Making vaccines more acceptable - methods to prevent and minimize pain andother common adverse events associated with vaccines

The growing abundance of highly immunogenic vaccines has arrived with a bur den of pain, distress, and common adverse reactions that in turn may interf ere with parental compliance and aggravate anti-vaccine sentiment. In a stu dy of 150 children in each of 2 age-groups, we found that approximately 20% of the subjects suffered serious distress or worse. During the procedural phase, approximately 90% of the 15-to-18 month old children and 45% of the 4-to-6 year old children showed serious distress or worse. To address non-a dherence with pediatric vaccine schedules, we must consider all of the poss ible issues that might prevent a parent from taking a child to a health car e provider for vaccination. In that same study we identified useful predict ors for both preparatory and procedural distress - predictors that might be used in identifying children who might benefit from preventive interventio ns. Vaccine providers might consider a variety of interventions. Attitude, empathy, instruction. and practice have all been shown to have a salutatory effect upon pain and anxiety with medical procedures in general and specif ically with vaccinations. Distraction has also been found to be an effectiv e method for distress and pain prevention in children. More formal methods of clinical hypnosis which combine a deep state of relaxation with focused imagery and suggestion have also been found to be effective in helping chil dren and adolescents prepare for, cope with, and tolerate the pain and anxi ety associated with medical procedures. So-called 'sugar nipples' deliverin g small amounts of sucrose orally at the time of a painful procedure in an infant has been not been shown to decrease vaccination pain and studies on refrigerant topical anesthetics are mixed. Studies have found a eutectic mi xture of 2.5% lidocaine and 2.5% prilocaine (EMLA) effective in providing a dequate local anesthesia in children, but it suffers from problems in pract ical application. Studies with various injection techniques have not identi fied ready solutions, and although jet injection appears to provoke less an xiety and cause less immediate pain, studies also indicate a somewhat great er incidence of delayed local reactogenicity including soreness and edema. Other measures to prevent or rapidly treat other common adverse events have been shown effective and should be considered as well. (C) 2001 Elsevier S cience Ltd. All rights reserved.