A nationally prominent vaccine expert proposes that physicians and public health officials make a stronger effort to inform parents and patients about the vaccine and its potential benefits. He adds that health insurance companies should consider paying for such vaccines when parents and patients request them.
Given high health care costs and limited public resources, implementing mass vaccination against meningococcal disease may not be cost-effective public policy, but a parent's individual decision about the vaccine is a different issue, says Paul A. Offit, M.D., chief of Infectious Diseases and director of the Vaccine Education Center at The Children's Hospital of Philadelphia. Dr. Offit is the lead author of a commentary in the Dec. 11 issue of the New England Journal of Medicine.
"Although the meningococcal vaccine may be an inefficient use of public health resources, the decision to receive the vaccine could save lives and prevent the devastating effects of meningococcal infection," writes Dr. Offit. Dr. Offit's co-author is Georges Peter, M.D., of the Division of Pediatric Infectious Diseases, Rhode Island Hospital, Providence, R.I.
Invasive meningococcal infection strikes an estimated 2,200 to 3,000 U.S. patients annually. Some 10 percent of those patients die, sometimes within hours of the first signs of illness, from meningitis (inflammation of the brain's lining) or sepsis (bloodstream infection). Survivors may suffer hearing loss, seizures, mental retardation or limb amputation.
The contagious disease is most likely to strike infants under the age of one--for whom the current vaccine is, unfortunately, not effective. The infection may also affect older children and adults in close proximity to one another. Outbreaks that occur in college dormitories, schools and child-care centers may cause considerable anxiety in a community.
The meningococcal vaccine is routinely given to military recruits. The Centers for Disease Control and the American Academy of Pediatrics recommend that students entering college be informed of the risks of the disease and benefits of the vaccine.
However, neither agency routinely recommends that the vaccine be given, and not all health plans reimburse the cost (approximately $80). Thus, parents may face the decision of whether to pay out of pocket to vaccinate their child against a one in 125,000 chance of contracting meningococcal infection.
Many parents may not even be aware of the meningococcal vaccine, because it is not routinely recommended. The authors urge physicians to inform parents and patients about the vaccine during routine adolescent visits. They also recommend that physical examination forms required for school, camp and sports activities include information about the vaccine and that school nurses and parent-teacher organizations disseminate information through the schools.
The authors suggest that health maintenance organizations and health insurance companies consider paying for these vaccinations when parents or patients request them. "The meningococcal vaccine is safe and effective, and is the only currently available method to protect against invasive meningococcal disease," added Dr. Offit.
About the Expert:
Paul A. Offit, M.D., is the director of the Vaccine Education Center and chief of Infectious Diseases at The Children's Hospital of Philadelphia. An internationally recognized expert in virology, immunology and vaccine safety, he is a former member of the Advisory Committee on Immunization Practices to the Centers for Disease Control and Prevention. In addition to publishing more than 90 peer-reviewed scientific papers, Dr. Offit is co-author of the book "Vaccines: What You Should Know." He frequently lectures to national and international healthcare organizations about vaccine safety and efficacy.
Under the direction of Dr. Offit, The Children's Hospital of Philadelphia established The Vaccine Education Center in October 2000 to respond to the rapidly growing need for accurate, up-to-date, science-based information about vaccines and the diseases they prevent. The Center is a nationally recognized educational resource for healthcare professionals and parents, providing information on the full spectrum of vaccine-related topics. Approximately 400 people per day visit the Center's comprehensive Web site (vaccine.chop.edu).
Founded in 1855 as the nation's first pediatric hospital, The Children's Hospital of Philadelphia is ranked today as the best pediatric hospital in the nation by U.S. News & World Report and Child magazine. Through its long- standing commitment to providing exceptional patient care, training new generations of pediatric healthcare professionals and pioneering major research initiatives, Children's Hospital has fostered many discoveries that have benefited children worldwide. Its pediatric research program is among the largest in the country, ranking second in National Institutes of Health funding. In addition, its unique family-centered care and public service programs have brought the 430-bed hospital recognition as a leading advocate for children and adolescents from before birth through age 19. For more information, visit http://www.chop.edu.
Journal
New England Journal of Medicine