from Contemporary Pediatrics
Posted 05/22/2003

Abstract

The sheer number of recommended childhood immunizations makes it imperative that pediatricians be able to recognize and treat allergic reactions and identify those children in whom revaccination is contraindicated.

Introduction

Routine childhood immunizations represent one of the greatest advances in public health of the 20th century. Previously lethal childhood infections -- measles, paralytic poliomyelitis, congenital rubella -- are no longer commonly seen. Invasive Haemophilus influenzae type b (Hib) disease has been virtually eradicated. In recent years, the incidence of varicella has appreciably declined. However, as the number of routine immunizations has increased -- the average child born in 2002 will receive 23 immunizations for 11 different diseases by the time he is 6 years old -- so have public concerns about vaccine safety.

In lay circles, blame for a variety of conditions has been laid at the feet of childhood vaccines; addressing those concerns is beyond the scope of this article. This review focuses instead on clinical adverse reactions -- allergic and nonallergic -- to required childhood vaccinations. Of the 1.9 billion doses of vaccines administered in the United States between 1991 and 2001, only 2,281 cases of allergic reactions were reported.^[1] (By way of comparison, the estimated incidence, in the pediatric population, of allergic reactions to food of any kind is 6% to 8%; the incidence of allergy to an antibiotic in the same population is reported to be 7.3%.^[2]) Although allergic reactions to vaccines are rare, the general pediatrician must nonetheless be able to recognize and treat such reactions, as well as the far more common nonallergic reactions. What's more, in light of the multiple dose regimens of many pediatric vaccines, the general practitioner must be able to identify those children in whom revaccination is contraindicated to avoid a potentially life-threatening event.