Counseling Parents on Infant Immunizations

Editor's Note: In recognition of National Infant Immunization Week, a global initiative that runs from April 23-30, we've provided information and resources to keep pharmacists up-to-date on the latest FDA approvals and current guidelines for immunizations in infants and children.

By Kate H. Gamble, Senior Editor

The recent proliferation of health-related Internet sites and social networks has given patients access to more information than ever before on a number of medical topics, including vaccines. As a result, parents are more likely to voice concerns about vaccine safety and ask questions about the necessity of certain immunizations.

For pediatricians and family physicians that have a short window of time with each patient, this can pose a significant challenge. For pharmacists, however, it presents an opportunity to take on a larger role in educating parents about the importance of vaccines and helping them to stay on track.

With all of the media coverage that vaccinations have received in the past year—some of which has been negative, there is a huge demand for information, even in regions where immunization rates are high. In a recent Pediatrics study, pediatricians reported that vaccine safety discussions with parents have begun to dominate well-child visits, in some cases compromising the physicians’ ability to focus on other health needs.

And even then, some parents still balk at the idea of immunizing their child. Another study from the American Journal of Preventative Medicine found that during a typical month, 79% of physicians reported at least 1 vaccine refusal, and 89% received at least 1 request from parents to spread out vaccinations.

It’s a trend that providers want to see reversed; without parental acceptance, immunization rates could fall, causing children to become more vulnerable to preventable diseases. And this, many believe, is where pharmacists can make a significant impact.

As one of the most accessible health care professionals, “pharmacists can be instrumental in providing patients with pertinent information to make informed choices when it comes to immunizations, in terms of the benefits as well as the risks,” according to a 2010 Pharmacy Times article. Pharmacists “may be able to ease the fears of many patients by providing them with the facts as well as the significant risks associated with not being vaccinated.”

The Latest on Infant Immunizations

In order to assume that critical role, it is critical that pharmacists are up-to-date on current immunization guidelines, and kept informed on new vaccinations and indications. Last week, the FDA approved the use of Menactra in children as young as 9 months for the prevention of invasive meningococcal disease caused by Neisseria meningitidis serogroups A, C, Y and W-135. Menactra, which is given as a two-dose series, three months apart, was previously approved for use in patients aged 2 through 55 years.

Neisseria meningitidis is a leading cause of meningitis in young children, according to the FDA. Even with appropriate antibiotics and intensive care, between 10% and 15% of patients who develop meningococcal disease die from the infection, and another 10% to 20% suffer complications such as brain damage or loss of limb or hearing.

Although the rates of meningococcal disease are low in the United States, infants and toddlers are more susceptible to getting the illness, which progresses rapidly and can cause death within hours. Early symptoms are often difficult to distinguish from influenza and other common illnesses, making it critical that infants are vaccinated.

Earlier this year, the CDC’s Advisory Committee on Immunization Practices issued updated clinical guidelines for immunization schedules, including the following changes pertaining to infants:

• Hepatitis B (HepB) vaccine: Infants who did not receive a dose at birth should receive three doses of HepB on a schedule of 0, 1, and 6 months.
• Influenza vaccine: Children aged 6 months to 8 years who did not receive the 2009 monovalent H1N1 vaccine should receive two doses of the 2010—2011 seasonal influenza vaccine.

To access the 2011 Child & Adolescent Immunization Schedules for patients aged 0-6 years and 7-18 years as well as “catch-up schedules,” visit this CDC page, which offers color posters, pocket-size printouts, and downloadable apps for health care providers.

For more guidelines and recommendations, click on the links below:

• Recommendations for the Prevention of Streptococcus pneumoniae Infections in Infants and Children: Use of 13-Valent Pneumococcal Conjugate Vaccine and Pneumococcal Polysaccharide Vaccine
• Recommendations for the Prevention and Control of Influenza in Children, 2010—2011
• Immunization of Preterm and Low Birth Weight Infants

For more resources on immunizations, click on the links below.

• How to Communicate With Vaccine-Hesitant Parents
• Talking with Parents about Vaccines for Infants
• ASHP Guidelines on the Pharmacist’s Role in Immunization
• Common Questions Parents Ask About Infant Immunizations