The Ever-Changing Story of Immunizations
Used to be you could learn the immunization schedule once but not anymore. This year was a year full of news. Here are the highlights:
The year began with an editorial in the British Medical Journal calling Andrew Wakefield's claim that the measles-mumps-rubella (MMR) vaccine was linked to autism an "elaborate fraud."
In February, the Advisory Committee in Immunization Practices (ACIP) recommended that all healthcare workers regardless of age, should receive a single dose of tetanus toxoid, reduced diphtheria toxoid and acellular pertussis vaccine (Tdap) as soon as feasible if they have not previously received Tdap, and regardless of time since their last dose of tetanus and diphtheria toxoids (Td) vaccine.
In an October update, the AAP and ACIP also recommended Tdap vaccination of adolescents, including pregnant adolescents, and pregnant women during pregnancy rather than waiting until after delivery. The organizations removed their previous minimum interval between administering a Td vaccine and Tdap.
Earlier this year, ACIP recommended that persons aged 2-55 years at increased risk for meningococcal disease and all adolescents aged 11-18 years should be immunized with meningococcal conjugate vaccine. They also recommended that all adolescents receive a booster dose of quadrivalent meningococcal conjugate vaccine at age 16 years. The 2 licensed meningococcal conjugate vaccines were noted to be interchangeable.
Human papillomavirus quadrivalent vaccine (HPV4) should now be administered to boys aged 11-12 years according to an October recommendation from ACIP.
A 13-valent pneumococcal vaccine was licensed and incorporated in the vaccination schedule in March 2010. However a recent study found that over half of bacterial isolates (56.2% in 2010) are serotypes not covered by this newest vaccine. It is anticipated that strain replacement will continue to occur and, while these newer strains may be initially less virulent, they could acquire more virulence traits with time.
In late 2010, the American College of Obstetricians and Gynecologists (ACOG) issued new guidelines for influenza vaccine that recommended all unvaccinated pregnant women at any gestational age be immunized at any time during the influenza season, preferably early in the season. In July 2011, a large, population-based study found that infants of vaccinated mothers were 45%-48% less likely to have influenza hospitalizations.
Why Is This a Game Changer?
For good reason, immunizations have been have been declared one of the Ten Great Public Health Achievements in the 20th Century by the Centers for Disease Control and Prevention (CDC) making them the ultimate game changer. More can be anticipated with ongoing research into vaccines against malaria, Clostridium difficile, and CMV. Pediatric providers are on the front lines in insuring the widest uptake for these life-saving interventions. However, reimbursement for this widening array of vaccines continues to be an issue with the ever-increasing costs of vaccines often leaving providers in huge debt to vaccine manufacturers for months at a time while awaiting reimbursement from insurance that fails to adequately cover all expenses associated with administration. While the Affordable Care Act expanded government-sourced free vaccine to a larger pool of children, it has not solved the reimbursement issue. Vaccine purchasing groups (VPG), a type of group-purchasing organization, have now entered the scene. If a practice is not buying vaccine through a VPG, then they may be losing money before they even provide a single vaccine.
Medscape Pediatrics © 2011 WebMD, LLC
Cite this: Laurie E. Scudder. Game Changers in Pediatrics 2011 - Medscape - Nov 23, 2011.