Frequency and cost of live vaccines administered too soon after prior live vaccine in children aged 12 months through 6 years, 2014-2017

Risk of Inappropriately Timed Live Vaccination After Pediatric Cardiovascular Surgery

OBJECTIVE

The American Academy of Pediatrics (AAP), Advisory Committee on Immunization Practices (ACIP), and Centers for Disease Control and Prevention (CDC) recommend delaying live vaccinations up to 11 months after transfusions of certain blood products due to the risk of immunoglobulins decreasing immunization efficacy. Because vaccination schedules recommend live immunizations at 12 months, infants aged 5 to 12 months who undergo cardiac surgery requiring blood products are potentially at risk for improper vaccination. The objective of this study was to identify the risk of inappropriately timed live vaccination in pediatric patients after cardiovascular surgery.

METHODS

This single-center, retrospective chart review included 345 patients 5 to 12 months of age who underwent cardiovascular surgery between January 1, 2010, and December 31, 2016. Included patients received packed red blood cells (PRBCs) and/or platelets during the surgical admission and a live vaccine within the first 18 months of life. The primary endpoint was the incidence of live vaccine administration within 7 months of receiving PRBCs and/or platelets.

RESULTS

Of the 345 included patients, 67% (n = 230) were inappropriately vaccinated after receiving platelets and/or PRBCs during cardiac surgery.

CONCLUSIONS

Infants who undergo cardiac surgery between the ages of 5 and 12 months are at risk for inappropriate live vaccination timing. A clinically significant percentage of pediatric patients who received blood products during a cardiac surgical admission later received live vaccines at times that were inconsistent with AAP, ACIP, and CDC recommendations. Future interventions aimed at educating providers and patients may be warranted.

Clinical Decision Support for Immunization Uptake and Use in Immunization Health Information Systems

CONTEXT

In the United States, immunization recommendations and their associated schedules are developed by the Advisory Committee on Immunization Practices (ACIP). To assist with the translation process and better harmonize the outcomes of existing clinical decision support tools, the Centers for Disease Control and Prevention (CDC) created clinical decision support for immunization (CDSi) resources for each set of ACIP recommendations. These resources are continually updated and refined as new vaccine recommendations and clarifications become available and will be available to health information systems for a coronavirus disease 2019 (COVID-19) vaccine when one becomes available for use in the United States Objectives: To assess awareness of CDSi resources, whether CDSi resources were being used by immunization-related health information systems, and perceived impact of CDSi resources on stakeholders' work Design: Online surveys conducted from 2015-2019 including qualitative and quantitative questions Participants: The main and technical contact from each of the 64 CDC-funded immunization information system (IIS) awardees, IIS vendors, and electronic health record vendors Results: Awareness of at least one resource increased from 75% of respondents in 2015 to 100% in 2019. Use of at least one CDSi resource also increased from 47% in 2015 to 78% in 2019. About 80% or more of users of CDSi are somewhat or very highly satisfied with the resources and report a somewhat or very positive impact from using them Conclusion: As awareness and use of CDSi resources increases, the likelihood that patients receive recommended immunizations at the right time will also increase. Rapid and precise integration of vaccine recommendations into health information systems will be particularly important when a COVID-19 vaccine becomes available to help facilitate vaccine implementation.

Inflammasomes as Targets for Adjuvants

Inflammasomes are an essential part of the innate immune system. They are necessary for the development of a healthy immune response against infectious diseases. Inflammasome activation leads to the secretion of pro-inflammatory cytokines such as IL-1β and IL-18, which stimulate the adaptive immune system. Inflammasomes activators can be used as adjuvants to provide and maintain the strength of the immune response. This review is focused on the mechanisms of action and the effects of adjuvants on inflammasomes. The therapeutic and prophylaxis significance of inflammasomes in infectious diseases is also discussed.