This document discusses immunization principles and vaccine use. It notes that vaccines have significantly increased longevity, economic savings, and quality of life by preventing 17 diseases. Vaccines have reduced rates of most vaccine-preventable childhood diseases to historically low levels. The document also outlines the direct and indirect impacts of vaccines, including herd immunity, and how widespread childhood vaccination in the US has led to major declines in vaccine-preventable diseases among children and adults. Furthermore, it discusses the goals of immunization programs to control, eliminate or eradicate diseases and provides examples of diseases that were eliminated from the US through vaccination.
This document discusses immunization principles and vaccine use. It notes that vaccines have significantly increased longevity, economic savings, and quality of life by preventing 17 diseases. Vaccines have reduced rates of most vaccine-preventable childhood diseases to historically low levels. The document also outlines the direct and indirect impacts of vaccines, including herd immunity, and how widespread childhood vaccination in the US has led to major declines in vaccine-preventable diseases among children and adults. Furthermore, it discusses the goals of immunization programs to control, eliminate or eradicate diseases and provides examples of diseases that were eliminated from the US through vaccination.
This document discusses immunization principles and vaccine use. It notes that vaccines have significantly increased longevity, economic savings, and quality of life by preventing 17 diseases. Vaccines have reduced rates of most vaccine-preventable childhood diseases to historically low levels. The document also outlines the direct and indirect impacts of vaccines, including herd immunity, and how widespread childhood vaccination in the US has led to major declines in vaccine-preventable diseases among children and adults. Furthermore, it discusses the goals of immunization programs to control, eliminate or eradicate diseases and provides examples of diseases that were eliminated from the US through vaccination.
Anne Schuchat Lisa A. Jackson Few medical interventions of the past century can rival the effect that immunization has had on longevity, economic savings, and quality of life. Seventeen diseases are now preventable through vaccines routinely administered to children and adults in the United States ( Table 122-1 ) , and most vaccine-preventable diseases of childhood are at historically low levels ( Table 122-2 ) . Health care providers deliver the vast majority of vaccines in the United States in the course of providing routine health services and therefore play an integral role in the nations public health system. _ VACCINE IMPACT Direct and indirect effects Immunizations against specific infectious diseases protect individuals against infection and thereby prevent symptomatic illnesses. Specific vaccines may blunt the severity of clinical illness (e.g., rotavirus vaccines and severe gastroenteritis) or reduce complications (e.g., zoster vaccines and postherpetic neuralgia). Some immunizations also reduce transmission of infectious disease agents from immunized people to others, thereby reducing the impact of infection spread. This indirect impact is known as herd immunity . The level of immunization in a population that is required to achieve indirect protection of unimmunized people varies substantially with the specific vaccine. Since childhood vaccines have become widely available in the United States, major declines in rates of vaccine-preventable diseases among both children and adults have become evident ( Table 122-2 ). For example, vaccination of children <5 years of age against seven types of Streptococcus pneumoniae led to a >90% overall reduction in invasive disease caused by those types. A series of vaccines targeting 10 vaccine-preventable childhood diseases in a single birth cohort leads to prevention of 33,000 premature deaths and 14 million illnesses and saves $42 billion (U.S.): $9 billion in direct medical savings and $33 billion in indirect societal savings. Control, elimination, and eradication of vaccine-preventable diseases Immunization programs are associated with the goals of controlling, eliminating, or eradicating a disease. Control of a vaccine- preventable disease reduces illness outcomes and often limits the disruptive impacts associated with outbreaks of disease in communities, schools, and institutions. Control programs can also reduce absences from work for ill persons and for parents caring for sick children, decrease absences from school, and limit health care utilization associated with treatment visits. Elimination of a disease is a more demanding goal than control, usually requiring the reduction to zero of cases in a defined geographic area but sometimes defined as reduction in the indigenous sustained transmission of an infection in a geographic area. As of 2010, the United States had eliminated indigenous transmission of measles, rubella, poliomyelitis, and diphtheria. Importation of
pathogens from other parts of the world continues to be important,
and public health efforts are intended to react promptly to such cases and to limit forward spread of the infectious agent. Eradication of a disease is achieved when its elimination can be sustained without ongoing interventions. The only vaccinepreventable disease that has been globally eradicated thus far is smallpox. Although smallpox vaccine is no longer given routinely, the disease has not naturally reemerged because all chains of human transmission were interrupted through earlier vaccination efforts and humans were the only natural reservoir of the virus. Currently, a major health initiative is targeting the global eradication of polio. Sustained transmission of polio has been eliminated from most nations but has never been interrupted in four countries: Afghanistan, India, Nigeria, and Pakistan. Detection of a case of disease that has been targeted for eradication or elimination is considered a sentinel event that could permit the infectious agent to become reestablished in the community or region. Hence, such episodes must be promptly reported to public health authorities. Outbreak detection and control Clusters of cases of a vaccine-preventable disease detected in an institution, a medical practice, or a community may signal important changes in the pathogen, vaccine, or environment. Several factors can give rise to increases in vaccine-preventable disease, including (1) low rates of immunization that result in an accumulation of susceptible people (e.g., measles resurgence among vaccination abstainers); (2) changes in the infectious agent that permit it to escape vaccine-induced protection (e.g., nonvaccine-type T
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