▸ Have we forgotten chickenpox? The average pediatric resident (as well as many young attendings) has never seen clinical varicella. Cases have steadily declined 80%–85% in surveillance sites since licensure of the vaccine. From 1995 to 2001, varicella hospitalizations declined by 72%, and deaths among those 50 years old and younger decreased by 75% or more. A second dose of varicella vaccine is recommended at 4–6 years of age since we learned that 15%–24% of children who have received one dose are not fully protected. Additionally, one dose of the vaccine may not provide immunity into adulthood, when chickenpox is more severe. The Advisory Committee on Immunization Practices also recommends that children, adolescents, and adults who previously received one dose receive a second. The future epidemiologic impact of this disease is not entirely clear.
▸ How is the new vaccine to prevent cervical cancer being received? The licensure and implementation of the human papillomavirus vaccine has challenged pediatricians to educate themselves and their families about the importance of adolescent immunization programs. The Infectious Diseases Society of America is working on a document delineating the working principles and actions needed to strengthen U.S. adult and adolescent immunization coverage. Pediatricians are encouraged to offer immunization at all encounters with teens, and financial structures to ensure opportunities for immunization in nontraditional settings (school-based clinics) are being discussed. Getting public and private payers to provide coverage for vaccines is key, and is a current barrier for some physicians to providing immunizations.
▸ Speaking of adolescent immunization, is eradication of whooping cough achievable now that the adolescent/adult formulation of tetanus-diphtheria-acellular pertussis vaccine (Tdap) has been licensed? Although the incidence of pertussis in North America declined by more than 90% during the last half century as a result of universal childhood pertussis immunization, there has been a steady increase in cases during the last decade, particularly among adolescents and adults. One study found that universal immunization of adolescents 10–19 years old would be expected to prevent between 400,000 and 1.8 million cases and would save between $1.3 billion and 1.6 billion. Pediatricians should also encourage the use of Tdap vaccine for adults (including themselves) who will have close contact with an infant less than 12 months old, ideally at least 1 month before beginning such contact.
▸ What is the risk of Guillain-Barré syndrome in adolescents who receive meningococcal conjugate vaccine? As of September 2006, 17 cases of GBS had been confirmed within 1 month of vaccination. Based on current data, the number of excess cases of GBS for every 1 million doses distributed to persons aged 11–19 years is approximately 1.25 (CI = 0.058–5.99). Although a surge of cases following vaccine licensure has not been noted, the timing issue is interesting in that most cases occurred 2 weeks after the patient received the vaccine.