Talking About Vaccines with Dr. Paul Offit: News Briefs – October 2018 – What Do Different Kinds of Recommendations Mean for Parents Making Vaccine Decisions?

News Briefs — What Do Different Kinds of Recommendations Mean for Parents Making Vaccine Decisions?

Paul A. Offit, MD: Hi, my name is Paul Offit. I’m talking to you today from the Vaccine Education Center here at the Children’s Hospital of Philadelphia. And I thought what we’d talk about today is something that’s confusing not just for parents, but I think to some extent to doctors, is the way vaccines are recommended in this country.

So, the principal recommending body is called the Centers for Disease Control and Prevention, or CDC. The group that advises that body is called the Advisory Committee for Immunization Practices or ACIP. And when they make a recommendation it falls into two categories.

The first category is the Category A recommendation, which is to say that they think that a vaccine should be used by everyone within a particular group. So, for example, the whooping cough or pertussis vaccine has a Category A recommendation. That vaccine is recommended then for all children of a certain age to prevent whooping cough.

And then there’s a recommendation called the Category B recommendation, which I think is where people get confused because basically what the ACIP is saying there is that you can give the vaccine. That’s it’s OK to give that vaccine, but it’s not necessarily a routine recommendation.

So, the vaccine that fell under category recently is called the meningococcal serogroup B vaccine or the MenB vaccine. So, meningococcus is a bacteria. It’s a bacteria that causes meningitis; it also causes sepsis, which is a bloodstream infection where a child can be fine one minute and then be overwhelmed by that by infection and dead four to six hours later. It’s a bacteria that clearly causes panic in the community. The CDC remarks, I think correctly, that one can actually just know epidemiology of that bacteria, meaning how many people are affected by that bacteria, by simply reading newspapers because it creates that kind of level of angst and fear in the community.

So why is it, given that the bacteria can cause overwhelming disease, why is it that it only got a Category B recommendation, meaning you can use it if you want.

And the reason has primarily to do in this case with what’s called epidemiology, meaning the likelihood that one is to get that infection.

So for example, with this MenB vaccine, the vaccine is licensed for anyone between 10 and 25 years of age. If you look at the total number of people in this country that will get that disease, it’s about 55. So, even if you immunized everyone in the country between 10 and 25 years of age, you will prevent 55 cases, which would probably account for 5 to 10 deaths, and would probably account for also about 10 or 15 patients who have permanent, lifelong problems following that infection. And the ACIP did not think it was worth immunizing everyone for that because the numbers are so small.

Now, from a parents’ standpoint, that shouldn’t matter. I mean, from a parent's standpoint, it may be my child. The vaccine is safe, and although it might not be covered by an insurance company, it’s still of value. So, I think it’s the contrast, the variance between a good public health recommendation and a good individual recommendation. I think from the individual standpoint, it makes sense to protect a child against meningococcal B because it can be an overwhelming, fatal infection or it can cause permanent harm. From the population standpoint, the question is, is it worth spending millions of dollars per case prevented. That I think is the tension. My way of resolving that tension is to say that if the vaccine is safe, if it’s potentially valuable, then it should be used. And I think the Category B recommendations can be unfortunately confusing for both the parent and the doctor. Thank you.