Protecting the most vulnerable

Although pediatric gastroenterologists are not on the front lines of the vaccine controversies, we should add our voices to support immunizations.  Some of our immunocompromised patients are among the most vulnerable and rely on herd immunity to lessen their chances of serious infection.  When healthy children and adults do not receive their immunizations, this does not only increase their risk of infections but the risk to others.

A perfect example of this is highlighted in NEJM 2012; 366: 391-92.  In 2010, California reported over 9000 cases of pertusis; of these cases, 89% occurred in infants less than 6 months.  This population is too young to be adequately immunized.  Ten of these infants died.

The author recommends trying to persuade those who are hesitant to proceed with immunizations.  Parents who are opposed based on personal beliefs will not be persuaded.

  • Remove socioeconomic barriers to vaccination
  • Enforce school entry requirements; it should not be easier to opt out of immunizations than to receive them
  • Aggressively address misinformation
  • Learn to use persuasion effectively: http://www.cdc.gov/vaccines/conversations

Additional references:

  • -NEJM 2011; 365: 1108. RV vaccine resulted in 64,000 less hospitalizations in US between 2007-2009.
  • -NEJM 2010; 362: 289, 299, & 358. Rotavirus vaccines lowering death rate in Africa & Mexico.
  • -NEJM 2011; 364: 2283. Rotavirus vaccine: risk of intussception ~1:50,000-1:70,000; thus could cause ~96 cases per year. Vaccine at same time prevented 80,000 hospitalizations & 1300 deaths in Brazil & Mexico.
  • -Gastroenterology 2007; 132: 1287. Two decades of HBV vaccination in Taiwan
  • -NEJM 2007; 16: 1275, 1278, 1281.  Medical evidence refuting Thimersol toxicity; yet many vaccine cases in litigation
  • -Liver Transplant 2008; 14: 1389.  Vaccine policies:  MMR/Varicella can be given as early as 6 months of age. Must give 3-4weeks before Tx. Can give inactivated ~6-12 mo p-OLT. Except for oral polio, good idea for contacts to get all their immunizations.
  • -Inflamm Bowel Dis 2009;15:1410–1416.  Vaccination Strategies for Patients with Inflammatory Bowel Disease on immunomodulators and biologics

Live Virus Vaccines, Generally Contraindicated in Patients Receiving Immune-Suppressive Therapy:

Anthrax vaccine
Intranasal influenza
Measles-mumps-rubella (MMR)
Polio live oral vaccine (OPV)
Rotavirus
Smallpox vaccine
Tuberculosis BCG vaccine
Typhoid live oral vaccine
Varicella
Yellow fever

12 thoughts on “Protecting the most vulnerable

  1. Thank you for posting this article…
    It is research like this that will help refocus attention on important scientific-driven public knowledge about the years of research and then policy-driven vaccinations which had a significant impact on eliminating a host of diseases that wiped out populations.

    Science like this will hopefully, reverse the emotion-based, internet driven media fueled culture of being resistant to vaccination for fear of the potential neurological and cognitive (i.e. autism) sequelae.

  2. Pingback: Norovirus -now more important than rotavirus | gutsandgrowth

  3. Pingback: Update on pertusis epidemic | gutsandgrowth

  4. Pingback: Vaccine successes and ambitions | gutsandgrowth

  5. Pingback: “Too many vaccines and autism” is debunked | gutsandgrowth

  6. Pingback: Immunization Recommendations from CDC 2013 | gutsandgrowth

  7. Pingback: “Because It Doesn’t Just Happen to Other People” | gutsandgrowth

  8. Pingback: Why Doctors Don’t Want Unvaccinated Children in Their Practice | gutsandgrowth

  9. Pingback: More Measles Cases -Here’s the Data | gutsandgrowth

  10. Pingback: 1400 Different Immunization Schedules -What Could Go Wrong? | gutsandgrowth

  11. Pingback: Just Saying…Vaccines Don’t Trigger Inflammatory Bowel Disease | gutsandgrowth

  12. Pingback: Varicella and Zoster Infections in Children with Inflammatory Bowel Disease | gutsandgrowth

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s

This site uses Akismet to reduce spam. Learn how your comment data is processed.