Pneumonia Vaccination

June 9th, 2020 by

Vaccine against bacterial pneumonia has been available for many years. In fact, there are two vaccines and both are effective against a group of streptococcal bacteria that are collectively known as the pneumococcus.

These bacteria cause pneumonia and other severe illnesses, especially in children and people with weakened immune systems.

The two vaccines are called PCV (Prevnar-13) and PPSV (PPV, or Pneumovax-23). In several countries around the world, PCV vaccine has been part of the routine childhood vaccine program for over 10 years already and is usually given to children under the age of 2 years.

For a long time PPV-23 vaccine was only given to people with underlying health conditions that put them at high risk of infection. More recently it has been recommended for all adults of 60 years and above.

Recommended schedules for adult vaccination against pneumococcus vary widely between nations. It became even more confusing when, on the basis of research study, the US recommended that adults should receive both of the vaccines, starting with Prevenar-13 and then one year later Pneumovax-23. This advice was subsequently reversed a few years later once it became apparent that the addition of Prevenar-13 wasn’t adding much benefit in countries where it was already part of the standard childhood vaccination program.

In most cases both of these vaccines are given just one time, because the composition of the vaccine always remains the same, unlike the influenza vaccine which changes every year and so must be repeated each year.

If you are interested in receiving the pneumonia vaccine and/or the influenza vaccine, please contact the clinic, but please note that this vaccine will not give any protection against the new coronavirus SARS-CoV-2 that causes Covid-19 disease.

Dengue Fever

June 9th, 2020 by

Dengue Fever is a common and at times severe virus infection transmitted by mosquitoes. There were 98,000 cases of dengue in Thailand in 2019, along with 100 deaths, and yet 3 out of every 4 infections are thought to give no symptoms at all.

Like most viral illnesses there is no cure and hospital treatment for severe cases consists of supportive care, maintaining vital systems so that the patient has chance to fight off the infection themselves.

The symptoms of dengue begin a few days after a mosquito bite. Typically, there’s a sudden fever, pain behind the eyes, headache and severe body aches (so bad that in earlier times dengue was known as ‘break bone fever’). In extreme cases there may be bleeding from the eyes, nose and mouth, explaining dengue’s Thai name of ‘khai leuat ork’ (fever blood out).

The Aedes mosquito that transmits dengue has white stripes and is easy to recognise but not so easy to avoid. This mosquito bites in the daytime as well as at night and can transmit other similar viruses like Zika, chikungunya and yellow fever virus.

There are 4 distinct strains of dengue virus and the interaction between them and the human immune defence system is key to why vaccination can be dangerous.

Infection with a dengue virus results in long-term immunity to that strain. For a year or two there is cross-over immunity to the other strains also, but this protection is lost as the antibody levels fall, making it possible to catch dengue again. The strains can be caught in any order, with the second infection usually much worse than the first, third or fourth (whichever strain causes it).

This happens because antibody levels from the first infection pass through a ‘danger zone’ as they fall from high to low levels over time. If the second virus comes along when antibodies are in the danger zone then the immune response goes into overdrive, generating an excessive, harmful and sometimes fatal reaction. Levels above or below the danger zone are safe.

This is why we don’t recommend the dengue vaccine – if you’ve never had a dengue infection and you take the vaccine then you will make a high level of antibodies, the same as happens with a first dengue infection. As those antibody levels fall you will for a while be at a much higher risk for severe and possibly fatal dengue than if you’d never been vaccinated at all.

Checking for antibodies before giving the vaccine would avoid this problem but the antibody test for dengue is not reliable and there are false positive results from antibodies to similar viruses (chikungunya, yellow fever and Zika).

In the absence of a safe vaccination program, the best way to protect yourself against dengue is to eliminate mosquito breeding sites around the home, ie remove or drain anything that may collect small pools of water during the rainy season. We also recommended wearing long sleeves, long trousers and to use insect repellant, even during the daytime in the rainy season.

The Be Well Team Hua Hin, 26 April 2020