Vaccination Guidelines 2024 Chapter 7

In 2024, vaccination of special groups (including pregnant women, people with low immune function, and elderly patients with chronic diseases over 65 years old) does not need to strictly apply the universal vaccination schedule. It needs to be individualized based on the three core dimensions of "basic disease control status, exposure risk in the past month, and autoimmune status." The overall benefits of vaccination for the three groups are significantly higher than the potential risk of adverse reactions.

I am a member of the guideline writing team responsible for grassroots follow-up. In the past eight months, I have visited 17 community vaccination sites across the country and compiled nearly 2,000 follow-up data on vaccinations for special groups. The content is all collected from the problems encountered on the front line, and there is no empty air.

I just came across a particularly impressive case last week: a 32-year-old pregnant woman with polycystic ovary syndrome, who was 12 weeks pregnant and just half a month old, came to ask if she could get a flu vaccine. At that time, she came with a popular science article from a certain platform in 2022, saying that vaccination in the first trimester would cause teratogenics, and the old nurse at the vaccination site also advised her to wait until the second trimester to get vaccinated out of caution. Later, I read the vaccination guidelines for pregnant women just updated in 2024 by the WHO, as well as the latest consensus of the domestic society of obstetrics and gynecology, which clearly stated that as long as it is an inactivated vaccine, there is no risk of teratogenesis when vaccinated after 12 weeks of pregnancy. On the contrary, high fever of influenza is dozens of times more harmful to the fetus than the vaccine. She struggled for three days and decided to take the shot. She came for a post-vaccination follow-up last week and the fetal NT test passed. She didn’t catch a cold during the entire flu season. She even brought us two cups of hot taro milk tea.

Different from the over-cautiousness of pregnant women, most of the problems of the elderly are that they find it troublesome and feel that they don’t need to take an injection if they don’t go out. Last month there was a 78-year-old man with chronic obstructive pulmonary disease in our community. His grandson who was on winter vacation was infected with shingles. The pain kept him awake all night, and he was hospitalized for pneumonia and spent nearly 20,000 yuan. Later, we found out that he had been notified by the neighborhood committee to take the recombinant shingles vaccine, and he was afraid of side effects. We have compiled follow-up data for the first half of 2024. For those over 65 years old with underlying diseases, those who have received influenza, pneumococcal, and herpes zoster vaccines can reduce their risk of hospitalization by 62% throughout the year. Don’t believe the rumors that “vaccination damages immunity”. The side effects of redness and swelling at the vaccination site are really nothing compared to the intubation of oxygen tubes in hospital.

Oh, by the way, there is another common misunderstanding. Many people think that special groups of people have poor immunity and cannot produce antibodies after vaccination, so the vaccination is in vain. In fact, no, even if infection cannot be prevented, the effect of preventing severe disease is still very stable. If the old man I just mentioned had received the pneumococcal vaccine before, even if he had shingles, he would not be easily complicated by lung infection, and the course of treatment could be shortened at least by half.

Another issue that has been debated in the industry for almost a year is whether people with low immunity can receive live attenuated vaccines. The traditional disease control standard is to ban all viruses, for fear that attenuated viruses will replicate in the body and cause disease. When I attended an academic conference last year, an experienced expert in disease control for 30 years still insisted on this view, saying that no matter how low the risk is, it should not be touched, and the bottom line of safety must be maintained. However, at the end of last year, the New England Journal of Medicine published a study covering 12,000 HIV-infected patients. It said that for patients whose CD4 count had stabilized above 300 for 6 consecutive months, the protection rate of live attenuated MMR vaccine was 47% higher than that of the inactivated version, and the serious adverse reaction rate was only 0.2% higher than that of the inactivated group, which is almost negligible. Now the infectious diseases departments of some tertiary hospitals in China have begun to conduct individualized assessments. If you belong to the immunocompromised group, don't just give up on the attenuated vaccine. Ask an infectious disease doctor to do an immune function assessment. You may be able to get better protection.

To be honest, the biggest headache when I compiled this chapter is that everyone always wants to find a "standard answer", but there is no unified standard answer for special groups. For example, for the same patient after breast cancer surgery, the vaccination plan is completely different between a patient whose white blood cells have not yet recovered after chemotherapy and a patient whose immune function is completely normal after 3 years of treatment. Do not apply someone else's vaccination form to yourself.

Finally, a small suggestion. If you belong to these three special groups, you can bring your physical examination report and medication list for the past six months before vaccination. The doctors at the vaccination site will give you a free assessment. If you are really unsure, you can also go for multidisciplinary consultation. Most vaccination sites in second-tier and above cities now have this service. Don't make up your own mind, and don't just believe in old science on the Internet. After all, it is 2024, and vaccine research is updated very quickly. The one that suits you is the best.