Primary care
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The continuum of preconception, antenatal period, fourth trimester, and interconception period are a critical time for comprehensive care to advance maternal-child health and deliver family-centered care. Immunizations are a key component of this care delivery; however, there are intricacies around indications of vaccinations during this key period. Both active immunity to the individual receiving the vaccine as well as passive immunity passed to the fetus during pregnancy highlight the benefits of this care. Understanding the indications and benefits of vaccine administration during this continuum is critical for providers caring for individuals of reproductive age.
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This highlights the key recommendations for immunization in the setting of chronic disease, children and adults with special needs, and health care providers. Immunization is an effective strategy to reduce the burden of suffering and cost of care from chronic disease. ⋯ Clinicians need to develop systems to evaluate patients' risk factors and tailor immunization recommendations to their individual needs. Patients with intellectual disabilities, neurologic and neurodevelopmental disorders, and autism are at higher risk for vaccine-preventable illness and face significant health disparities.
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The risk of travel-related illnesses that require vaccines varies depending on destination and traveler characteristics. Travelers who are not immune and going to countries and regions with endemic diseases are at risk of contracting vaccine-preventable diseases; they can serve as conduits of the disease on return to their home country. Individual travelers can work with a health care professional to assess travel risk based on diseases endemic to the region, time of year of travel, and presence of acute outbreaks. Travelers should discuss personal medical history, immunization status, purpose of trip, and other individual risk factors to help determine which vaccines they need.
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A significant minority of patients and parents are vaccine hesitant, defined as having the desire to delay or defer immunizations despite easy access to vaccines. Vaccine hesitancy exists along a spectrum, from patients who are concerned but willing to accept the recommended vaccine schedule to those who wish to use a delayed schedule to those who refuse vaccines altogether. A strong recommendation in favor of a vaccine is the most important reason a patient or parent accepts the immunization. Structural changes, such as removing personal and religious exemptions for vaccines required for attending school, are effective tools in increasing vaccination rates.
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Vaccines can prevent illness but are effective only if they reach a majority of the population at risk. Disparities based on many factors, such as race and ethnicity, economic status, and rural versus urban locations of residents, are ongoing issues in the United States. ⋯ At the government level, programs like Vaccines for Children, Medicaid reform, Medicare, and state efforts funded in part by 317 grants have helped reduce but not eliminate disparities. At a practice level, vaccine disparities can be addressed by community outreach and systems to offer and deliver vaccines.