SVaccination

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From Wikipedia, the free encyclopedia

This article is about administration of a vaccine. For the vaccines themselves,

see vaccine.
See also: Immunization
Vaccinations

Girl about to be vaccinated in her upper arm

 ICD-9-CM 99.3-99.5
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Vaccination is the administration of a vaccine to help the immune

system develop immunity from a disease. Vaccines contain
a microorganism or virus in a weakened, live or killed state,
or proteins or toxins from the organism. In stimulating the body's adaptive
immunity, they help prevent sickness from an infectious disease. When a
sufficiently large percentage of a population has been vaccinated, herd
immunity results. Herd immunity protects those who may be
immunocompromised and cannot get a vaccine because even a weakened
version would harm them.[1] The effectiveness of vaccination has been widely
studied and verified.[2][3][4] Vaccination is the most effective method of
preventing infectious diseases;[5][6][7][8] widespread immunity due to
vaccination is largely responsible for the worldwide
eradication of smallpox and the elimination of diseases such
as polio and tetanus from much of the world. However, some diseases, such
as measles outbreaks in America, have seen rising cases due to relatively low
vaccination rates in the 2010s – attributed, in part, to vaccine hesitancy.
[9] According to the World Health Organization, vaccination prevents 3.5–
5 million deaths per year.[10]

The first disease people tried to prevent by inoculation was most likely
smallpox, with the first recorded use of variolation occurring in the 16th
century in China.[11] It was also the first disease for which a vaccine was
produced.[12][13] Although at least six people had used the same principles
years earlier, the smallpox vaccine was invented in 1796 by English
physician Edward Jenner. He was the first to publish evidence that it was
effective and to provide advice on its production.[14] Louis Pasteur furthered
the concept through his work in microbiology. The immunization was
called vaccination because it was derived from a virus affecting cows
(Latin: vacca 'cow').[12][14] Smallpox was a contagious and deadly disease,
causing the deaths of 20–60% of infected adults and over 80% of infected
children.[15] When smallpox was finally eradicated in 1979, it had already killed
an estimated 300–500 million people in the 20th century.[16][17][18]

Vaccination and immunization have a similar meaning in everyday language.

This is distinct from inoculation, which uses unweakened live pathogens.
Vaccination efforts have been met with some reluctance on scientific, ethical,
political, medical safety, and religious grounds, although no major religions
oppose vaccination, and some consider it an obligation due to the potential to
save lives.[19] In the United States, people may receive compensation for
alleged injuries under the National Vaccine Injury Compensation Program.
Early success brought widespread acceptance, and mass vaccination
campaigns have greatly reduced the incidence of many diseases in numerous
geographic regions. The Centers for Disease Control and Prevention lists
vaccination as one of the ten great public health achievements of the 20th
century in the U.S.[20]

Mechanism of function[edit]

In Sweden, polio vaccination started in 1957.

A mobile medicine laboratory providing

vaccinations against diseases spread by ticks

COVID-19 Vaccination Center of the Medical University of Gdańsk, Poland

Vaccines are a way of artificially activating the immune system to protect

against infectious disease. The activation occurs through priming the immune
system with an immunogen. Stimulating immune responses with an infectious
agent is known as immunization. Vaccination includes various ways of
administering immunogens.[21]

Most vaccines are administered before a patient has contracted a disease to

help increase future protection. However, some vaccines are administered
after the patient already has contracted a disease. Vaccines given after
exposure to smallpox are reported to offer some protection from disease or
may reduce the severity of disease.[22] The first rabies immunization was
given by Louis Pasteur to a child after he was bitten by a rabid dog. Since its
discovery, the rabies vaccine has been proven effective in preventing rabies
in humans when administered several times over 14 days along with
rabies immune globulin and wound care.[23] Other examples include
experimental AIDS, cancer[24] and Alzheimer's disease vaccines.[25] Such
immunizations aim to trigger an immune response more rapidly and with less
harm than natural infection.[26]

Most vaccines are given by injection as they are not absorbed reliably through
the intestines. Live attenuated polio, rotavirus, some typhoid, and some
cholera vaccines are given orally to produce immunity in the bowel. While
vaccination provides a lasting effect, it usually takes several weeks to
develop. This differs from passive immunity (the transfer of antibodies, such
as in breastfeeding), which has immediate effect.[27]

A vaccine failure is when an organism contracts a disease in spite of being

vaccinated against it. Primary vaccine failure occurs when an organism's
immune system does not produce antibodies when first vaccinated. Vaccines
can fail when several series are given and fail to produce an immune
response. The term "vaccine failure" does not necessarily imply that the
vaccine is defective. Most vaccine failures are simply due to individual
variations in immune response.[28]

Measles infection rate vs. vaccination rate,

1980–2011. Source: WHO

Vaccination versus inoculation[edit]

The term "inoculation" is often used interchangeably with "vaccination."

However, while related, the terms are not synonymous. Vaccination is
treatment of an individual with an attenuated (i.e. less virulent) pathogen or
other immunogen, whereas inoculation, also called variolation in the context
of smallpox prophylaxis, is treatment with unattenuated variola virus taken
from a pustule or scab of a smallpox patient into the superficial layers of the
skin, commonly the upper arm. Variolation was often done 'arm-to-arm' or,
less effectively, 'scab-to-arm', and often caused the patient to become
infected with smallpox, which in some cases resulted in severe disease.[29][30]

Vaccinations began in the late 18th century with the work of Edward
Jenner and the smallpox vaccine.[31][32][33]

Preventing disease versus preventing infection[edit]

Some vaccines, like the smallpox vaccine, prevent infection. Their use results
in sterilizing immunity and can help eradicate a disease if there is no animal
reserve. Other vaccines, including those for COVID-19, help to (temporarily)
lower the chance of severe disease for individuals, without necessarily
reducing the probability of becoming infected.[34]

Safety[edit]

Further information: Vaccine hesitancy and Vaccine adverse event

Global smallpox cases from 1920 to 2010.

Source: WHO

Vaccine development and approval[edit]

Just like any medication or procedure, no vaccine can be 100% safe or

effective for everyone because each person's body can react differently.[35]
[36] While minor side effects, such as soreness or low grade fever, are
relatively common, serious side effects are very rare and occur in about 1 out
of every 100,000 vaccinations and typically involve allergic reactions that can
cause hives or difficulty breathing.[37][38]

However, vaccines are the safest they ever have been in history and each
vaccine undergoes rigorous clinical trials to ensure their safety
and efficacy before approval by authorities such as the US Food and Drug
Administration (FDA).[39]

Prior to human testing, vaccines are tested on cell cultures and the results
modelled to assess how they will interact with the immune system.[37]
[39] During the next round of testing, researchers study vaccines in animals,
including mice, rabbits, guinea pigs, and monkeys.[37] Vaccines that pass each
of these stages of testing are then approved by the public health safety
authority (FDA in the United States) to start a three-phase series of human
testing, advancing to higher phases only if they are deemed safe and effective
at the previous phase. The people in these trials participate voluntarily and
are required to prove they understand the purpose of the study and the
potential risks.[39]

During phase I trials, a vaccine is tested in a group of about 20 people with

the primary goal of assessing the vaccine's safety.[37] Phase II trials expand
the testing to include 50 to several hundred people. During this stage, the
vaccine's safety continues to be evaluated and researchers also gather data
on the effectiveness and the ideal dose of the vaccine.[37] Vaccines
determined to be safe and efficacious then advance to phase III trials, which
focuses on the efficacy of the vaccine in hundreds to thousands of volunteers.
This phase can take several years to complete and researchers use this
opportunity to compare the vaccinated volunteers to those who have not been
vaccinated to highlight any true reactions to the vaccine that occur.[39]

If a vaccine passes all of the phases of testing, the manufacturer can then
apply for license of the vaccine through the relevant regulatory authorities
such as the FDA in US. Before regulatory authorities approve use in the
general public, they extensively review the results of the clinical trials, safety
tests, purity tests, and manufacturing methods and establish that the
manufacturer itself is up to government standards in many other areas.[37][40]

After regulatory approval, the regulators continue to monitor the

manufacturing protocols, batch purity, and the manufacturing facility itself.
Additionally, vaccines also undergo phase IV trials, which monitor the safety
and efficacy of vaccines in tens of thousands of people, or more, across many
years.[37][40]

Side effects[edit]

The Centers for Disease Control and Prevention (CDC) has compiled a list of
vaccines and their possible side effects.[38] The risk of side effects varies
between vaccines.

Notable vaccine investigations[edit]

In 1976 in the United States, a mass swine flu vaccination programme was
discontinued after 362 cases of Guillain–Barré syndrome among 45 million
vaccinated people. William Foege of the CDC estimated that the incidence of
Guillain-Barré was four times higher in vaccinated people than in those not
receiving the swine flu vaccine.

Dengvaxia, the only approved vaccine for Dengue fever, was found to
increase the risk of hospitalization for Dengue fever by 1.58 times in children
of 9 years or younger, resulting in the suspension of a mass vaccination
program in the Philippines in 2017.[41]

Pandemrix – a vaccine for the H1N1 pandemic of 2009 given to around 31

million people[36] – was found to have a higher level of adverse events than
alternative vaccines resulting in legal action.[42] In a response to
the narcolepsy reports following immunization with Pandemrix, the CDC
carried out a population-based study and found the FDA-approved 2009
H1N1 flu shots were not associated with an increased risk for the neurological
disorder.[43]

Ingredients[edit]

The ingredients of vaccines can vary greatly from one to the next and no two
vaccines are the same. The CDC has compiled a list of vaccines and their
ingredients that is readily accessible on their website.[44]
Aluminium[edit]

Aluminium is an adjuvant ingredient in some vaccines. An adjuvant is a type

of ingredient that is used to help the body's immune system create a stronger
immune response after receiving the vaccination.[45] Aluminium is in
a salt form (the ionic version of an element) and is used in the following
compounds: aluminium hydroxide, aluminium phosphate, and aluminium
potassium sulfate. For a given element, the ion form has different properties
from the elemental form. Although it is possible to have aluminium toxicity,
aluminium salts have been used effectively and safely since the 1930s when
they were first used with the diphtheria and tetanus vaccines.[45] Although
there is a small increase in the chance of having a local reaction to a vaccine
with an aluminium salt (redness, soreness, and swelling), there is no
increased risk of any serious reactions.[46][47]

Mercury[edit]

Certain vaccines once contained a compound called thiomersal or thimerosal,

which is an organic compound containing mercury. Organomercury is
commonly found in two forms. The methylmercury cation (with one carbon
atom) is found in mercury-contaminated fish and is the form that people might
ingest in mercury-polluted areas (Minamata disease), whereas
the ethylmercury cation (with two carbon atoms) is present in thimerosal,
linked to thiosalicylate.[48] Although both are organomercury compounds, they
do not have the same chemical properties and interact with the human body
differently. Ethylmercury is cleared from the body faster than methylmercury
and is less likely to cause toxic effects.[48]

Thimerosal was used as a preservative to prevent the growth

of bacteria and fungi in vials that contain more than one dose of a vaccine.
[48] This helps reduce the risk of potential infections or serious illness that
could occur from contamination of a vaccine vial. Although there was a small
increase in risk of injection site redness and swelling with vaccines containing
thimerosal, there was no increased risk of serious harm or autism.[49][50] Even
though evidence supports the safety and efficacy of thimerosal in vaccines,
thimerosal was removed from childhood vaccines in the United States in 2001
as a precaution.[48]