Preparation containing either killed or weakened live microorganisms or their toxins, introduced by mouth, by injection, or by nasal spray to stimulate production of antibodies against an infectious agent. This confers immunity to that agent, since the B lymphocytes remain sensitized to it and respond to later infection by producing more antibodies. The first vaccine, against smallpox, was introduced by Edward Jenner in 1798. Vaccines have been developed against diseases caused by bacteria (e.g., typhoid, whooping cough, tuberculosis) and by viruses (e.g., measles, influenza, rabies, poliomyelitis). Effectiveness varies, and a small percentage of people have adverse reactions. Those with immunodeficiency disorders should not receive live vaccines.
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Vaccines can be prophylactic (e.g. to prevent or ameliorate the effects of a future infection by any natural or "wild" pathogen), or therapeutic (e.g. vaccines against cancer are also being investigated; see cancer vaccine).
Jenner's work was continued by Louis Pasteur and others in the 19th century. Since vaccination against smallpox was much safer than smallpox inoculation, the latter fell into disuse and was eventually banned in England in 1849.
The 19th and 20th centuries saw the introduction of several successful vaccines against a number of infectious diseases. These included bacterial and viral diseases, but not (to date) any parasitic diseases.
Vaccines may be dead or inactivated organisms or purified products derived from them.
There are four types of traditional vaccines:
A number of innovative vaccines are also in development and in use:
While most vaccines are created using inactivated or attenuated compounds from micro-organisms, synthetic vaccines are composed mainly or wholly of synthetic peptides, carbohydrates or antigens.
Vaccines may be monovalent (also called univalent) or multivalent (also called polyvalent). A monovalent vaccine is designed to immunize against a single antigen or single microorganism. A multivalent or polyvalent vaccine is designed to immunize against two or more strains of the same microorganism, or against two or more microorganisms.
Vaccines have contributed to the eradication of smallpox, one of the most contagious and deadly diseases known to man. Other diseases such as rubella, polio, measles, mumps, chickenpox, and typhoid are nowhere near as common as they were just a hundred years ago. As long as the vast majority of people are vaccinated, it is much more difficult for an outbreak of disease to occur, let alone spread. This effect is called herd immunity. Polio, which is transmitted only between humans, is targeted by an extensive eradication campaign that has seen endemic polio restricted to only parts of four countries. The difficulty of reaching all children as well as cultural misunderstandings, however, have caused the eradication date to be missed several times.
In order to provide best protection, children are recommended to receive vaccinations as soon as their immune systems are sufficiently developed to respond to particular vaccines, with additional 'booster' shots often required to achieve 'full immunity'. This has led to the development of complex vaccination schedules. In the United States, the Advisory Committee on Immunization Practices, which recommends schedule additions for the Center for Disease Control, recommends routine vaccination of children against: hepatitis A, hepatitis B, polio, mumps, measles, rubella, diphtheria, pertussis, tetanus, HiB, chicken pox, rotavirus, influenza, meningococcal disease and pneumonia. The large number of vaccines and boosters recommended (up to 24 injections by age two) has led to problems with achieving full compliance. In order to combat declining compliance rates, various notification systems have been instituted and a number of combination injections are now marketed (e.g., Prevnar and ProQuad vaccines), which provide protection against multiple diseases.
Besides recommendations for infant vaccinations and boosters, many specific vaccines are recommended at other ages or for repeated injections throughout life -- most commonly for measles, tetanus, influenza, and pneumonia. Pregnant women are often screened for continued resistance to rubella. The human papillomavirus vaccine is currently recommended in the U.S. and UK for ages 11–25. Vaccine recommendations for the elderly concentrate on pneumonia and influenza, which are more deadly to that group. In 2006, a vaccine was introduced against shingles, a disease caused by the chicken pox virus, which usually affects the elderly.
In Australia, a massive increase in vaccination rates was observed when the federal government made certain benefits (such as the universal 'Family Allowance' welfare payments for parents of children) dependent on vaccination. As well, children were not allowed into school unless they were either vaccinated or their parents completed a statutory declaration refusing to immunize them, after discussion with a doctor, and other bureaucracy. (Similar school-entry vaccination regulations have been in place in some parts of Canada for several years.) It became easier and cheaper to vaccinate one's children than not to. When faced with the annoyance, many more casual objectors simply gave in.
Even if the host develops antibodies, the human immune system is not perfect and in any case the immune system might still not be able to defeat the infection.
Adjuvants are typically used to boost immune response. Adjuvants are sometimes called the dirty little secret of vaccines in the scientific community, as not much is known about how adjuvants work. Most often aluminium adjuvants are used, but adjuvants like squalene are also used in some vaccines and more vaccines with squalene and phosphate adjuvants are being tested. The efficacy or performance of the vaccine is dependent on a number of factors:
When a vaccinated individual does develop the disease vaccinated against, the disease is likely to be milder than without vaccination.
The following are important considerations in the effectiveness of a vaccination program:
In 1958 there were 763,094 cases of measles and 552 deaths in the United States. With the help of new vaccines, the number of cases dropped to fewer than 150 per year (median of 56). In early 2008, there were 64 suspected cases of measles. 54 out of 64 infections were acquired outside of the United States, and 63 of 64 either had never been vaccinated against measles, or were uncertain whether they had been vaccinated.
Opposition to vaccination, from a wide array of vaccine critics, has existed since the earliest vaccination campaigns. Disputes have arisen over the morality, ethics, effectiveness, and safety of vaccination. The mainstream medical opinion is that the benefits of preventing suffering and death from serious infectious diseases greatly outweigh the risks of rare adverse effects following immunization. Some vaccination critics say that vaccines are ineffective against disease or that vaccine safety studies are inadequate. Some religious groups oppose vaccination as a matter of doctrine, and some political groups oppose mandatory vaccination on the grounds of individual liberty.
Most vaccine development to date has relied on 'push' funding by government, universities and non-profit organizations. Many vaccines have been highly cost effective and beneficial for public health. The number of vaccines actually administered has risen dramatically in recent decades. This increase, particularly in the number of different vaccines administered to children before entry into schools may be due to government mandates and support, rather than economic incentive.
Many researchers and policymakers are calling for a different approach, using 'pull' mechanisms to motivate industry. Mechanisms such as prizes, tax credits, or advance market commitments could ensure a financial return to firms that successfully developed a HIV vaccine. If the policy were well-designed, it might also ensure people have access to a vaccine if and when it is developed.
Vaccinations of animals are used both to prevent their contracting diseases and to prevent transmission of disease to humans. Both animals kept as pets and animals raised as stock are vaccinated. In some instances, wild populations may be vaccinated. This is sometimes accomplished with vaccine-laced food spread in a disease-prone area and has been used to attempt to control rabies in raccoons.
Where rabies occurs, rabies vaccination of dogs may be required by law. Other canine vaccines include canine distemper, canine parvovirus, canine hepatitis virus, adenovirus-2, leptospirosis, bordatella, canine parainfluenza virus, and Lyme disease among others.
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