AAP: Immunizing adults in pediatric offices offers additional protection for children

Lessin HR. Pediatrics. 2012;129:e247–e253.

For young children who have not yet received the complete primary immunization series, as well as those who are immunocompromised, additional strategies are needed to protect them from vaccine-preventable diseases, according to the American Academy of Pediatrics.

Therefore, the AAP released this week a technical report that details the advantages and potential concerns involved with immunizing parents and other close family contacts in 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,” the statement said.

According to the report, pediatric offices may choose to offer vaccinations if the practice is acceptable to both pediatricians and the adults who are to be vaccinated, and this option should not deviate from the pediatric standard of care.

To avoid undermining the adult medical home, the AAP advised that pediatricians can inquire about the availability and likelihood that the adult will be vaccinated in their medical home, or notify the adult’s primary care provider if vaccines are administered. In addition, pediatricians can educate adults about the value of immunizations.

If a pediatrician vaccinates parents and family contacts, appropriate indications, contraindications and precautions should be assessed and documented in an immunization/medical record; a vaccine information statement and necessary consent to treatment should; and the vaccines should be recorded in vaccine registries.

The AAP report also stated that if a pediatric practice chooses to provide immunizations to parents and close family contacts, the focus should be centered on the influenza and tetanus-diphtheria-pertussis vaccine.

Liability issues surrounding adult immunizations in the pediatric office may be discussed with the malpractice insurance carriers for the pediatric practice, which may vary by state. However, pediatricians providing influenza and Tdap vaccinations would be protected by the Vaccine Injury Compensation Program, according to the AAP report, which was co-written by Infectious Diseases in Children Editorial Board member Kathryn M. Edwards, MD.

Issues related to insurance regulations can be investigated by individual pediatricians, and method of payment for applicable adults should be clearly outlined.

The AAP report concluded with a statement about the need for further research “to address the clinical implications of immunizing parents and close family contacts in the pediatric office, patient satisfaction, public health benefit, effects on adult medical homes, and cost-effectiveness.”

Richard F. Jacobs

Protection of young infants in the first 6 months of age would be enhanced through passive antibody transfer from the mother during a term pregnancy. Although we have never had a greater opportunity to reduce vaccine-preventable diseases in infants and children, any additional protection for this vulnerable population would be welcome. This article recommends immunizing parents of young infants and children to enhance the protective effect of our immunization programs. For the youngest of infants, a population in which diseases such as pertussis has the highest mortality, immunizing adult women (even in pregnancy) with Tdap would be beneficial. The most significant barrier to this strategy will be the office practice of pediatricians who are struggling to break even on their immunization programs targeting their pediatric patients. Although influenza vaccine programs where ‘one-stop shopping’ has proven effective, this would require an orchestrated effort on behalf of public and private payers and providers to make it successful and not a financial burden for the practicing physician, which would doom its successful implementation.

Richard F. Jacobs, MD
Chief Medical Editor, Infectious Diseases in Children

Disclosure: Dr. Jacobs reports no relevant financial disclosures.

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