Pediatric Immunization: Current Recommendations and Controversies

Abstract

The prevention of life-threatening childhood infections through vaccination is a remarkable achievement in the history of medicine. Although 98% of all American children are fully immunized at age 5 to 6 years because state laws require it for school entry, in 1991 less than half of children younger than 2 years of age were up to date for their diphtheria, tetanus, and pertussis (DTP); polio; measles, mumps, and rubella (MMR), and Haemophilus influenzae type b (HIB) immunizations. These children are at greatest risk for life-threatening infection. The last decade has seen many changes in the recommendations for routine childhood immunization. The resurgence of measles led to the addition of a second measles immunization. The introduction of the HIB vaccine has had a significant impact on the incidence of dreaded childhood meningitis. The effort to reduce adverse events associated with the pertussis component of the DTP vaccine resulted in the development of a new pertussis vaccine. The oral polio vaccine (OPV) is still being used with much debate on the merits of the inactivated polio vaccine (IPV). The hepatitis B vaccine was recently incorporated into the childhood immunization schedule in an attempt to eliminate this costly and devastating disease. The childhood disease chickenpox may become a disease of the past with the recent introduction of the varicella vaccine. With the multiplicity of new vaccines on the horizon, childhood immunization schedules will become more complex. To ameliorate an increase in the number of injections and physician visits, major efforts are currently being devoted to the development of combination vaccines, and the latest routine childhood immunization schedule has made every attempt to provide flexibility. The Children's Vaccine Initiative (CVI) defines a goal of developing a single supervaccine that "could be given once at or near birth, provide immunity for life, require no boosters, permit storage without refrigeration, obviate the use of needles and syringes and protect against as many as 20 diseases at once." To achieve this goal, enormous investments in research and development will be necessary. In the meantime, pharmacists can do much to encourage good immunization practices in their daily interaction with patients, and in so doing further the goals of pharmaceutical care. Copyright © 1996 by W.B. Saunders Company