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Vaccination strategies for children with specific medical conditions: a paediatrician's viewpoint
1Centre for Vaccinology and Neonatal Immunology, University Children's Hospital of Geneva, Switzerland. siegrist@cmu.unige.ch
Insights
Vaccine administration is safe and effective for most children, even those with medical conditions. Special strategies may be needed for premature infants, but most children can receive immunizations without delay.
Area of Science:
- Pediatrics
- Immunology
- Public Health
Background:
- Careful attention to the benefit/risk ratio of vaccination is crucial for children with underlying medical conditions.
- Existing data indicate that most children can be safely and effectively immunized.
- Specific strategies may be necessary for certain pediatric populations, including premature infants.
Purpose of the Study:
- To review existing data informing immunization practices for children with medical conditions.
- To identify areas requiring further research for specific immunization recommendations.
- To propose interim attitudes for immunization in complex pediatric cases.
Main Methods:
- Review of available data on vaccine safety and efficacy in children with various medical conditions.
- Analysis of expert society recommendations on pediatric immunization.
- Identification of knowledge gaps and areas for future study.
Main Results:
- Vaccine administration is generally safe and efficient for most children, including those with atopic conditions or mild infections.
- Premature infants may benefit from deferred immunization or additional vaccine doses.
- Seizure history (without encephalopathy) and mild infections are not contraindications for pertussis immunization.
- Children at high risk for pneumococcal disease require repeated immunization after age 2.
- Immunizing family members can enhance protection for immunodeficient children.
Conclusions:
- Current data support the safety and efficacy of most childhood immunizations, even for those with underlying conditions.
- Further studies are needed to refine recommendations for specific pediatric groups and complex cases.
- Interim approaches can guide immunization practices while awaiting additional evidence.
Unlabelled:
Children with underlying medical conditions have to be given careful attention at the time of planned immunization in order to define the individual benefit/risk ratio of a given vaccination. Analysis of available data demonstrates that vaccine administration is indeed both safe and efficient in most children. Immunization of very premature infants may require specific vaccine strategies consisting either of short-term deferral of immunization or the addition of an extra vaccine dose. With the exception of influenza immunization of children with egg allergy, immunization is safe and efficient in atopic or asthmatic children. A family or personal history of seizure without evidence of encephalopathy is no longer considered a limitation to pertussis immunization. Children with mild intercurrent infection can be immunized without further delay. Repeated pneumococcal immunization should be offered to children at high risk of pneumococcal disease after the age of 2 years. Optimal protection of immunodeficient children could include immunization of family members.
Conclusion:
This article attempts to review existing data upon which immunization practices have been recommended by expert societies. It outlines some areas that need additional studies before specific recommendations can be made and it proposes attitudes that could be considered in the meantime.