Vaccination

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A child being immunized against polio

Vaccination

Overview

Vaccine Preventable Diseases

Classification

Adverse Reactions

Vaccination schedule

Childhood Vaccination
Adulthood Vaccination
Specific Groups
Maternal Vaccination
Traveller Vaccination

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Seyedmahdi Pahlavani, M.D. [2]

Overview

Vaccination is the administration of agent-specific, but relatively harmless, antigenic components that can induce protective immunity against the corresponding infectious agent in those individuals who are vaccinated. In practice, the terms vaccination and immunization are often used interchangeably. Vaccination is highly effective in the prevention of some particular infections. Vaccines are safe and are associated with minimal adverse reactions. Vaccination can prevent illness, disability, and death from vaccine-preventable diseases, which includes cervical cancer, diphtheria, hepatitis B, measles, mumps, pertussis, pneumonia, polio, rotavirus diarrhea, rubella, and tetanus. Vaccines help develop immunity by imitating an infection. This type of infection, however, does not cause illness, though it does cause the immune system to produce T-lymphocytes and antibodies. Immunization currently prevents an estimated 2 to 3 million deaths every year. An additional 1.5 million deaths could be avoided, however, if global vaccination coverage is improved. An estimated 19.4 million infants worldwide are still missing out on basic vaccines. The material administered as a vaccine can either be live but weakened forms of pathogens such as bacteria or viruses; killed or inactivated forms of these pathogens; or purified material such as proteins.

Benjamin Jesty is notable for being perhaps the first person recorded to have been vaccinated with cowpox in order to artificially induce immunity to smallpox during the epidemic of 1774. The term vaccination was first used by Edward Jenner, an English physician, 22 years later in 1796. Louis Pasteur further adapted this principle in his pioneering work in microbiology. Vaccination (vacca in latin means cow) is so named because the first vaccine was derived from a virus affecting cows—the relatively benign cowpox virus, which provides a degree of immunity to smallpox, a contagious and deadly disease. The World Health Organization coordinated the global effort to eradicate smallpox. The last naturally occurring case of smallpox occurred in Somalia in 1977.

Vaccine-preventable diseases



Characteristics of diseases vaccinated against in most vaccine schedules[1][2][3][4][5][6][7]
Disease Characteristics Worldwide U.S. U.K.
Transmission Incubation Incidence Deaths Incidence Deaths Incidence Deaths
Diphtheria Saliva 1-4 days 30,000 3,000 1 0 0 0
Haemophilus
influenzae
Airborne droplet 1-4 days 2-3,000,000 450,000
(mostly children)
1,743 7 30 0
Hepatitis B Contact with body fluids 6 weeks - 6 months 5,700,000 (acute) 521,000 7,996 7 600 Not reported
Measles Airborne 10-12 days 30-40,000,000 610,000 44 0 77 1
Mumps Airborne droplets 14-21 days 477,079 (reported) N/A 270 1 16,436 0
Pertussis Airborne droplets 5-10 days 39,000,000 297,000 9,771 18 2 2
Polio Fecal contamination Hours 1,951 <1,000 0 0 0 0
Rubella Airborne droplets 5-7 days Not reported 631,571
Congenital rubella syndrome (CRS)
18 (1 CRS) 0 0
Tetanus Penetrating injury,
blood contamination,
3-10 days 18,781 200,000 25 5 6 0
Tuberculosis Airborne 3 day - 15 weeks 8,000,000 1,600,000 15,056 784 6,572 373
Varicella Airborne 2 weeks Not reported Not reported 22,841 32 Not reported Not reported

Classification



 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Immunization
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Passive
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Active (vaccination)
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Human immune globulin (IG)
 
 
 
Hyperimmune globulin
 
 
 
Monoclonal antibodies
 
 
 
 
­Live, attenuated vaccines
 
 
Inactivated vaccines
 
 
Toxoid vaccines
 
 
Subunit vaccines
 
 
Conjugate vaccines
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
IV immune globulin (IVIG)
 
 
 
Subcutaneous immune globulin (SCIG)


Passive immunization

Passive immunization is a method of disease prevention that functions by transferring pre-made antibodies to a person at risk of acquiring a certain disease. This type of immunity could be acquired naturally during pregnancy, via trans-placental maternal antibodies' transfer to the fetus. Artificial passive immunization is normally given by pre-made immunoglobulins to a person at risk of acquiring a certain disease.

Human immune globulin (IG)

Human immune globulin is obtained from normal, healthy people; it is a concentrated solution of antibodies, mainly IgG antibodies. Human immune globulin is given intra-muscularly (IM). Up to 48 hours is required for IGs to reach the maximum serum concentration and their half-life is about 3 weeks. The sooner administration occurs, the more effective the prevention. IGs only provide temporary protection. Diseases with available human immune globulins include:

IV immune globulin (IVIG)

IV immune globulin contains larger amounts of human immune globulin and is administered via the IV route. Diseases that may be prevented or ameliorated by using IVIGs include:

Subcutaneous immune globulin (SCIG)

Subcutaneous immune globulin (SCIG) is prepared for home-based use, especially for patients affected by primary immunodeficiency.

Hyperimmune globulin

Hyperimmune globulin is derived from human plasma containing large amounts of antibodies. Those from whose plasma the globulin is derived are patients convalescing from natural infections or donors who are artificially immunized. Hyperimmune globulins are available for cytomegalovirus, varicella-zoster, hepatitis B, infant botulism, rabies, and tetanus.

Monoclonal antibodies

Specific monoclonal antibodies can be used against infections. The only one that is currently available is palivizumab, which is active against RSV.

Active immunization

­Live attenuated vaccines

Live attenuated vaccines are produced by modifying a disease-producing (wild) virus or bacterium in a laboratory. The resulting vaccine organism retains the ability to replicate and produce immunity, but usually does not cause illness. These vaccines are produced by growing the virus in tissue cultures that will select for less virulent strains, or by mutagenesis or targeted deletions in genes required for virulence. Attenuated vaccines can not be used by immunocompromised individuals. Examples of live attenuated vaccines include measles, mumps, and rubella vaccine (MMR) and varicella (chickenpox) vaccine.

­Inactivated vaccines

These vaccines are made by inactivating or killing the pathogen (mostly viruses). The inactivated polio vaccine is an example of this type of vaccine.

Toxoid vaccines

Toxoid vaccines are effective against bacteria that produces toxins. The vaccines are weakened toxins produced by particular bacteria. The DTaP vaccine contains diphtheria and tetanus toxoids.

­Subunit vaccines

­Subunit vaccines contain only some parts of bacteria or virus, not the entire germ. Because these vaccines contain only the essential antigens and not all the other molecules that make up the germ, side effects are less common. The pertussis component of the DTaP vaccine is an example of a subunit vaccine.

­Conjugate vaccines

­Conjugate vaccines are effective against bacteria that have polysaccharides in their cell wall components. Polysaccharides may cause less stimulation of immune system and result in a defective immune response. Conjugate vaccines are effective for these types of bacteria because they connect (or conjugate) the polysaccharides to antigens that the immune system responds to very well. This linkage helps the immature immune system react to the coating and develop an immune response. An example of this type of vaccine is the Haemophilus influenzae type B (Hib) vaccine.

Adverse reactions

Adverse reactions to vaccines can be divided into 2 major groups:[8]

Allergic reactions

  • Immediate reactions: Immediate reactions are IgE-related reactions that begins within minutes.
  • Delayed reactions: Delayed reactions appear several hours or even days after administration and they are mostly non-IgE related reactions.

Immediate reactions

Anaphylaxis is rare but important among immediate reactions. Health care providers should be aware of its symptoms and signs and be prepared for prompt treatment.[9][10]
Other common but less serious immediate reactions include:

Delayed reactions

Common delayed reactions to vaccines include:

  • Fever: Fever is common after vaccination and should not preclude vaccination in the future.[11]
  • Local reactions: Local reactions such as swelling and erythema are common and can be treated with a cold compress.[11]
  • Serum sickness and serum sickness-like reactions

Vasovagal reactions

Vasovagal reactions such as fainting, hypotension, pallor, diaphoresis, weakness, nausea, vomiting, bradycardia, and if severe, loss of consciousness may be seen after vaccination.[12]

Reaction to vaccine components

Vaccine components such as gelatin, egg proteins, cow's milk, thimerosal, aluminum, and phenoxyethanol that are used as vaccine preservatives, and they may cause adverse reactions ranging from fever or skin reactions to severe reactions that may require skin testing before future administration.[13][14][11][15][16]

Severe reportable reactions

Anaphylaxis or anaphylactic shock within seven days of any vaccine should be reported. Other vaccine-specific reactions that must be reported include:[11]

References

  1. Estimated Incidence/deaths World Health Organization Immunization, Vaccines and Biologicals Year 2000 data
  2. Reported cases/deaths (pdf) CDC "Pink Pages", Year 2002 data
  3. Reported cases/deaths NHS Immunisation Information, Year 2000 data (unless noted)
  4. See also: Estimated regional measles deaths (with uncertainty bounds) Fact sheet N°286 (2004). The World Health Organization (WHO) and UNICEF. Revised March 2006.
  5. (2005 data) Polio is endemic in only four countries; Nigeria, India, Afghanistan and Pakistan
  6. (year 2000: due to neonatal tetanus from non-sterile delivery and/or umbilical severing tools)
  7. Reported Tuberculosis in the United States The National Center for HIV, STD, and TB Prevention Statistics: 2002
  8. Johansson SG, Bieber T, Dahl R, Friedmann PS, Lanier BQ, Lockey RF, Motala C, Ortega Martell JA, Platts-Mills TA, Ring J, Thien F, Van Cauwenberge P, Williams HC (2004). "Revised nomenclature for allergy for global use: Report of the Nomenclature Review Committee of the World Allergy Organization, October 2003". J. Allergy Clin. Immunol. 113 (5): 832–6. PMID 15131563. doi:10.1016/j.jaci.2003.12.591. 
  9. Sampson HA, Muñoz-Furlong A, Campbell RL, Adkinson NF, Bock SA, Branum A, Brown SG, Camargo CA, Cydulka R, Galli SJ, Gidudu J, Gruchalla RS, Harlor AD, Hepner DL, Lewis LM, Lieberman PL, Metcalfe DD, O'Connor R, Muraro A, Rudman A, Schmitt C, Scherrer D, Simons FE, Thomas S, Wood JP, Decker WW (2006). "Second symposium on the definition and management of anaphylaxis: summary report--Second National Institute of Allergy and Infectious Disease/Food Allergy and Anaphylaxis Network symposium". J. Allergy Clin. Immunol. 117 (2): 391–7. PMID 16461139. doi:10.1016/j.jaci.2005.12.1303. 
  10. McNeil MM, Weintraub ES, Duffy J, Sukumaran L, Jacobsen SJ, Klein NP, Hambidge SJ, Lee GM, Jackson LA, Irving SA, King JP, Kharbanda EO, Bednarczyk RA, DeStefano F (2016). "Risk of anaphylaxis after vaccination in children and adults". J. Allergy Clin. Immunol. 137 (3): 868–78. PMC 4783279Freely accessible. PMID 26452420. doi:10.1016/j.jaci.2015.07.048. 
  11. 11.0 11.1 11.2 11.3 "General recommendations on immunization --- recommendations of the Advisory Committee on Immunization Practices (ACIP)". MMWR Recomm Rep. 60 (2): 1–64. 2011. PMID 21293327. 
  12. Kang LW, Crawford N, Tang ML, Buttery J, Royle J, Gold M, Ziegler C, Quinn P, Elia S, Choo S (2008). "Hypersensitivity reactions to human papillomavirus vaccine in Australian schoolgirls: retrospective cohort study". BMJ. 337: a2642. PMC 2769055Freely accessible. PMID 19050332. 
  13. Kelso JM (2000). "Raw egg allergy-a potential issue in vaccine allergy". J. Allergy Clin. Immunol. 106 (5): 990. PMID 11080728. 
  14. Kattan JD, Konstantinou GN, Cox AL, Nowak-Węgrzyn A, Gimenez G, Sampson HA, Sicherer SH (2011). "Anaphylaxis to diphtheria, tetanus, and pertussis vaccines among children with cow's milk allergy". J. Allergy Clin. Immunol. 128 (1): 215–8. PMID 21624648. doi:10.1016/j.jaci.2011.04.046. 
  15. Heidary N, Cohen DE (2005). "Hypersensitivity reactions to vaccine components". Dermatitis. 16 (3): 115–20. PMID 16242081. 
  16. Kelso JM, Jones RT, Yunginger JW (1993). "Anaphylaxis to measles, mumps, and rubella vaccine mediated by IgE to gelatin". J. Allergy Clin. Immunol. 91 (4): 867–72. PMID 8473675. 

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