Vaccines

It's Monday morning and you're only 20 minutes behind. Per routine, you ask the mother of the 12-month-old in your office if she has any questions about the shots he's about to receive...

The mother of a 12-month-old says she'd rather her son have the chickenpox ("It's such a mild disease...") than be vaccinated today. Here, the pros and cons.

FluBlok, new this year, is egg-free but approved for persons aged 18 to 49 years only. The other options, and precautions, are discussed here.

The 5-year-old in your office has asthma and is egg-allergic. Mom wants him to have a flu shot today, but only if it can be given safely. Can it? With which vaccine?

If you aren't ready with the answer to this question and a way to put it in context for parents, you just might not get another chance. What would you say?

Here's how to put a parent's concern to rest.

Since mom went to the hassle of bringing along the 4 year old to her little brother's appointment, why not help make it worth the trip and get her up-to-date, too?

As the calendar advances to the fall months, we are reminded everywhere that it’s time for the annual influenza vaccination. In August 2011, the Advisory Committee on Immunization Practices (ACIP) updated its vaccination recommendations to include new guidelines for children ages 6 months through 8 years, and for persons with egg allergy.

My 18-month-old son has had a diaper rash, with no other symptoms, within a few days of eating a poached egg on 3 separate occasions.

Vaccination against infectious diseases has saved millions of lives. The recurrent threat of influenza pandemics and the prevalence of global HIV infections underscore the need for better-designed, more effective vaccines.

The lay public is being increasingly educated about the significant impact of HPV infection and the potential benefits of vaccination in reducing female cervical cancer. More medical providers need to recognize the substantial disease that could be prevented in men.

It certainly is reasonable for pediatricians to discharge patients if parents consistently refuse vaccinations. More than one-third of surveyed pediatricians agree.1 Although the American Academy of Pediatrics suggests avoiding the dismissal of vaccination refusers, it also recommends consideration of dismissal “when a substantial level of distrust develops, significant differences in the philosophy of care emerge, or poor quality of communication persists.”

Newborns and young infants represent the population most at risk for the burden of severe pertussis-related and influenza-related morbidity and mortality. The sources of these infections in infants are often unclear but are probably adolescents and adults (pertussis) and children and adults (influenza)

With the sole exception of the multidose influenza vaccine, childhood vaccines are now thimerosal-free. Communicating this fact (with signs in clinic) is a quick and effective way of making this concern a non-issue. It helps reinforce the message that vaccines are safe. Parents are made aware that the pediatrician is cognizant of their concerns and has endeavored to address those concerns.

The importance of vaccination has been well proved over the years for both individuals and the community as a whole. According to the 2004 to 2006 National Immunization Survey sponsored by the CDC, about 80% of children in the United States are up-to-date (UTD) with their immunizations, a rate that although respectable still leaves room for improvement.

Invasive pneumococcal disease (IPD) in children can cause serious illness-including meningitis, pneumonia, and bacteremia-and death. Fortunately for children, their families, and their pediatricians, the incidence of IPD in children younger than 5 years has dropped significantly following the widespread adoption of the pneumococcal conjugate vaccine (PCV).

On awakening in the morning, a 2-year-old girl was noted to have left-sided facial swelling and was brought to the emergency department. The child had had no fever, trauma to the area, pain, or difficulty in swallowing. Her medical history was unremarkable. Her immunizations were up-to-date; she had received both doses of the measles, mumps, and rubella (MMR) vaccine about 6 months before presentation. There were no sick contacts.

After independent academic researchers, using a new technology, found DNA from porcine circovirus 1 (PCV1) in GlaxoSmithKline’s Rotarix vaccine, the FDA has recommended that clinicians temporarily suspend administration of the vaccine. The recommended suspension is a precautionary measure, put into effect while the FDA reviews the data and conducts further investigations.

For decades, our country's health care system and its government have struggled with the challenge of providing immunization coverage for all children. Starting with the Section 317 legislation of 1962, numerous policy initiatives have been passed in an effort to ensure that sufficient supplies of vaccines are available, that the cost of vaccines for low–income children is covered-and that these vaccines are actually administered to the children that need them.

The expansion of the immunization schedule for 2009 has resulted in several success stories. Two rotavirus vaccines are now available. Following the introduction of immunization against rotavirus, a sharp decline in cases of rotavirus gastroenteritis was seen.

Children with asthma who had received influenza vaccination had fewer asthma exacerbations, according to a recent study conducted in the pediatric clinics of Brooke Army Medical Center, Fort Sam Houston and Wilford Hall Medical Center, Lackland Air Force Base in Texas.

A 17-month-old girl awoke with drooling, cough, respiratory distress, and a muffled cry and was brought to the emergency department. She had no nausea, vomiting, or diarrhea and no history of choking, aspiration, or airway problems.

Vaccines are perhaps the single most important contribution the 20th century made to civilization. They have been responsible for saving untold numbers of lives and for vastly improving the quality of many more. Although vaccines have had some bad press of late, they are still strongly recommended by the medical community. However, financial issues, difficulties with managed care organizations (MCOs) and other parts of our health care system, and problems with the manufacture and delivery of vaccines prevent optimal use of this crucial preventive service. Here I discuss the problems associated with vaccine delivery and administration and suggest several practical solutions.

Vaccines may represent the greatest advance in children’s health of the past 50 years, but they also, sadly, can frequently be a source of stress for today’s pediatricians. There is the issue of potential difficulty in recouping the cost of the vaccines from managed care organizations.

According to one Web site, pediatric health care providers should be arrested and prosecuted because of their involvement in the “chemical holocaust” of children.1 This chemical holocaust refers to vaccination- one of the greatest public health successes in the history of modern medicine.

Parents are understandably concerned about vaccines and autism, a relationship publicized by lawsuits, alternative therapies, and claims of government cover-up.

The approval of Gardasil (Merck)-a recombinant vaccine providing protection against human papillomavirus (HPV)-in 2006 sparked instant controversy.1,2 Because HPV infection is a sexually transmitted disease, the use of a vaccine for such a disease brought the following political, medical, and moral questions to the forefront:

Pertussis has long been known to cause severedisease and death in infants, especially in thosewho are unvaccinated or who are too young tobe immunized. With the number of pertussiscases in the United States increasing,1 those ofus who care for susceptible infants are looking for solutionsto this dangerous problem.

A 23-month-old girl presented with an erythematous papular rash on her torso that extended in a linear pattern around to the back. The mother first noticed the rash while bathing the child 3 days earlier. The child had no associated itching, irritability, or fever, but she had mild rhinorrhea preceding the rash that resolved without treatment. The patient and her older sibling were cared for at home by their mother.

By the pre-middle school visit, the child should have already received 3 or 4 doses of IPV (only 3 are required if the last dose was given after the age of 4 years); 3 doses of hepatitis B vaccine; 2 doses of MMR vaccine; 2 doses of varicella vaccine; and 2 doses of hepatitis A vaccine.