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Kaiser Permanente Research Brief Vaccines This Brief Summarizes the Contributions of Kaiser Permanente Research Since 2007 on the Topic of Vaccines

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Kaiser Permanente Research Brief Vaccines This Brief Summarizes the Contributions of Kaiser Permanente Research Since 2007 on the Topic of Vaccines Kaiser Permanente Research Brief Vaccines This brief summarizes the contributions of Kaiser Permanente Research since 2007 on the topic of vaccines. This includes vaccinations delivered in early childhood as well as those delivered to adolescents and adults. Although the development of vaccina- tions against communicable diseases Kaiser Permanente Publications dates back to the 18th century, the Related to Vaccines since 2007 creation of modern vaccines and their widespread use in the United States began in the 20th century.1 Today, the Advisory Committee on Immunization Practices of the Centers for Disease Con- 586 14,000 Journal Articles Citationsa trol and Prevention provides national rec- ommendations for 15 vaccines, including pertussis (whooping cough) shots for pregnant women and numerous vaccina- tions delivered to children, adolescents, 2 and adults (see figure below). Although 123Practice Clinical80 Decision c Guideline Aid References vaccination has largely eliminated dis- b eases such as measles and rubella in the References United States,1 these and others are still found frequently in countries with lower Source: Kaiser Permanente Publications 3 rates of vaccine coverage, and the ease Library and PLUM metrics, as of October 19, of global travel has led to cases in which 2020. a Number of citing journal articles, unvaccinated persons from well-vac- according to Scopus. cinated nations have contracted these b Number of references in PubMed infections.4 Moreover, diseases such as guidelines. c Citations in DynaMed Plus, a point-of-care 1 5 pertussis, varicella (chicken pox) and clinical reference tool. human papillomavirus (HPV)6 still occur frequently in the United States. In addition to the direct effect of immunizing patients against dangerous dis- eases, vaccination also benefits society more broadly through so-called “herd immunity” effects. Through herd immunity, higher rates of effective vaccination for a given illness at a population level confer protection to unvaccinated indi- viduals by making encounters with infected individuals increasingly rare. For example, increased uptake of the pediatric pneumococcal vaccine has been associated with decreased rates of the disease among adults, many of whom have not, until recently, received this vaccine.7,8 The level of vaccination cover- age required to create herd immunity for a given disease depends on both the This brief summarizes a selection of the publications contained within the Kaiser Permanente Publications Library, which indexes journal articles and other publications authored by individuals affiliated with Kaiser Permanente. The work described in this brief originated from across Kaiser Permanente’s 8 regions and was supported by a wide range of funding sources including internal research support as well as both governmental and nongovernmental extramural funding. vaccine’s effectiveness and how easily the disease higher rates of infection in children who failed to is transmitted between unvaccinated persons. complete all courses of multicourse vaccines.17 In some instances, delaying vaccinations can Vaccination is an active area of study for Kai- increase the risk of side effects. For example, de- ser Permanente Research. Scientists across the layed receipt of measles-mumps-rubella (MMR) organization have used our rich, comprehensive, or measles-mumps-rubella-varicella (MMRV) longitudinal data to advance knowledge in the vaccine has been associated with a higher risk of areas of understanding risk, improving patient febrile seizures.18 Infants too young to be vacci- outcomes, and translating research findings into nated against particular diseases are also at risk policy and practice. We have published near- of acquiring those diseases; research has found ly 600 articles related to vaccines since 2007. that preterm infants may have lower immune Together, these articles have been cited approxi- mately 14,000 times. These articles are the product of observational The CDC’s Advisory Committee on studies, randomized controlled trials, meta-anal- Immunization Practices sets national guidelines yses, and other studies led by Kaiser Permanen- for recommended vaccines.2 te scientists. Our unique environment, which includes our fully integrated care and coverage model, lets our research scientists, clinicians, Childhood medical groups, and health plan leaders collab- (BIRTH TO 10 YEARS) orate to contribute generalizable knowledge on • Pertussis (during pregnancy) vaccines, and many other topics of research. • Diphtheria, Tetanus and Pertussis Understanding Risk • Hepatitis A, Hepatitis B • Polio Kaiser Permanente researchers have contributed • Pneumococcal to understanding vaccine safety and the risks of • Haemophilus Influenza Type B (Hib) acquiring vaccine-preventable diseases. • Measles, Mumps, Rubella Who is at risk of acquiring vaccine- and Varicella preventable communicable diseases? • Rotavirus • Annual Flu (beginning at 6 months) Any person who has not been vaccinated against a particular disease and encounters a person infected with that disease is at risk of infection Adolescence (11 TO 18 YEARS) themselves. Additionally, no vaccine is 100% effective in preventing disease transmission, so • Human vaccinated persons may continue to be at risk.9,10 Papillomavirus In children, undervaccination (either delaying or (HPV) not receiving vaccines) appears to be increas- • Meningococcal Conjugate 11 ingly common. Parental refusal of vaccines • Tetanus, Diphtheria and Pertussis has been associated with outbreaks of measles, • Annual Flu pertussis, varicella, Haemophilus influenzae type b (Hib), and pneumococcal disease,12 and our recent studies have linked parental hesitancy Adulthood with significantly higher rates of pertussis,13 var- (19+ YEARS) 14 15 icella, and pneumococcal disease. Another • Annual Flu study conducted by our scientists found lower • Tetanus and Diphtheria rates of vaccination in children diagnosed with (with/without Pertussis) autism spectrum disorder, as well as their young- • Herpes Zoster (at Age 50) er siblings.16 Our researchers also have found March 2021 Kaiser Permanente Research Brief: Vaccines — 2 — hepatitis A71,72 and hepatitis B73 vaccines, among Kaiser Permanente scientists have developed others.74-79 Nevertheless, the rarity of problems and tested programs that address parental with vaccine safety makes the prediction of these concerns about vaccinating their young risks challenging, and requires considerable re- 80,81 82-84 children. search expertise and ongoing surveillance. Allergic reactions such as swelling or soreness at Beginning during the vaccination site,85-88 and complications such pregnancy and continuing as febrile seizures89,90 or fevers,91,92 are known through infancy, physicians side effects of vaccines, though these are rarely should provide information associated with long-term health problems.93 Our about vaccines, and work scientists have led studies linking febrile seizure actively to build trust with risks to specific vaccines, including the MMRV94- hesitant parents101-103 97 and influenza98 vaccines. Elderly patients have also experienced higher rates of adverse effects from the shingles86 and tetanus-diphtheria-per- A website featuring vaccine tussis (Tdap)99 vaccines, although these risks are information and social arguably outweighed by the benefits of these capabilities that allows parents vaccines, such as prevention of neuralgic pain to communicate and share and tetanus or diphtheria infection. information is associated with improved vaccination rates106-108 Improving Patient Outcomes What strategies are effective in responses to vaccines,19 while neonatal inten- increasing vaccination rates? sive care unit-treated infants may not receive all Our researchers have explored a variety of ap- 20 appropriate vaccines. proaches for increasing vaccination rates. In gen- In adults, our research has found higher risks eral, the approaches used for early-childhood of herpes zoster21 and influenza22 among the vaccination are very different from those used for unvaccinated, and cervical cancer may be more other types of vaccines. Successful interventions common among women who do not receive for increasing vaccine uptake in young children 23 include physician-oriented approaches to ad- HPV vaccination during adolescence. Individ- 100-105 uals with weakened immune systems also are at dress parental hesitancy, tailored messages delivered via social media,106-109 school-based higher risk of acquiring vaccine-preventable dis- 110-113 eases. For example, reactivation of latent herpes vaccination, and community-based edu- cation (for example, public-service announce- zoster infection is more likely to occur in patients 114,115 using immunosuppressive drugs.24 ments). In contrast, outreach approaches that have been shown to increase adolescent How safe are vaccines? and adult uptake of vaccines include workplace vaccination programs116,117 and reminders placed Because vaccines are, by definition, delivered to in the electronic health records of patients or large numbers of healthy individuals, they are parents.110,118,119 judged by very strict standards of safety, and reg- ulatory approval is only granted to vaccines with How effective is vaccination in extremely low observed risks. Kaiser Permanente preventing the transmission of researchers have been involved in studying the communicable diseases? safety of meningococcal,25-35 pneumococcal,36,37 HPV,38-42 MMR,43 MMRV,44-46 tetanus-diphthe- Kaiser Permanente
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