Monday, October 31, 2011

What vaccines say about parents

Two vaccines targeted to children have been in the news this month: a vaccine in clinical trials in parts of Africa that offers some protection from malaria (which is a leading cause of death in African children, according to the World Health Organization), and the human papillomavirus (HPV) vaccine, which prevents infection with certain cancer-causing strains of the HPV virus. Although the HPV vaccine has been recommended for tween girls for several years, the CDC will likely recommend it for boys as well soon.
    Each of these vaccines is quite unique. The malaria vaccine, if approved, would be the only vaccine that prevents a parasitic infection (all other vaccines prevent infection with certain viruses or bacteria). The HPV vaccine is one of only two vaccines that can prevent cancer (the other one is the Hepatitis B vaccine, which prevents infection with a virus that can cause liver cancer). Until recently, the HPV vaccine was the only childhood vaccine recommended only for girls, not boys, because HPV infections can cause cervical cancer.

    The malaria vaccine, which is only about 35% effective in preventing malaria, is being heralded as a major breakthrough in preventing a disease that can be deadly in children, especially as the mosquitoes that transmit malaria become resistant to pesticides. On the other hand, the HPV vaccine, which prevents infection with certain strains of HPV that can cause serious health problems such as cervical cancer, genital warts, and oral cancers, has triggered a lot of angst and hand-wringing. It has been criticized as a pharmaceutical boondoggle (costing about $400 for the three-dose series), an invitation to promiscuity for the tweens who receive the vaccine, or (when the vaccine is mandated), a governmental intrusion in the lives of people.

    Malaria is transmitted by mosquitoes, while HPV is generally transmitted by sexual contact, which is part of the reason some Americans are squeamish about the HPV vaccine. Vaccines are a public health initiative, though, and American parents tend to forget this as they fret about whether a vaccine will reset their child's moral compass.

    Although many parents view vaccines as an individual choice that affects only their family, a vaccine doesn't just protect one child from an infection. Most vaccines also prevent the child from transmitting an infectious disease to someone else. Others might be vulnerable to a disease because they are unvaccinated, too young to be vaccinated, have an illness that prevents them from getting a vaccination, or because (often unknown to them) they have not developed immunity to a disease after being vaccinated.

    The HPV vaccine recommendation was extended to boys because they also transmit the virus, even if they are generally at less risk for developing cancer from the virus than girls are. It can be hard, though, to persuade parents to think about their neighbor's children as well as their own.

    Monday, October 17, 2011

    Ignoring Long Term Care

    In print and screen advertisements, retirement is often portrayed as a time to start a second career, spend more time with the grandchildren, volunteer for a worthy cause, or travel around the world. Any health problems can be managed with prescription medications and moderate exercise.

    Realistically, however, many Americans will ultimately need long-term care in a nursing home or in their own homes when they get older. Medicare, which in most cases does not cover long term care, predicts that 12 million elderly will need long term care by 2020, and HHS predicts that 40% of 65-year-olds will ultimately go into a nursing home for some period of time. Non-skilled long term care is often provided by family and friends, such as help with daily activities, while skilled long-term care often must be paid out of pocket.

    With the recent demise of the CLASS Act, a section of health care reform designed to encourage Americans to purchase long-term care insurance, the issue of long term care has come to the forefront. The CLASS Act had fiscal flaws, with high monthly costs for insurance, but dropping it does not solve the problem of long-term care. In this economy, with many families struggling, few want to contemplate the stress and expense of caring for an ill spouse or relative. But ultimately, many of us will need to help out.

    Kaiser Health News' Howard Gleckman suggests providing long-term care in the future through universal coverage or through insurance policy incentives. Whatever the solution, the current gaps promise to cause many problems for families as the large generation of Baby Boomers ages, along with the rest of us.