Optimizing immunization in pediatric special risk groups

Abstract

This article analyzes the current recommended practices and evidence in the immunization of pediatric ‘special risk groups’. Special risk group patients are at higher risk of vaccine-preventable diseases and hence require additional strategies to maximize protection against these diseases. The special risk groups include those with an underlying chronic disease, some of whom are on immunosuppressive therapy to treat that condition. The article uses four special risk groups (acute lymphoblastic leukemia; preterm birth; juvenile idiopathic arthritis; and inflammatory bowel disease), to highlight the management considerations and potential vaccination strategies. The risks, benefits and timing of vaccination in the setting of immunosuppression require detailed discussion with treating clinicians, in particular the use of live-attenuated vaccines. The immunogenicity of vaccines in these special risk groups helps provide the evidence base for their immunization guidelines. Protection can include ‘cocooning’ (i.e., ensuring appropriate immunizations within the immediate family; e.g., varicella, influenza and pertussis vaccination). Improving timeliness and minimizing missed opportunities to vaccinate individuals with these special risk conditions will also optimize protection from vaccine-preventable diseases.

Keywords::

• chronic diseases
• immunogenicity
• immunosuppressed
• pediatric vaccines

Financial & competing interests disclosure

Nigel Crawford acknowledges support from a National Health and Medical Research Council (NHMRC) of Australia PhD Postgraduate Public Health Scholarship (437031) for his University of Melbourne thesis. The Murdoch Childrens Research Institute research fund has received honoraria for Nigel Crawford sitting on a Wyeth/Pfizer advisory board for pneumococcal vaccines and presentations at conferences and Nigel Crawford investigator-led research project support from CSL. Julie E Bines has investigator-led research on baseline epidemiology of intussusception and post-marketing surveillance of rotavirus vaccines supported by CSL and GSK and is Chair, Adverse Events Committee, Human Rotavirus Vaccine Group, Rotarix Trials, GSK. Julie E Bines and Jim P Buttery have collaboration with BioFarma, Indonesia, for the development of the RV3 Rotavirus Vaccine. The Murdoch Childrens Research Institute research fund has received honoraria for Jim P Buttery sitting on a data safety monitoring board for influenza vaccines (CSL) and GSK conference travel support. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.