Letters to the Editor

Importance of Vaccinations for Close Contacts and Caregivers

Am Fam Physician. 2008 Jun 15;77(12):1664.

Original Article: Outpatient Care of the Premature Infant

Issue: October 15, 2007

Available at: http://www.aafp.org/afp/20071015/1159.html

to the editor: Drs. LaHood and Bryant should be commended for outlining the need for vigilant health care screening of the premature infant, especially for emphasizing the importance of influenza vaccinations for close contacts and caregivers, who can serve as reservoirs and agents of disease transmission.

However, two points from the article regarding premature infants and vaccination require explanation. First, administration of acellular pertussis vaccine as part of a tetanus toxoid, reduced diphtheria toxoids, and acellular pertussis vaccine (Tdap; Adacel) is recommended for all close contacts and caregivers of children younger than one year.1 As with influenza, infected parents can transmit pertussis to their preterm infants. A 2004 study pointed to an adult contact (parent or grandparent) in almost all of the 264 infant cases of pertussis studied.2

In the 1990s, between 29 and 51 percent of infant deaths caused by pertussis were in children younger than 37 and 35 weeks' gestation, respectively.3 Preterm infants also produce lower antibody levels in response to vaccination against pertussis infection.4 Providing complete protection and optimizing outpatient care of preterm infants against vaccine-preventable diseases requires administration of Tdap to contacts of preterm infants as part of an overall vaccination regimen.

Secondly, the authors note that the Advisory Committee on Immunization Practices supports rotavirus vaccination of preterm infants after six weeks of age. This recommendation was based on a prelicensure trial of live, oral rotavirus vaccine in 2,070 preterm infants (25 to 36 weeks' gestation; median age 34 weeks).5 Rotavirus vaccine has not been studied; thus, its use cannot be recommended in children younger than 25 weeks' gestation. As larger numbers of premature infants survive, the key points discussed here and in the article are important to manage the complex medical needs of this unique patient population.

Author disclosure: Nothing to disclose.

References

1. Bisgard KM, Pascual FB, Ehresmann KR, et al. Infant pertussis: who was the source? Pediatr Infect Dis. 2004;23(11):985–989.

2. Vitek CR, Pascual FB, Baughman AL, Murphy TV. Increase in deaths from pertussis among young infants in the United States in the 1990s. Pediatric Infect Dis. 2003;22(7):628–634.

3. Washburn LK, O'Shea TM, Gillis DC, Block SM, Abramson JS. Response to Haemophilus influenzae type b conjugate vaccine in chronically ill premature infants. J Pediatr. 1993;123(5):791–794.

4. Parashar UD, Alexander JP, Glass RI, for the Advisory Committee on Immunization Practices (ACIP), Centers for Disease Control and Prevention (CDC). Prevention of rotavirus gastroenteritis among infants and children. Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2006;55(RR-12):1–13.

5. Vesikari T, Matson DO, Dennehy P, et al., for the Rotavirus Efficacy and Safety Trial (REST) Study Team. Safety and efficacy of a pentavalent human-bovine (WC3) reassortant rotavirus vaccine. N Engl J Med. 2006;354(1):23–33.

Send letters to Kenneth W. Lin, MD, MPH, Associate Deputy Editor for AFP Online, e-mail: afplet@aafp.org, or 11400 Tomahawk Creek Pkwy., Leawood, KS 66211-2680.

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