The Evolving Childhood Vaccine Schedule: Considerations for Those With Chronic Diseases, Immunocompromise

Although pediatric populations with developing chronic conditions or those who are at risk of being immunocompromised carry a potentially heavier burden for severe respiratory diseases such as respiratory syncytial virus (RSV) or influenza, Mary Koslap-Petraco, DNP, PNP-BC, CPNP, clinical assistant professor at Stony Brook University School of Nursing, pointed out the importance of all children obtaining the American Academy of Pediatrics’ recommended vaccines.

“We still want to vaccinate all of those children. It was very interesting when Dr Nachman was talking about the RSV vaccine, and that's supposed to be only for high-risk children. In my opinion, every baby's a high-risk child,” said Koslap-Petraco. “They all deserve the vaccine, and that's kind of the way that we approach it with these high-risk children. There's nothing changed for your child. We want to make sure that we give as much vaccine protection to your child as we possibly can because your child either has an immune system issue or has a chronic illness or something else.”

She also pointed out that young children can go from being perfectly healthy to developing chronic conditions such as asthma after having vaccine-preventable diseases such as influenza or RSV.

“We have clear data that RSV can cause chronic lung disease,” Koslap-Petraco said. “I was involved with a study in Europe with that and with parents talking about how long it took their children to recover and the reactive airway disease, which is the name before you label a child with asthma after they've had RSV disease.”

Koslap-Petraco has not only treated patients with these diseases but has also witnessed close family members being affected by these diseases, so she knows firsthand their devastation.

Sharon Nachman, MD, chief of the Division of Pediatric Infectious Disease at Stony Brook Children's Hospital, said there will be variability in the consequences associated with children not being vaccinated, with some health events happening as early as the spring and others potentially taking decades to realize.

“One of the things that I worry about with these changes and families hearing something is not recommended [is that] they take it to be, if it's not recommended, ‘I for sure don't need it.’ And unfortunately, the outcome of the ‘I don't need it’ for some of these will come relatively soon. Next year, in the spring, we'll have our rotavirus epidemics. Rotavirus is a spring event. So we'll see that hitting us. Hepatitis B is a decades-long problem. Two decades from now, we're going to see hepatitis, cirrhosis, liver cancers, and at that point, no one's going to remember who in the world said, ‘Don't give kids hepatitis B vaccine.’ By then, it's going to be too late,” Nachman said.

Jacinda Abdul-Mutakabbir, PharmD, MPH, associate professor of clinical pharmacy and antimicrobial resistance researcher at the University of California San Diego, pointed out another unintended consequence in that many providers who have been practicing for years have never had to treat vaccine-preventable diseases. This could leave a dangerous void in clinicians not being trained to care for these patients as well as a lack of therapeutics.

“I was talking to someone who was about 20 years my senior, and they had told me that they had never treated measles before. They had never seen it…. Well, now it becomes a discussion of, when do we treat people for these diseases? Because now they're going to exist, because we're going to have fewer folks who get vaccinated against them. And I think about that person who was in their 50s who had never treated it before. So now I think about myself, or I think about the clinicians whom I train and those who will be trained subsequently. Are we prepared to even address, from an antimicrobial standpoint, these diseases that we may see?” Abdul-Mutakabbir said.

Nachman pointed out the lack of treatment for polio, RSV, and rotavirus, to name a few, and that most patients receive supportive care to manage symptoms. Many of these diseases do not have cures, and there are risks of potential mortality.

“We know the effectiveness of these vaccines. We know their safety profile. We know how well they work. How much more can we say than that?” she asked.