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Immunizations: Beyond the Basics

Rachel M. Garber MD1
Edward A. Mortimer Jr MD2
 1 Assistant Professor of Pediatrics, School of Medicine, Case Western Reserve University, and Rainbow Babies and Children's Hospital, Cleveland, OH 44106
2 Professor of Epidemiology and Pediatrics, School of Medicine, Case Western Reserve University, and Rainbow Babies and Children's Hospital, Cleveland, OH 44106

Since Edward Jenner's brilliant demonstration 200 years ago that inoculation of material from a cowpox lesion from one person to another provided protection against smallpox, vaccination programs have reduced morbidity and mortality from infectious diseases remarkably. Many diseases now can be controlled by immunization, and additional vaccines for other infections are anticipated. These developments have been summarized periodically in the American Academy of Pediatrics (AAP) Report of the Committee on Infectious Diseases (Red Book) since 1938. Immunization issues are not always simple; here we review more unusual issues, referring the reader to the Red Book for those that are routine. Recent vaccine developments are reviewed as well as popular misconceptions about contraindications. Many of these issues arise from questions asked by physicians and parents.

General Comments

Pertinent to consideration of the effectiveness of any vaccine is the issue of appropriate dosage. There is no indication for reducing or dividing doses of diphtheria-tetanus toxoids-pertussis vaccine adsorbed (DTP) or any other vaccine, including those given to premature or low-birth weight infants.1 There is no evidence that the frequency of significant reactions is reduced with changed doses. Additionally, there is the possibility that repeated small doses could sensitize a child and increase the chances of adverse reactions.




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R. M. Siegel and C. J. Schubert
Physician Beliefs and Knowledge About Vaccinations: Are Cincinnati Doctors Giving Their Best Shot?
Clinical Pediatrics, February 1, 1996; 35(2): 79 - 83.
[Abstract] [PDF]


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