated with peanut butter and paste products across 43 states between Sept 8, 2008 and Jan 2, 2009. (see http://hellotxt.com/l/VbIc%22%3Ehttp://hellotxt.com/l/VbIc for a map and breakdown of how many people per state)

We may be near the end of the outbreak (hopefully), but as in any statistical representation of a disease outbreak, there may be many more affected people than are reported. This is because not everyone seeks health care when they have an illness. And not all illnesses are confirmed by lab tests and then reported to the health department. Reported illnesses are only those that have confirmation by lab testing, which is usually in the case of illnesses severe enough to require hospitalization OR that last longer than the average routine illness.

The CDC is collaborating with the FDA to identify the source of infection.Just under a fifth of the people infected required hospitalization. There have been at least 6 deaths that may be associated with the outbreak. The elderly and the very young are at greatest risk. Symptoms include stomach cramps and diarrhea.

The salmonella typhimurium outbreak is linked to peanut butter and paste produced by PCA-Peanut Corporation of America in their Blakely, Georgia plant. The health department in the state of Minnesota reported that King Nut Peanut Butter (a product of PCA distributed by King Nut company and sold to schools and institutions) had salmonella bacteria that was a genetic match to the salmonella involved in this outbreak. Because of these findings, PCA has recalled peanut butter product that was produced in the Blakely, GA plant after August 8, 2008. Peanut PASTE products produced in that plant after September 26, 2008, are recalled as well.
Production has been stopped at that plant as of January 2009 while the FDA investigates the source of contamination.

AT THIS TIME, no nationally produced brand name jars of peanut butter are involved in the outbreak.

The investigation is expected to continue throughout this next week and as long as it takes to remove all contaminated food from the food supply. However, you are advised to avoid institutionally prepared peanut butter foods (school, hospital, company cafeteria, etc) until further notice. And specifically avoid food that has been named in the recall. This includes peanut butter ice cream, candy, cake, cookies, crackers, sandwiches, etc.

I'll try to keep you updated as the investigation goes along. Be cautious and stay safe!

The information for this summary was gleaned from the CDC outbreak website: http://hellotxt.com/l/VbIc%22%3Ehttp://hellotxt.com/l/VbIc and the FDA outbreak website: http://hellotxt.com/l/xhGa

Picture of Salmonella Typhinurium from http://www.giantmicrobes.com/ca/products/salmonella.html