Of recommendations

How many shots are needed? Can I give it even if it’s beyond the age indication? My patient is immunocompromised—when do I give it? I have allergies to certain medications; can I receive it? Is it safe? How much will it cost? These are some of the questions we receive on a regular basis for recommended vaccines, not only for children but for adults as well. While most answers are straightforward, there are conditions that require evaluation. This is manageable, and in certain situations is a shared decision if vaccination is to be given or momentarily deferred. There are those that are absolutely contraindicated, meaning that a particular vaccine cannot be administered. A concrete example is when an individual has a history of anaphylaxis to a component of the vaccine.

Most practitioners will probably agree that it is harder to give an answer when asked about the incidence of vaccine-preventable diseases. Locally, due to the lack of an active form of surveillance or immediate access to existing passive reports of cases, we are unable to provide statistics. Numbers will always impress. Currently, as in the past, our barometer for incidence has always been when we find ourselves in the middle of an outbreak or hear about pockets of outbreaks. The recommendation for vaccination only becomes essential once they have personally experienced a serious illness from a disease necessitating hospitalization, or suffered or witnessed complications that could have been prevented if they had been immunized. While many will agree about its benefits, apart from concerns of safety, out-of-pocket expenses for vaccines outside the ones available from the national government remain a barrier to receipt.

To help fill the gap in data—at least for viruses that can cause respiratory tract infections and are vaccine-preventable—I recently shared the numbers for flu cases across all ages, courtesy of our major hospitals, through their infection control committees, and as collated by the Philippine Society for Microbiology and Infectious Diseases in this column. Hopefully, that piece of information will serve as a constant reminder of why there is a need to receive the vaccination before the flu season begins. Aside from influenza, pediatric data from three training hospitals, which have rapid antigen and multiplex respiratory panels, have seen a predominance of human rhinovirus/enterovirus and respiratory syncytial virus (RSV) this year. These findings are similar to those of a retrospective cohort study by Yulo and Garcia in a tertiary medical center in Metro Manila covering the period from August 2023 to 2024.

In the past months, I have seen young infants hospitalized and admitted to the intensive care unit for close monitoring due to RSV. Your immediate question may be: Is RSV a concern for adults as well? Can we have a repeat infection? Is there a vaccine available? The answer to all three questions is a yes. RSV can affect all age groups, and reinfection is possible. Young age, especially premature infants, older adults, immunocompromising conditions, and existing comorbid conditions, which include those affecting the heart and the lungs, place individuals at a higher risk for serious disease. Currently, there is no vaccine specific to the pediatric population. Protection comes in the form of preformed antibodies passively transferred from a vaccinated mother during the third trimester of pregnancy (32-36 weeks), which is said to last for the first six months of life. To my knowledge, monoclonal antibodies that can confer protection before the RSV season are still to be introduced to the market.

For specifics on RSV immunization that you may want to know for adults, according to the Centers for Disease Control and Prevention and Advisory Committee on Immunization Practices, the RSV vaccine is recommended as a single dose for adults 75 years of age and older, or for those 50-74 years old with high-risk conditions. These include individuals with chronic cardiovascular, lung, liver, or hematologic diseases; end-stage renal disease; diabetes mellitus; and neurologic or neuromuscular conditions causing impaired airway clearance. It is strongly advised that you consult with your physician if vaccination is appropriate for you.

Management of RSV is mainly supportive, and there is no antiviral treatment that is a standard of care. Given the high cost of health care in our setting, immunization, not only for RSV but also for other recommended vaccines, will always be a preventive measure that we should begin seriously considering as one of our top priorities. While we have repeatedly reiterated that no vaccine is 100 percent effective, the benefits of vaccination can prevent complications or the progression of a disease.

I remember one renowned international speaker who showed a picture of himself carrying his grandchild with the word ”terrorist.” While it may have looked cute, the message was clear. Infections can be passed on and create problems for the most vulnerable.