Darby O’Donnell, JD Alliance for Patient Access (AfPA) Government Affairs Team
Researchers, health care officials, and legislators across the country have been debating vaccination policies and legislation. As outbreaks of vaccine-preventable diseases have increased, different approaches are emerging, including studying access for vulnerable populations, expanding authority to increase vaccinations and a focus on vaccination exemptions.
Preterm Infant Vaccination Study
Annika M. Hofstetter (Assistant Professor of Pediatrics, University of Washington; Principal Investigator, Seattle Children’s Research Institute) led a team to study the “Early Childhood Vaccination Status of Preterm Infants” published by the American Academy of Pediatrics Journal. (1)
The Hofstetter study was based on the premise that preterm infants face a higher risk of vaccine-preventable diseases and other complications, but only limited studies have been made to detail the impact of delay and timeliness of infant vaccinations on this vulnerable population. Premature birth (birth before 37 weeks of gestational age) and its complications are the number one cause of death of babies in the United States, which makes the findings of this new study particularly valuable.
According to Dr. Hofstetter, the United States Advisory Committee on Immunization Practices recommends that all medically-stable preterm infants receive a full panel of early childhood vaccinations. For the study, her team investigated preterm infants compared to vaccinations of term and post-term infants (those born at 37-43 weeks gestation) — 10,300-plus infants total made up the study.
Unfortunately, the study found that a lower percentage of preterm infants completed the recommended 7-vaccine series of immunizations by 19 months of age, compared to term/post-term infants. “Over half of preterm infants were under-vaccinated at 19 months; one-third failed to catch up by 36 months,” the study concluded.
As a result of the findings, it was recommended that a road map and “strategies” were needed to improve vaccination timeliness for preterm babies, as they are already deemed “high-risk” at birth based on their gestational age. (2)
New York – Measles Outbreak & Lowering the Age of Vaccination
Health care officials in New York are looking at limitations on infant vaccinations and delays based on age – policies that may be changed by health officials based on exigent circumstances.
New York has seen a significant increase in the rise of measles cases. In May 2019, The Verge reported that New York health officials had made a policy change to give “doctors the go-ahead to lower the vaccination age to six months in areas with ongoing outbreaks” of measles alone – to ensure the early vaccination of infants (before one year old).
The article noted a policy change for earlier dosing of babies was unusual, and the age was lowered only because of the particular circumstances of the measles outbreak. It was mentioned that immune response and longevity of the vaccine would vary baby to baby, hence the hesitation in lowering the age.
The early dose protection was described as applying to infants in general. “Making sure everyone who can be vaccinated is vaccinated is the best way to keep the virus from gaining traction in the US again, according to the CDC.” (3)
California – Vaccines & Exemption Policy Tighten
Late this summer the California Assembly and Senate sent a controversial immunization measure to the state’s governor. SB 276 would give state public health officials oversight of doctors who provide more than five medical exemptions annually (with the ability to reject those medical exemptions), and the bill calls for scrutiny by the Public Health Department of schools with vaccination rates less than 95%.
“SB 276 was introduced amid the worst measles outbreak in more than two decades, with more than 1,200 people diagnosed with the disease this year,” wrote the Los Angeles Times.
Demonstrating the controversial nature of vaccination exemptions – California Governor Gavin Newsom is seeking last-minute changes to the vaccination bill before deciding whether to sign it into law.
Conclusion
Given the findings of the Hofstetter study, policymakers would be well-served to receive and review additional studies on infant health and immunization, particularly in their state. If they knew more about the vaccination disparity that preterm infants are woefully behind in their immunizations compared to term/post-term infants, perhaps then the child vaccination debates – perpetually shrouded by controversy – would focus on more vulnerable populations.
References:
- Hofstetter AM, Jacobson EN, deHart MP, Englund JA. Early Childhood Vaccination Status of Preterm Infants. Pediatrics. 2019;144(3):e20183520.
- Fighting Premature Birth: The Prematurity Campaign | March, https://www.marchofdimes.org/mission/prematuritycampaign.aspx (accessed September 09, 2019)
- New York State Is Allowing Early Vaccination For Infants ..,
https://news.2dms.com/posts/3429/new-york-state-is-allowing-early-vaccination-fo (accessed September 09, 2019).
The author has not indicated any disclosures.