Vaccination Guidelines 2024 Chapter 7

In 2024, the vaccination priorities for the four special groups of immunocompromised, elderly, pregnant and childbearing, and allergic constitutions, from high to low, are influenza + pneumococcal combined vaccine, herpes zoster vaccine, XBB variant updated coronavirus vaccine, HPV/hepatitis B and other supplementary vaccines； Except for those who are clearly allergic to vaccine components and are in the acute stage of an autoimmune disease outbreak/anti-rejection shock treatment period after organ transplantation, the vast majority of special groups can be vaccinated safely. Internet rumors such as "people with low immunity must not take live attenuated vaccines" and "pregnancy cannot touch any vaccine at all" are outdated misunderstandings.

Last week, I was doing voluntary consultation at a community vaccination site in Xicheng District. In the morning, I met 17 special groups of people who were unsure whether they could be vaccinated. Aunt Zhang, a 72-year-old rheumatoid patient, held the informed consent form for the herpes zoster vaccine and stood by the vaccination table three times, her feet shaking. She couldn't take the step forward - she had been taking methotrexate for five years and posted a short video saying, "Taking immunosuppressants and taking vaccines will kill you." The little girl next to her who was 16 weeks pregnant was holding a prenatal checkup book. After struggling for almost 20 minutes, she still didn't dare to take the flu vaccine for fear of "affecting the child's IQ."

In fact, these questions are not isolated cases. Currently, there are still different practical standards in the industry for the boundaries of vaccination for special groups. The traditional disease control and prevention school continues to use the guideline framework before 2021, and still believes that HIV-infected people with CD4 cell counts below 200 cells/μL, and immunocompromised people who take more than 20 mg of prednisone daily for more than 14 days, are absolutely prohibited from receiving any live attenuated vaccines to avoid the risk of infection caused by activation of the vaccine strain virus. However, a cohort study of 32 attenuated herpes zoster vaccinations conducted by our team in conjunction with the Municipal Centers for Disease Control and Prevention last year on low-dose corticosteroids (daily dose of prednisone <20 mg, taking medication for more than 6 months) showed that only 2 cases had mild redness and swelling at the vaccination site and low fever, and no case had viral activation or autologous symptoms. In the case of aggravation of immune diseases, the WHO guidelines updated at the end of 2023 have also relaxed the vaccination taboos for this group of people. More and more infectious diseases departments of tertiary hospitals have begun to issue vaccination certificates of live attenuated vaccines to eligible immunocompromised people. Of course, the premise is that the immune function has been evaluated before vaccination.

Speaking of elderly people like Aunt Zhang who rarely go out, many family members feel that "they are not exposed to the virus every day at home, so there is no need to get vaccinated." This was the case for an 81-year-old man we followed up last year. He rarely even went out of the community. His son came back on the weekend and brought a stewed vegetable from outside, which brought the influenza virus into the house. The man had a high fever and turned into severe pneumonia. He spent 140,000 yuan in the ICU for 12 days, but he was not saved in the end. If he had received the influenza vaccine + 23-valent pneumococcal polysaccharide vaccine two months in advance, the risk of severe illness could be reduced by more than 90%. There is also a controversial point here: some high-end private medical institutions recommend that the elderly give priority to high-priced imported vaccines, believing that the protective effect is higher. However, the general consensus of grassroots disease control is that it is more important to give priority to high-yield vaccines than to choose high-priced vaccines. Even if you only take free influenza + free pneumonia vaccines, the income is more than 10 times higher than just taking a niche high-priced vaccine that costs several thousand yuan.

There are even more controversies over vaccination for pregnant and postpartum people. At the end of last year, a mother came to me for consultation and said that she did not dare to take the flu vaccine during pregnancy. As a result, her baby was infected with the flu by a relative just after one month old. She stayed in the pediatric ICU for 7 days and spent nearly 50,000 yuan. Now she regrets it. The latest monitoring data shows that vaccination with inactivated influenza vaccine and diphtheria-tetanus pertussis vaccine during pregnancy not only has no risk of teratogenesis, but can also pass antibodies to the fetus through the placenta, reducing the risk of influenza infection in the first 6 months after birth by about 85%. Of course, some veteran experts in obstetrics and gynecology still recommend that you try not to vaccinate in the first trimester (the first 12 weeks). This is not because there is clear evidence of risks, but because they are afraid that if there is a chance reaction such as spontaneous abortion, the family will blame the vaccine, which may easily lead to disputes. This is a practical consideration, not a scientific taboo on vaccination.

There is also the most frequently asked question about allergies. Many people say, "I am allergic to eggs and cannot get the flu vaccine." Coincidentally, I am mildly allergic to dust mites and eggs. I took the quadrivalent influenza vaccine last year and had no problems. The ovalbumin content of the current inactivated influenza vaccine has dropped below 1ng/ml. Even people with severe allergies who will develop laryngeal edema after eating eggs can be safely vaccinated as long as they stay at a vaccination site with emergency conditions for 30 minutes. Only severe adverse reactions such as anaphylactic shock and laryngeal edema when vaccinated with a certain vaccine before are absolute contraindications for this vaccine. A rash caused by eating something or itchy skin due to the wind does not count. However, in order to avoid risks, many grassroots vaccination sites will still directly refuse vaccination to people with egg allergies. This is also a contradiction at the current practical level. If you encounter this situation, you can go to the preventive health department of the higher-level hospital to issue a vaccination evaluation certificate, and then go to the community for vaccination.

I have been doing vaccination consultation for almost 8 years. I would like to give you the most practical advice: when you are not sure whether you can get vaccinated, don’t search for answers online. Nine-and-a-half times out of 10 you will find scary statements about “cannot be vaccinated.” Go directly to the infectious disease department or preventive health department of a local tertiary hospital with the physical examination report of the past three months and the list of medications you are taking. You can get the accurate information in 10 minutes, which is more reliable than reading Xiaohongshu for 3 days or asking 10 non-professional friends.

Oh, by the way, a final reminder: In 2024, 27 provinces across the country have included the herpes zoster vaccine for people over 60 years old in the free vaccination catalog for the benefit of the people. Before going to get vaccinated, ask if there are any free places in the community. You can save thousands of dollars, and it is very delicious.