• New guidelines issued for immunizations

    December 2009

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    An organization of infectious disease specialists in September 2009 released updated, evidence-based guidelines for immunization of infants, children, adolescents and adults. These new standards, prepared by an expert panel of the Infectious Disease Society of America (IDSA), include a host of new vaccines that have been introduced since IDSA’s last directive in 2002. The guidelines are voluntary and intended to assist clinicians in providing vaccinations to patients of all ages.

    “Vaccines have helped eradicate smallpox, control polio, eliminate measles and rubella in the United States, and reduce the number of deaths from tetanus and whooping cough.” 

    Over the last 100 years, vaccines have helped eradicate smallpox, control polio, eliminate measles and rubella in the United States, and reduce the number of deaths from tetanus and whooping cough. Immunization of adults older than 50 with influenza vaccine and adults older than 65 with pneumococcal vaccine has proven highly cost-effective in preventing health problems.

    Between 1989 and 1991, there was an upsurge in measles in the United States due to a decline in immunization among preschoolers. Again, in 2008, the number of cases of measles increased, with most cases among people who had not been vaccinated.

    Vaccines work by preparing the body to fight illness. Each shot contains either a dead or weakened germ of a particular disease. The body responds to the vaccine by making antibodies against the germ so the person doesn’t get sick when exposed to the actual disease.

    Expert panel’s methods

    Members of the IDSA panel had experience in pediatric and adult clinical and laboratory medicine, nursing, public health, and infectious diseases. In disclosing possible conflicts of interest, some of the authors of the guidelines report various financial relationships with Merck, GlaxoSmithKline, AstraZeneca, Novartis, Wyeth and other agencies and companies.

    In making their recommendations, the panel reviewed vaccine licensure, approval, recommendations, safety, financing, barriers and implementation issues. They also made recommendations for removing barriers to immunization, eliminating racial/ethnic disparities, addressing vaccine safety issues, financing recommended vaccines and immunizing specific groups. The guidelines were endorsed by the American Academy of Pediatrics, the National Association of Pediatric Nurse Practitioners and the Pediatric Infectious Diseases Society.

    They are published in the Sept. 15, 2009, issue of Clinical Infectious Diseases.

    New vaccines and recommendations

    New vaccines appearing in the guidelines include:

    • Human papillomavirus vaccine;
    • Live, attenuated influenza vaccine;
    • Meningococcal conjugate vaccine;
    • Rotavirus vaccine;
    • Tetanus toxoid, reduced diphtheria toxoid and acellular pertussis vaccine;
    • Zoster vaccine.

    New combination vaccines are:

    • Measles, mumps, rubella and varicella vaccine;
    • Tetanus, diphtheria and pertussis and inactivated polio vaccine;
    • Tetanus, diphtheria and pertussis and inactivated polio/Haemophilus influenzae type b vaccine.

    Hepatitis A vaccines are now recommended universally for young children. All children ages 6 months through 18 years and adults older than 50 should receive influenza vaccines.

    Additionally, a second dose of varicella vaccine has been added to the routine childhood and adolescent immunization schedule.

    Safety concerns

    IDSA’s 2009 report does not include issues involving vaccines and autism and other potential adverse events. Instead, it refers readers to a review of vaccine safety concerns by a 2000 committee convened by the Centers for Disease Control and Prevention and the National Institutes of Health. The committee addressed these issues:

    • Thimerosal-containing vaccines and neurodevelopmental disorders
    • Multiple immunizations and immune dysfunction
    • Hepatitis B vaccine and demyelinating neurologic disorders
    • SV40 contamination of polio vaccine and cancer
    • Vaccinations and sudden, unexpected death in infancy (SIDS)
    • Influenza vaccinations and neurologic complications
    • Vaccines and autism

    “For each topic,” the IDSA report states, “the committee found the evidence to be inconclusive or in favor of rejection of causal associations between vaccines and the adverse events reviewed.”

  • more-information
  • Related resources

    For more information, see:

    Infection Control & Prevention – UK HealthCare

  • UK HealthCare Pediatric Services - Kentucky Children’s Hospital

    For more information, or to make an appointment with a UK HealthCare physician, please call UK Health Connection at 800-333-8874. 

Page last updated: 8/7/2015 2:15:26 PM
  • What the news means for you

    Vaccines still strong weapon for preventing infectious diseases

    Christopher T. Nelson, MD
    Infectious Disease

    Wright, Heather, MDIDSA guidelines are standards of care and generally embraced by clinicians. There are so many new vaccines it’s often hard for doctors to keep up with them.

    In issuing their 2009 guidelines, IDSA has compiled the literature on vaccines and looked at the strength of the evidence for their usage.

    “IDSA has compiled the literature on vaccines and looked at the strength of the evidence for their usage.” 

    Many of the newer, combination vaccines are quite expensive. It’s very costly to get them approved since the FDA now requires a very large pool of patients for clinical trials. Unfortunately, Medicaid has reimbursed at a much higher rate for procedures than for primary care. Vaccines are obviously preventive.

    It’s recommended today that all children and adolescents be vaccinated against diphtheria, pertussis, tetanus, polio, measles, rubella, mumps, Haemophilus influenza type B (a common cause of pneumonia and meningitis in infants), hepatitis B, hepatitis A, human papilloma virus, Streptococcus pneumoniae, chickenpox and influenza. Schools do a good job of making sure that all pupils are up to date with their shots.

    People whose immune systems are compromised due to underlying causes are the most likely to get infectious diseases. It’s important that they be vaccinated. Aside from their own health, these people can develop resistance to treatments if they develop a disease. They may then spread the mutated virus to other people.

    Parental resistance to vaccines

    Some parents resist getting their children vaccinated because of publicity about adverse effects. In some instances, a pediatrician might send that child to another practitioner if a parent refuses to have the child vaccinated. But if the pediatrician has a rational discussion with the parents, gives them literature on the vaccines, and has them come back in after talking things over with each other, most will agree to the vaccines, at least partially. If they don’t, the doctor can clearly note on the child’s chart that vaccinations were refused.

    “The numbers of individuals experiencing serious reactions is very small.” 

    Unfavorable outcomes do occur, but they are very rare. The most common is a local reaction at the site of the vaccine. In some cases the swelling can be profound. More serious complications are anaphylactic shock, a drop in blood pressure and cardiac arrest. But again, the numbers of individuals experiencing serious reactions is very small.

    There is no clear link between the development of autism and vaccination. In fact, it does a disservice to autistic children and children in general to continue to focus on a possible link between autism and vaccination even after several large population studies have failed to identify a causal association between the two. We have eliminated mercury as a preservative from the majority of vaccines, yet the number of cases of autism continues to rise. This strongly suggests there are other contributing causes not being addressed, and we may be missing the big picture by focusing on vaccines.

    Some people who received flu vaccines in the 1970s developed Guillain-Barre syndrome. However, Guillain-Barre is also a complication of flu, so it could’ve been the flu virus rather than the vaccination that caused it. We’ll never know. In any case, since the 1970s there has been no connection between the flu shot and Guillain-Barre.

    We do occasionally see children in the hospital who develop a disease that they’ve been vaccinated against, but it is rare to see a complete lack of immune response when a recommended vaccine series has been appropriately completed. It often takes three doses of any vaccine to truly get an appropriate protective immune response in a young infant. The majority respond after the second dose.

    Then there are some people who just don’t respond well to a vaccine. For example, with the seasonal flu vaccine we have now, there is an 80 percent take rate. That means 20 percent of the people who get the vaccine don’t respond at all.

    Nevertheless, vaccines are among our most effective strategies in fighting infectious disease.

    Dr. Nelson is a pediatric infectious diseases specialist, UK HealthCare director of infection prevention and control, and associate professor of pediatrics in the UK College of Medicine.

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