Pediatrician’s Corner—

IMMUNIZATION UPDATE

By Jeff Cersonsky, MD, FAAP

I think it is worthwhile to give parents an update on immunizations and changes in recommendations relating to them. There have been two important changes in immunization guidelines in the last few months and many more are on the horizon.

First, a new vaccine was released this year with the unwieldy name of “meningococcus conjugate vaccine” and the trade name of Menactra. This is actually an upgrade to the other meningococcus vaccine, Menomune. This vaccine has been available for many years, but only was approved for college freshmen or older and only recommended for those college students living in dormitories.

Meningococcus is a peculiar bacteria that is infamous for the rapidly fatal blood infection it causes, meningoccemia. Though this bacterium can cause meningitis, those who get the meningitis usually do not get the blood infection, and usually survive. Meningococcemia is remarkable for a rash that looks like bruises all over, and may proceed within hours to shock, cardiovascular collapse, and death.

The new vaccine, Menactra, has been shown to be safe and reasonably effective in children 11 and up. It protects against the four most common serotypes of the bacteria, which means that about 30 percent of the infections will not be prevented. Fever and soreness at the injection site occur occasionally, and allergic reactions are possible but rare.

There is a system set up in the United States for reporting potential adverse reactions to vaccines. It is called the Vaccine Adverse Events Reporting System or VAERS. This month, the CDC released a statement from VAERS reports that five individuals who received Menactra developed Guillain-Barre syndrome within four weeks of receiving the vaccine. Guillain-Barre syndrome (GBS) is a neurologic disease that causes varying degrees of paralysis, with variable recovery, although the five individuals all made a complete recovery. Statistics show that, considering the many thousands of vaccines administered, the five cases of GBS would be expected, sheerly as coincidence, and are probably not related to the vaccine at all. I still recommend this vaccine for any child 11 years of age or older although this new information concerning GBS may cause some parents to have reservations. If you are concerned, talk with your pediatrician so that you can make the best possible decision. As far as we know now, one vaccination confers lifelong immunity, and no booster is necessary.

Another major change that is gradually being implemented is immunizing adolescents and adults against pertussis. The new acellular vaccine for pertussis (whooping cough), unlike the old whole-cell vaccine, has been shown to be safe and effective in older children and adults. Adults continue to circulate this illness, putting younger children at risk. By combining the acellular pertussis vaccine with the existing diphtheria-tetanus vaccine, creating a so called dTaP vaccine, we have a vaccine to give to those 10 years old or older every five to ten years. We are able to prevent all three illnesses and decrease the chances of everyone, including young infants, of getting the whooping cough.

Briefly, here are some up-and-coming events you can anticipate in vaccine development:

A vaccine for human papillomavirus (HPV) is soon to be released. HPV causes venereal warts, which can be very bothersome, but the reason behind the vaccine is to prevent the cervical cancer that the virus can cause. As we learn more about cancer and which viruses may cause them, look for more “cancer vaccines” in the future. The vaccine will probably be recommended for adolescents.

A vaccine against Heliobacter pylori is in development. This bacteria has been associated with peptic ulcers. This vaccine also will be for adolescents.

Supervaccines containing many vaccines are in various stages of development. We are already using one such vaccine, Pediarix which combines the DtaP, polio, and hepatitis B vaccines. There is a vaccine soon to be released combining the MMR and varicella (chicken pox) vaccines. There are also ones being developed for DtaP-Hib-Polio and DtaP-Hib-Polio-Hepatitis B.

The rotavirus vaccine, which was removed from the market because of concerns about a bowel obstruction (intussusception) has been improved and may be released. Rotavirus is a primary cause of fatal dehydration in third-world countries, but also a cause of frequent hospitalizations in the United States.

Vaccines against strep throat, genital herpes, parainfluenza (the most common cause of croup and laryngitis), campylobacter (a cause of severe diarrhea), and cholera are all in development phases.

HIV vaccine development is still progressing though don’t look for any vaccine release in the near future.

One final word about the mercury vaccines. With the exception of a few influenza vaccines and vaccines used exclusively in adolescents and adults, no vaccines currently contain mercury. Even so, the American Academy of Pediatrics (http://search.aap.org/aap), the Center for Disease Control (www.cdc.gov/nip/vacsafe/concerns/thimerosal/thimerosal-vacs-facts.htm), and the Institute of Medicine (www.iom.edu/focuson.asp?id=4189) state that there never has been any evidence that the mercury in vaccines ever caused any adverse outcomes — in fact, they say, there is extremely strong evidence that mercury in vaccines did not.

Note: Most of the questions used in my articles are derived from questions I am asked in my practice. I welcome questions from readers, which can be sent to my email address at jmcsdii@erols.com or to my office at 30 Quaker Farms Road, Southbury CT 06488. I cannot respond to all questions nor give medical direction for specific children, but I can give helpful general advice.