Parents PACK Newsletter

November 2009

Parents Pack Newsletter

Possessing, Accessing and Communicating Knowledge About Vaccines

In this issue:

• Feature Article: Vaccines and Egg Allergies
• Spotlight: Living Proof Project
• Did You Know? . . . Cost to Immunize a Child in the Developing World
• Ask the VEC – Egg Allergies and Vaccines
• Around the World: "State of the World’s Vaccines and Immunization"
• Trivia Corner – Vaccine Required for Travel

November Trivia Corner

Which vaccine is required for entry into certain countries? Find out.

Feature Article: Vaccines and Egg Allergies

Editor’s Note: The feature article for November was written by Jonathan Spergel, MD, PhD. Dr. Spergel is Chief of the Allergy Section and Co-Director of the Center for Pediatric Eosinophilic Disorders at The Children’s Hospital of Philadelphia.

Egg allergy

Egg allergy is one of the more common pediatric food allergies. It typically affects just 0.5 percent of the pediatric population (less than 1 of every 100 children) and 5 of every 100 children with allergies. Reactions to egg can vary from life-threatening anaphylaxis to atopic dermatitis (eczema) to hives.

Food allergies are diagnosed by physical examination, previous experience, and allergy testing. There are two types of allergy testing: skin testing and blood testing for specific antibodies to eggs (commonly called RAST testing). Each test has advantages and disadvantages. In general, if you are negative on either test, you do not have an allergy to egg; however, the blood test can be negative in about 5 of every 100 children who actually have an egg allergy. A positive blood or skin test indicates a potential to react to egg, and the larger the skin or blood test, the more likely it is that a reaction will occur. However, the size of the skin or blood test does not correlate with how severe a reaction will be.

Egg allergies and vaccines

Because influenza and yellow fever vaccines are both made in eggs, egg proteins (primarily ovalbumin) are present in the final products and are in sufficient quantities to cause allergic reactions in susceptible patients.

For patients who are at a high risk of getting these diseases, there is concern if they can’t get the vaccine; however, the good news is that protocols exist to give the vaccines to egg-allergic patients. The most common protocol involves skin testing the individual to the vaccine, administration of the vaccine in the same visit, and observing the patient for 30 minutes to monitor for an allergic reaction. The vaccine is typically administered in partial doses (up to four doses) that together make the whole dose. The entire protocol takes about one to four hours to complete and is usually done in a single visit. Reactions, if any, are usually mild, such as hives near the site of administration. At The Children’s Hospital of Philadelphia, we have done this type of testing in over 900 egg-allergic patients and have not seen any significant reactions.

Getting the testing

If you or your child is allergic to eggs and you are interested in getting the vaccine, you should make an appointment with an allergist. Most allergists are aware of and comfortable performing this type of vaccine testing and administration.

What about future doses of the vaccine?

Current protocols require that people with egg allergies repeat the process with an allergist each time they get the vaccine because the protocols do not prevent the allergy, they simply provide a way to get around the allergic response in the short term, so that the vaccine can be given safely.

References:

1. Erlewyn-Lajeunesse et al, BMJ 2009
2. Piquer- GIbert M, Allergol Immunopathol (Madr). 2007 Sep-Oct;35(5):209-12
3. James et al, J Pediatr. 1998 Nov;133(5):624-8
4. Saltzman, et al. J Aller Clinical Immuno 2009; 123 (2):S175

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Spotlight: Living Proof Project

In October 2009, the Bill and Melinda Gates Foundation launched a new program called the “Living Proof Project.” The Gates Foundation is based on the belief that “every life has equal value," and toward this end, the Living Proof Project is designed to highlight the success of U.S. investments in global health. The stories tell of people throughout the world who have been helped by projects targeting infectious diseases, nutrition, and maternal and child health.

Learn more through videos, photos, and progress sheets.

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Did You Know? . . . Cost to Immunize a Child in the Developing World

It costs about $20 to fully immunize a child in the developing world against diphtheria, tetanus, pertussis, measles, polio, tuberculosis, hepatitis B, and Haemophilus influenzae type b. Learn more about the “Immunize Every Child” campaign and the GAVI Alliance.

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Ask the VEC – Egg Allergies and Vaccines

Q. I have an egg allergy. Can you tell me which vaccines I should avoid?

A. The only two vaccines that people with egg allergies cannot get are the influenza and yellow fever vaccines. However, as discussed in the “Feature Article” above, there are protocols available to get these vaccines if you are at high risk of getting the disease.

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Around the World: Cost to Immunize a Child in the Developing World

Each year immunizations prevent the deaths of about 2.5 million children less than 5 years old around the world. However, almost 1 in 5 children still do not get the routine vaccines suggested for the first year of life for reasons, such as:

• Limited access to healthcare, particularly in rural areas of the world
• Weak or nonexistent public health infrastructures in some countries or areas
• Lack of information regarding how vaccines work and why they are important
• Fear of vaccines due to vaccine safety concerns
• Lack of funding to set up and complete programs

In late October 2009, the World Health Organization (WHO) released the third edition of the “State of the world’s vaccines and immunization.” This book contains a wealth of information regarding immunizations throughout the world. In addition to describing global progress toward prevention of 20 vaccine-preventable diseases, the book discusses progress toward global goals for disease eradication and issues limiting further success such as those mentioned above.
 

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Trivia Corner – Shots and Nasal Forms of Vaccines

Proof of having received the yellow fever vaccine is required for entry into certain countries.

To learn more about yellow fever, read this chapter of the Yellow Book.
To learn which countries require this immunization, consult the online table from the Yellow Book.
To find out where to get a yellow fever vaccine, check out the CDC’s interactive map.

Send us your comments

If you have any comments about this newsletter or suggestions about how we can make our Web site more helpful, please send your comments to contactPACK@email.chop.edu.

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