Vaccination 32473 225307493 2008-07-13T00:30:18Z Chescapn 7466761 /* Vaccination policies, compulsory vaccination */ [[Image:Vaccination-polio-india.jpg|thumb|right|Child receiving an oral polio vaccine.]] '''Vaccination''' is the administration of [[antigen]]ic material (the [[Vaccine]]) to produce [[immunity (medical)|immunity]] to a disease. Vaccines can prevent or ameliorate the effects of [[infection]] by a [[pathogen]]. It is considered to be the most effective and cost-effective method of preventing infectious diseases. The material administrated can either be live, but weakened forms of [[pathogen]]s such as [[bacteria]] or [[virus]]es, killed or inactivated forms of these pathogens, or purified material such as [[protein]]s. [[Smallpox]] was the first disease people tried to prevent by purposely inoculating themselves with other types of infections; smallpox [[inoculation]] was started in [[China]] or [[India]] before 200 BC.<ref name="pmid17633292">{{cite journal |author=Lombard M, Pastoret PP, Moulin AM |title=A brief history of vaccines and vaccination|journal=Rev. - Off. Int. Epizoot. |volume=26 |issue=1 |pages=29–48 |year=2007 |pmid=17633292 |doi=}}</ref> In 1718, [[Lady Mary Wortley Montague]] reported that the [[Turkish people|Turks]] have a habit of deliberately inoculating themselves with fluid taken from mild cases of smallpox and she inoculated her own children.<ref name="pmid6319980">{{cite journal |author=Behbehani AM |title=The smallpox story: life and death of an old disease. |journal=Microbiol. Rev. |volume=47 |issue=4 |pages=455–509 |year=1983 |pmid=6319980 |doi= |url=http://mmbr.asm.org/cgi/pmidlookup?view=long&pmid=6319980}}</ref>Before Edward Jenner tested the possibility of using the cowpox vaccine as an immunisation for smallpox in humans in 1796 for the first time, at least six people had done the same several years earlier: a person whose identity is unknown, England, (about 1771), Mrs. Sevel, Germany (about 1772), Mr. Jensen, Germany (about 1770), Benjamin Jesty, England, in 1774, Mrs. Rendall, England (about 1782) and Peter Plett, Germany, in 1791.<ref name="Sudhoffs">{{cite journal |author=Plett PC |title=[Peter Plett and other discoverers of cowpox vaccination before Edward Jenner] |language=German |journal=Sudhoffs Arch |volume=90 |issue=2 |pages=219–32 |year=2006 |pmid=17338405 |url=http://lib.bioinfo.pl/meid:4459 |accessdate=2008-03-12 }}</ref> In 1796 [[Edward Jenner]] inoculated using [[cowpox]] (a mild relative of the deadly smallpox virus). [[Pasteur]] and others built on this.<ref name="pmid17633292"/> The word [[vaccination]] was first used by [[Edward Jenner]] an English physician 22 years later, in 1796. [[Louis Pasteur]] further adapted in his pioneering work in microbiology. Vaccination ([[Latin]]: ''vacca&mdash;[[cow]]'') is so named because the first [[vaccine]] was derived from a [[virus (biology)|virus]] affecting cows&mdash;the relatively benign [[cowpox]] virus&mdash;which provides a degree of immunity to [[smallpox]], a contagious and deadly disease. In common speech, 'vaccination' and 'immunization' generally have the same colloquial meaning. This distinguishes it from [[inoculation]] which uses unweakened live pathogens, although in common usage either is used to refer to an [[immunization]]. The word "vaccination" was originally used specifically to describe the injection of [[smallpox]] vaccine.<ref name="Sudhoffs"/> Vaccination efforts have been met with some [[Vaccine controversy|controversy]] since their inception, on ethical, political, medical safety, religious, and other grounds. Early success and [[Vaccination Act|compulsion]] brought widespread acceptance and mass vaccination campaigns were undertaken which are credited with greatly reducing the incidence of many diseases in numerous geographic regions. ==Triggering immune sensitization== In the generic sense, the process of [[artificial induction of immunity]], in an effort to protect against [[infectious disease]], works by 'priming' the [[immune system]] with an '[[immunogen]]'. Stimulating immune response, via use of an infectious agent, is known as ''[[immunization (medicine)|immunization]]''. Vaccinations involve the administration of one or more immunogens, which can be administered in several forms. Some modern vaccines are administered after the patient already has contracted a disease, as in the cases of experimental [[AIDS]], [[cancer]] and [[Alzheimer's disease]] vaccines. Vaccinia given after exposure to smallpox, within the first four days, is reported to attenuate the disease considerably, and vaccination within the first week is known to be beneficial to a degree. The first [[rabies]] immunization was given by [[Louis Pasteur]] to a child bitten by a rabid dog, subsequently post-exposure immunization to rabies has generally been followed by survival. The essential empiricism behind such immunizations is that the vaccine triggers an immune response more rapidly than the natural infection itself. Most vaccines are given by hypodermic injection as they are not absorbed reliably through the gut. Live attenuated Polio, some Typhoid and Cholera Vaccines are given orally in order to produce immunity based in the bowel. ==Types of vaccinations==<!-- This section is linked from [[MMR vaccine]] --> All '''vaccinations''' work by presenting a foreign antigen to the immune system in order to evoke an immune response, but there are several ways to do this. The three main types are as follows: #An inactivated vaccine consists of virus particles which are grown in culture and then killed using a method such as heat or formaldehyde. The virus particles are destroyed and cannot replicate, but the virus [[capsid]] proteins are intact enough to be recognized by the immune system and evoke a response. When manufactured correctly, the vaccine is not infectious, but improper inactivation can result in intact and infectious particles. Since the properly produced vaccine does not reproduce, [[booster dose|booster]] shots are required periodically to reinforce the immune response. #In an attenuated vaccine, live virus particles with very low virulence are administered. They will reproduce, but very slowly. Since they do reproduce and continue to present antigen beyond the initial vaccination, boosters are required less often. 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. There is a small risk of reversion to [[virulent|virulence]], this risk is smaller in vaccines with deletions. Attenuated vaccines also cannot be used by [[immunocompromised]] individuals. #A subunit vaccine presents an antigen to the immune system without introducing viral particles, whole or otherwise. One method of production involves isolation of a specific protein from a virus and administering this by itself. A weakness of this technique is that isolated proteins can be denatured and will then bind to different antibodies than the proteins in the virus. A second method of subunit vaccine is the [[recombinant]] vaccine, which involves putting a protein gene from the targeted virus into another virus. The second virus will express the protein, but will not present a risk to the patient. This is the type of vaccine currently in use for hepatitis, and it is experimentally popular, being used to try to develop new vaccines for difficult to vaccinate viruses such as [[Ebola]] and [[HIV]].<ref> [http://microvet.arizona.edu/courses/mic419/Tutorials/vaccines.html Department of Veterinary Science & Microbiology at The University of Arizona] ''Vaccines'' by Janet M. Decker, PhD</ref> ==History of vaccinations== [[Image:Edward Jenner manuscript.jpg|thumb|right|Jenner's handwritten draft of the first vaccination.]] Early forms of vaccination were developed in ancient [[China]] as early as 200 B.C.<ref name="pmid17633292"/> Scholar Ole Lund comments: "The earliest documented examples of vaccination are from [[India]] and [[China]] in the 17th century, where vaccination with powdered scabs from people infected with smallpox was used to protect against the disease. Smallpox used to be a common disease throughout the world and 20% to 30% of infected persons died from the disease. Smallpox was responsible for 8 to 20% of all deaths in several European countries in the 18th century. The tradition of vaccination may have originated in India in AD 1000."<ref>Lund, Ole; Nielsen, Morten Strunge and Lundegaard, Claus (2005). ''Immunological Bioinformatics''. MIT Press. ISBN 0262122804</ref> The mention of vaccination in the ''Sact'eya Grantham'', an [[Ayurvedic]] text, was noted by the French scholar Henri Marie Husson in the journal ''Dictionaire des sciences me`dicales''.<ref>Chaumeton, F.P.; F.V. Me`rat de Vaumartoise. ''Dictionaire des sciences me`dicales''. Paris: C.L.F. Panckoucke, 1812-1822, lvi (1821).</ref> [[Almroth Wright]], the professor of pathology at [[Netley]], further helped shape the future of vaccination by conducting limited experiments on the professional staff at Netly, including himself. The outcome of these experiments resulted in further development of vaccination in Europe.<ref>Curtin, Phillip (1998). "Disease and Empire: The Health of European Troops in the Conquest of Africa". Cambridge University Press. ISBN 0521598354</ref> The Anatolian Ottoman Turks knew about methods of vaccination about a hundred years before [[Edward Jenner]] to whom the discovery is attributed. They called vaccination Ashi or engrafting, which they used to apply to their children with cowpox taken from the breast of cattle. This kind of vaccination and other forms of variolation were introduced into England by Lady Montagu, a famous English letter-writer and wife of the English ambassador at Istanbul between 1716 and 1718. She came across the Turkish methods of vaccination, consenting to have her son inoculated by the Embassy surgeon Charles Maitland in the Turkish way. Lady Montagu wrote to her sister and friends in England describing the process in details. On her return to England she continued to propagate the Turkish tradition of vaccination and had many of her relatives inoculated. The breakthrough came when a scientific description of the vaccination operation was submitted to the Royal Society in 1724 by Dr Emmanual Timoni, who had been the Montagu’s family physician in Istanbul. Inoculation was adopted both in England and in France nearly half a century before [[Edward Jenner|Jenner]]'s famous smallpox vaccine of 1796.<ref>{{cite book |author=Anthony Henricy (ed.)|title=Lady Mary Wortley Montagu,Letters of the Right Honourable Lady Mary Wortley Montagu:Written During her Travels in Europe,Asia and Africa |volume=1 |issue=4 |pages=167-169 |year=1796}}</ref> Since then vaccination campaigns have spread throughout the globe, sometimes prescribed by law or regulations (See [[Vaccination Act]]s). Vaccines are now used to fight a wide variety of disease threats besides [[smallpox]]. [[Louis Pasteur]] further developed the technique during the 19th century, extending its use to protecting against bacterial [[anthrax disease|anthrax]] and viral [[rabies]]. The method Pasteur used entailed treating the infectious agents for those diseases so they lost the ability to cause serious disease. Pasteur adopted the name ''vaccine'' as a generic term in honor of Jenner's discovery, which Pasteur's work built upon. Prior to vaccination with cowpox, the only known protection against smallpox was ''[[inoculation]]'' or ''variolation'' (Variola - the Smallpox viruses) where a small amount of live smallpox virus was administered to the patient; this carried the serious risk that the patient would be killed or seriously ill. The death rate from variolation was reported to be around a tenth of that from natural infection with Variola, and the immunity provided was considered quite reliable. Factors contributing to the efficacy of variolation probably include the choices of Variola Minor strains used, the relatively low number of cells infected in the first phase of multiplication following initial exposure, and the exposure route used, via the skin or nasal lining rather than inhalation of droplets into the lungs. Consistency would suggest the activity should have predated Jenner's description of an effective vaccination system, and there is some history relating to opposition to the older and more hazardous procedure of variolation. In modern times, the first vaccine-preventable disease targeted for eradication was smallpox. The [[World Health Organization]] (WHO) coordinated the global effort to eradicate this disease. The last naturally occurring case of smallpox occurred in [[Somalia]] in 1977. In 1988, the governing body of WHO targeted [[Polio eradication|polio for eradication]] by the year 2000. Although the target was missed, eradication is very close. The next eradication target would most likely be measles, which has declined since the introduction of measles vaccination in 1963. In 2000, the [[Global Alliance for Vaccines and Immunization]] was established to strengthen routine vaccinations and introduce new and under-used vaccines in countries with a per capita GDP of under US$1000. GAVI is now entering its second phase of funding, which extends through 2014. ==Vaccination policies, compulsory vaccination== [[Image:Poster for vaccination against smallpox.jpg|thumb|right|Poster for vaccination against smallpox.]] {{main|Vaccination policy}} {{see|Vaccine controversy}} In an attempt to eliminate the risk of outbreaks of some diseases, at various times several governments and other institutions have instituted policies requiring vaccination for all people. For example, an 1853 law required universal vaccination against smallpox in [[England]] and [[Wales]], with fines levied on people who did not comply. Common contemporary U.S. vaccination policies require that children receive common vaccinations before entering school. A few other countries also have some compulsory vaccinations. Beginning with early vaccination in the nineteenth century, these policies led to resistance from a variety of groups, collectively called [[anti-vaccinationist]]s, who objected on ethical, political, medical safety, [[vaccination and religion|religious]], and other grounds. Common objections are that compulsory vaccination represents excessive government intervention in personal matters, or that the proposed vaccinations are not sufficiently safe.<ref name=wolfesharp>{{cite journal |author= Wolfe R, Sharp L |title= Anti-vaccinationists past and present |journal=BMJ |volume=325 |issue=7361 |pages=430–2 |year=2002 |pmid=12193361 |doi=10.1136/bmj.325.7361.430 |url=http://bmj.bmjjournals.com/cgi/content/full/325/7361/430}}</ref> Many modern vaccination policies allow exemptions for people who have compromised immune systems, allergies to the components used in vaccinations or strongly-held objections.<ref name="Salmon2006">Salmon, Daniel A ''et al''. (2006) Compulsory vaccination and conscientious or philosophical exemptions: past, present, and future. ''The Lancet'' 367(9508):436-442.</ref> ==Herd immunity and medical risk management issues== Vaccination campaigns are generally accepted as having contributed to the worldwide elimination of [[smallpox]], through [[herd immunity]], and to the restriction of [[polio]] to isolated pockets in countries where healthcare access is difficult. The [[risk management]] practices of government health agencies' promoting widespread vaccination campaigns has prompted increasing controversy in recent years, despite the fact that many once-common childhood diseases, such as [[mumps]], [[measles]] and [[rubella]], are now relatively rare in developed countries. ==Adjuvants and preservatives== Vaccines typically contain one or more [[adjuvants]], used to boost the immune response. Tetanus toxoid, for instance, is usually adsorbed onto [[alum]]. This presents the antigen in such a way as to produce a greater action than the simple aqueous tetanus toxoid. People who get an excessive reaction to adsorbed tetanus toxoid may be given the simple vaccine when time for a booster occurs. In the preparation for the 1990 Gulf campaign, Pertussis vaccine (not acellular) was used as an adjuvant for Anthrax vaccine. This produces a more rapid immune response than giving only the Anthrax, which is of some benefit if exposure might be imminent. They may also contain preservatives, which are used to prevent contamination with [[bacteria]] or [[fungi]]. Until recent years, the preservative [[thiomersal]] was used in many vaccines that did not contain live virus. [[As of 2005]], the only childhood vaccine in the U.S. that contains thiomersal in greater than trace amounts is the influenza vaccine [http://www.vaccinesafety.edu/thi-table.htm], which is currently recommended only for children with certain risk factors.<ref>Melinda Wharton. National Vaccine Advisory committee [http://www.hhs.gov/nvpo/vacc_plan/ U.S.A. national vaccine plan]</ref> The UK is considering Influenza immunisation in children perhaps as soon as in 2006-7. Single-dose Influenza vaccines supplied in the UK do not list Thiomersal (its UK name) in the ingredients. Preservatives may be used at various stages of production of vaccines, and the most sophisticated methods of measurement might detect traces of them in the finished product, as they may in the environment and population as a whole [http://www.npl.co.uk/environment/vam/nongaseouspollutants/ngp_metals.html]. ==Combined vaccines== Combined vaccinations are now widely used around the world, a result of the rapid increase in the number of shots recommended in current [[vaccination schedule]]s. ==Methods of administration== A vaccine administration may be oral, by injection (intramuscular, intradermal, subcutaneous), by puncture, [[transdermal]] or intranasal.<ref>{{cite book | last = Plotkin | first = Stanley A. | title = Mass Vaccination: Global Aspects - Progress and Obstacles (Current Topics in Microbiology & Immunology) | publisher = Springer-Verlag Berlin and Heidelberg GmbH & Co. K | date = 2006 | isbn = 978-3540293828 }}</ref> ==Vaccine research== Some major contemporary research in vaccination focuses on development of vaccinations for diseases including [[HIV vaccine|HIV]] and [[malaria]]. ''Vaccine'' is an international [[peer-reviewed]] journal for vaccination researchers, indexed in [[Medline]] pISSN: 0264-410X. ==See also== * [[Inoculation]] * [[Influenza vaccine]] * [[H5N1 clinical trials|H5N1 flu vaccine clinical trials]] * [[Vaccine]] * [[Vaccine controversy]] * [[Vaccine trial]] * [[Vaccination schedule]] * [[Vaccination of dogs]] * [[Immunization during pregnancy]] ==References== {{reflist}} ==External links== {{commonscat|Vaccination}} * [http://vaccines.org/ The Vaccine Page] links to resources in many countries. * [http://www.immunisation.nhs.uk/article.php?id=97 Immunisation] Immunisation schedule for children in the UK. Published by the UK Department of Health. * [http://www.informedchoice.info/cocktail.html Vaccine Ingredients] A list of vaccine ingredients. * [http://briandeer.com/mmr-lancet.htm Brian Deer.com] - 'mmr & autism investigation: part 1: the ''Lancet'' scandal', [[Brian Deer]] * [http://www.cdc.gov/nip CDC.gov] - 'National Immunization Program: leading the way to healthy lives', [[Centers for Disease Control|US Centers for Disease Control]] (CDC information on vaccinations) * [http://www.cdc.gov/nip/vacsafe/concerns/thimerosal/default.htm CDC.gov] - 'Mercury and Vaccines (Thimerosal)', US Centers for Disease Control * [http://www.immunize.org/ Immunize.org] - Immunization Action Coalition' (nonprofit working to increase immunization rates) * [http://nytimes.com/2005/06/25/science/25autism.html NYTimes.com] - 'On Autism's Cause, It's Parents vs. Research', Gardiner Harris, Anahad O'Connor, ''New York Times'' (front page; June 25, 2005) * [http://www.opinionjournal.com/editorial/feature.html?id=110004700 OpinionJournal.com] - 'Autism and vaccines: Activists wage a nasty campaign to silence scientists' (unsigned editorial opinion), ''[[Wall Street Journal]]'' (February 16, 2004) * [http://www.shns.com/shns/g_index2.cfm?action=detail&pk=FUMENTO-03-11-04 SNHS.com] - 'Anti-vaccine activists get jabbed', Michael Fumento (March 11, 2004) * [http://www.who.int/immunization/en/ WHO.int] - 'Immunizations, vaccines and biologicals: Towards a World free of Vaccine Preventable Diseases', [[World Health Organization]] (WHO's global vaccination campaign website) * [http://www.909shot.com/ 909Shot.com] - 'National Vaccine Information Center: the oldest and largest national organization advocating reformation of the mass vaccination system' * [http://www.vaccinationdebate.com/ VaccinationDebate.com] - 'Vaccination Debate', Ian Sinclair * [http://www.vaclib.org/ VacLib.org] - 'Vaccination Liberation' {{Vaccines}} [[Category:Vaccination| Vaccination]] {{Link FA|de}} {{Link FA|vi}} {{Link FA|zh}} [[da:Vaccination]] [[de:Impfung]] [[es:Vacunación]] [[fr:vaccination]] [[it:Vaccinazione]] [[nl:vaccinatie]] [[pt:Vacinação]] [[ro:Vaccin]] [[simple:vaccination]] [[sk:Očkovanie]] [[fi:Rokotus]] [[sv:Vaccination]] [[vi:Vắc-xin]] [[zh:疫苗接種]]