Assessment: Neurologic risk of immunization [RETIRED]
1999; Lippincott Williams & Wilkins; Volume: 52; Issue: 8 Linguagem: Inglês
10.1212/wnl.52.8.1546
ISSN1526-632X
Autores Tópico(s)Intramuscular injections and effects
ResumoImmunization programs are among the most cost-effective public health measures.They are the first line of defense against infectious disease, and when abandoned, epidemics often follow.Vaccines are biological products and some differences exist from lot to lot.Although no vaccine is 100% effective or safe, modern vaccines have an excellent safety record.Smallpox was eradicated by a global immunization program, and the eradication of poliomyelitis is within reach for the year 2000.Physicians are quick to blame vaccines for adverse neurologic events that follow immunizations.This bias probably originated with the first vaccines for rabies.They were grown in the CNS of mature animals, contained myelin basic protein, and often caused encephalomyelitis.In fact, no vaccine currently licensed for use in the United States is known to cause or exacerbate a demyelinating disorder of the CNS.The United States maintains the most extensive obligatory childhood immunization schedule of any country, but has one of the worst records of infant immunization (table 1).The main reasons for the low immunization rate are deficiencies in health care delivery and access in the public sector.Full immunization is only realized at age 5, when it becomes prerequisite for school entry.Immunization practices are recommended to the Surgeon General by the Advisory Committee on Immunization Practices (ACIP) of the Centers of Disease Control and Prevention.New recommendations of the ACIP are published in Morbidity and Mortality Weekly Reports and are the standard of care for immunization practice.The annual influenza vaccine is recommended by the ACIP for "any person who wishes to reduce the chance of becoming infected with influenza."One would think this should be everyone.Several vaccines are recommended for specific classes of adults: the aged and infirm, health care professionals, the military, and those traveling to countries where the risk of certain infectious diseases is high.Unfortunately, adults as a group are hesitant to accept immunization, and adult immunization rates are usually below needed levels.Neurologists have assumed the role of principal care providers for adults with certain neurologic disorders.As part of this role, they must recommend, and sometimes provide, vaccines for their patients.Table 1 Schedule of routine immunization of healthy infants and children Recommended age Immunizations Birth HBV 2 mo DTaP, HBV, HIB, OPV, or eIPV 4 mo DTaP, HIB, OPV, or eIPV 6 mo DTaP, HBV, HIB 12-15 mo DTaP, HIB, MMR, OPV, or eIPV, Var 4-6 y DTaP, MMR, OPV, or eIPV 11-12 y DT, MMR, and Var if not given at or after 12 mo
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