Chapter 116. Immunization Principles and Vaccine Use (Part 13)

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Among the valid contraindications applicable to all vaccines are a history of anaphylaxis or other serious allergic reactions to a vaccine or vaccine component and the presence of a moderate or severe illness, with or without fever. Infants who develop encephalopathy within 72 h of a dose of DTP or DTaP should not receive further doses; those who experience a "precaution" event should not normally receive further doses. Because of theoretical risks to the fetus, pregnant women should not receive MMR or varicella vaccine. Diarrhea, minor respiratory illness (with or without fever), mild to moderate local reactions to a...

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Nội dung Text: Chapter 116. Immunization Principles and Vaccine Use (Part 13)

Chapter 116. Immunization Principles and Vaccine Use (Part 13) Among the valid contraindications applicable to all vaccines are a history of anaphylaxis or other serious allergic reactions to a vaccine or vaccine component and the presence of a moderate or severe illness, with or without fever. Infants who develop encephalopathy within 72 h of a dose of DTP or DTaP should not receive further doses; those who experience a "precaution" event should not normally receive further doses. Because of theoretical risks to the fetus, pregnant women should not receive MMR or varicella vaccine. Diarrhea, minor respiratory illness (with or without fever), mild to moderate local reactions to a previous dose of vaccine, the concurrent or recent use of antimicrobial agents, mild to moderate malnutrition, and the convalescent phase of an acute illness are not valid contraindications to routine immunization. Failure to vaccinate children because of these conditions is increasingly viewed as a missed opportunity for immunization.
Control of Vaccine-Preventable Disease A continuing task of public health practice is to maintain individual and herd immunity, and the job is not over once a population is fully vaccinated. Rather, it is imperative to immunize each subsequent generation as long as the threat of the reintroduction of the disease from anywhere in the world persists. Ongoing surveillance and prompt reporting of disease to local or state health departments are essential to this goal, ensuring a continuing awareness of the possibility of vaccine-preventable illness. Nearly all vaccine-preventable diseases are notifiable, and individual case data are routinely forwarded to the CDC. These data are used to detect outbreaks or other unusual events that require investigation and to evaluate prevention and control policies, practices, and strategies. International Considerations Since the establishment of the Expanded Programme on Immunization (EPI) by the WHO in 1981 and the involvement of UNICEF in the program's implementation, levels of coverage for the recommended basic children's vaccines (bacille Calmette-Guérin, poliomyelitis, DTP/DTaP, and measles) have risen from 5% to ~80% worldwide, although coverage does not necessarily translate into protective immunity. Each year, at least 2.7 million deaths from measles, neonatal tetanus, and pertussis and 200,000 cases of paralysis due to polio are prevented by immunization. Despite the successes of this program, many vaccine-preventable
diseases remain prevalent in the developing world. Measles, for example, continues to kill an estimated 500,000 children each year, and diphtheria, whooping cough, polio, and neonatal tetanus still occur at unacceptably high rates. An estimated 20–35% of all deaths of children are due to vaccine-preventable diseases. In addition to the antigens included in the EPI for routine use in the developing world, others (hepatitis B, Hib, Japanese B encephalitis, yellow fever, meningococcal, mumps, and rubella) are used regionally, depending on disease epidemiology and resources. The rationale for inclusion of hepatitis B vaccine in Africa and Asia is to prevent the subsequent development of hepatocellular carcinoma, which is strongly linked with the persistence of hepatitis B virus from early childhood. The delivery of vaccines in mass campaigns on national immunization days, superseding even civil wars and insurgencies, has resulted in the cessation of transmission of poliomyelitis in the Western Hemisphere, the western Pacific, and Europe and in the virtual elimination of clinical measles from the Western Hemisphere. Periodic vaccination campaigns complement routine infant and childhood vaccination services under the rubric "catch up, follow up, and keep up." Despite these successes, concerns remain about the adequacy of long-term strategies to ensure continuity, the impact of vaccine campaigns on the provision of routine services, and unsafe injection practices.
Because infectious diseases know no geographic or political boundaries, uncontrolled disease anywhere in the world poses a threat to the United States, even without bioterrorism. Vaccines offer the opportunity to effectively control and even eliminate some diseases through individual and herd protection. Vaccines also represent the best societal hope for stopping the pandemic of HIV infection throughout the world and for efficiently controlling malaria and tuberculosis. Issues of cost, liability, risk, and profitability limit the interest of the pharmaceutical industry in the development of vaccines for infectious diseases of the poor. Sources of Information on Immunization Official vaccine package circulars and Vaccine Administration Statements from the CDC Report of the Committee on Infectious Diseases of the American Academy of Pediatrics ("Red Book") Recommendations of the Advisory Committee on Immunization Practices, CDC Guide for Adult Immunization, American College of Physicians Health Information for International Travel (published yearly) and Advisory Memoranda on Travel (published periodically), CDC
Control of Communicable Diseases in Man, American Public Health Association Technical Bulletin of the College of Obstetrics and Gynecology National Network for Immunization Information, Infectious Diseases Society of America/Pediatric Infectious Diseases Society/American Academy of Pediatrics/American Nurses Association Further Readings Bonhoeffer J, Heininger U: Immunization: Perception and evidence. Curr Opin Infect Dis 20:237, 2007 [PMID: 17471032] Brown NJ et al: Vaccination, seizures and "vaccine damage." Curr Opin Neurol 20:181, 2007 [PMID: 17351489] Bruce Aylward R et al: Risk management in a polio-free world. Risk Anal 26:1441, 2006 Goldie S: A public health approach to cervical cancer control: Considerations of screening and vaccination strategies. Int J Gynaecol Obstet
94(Suppl 1):S95, 2006 Jacobson RM et al: Why is evidence-based medicine so harsh on vaccines? An exploration of the method and its natural biases. Vaccine 25:3165, 2007 [PMID: 17292516] Kaufmann SH: The contribution of immunology to the rational design of novel antibacterial vaccines. Nat Rev Microbiol 5:491, 2007 [PMID: 17558425] Kimmel SR et al: Addressing immunization barriers, benefits, and risks. J Fam Pract 56:S61, 2007 Reeler AV: Anthropological perspectives on injections: A reivew. Bull World Health Organ 78:135, 2000 [PMID: 10686748] Thompson KM, Tebbens RJ: Eradication versus control for poliomyelitis: An economic anlysis. Lancet 369:1363, 2007 [PMID: 17448822] van der Zeijst BA et al: On the design of national vaccination programmes. Vaccine 25:3143, 2007 Bibliography
Angel J et al: Rotavirus vaccines: Recent developments and future considerations. Nat Rev Microbiol 5:529, 2007 [PMID: 17571094] Aylward B et al: Reducing the risk of unsafe injections in immunization programmes: Financial and operational implications of various injection technologies. Bull World Health Organ 73:531, 1995 [PMID: 7554027] Berzofsky JA et al: Progress on new vaccine strategies against chronic viral infections. J Clin Invest 114:450, 2004 [PMID: 15314679] Beutels P et al: Convincing or confusing? Economic evaluations of childhood pneumococcal conjugate vaccination—a review (2002–2006). Vaccine 25:1355, 2007 [PMID: 17208339] Bhadelia N et al: The HIV-positive traveler. Am J Med 120:574, 2007 [PMID: 17602926] Broder KR et al: Preventing tetanus, diphtheria, and pertussis among adolescents: Use of tetanus toxoid, reduced diphtheria toxoid and acellular pertussis vaccines. Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 55:1, 2006 [PMID:
17167397] Casanova JL, Abel L: Inborn errors of immunity to infection: The rule rather than the exception. J Exp Med 202:197, 2005 [PMID: 16027233] Cono J et al: Prophylaxis and treatment of pregnant women for emerging infections and bioterrorism emergencies. Emerg Infect Dis 12:1631, 2006 [PMID: 17283610] Cortese MM et al: A "new age" in pertussis prevention: New opportunities through adult vaccination. Am J Prev Med 32:177, 2007 [PMID: 17296469] Davenport MP: The T cell repertoire in infection and vaccination: Implications for control of persistent viruses. Curr Opin Immunol 19:294, 2007 [PMID: 17433874] Donnelly JJ et al: DNA vaccines: Progress and challenges. J Immunol 175:633, 2005 [PMID: 16002657] Eldred BE et al: Vaccine components and constituents: Responding to consumer concerns. Med J Aust 184:170, 2006 [PMID: 16489901]
Fiore AE et al: Prevention of hepatitis A through active or passive immunization: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 55:1, 2006 [PMID: 17159833] Fiore AE et al: Prevention and control of influenza. Recommendations of the Advisory Committee on Immunization Practices (ACIP), 2007. MMWR Recomm Rep 56:1, 2007 [PMID: 17625497] Fraser CK et al: Improving vaccines by incorporating immunological coadjuvants. Expert Rev Vaccines 6:559, 2007 [PMID: 17669010] Guy B: The perfect mix: Recent progress in adjuvant research. Nat Rev Microbiol 5:505, 2007 [PMID: 17558426] Herrera G et al: The underrecognized burden of influenza in young children. N Engl J Med 355:31, 2006 [PMID: 16822994] Lowy DR, Schiller JT: Prophylactic human papillomavirus vaccines. J Clin Invest 116:1167, 2006 [PMID: 16670757] Mast EE et al: A comprehensive immunization strategy to eliminate
transmission of hepatitis B virus infection in the United States: Recommendations of the Advisory Committee on Immunization Practices (ACIP). Part 1: Immunization of infants, children, and adolescents. MMWR Recomm Rep 54:1, 2005 [PMID: 16371945] Middleman AB: Adolescent immunizations: Policies to provide a shot in the arm for adolescents. J Adolesc Health 41:109, 2007 [PMID: 17659213] Oxman MN et al: A vaccine to prevent herpes zoster and postherpetic neuralgia in older adults. N Engl J Med 352:2271, 2005 [PMID: 15930418] Parker SK et al: Thimerosal-containing vaccines and autistic spectrum disorder: A critical review of published original data. Pediatrics 114:793, 2004 [PMID: 15342856] Poehling KA et al: Efficacy of an acellular pertussis vaccine among adolescents and adults. N Engl J Med 353:1555, 2005 Subbarao K, Joseph T: Scientific barriers to developing vaccines against avian influenza viruses. Nat Rev Immunol 7, 267, 2007
Wood DL: American Academy of Pediatrics Committee on Community Health Services; American Academy of Pediatrics Committee on Practice and Ambulatory Medicine: Increasing immunization coverage. Pediatrics 112:993, 2003 [PMID: 14523201]