Immunizing Parents and Other Close Family Contacts in the Pediatric Office Setting

Abstract

Additional strategies are needed to protect children from vaccine-preventable diseases. In particular, very young infants, as well as children who are immunocompromised, are at especially high risk for developing the serious consequences of vaccine-preventable diseases and cannot be immunized completely. There is some evidence that children who become infected with these diseases are exposed to pathogens through household contacts, particularly from parents or other close family contacts. Such infections likely are attributable to adults who are not fully protected from these diseases, either because their immunity to vaccine-preventable diseases has waned over time or because they have not received a vaccine. There are many challenges that have added to low adult immunization rates in the United States. One option to increase immunization coverage for parents and close family contacts of infants and vulnerable children is to provide alternative locations for these adults to be immunized, such as the pediatric office setting. Ideally, adults should receive immunizations in their medical homes; however, to provide greater protection to these adults and reduce the exposure of children to pathogens, immunizing parents or other adult family contacts in the pediatric office setting could increase immunization coverage for this population to protect themselves as well as children to whom they provide care.

Reemergência da coqueluche: perfil epidemiológico dos casos confirmados

“…Esse fato estabelece importante relação com a duração da imunidade conferida pela vacina. Estudos nacionais e internacionais vêm apontando que a perda da imunidade, após cerca de dez anos do recebimento da última dose da vacina, torna adolescentes e adultos susceptíveis à infecção e, consequentemente, transforma-os em fonte de infecção para os lactentes [4][5][6]9,[11][12][13][15][16][17] . Estudo realizado nos Estados Unidos verificou que, após a quinta dose com a vacina acelular contra coqueluche, a chance de adquirir a doença aumenta, em média, 42% a cada ano 18 .…”

“…Tal fato mostra-se preocupante, pois, apesar dos altos índices de cobertura vacinal, isso mostra não se refletir em uma adequada vacinação nas diferentes faixas etárias. Sabe-se que, para que se desenvolva uma adequada imunidade contra a doença, é necessário que se garanta a completude do esquema vacinal, a qual se dá com o recebimento de três doses da vacina e pelo menos um reforço 1,4,15 . Nos locais onde as coberturas vacinais são elevadas ou heterogêneas, a doença acomete, principalmente, adolescentes, adultos jovens e lactentes não vacinados ou com esquema vacinal incompleto.…”

“…Portanto, observa-se o ressurgimento da doença nesses grupos devido à perda da imunidade com o passar dos anos. Tal fato contribui ainda mais para a ocorrência das doenças entre os susceptíveis, o que abrange também aqueles inadequadamente vacinados, como os lactentes menores de 6 meses 1,4,12,15,16,18 . A disponibilidade das vacinas contra coqueluche e o seu emprego universal ainda são a principal solução para o combate do ressurgimento da doença 4 .…”

A behavioral economics intervention to increase pertussis vaccination among infant caregivers: A randomized feasibility trial

“…Implementation of cocooning has proved challenging [5,12], and recent data suggest Tdap coverage rates as low as 10% among adults who have close contact with infants [13,14]. Several barriers to Tdap vaccination of household contacts have been identified, including lack of awareness, limited access to Tdap vaccines, and inadequate funding and reimbursement for adult vaccinations, which are not routinely covered by private or public health insurance plans in the United States [14].…”

“…Several barriers to Tdap vaccination of household contacts have been identified, including lack of awareness, limited access to Tdap vaccines, and inadequate funding and reimbursement for adult vaccinations, which are not routinely covered by private or public health insurance plans in the United States [14]. Interventions to vaccinate mothers and other caregivers in obstetrician offices and in the hospital during the postpartum period have had mixed results [15,16].…”