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Overview of Immunization...medical consulting

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Vaccination Before Foreign Travel











Residents of the United States may be required to receive specific vaccines before traveling to areas that have infectious diseases not normally found in the United States (see table Vaccines for International Travel). Recommendations change frequently in response to disease outbreaks.



The CDC provides the most up-to-date information on vaccination requirements in their Travelers’ Health section. Also the CDC has a 24-hour telephone service (1-800-232-4636 [CDC-INFO]) that provides information.


Types of Immunization











There are two types of immunization:





Active immunization




Passive immunization




Active immunization

In active immunization vaccines are used to stimulate the body’s natural defense mechanisms (the immune system). Vaccines are preparations that contain one of the following:





Noninfectious fragments of bacteria or viruses




A usually harmful substance (toxin) that is produced by a bacteria but has been modified to be harmless—called a toxoid




Weakened (attenuated) live whole organisms that do not cause illness






The body’s immune system responds to a vaccine by producing substances (such as antibodies and white blood cells) that recognize and attack the specific bacteria or virus contained in the vaccine. Then whenever the person is exposed to the specific bacteria or virus the body automatically produces these antibodies and other substances to prevent or lessen illness. The process of giving a vaccine is called vaccination although many doctors use the more general term immunization.



Vaccines that contain live but weakened organisms include





Bacille Calmette-Guérin (BCG—for tuberculosis)




Chickenpox (varicella)




Cholera (certain vaccines given by mouth)




Ebola




Influenza (only the nasal spray vaccine)




Measles-mumps-rubella




Polio (only the oral vaccine)




Rotavirus




Typhoid (only the oral vaccine)




Shingles (only one of the two available vaccines)




Yellow fever











Did You Know...










Some vaccines contain a weakened but living form of the microorganism that they protect against.


















Passive immunization

In passive immunization antibodies against a specific infectious organism are given directly to a person. These antibodies are obtained from several sources:





The blood (serum) of animals (usually horses) that have been exposed to a particular organism or toxin and have developed immunity




Blood collected from a large group of people—called pooled human immune globulin




People known to have antibodies to a particular disease (that is people who have been immunized or who are recovering from the disease)—called hyperimmune globulin—because these people have higher levels of antibodies in their blood




Antibody-producing cells (usually taken from mice) grown in a laboratory






Passive immunization is used for people whose immune system does not respond adequately to an infection or for people who acquire an infection before they can be vaccinated (for example after being bitten by an animal with rabies).



Passive immunization can also be used to prevent disease when people are likely to be exposed and do not have time to get or complete a vaccination series. For example a solution containing gamma globulin that is active against chickenpox virus can be given to a pregnant woman who does not have immunity to the virus and has been exposed to it. The chickenpox virus can harm the fetus and cause serious complications (such as pneumonia) in the woman.



Passive immunization lasts for only a few weeks until the body eliminates the injected antibodies.



More Information about Immunization











The following are some English-language resources that may be useful. Please note that THE MANUAL is not responsible for the content of these resources.





Centers for Disease Control and Prevention (CDC): Child and adolescent immunization schedule for ages 18 years or younger




CDC: Adult immunization schedule for ages 19 years and older




CDC: FAQs about vaccine safety for parents and caregivers




CDC: Travelers’ Health: Information about travel health notices and about what vaccines to get depending on destination




Food and Drug Administration (FDA): Thimerosal and Vaccines: Comprehensive information about thimerosal—what it is why it is used in vaccines why it is safe and how many vaccines are now made without it




Vaccine Adverse Event Reporting System (VAERS): Where and how to report side effects of vaccines




Vaccine Safety Datalink (VSD): A collaborative organization that monitors and evaluates the safety of vaccines





Vaccine Safety











In the United States the Centers for Disease Control and Prevention (CDC) monitors the safety of vaccines. Doctors must report certain problems that occur after routine vaccination to the CDC's Vaccine Adverse Event Reporting System (VAERS) and Vaccine Safety Datalink (VSD). If any health problem happens after vaccination anyone—doctors nurses or any member of the general public—can submit a report to VAERS. VAERS reports cannot determine whether a health problem was caused by the vaccine.



Before a new vaccine can be licensed it like any medical product is tested in controlled clinical trials. Such trials compare the new vaccine to a placebo or to a previously existing vaccine for the same disease. Such trials show whether the vaccine is effective and identify common side effects. However some side effects are too rare to be detected in any reasonably sized clinical trial and do not become apparent until after a vaccine is used routinely in many people. Thus a surveillance system called the Vaccine Adverse Event Reporting System was created to monitor the safety of vaccines that are used in the general public. VAERS collects reports from people who believe that they had a side effect after a recent vaccination and from health care practitioners who identify certain possible side effects after a vaccine was given even if they are unsure the effects are related to the vaccine. Thus the existence of a VAERS report is not proof that a vaccine caused a certain side effect. VAERS is simply a system for collecting data about things that might be side effects. Then the Food and Drug Administration (FDA) can further evaluate the concern by comparing how often the possible side effect occurred in people who were vaccinated to how often it occurred in people who were not vaccinated.



Vaccines usually cause no problems although mild side effects such as soreness or redness at the injection site may occur. Nonetheless many parents remain concerned about the safety of childhood vaccines and their possible side effects.



One of parents' main concerns has been





That certain vaccines such as the measles-mumps-rubella (MMR) vaccine or vaccines that contain thimerosal (a mercury-based preservative) may increase the risk of autism






Many different groups of scientists have studied these concerns and have completely disproved the supposed relationship between vaccines and autism (see Childhood Vaccination Concerns in THE MANUAL and FAQs About Vaccine Safety at the CDC web site).



Nevertheless most manufacturers have developed thimerosal-free vaccines for use in infants and adults. Information about vaccines that currently contain low levels of thimerosal is available at the Food and Drug Administration's web site (Thimerosal and Vaccines).


Common Vaccinations in Children











Children typically are given a number of vaccines according to a standard schedule (see figure Routine Vaccinations for Infants Children and Adolescents and Centers for Disease Control and Prevention: Immunization Schedules). If vaccines are missed most can be given later according to a catch-up schedule.




Table










Protecting Children Through Vaccines






Disease




When Do Vaccinations Typically Start








Chickenpox (varicella)




Age 12–15 months






Diphtheria




Age 2 months






Haemophilus influenzae type b infections (such as meningitis)




Age 2 months






Hepatitis A




Age 12–23 months






Hepatitis B




Birth






Human papillomavirus (HPV)




Age 11–12 years (can start at age 9 years)






Influenza




Age 6 months






Measles




Age 12–15 months






Meningococcal meningitis




Age 11–12 years



Age 2 to 9 months for children at high risk






Mumps




Age 12–15 months






Pertussis




Age 2 months






Pneumococcal infections




Age 2 months






Polio




Age 2 months






Rotavirus infection




Age 2 months






Rubella (German measles)




Age 12–15 months






Tetanus




Age 2 months
















Vaccination Restrictions and Precautions











For many vaccines the only reason for not being vaccinated is





A serious life-threatening allergic reaction (such as an anaphylactic reaction) to the vaccine or to one of its components






Egg allergy is common in the US. Some vaccines including most influenza vaccines contain very small amounts of material from eggs. Thus there is concern about using such vaccines in people who are allergic to eggs. However the Centers for Disease Control and Prevention (CDC) states that although mild reactions may occur serious allergic reactions (anaphylaxis) are unlikely. Recommendations for the influenza vaccine vary according to the severity of the allergic reaction to eggs and the vaccine. If people who had a severe life-threatening allergic reaction after they were given the influenza vaccine or eggs they should not be given the influenza vaccine. If people had only a rash after exposure to eggs or the vaccine they may be given the vaccine. If people had a more serious reaction such as facial swelling difficulty breathing or dizziness or reactions that required an injection of the drug epinephrine or other emergency treatment they should get the vaccine in a medical setting supervised by a clinician who has experience recognizing and managing severe allergic reactions.



Vaccines that contain live organisms should not be used or should be delayed in people with certain conditions such as





Use of drugs that suppress the immune system (immunosuppressants) such as corticosteroids and chemotherapy drugs




A disorder that weakens the immune system such as AIDS




Pregnancy




Development of Guillain-Barré syndrome within 6 weeks after a previous dose of the vaccine






If people stop taking the drugs that suppress their immune system or if their weakened immune system recovers sufficiently giving them vaccines that contain live virus may be safe.


Common Vaccinations in Adults











Adults may also be advised to receive certain vaccines (see also Centers for Disease Control and Prevention: Immunization Schedule for Adults). When advising adults about vaccination a doctor considers the person’s age health history childhood vaccinations occupation geographic location travel plans and other factors.




Table










Protecting Adults Through Vaccines






Disease*




Who Should Be Vaccinated








Anthrax




People who have been exposed to anthrax



People who may be exposed to anthrax such as the following:





Some military personnel




Some laboratory workers




Veterinarians









Chickenpox (varicella)




All adults who have not had the vaccine or chickenpox






Diphtheria




All adults (usually as a combination vaccine with tetanus as Td or also with pertussis as Tdap) if they have not already been vaccinated



Pregnant women should receive Tdap during each pregnancy






Haemophilus influenzae type b infections (such as meningitis)




Adults who have not been vaccinated and who are at increased risk such as the following:





People who do not have a functioning spleen




People who have a weakened immune system (such as those with AIDS)




People who have had chemotherapy for cancer




People who have had stem cell transplantation









Hepatitis A




Adults who have not been vaccinated and who are at increased risk such as the following:





People who travel to or work in areas where the infection is common




People who use illegal drugs (such as methamphetamine)




Men who have sex with men




People who have a chronic liver disorder or high levels of certain liver enzymes in their blood




Healthy adults 40 years or under who have recently been exposed to hepatitis A virus




People who anticipate close contact with an adopted child during the first 60 days after the child arrives in the United States from an area where hepatitis A is common




People who are homeless




Pregnant women who are identified to be at risk of getting hepatitis A infection during pregnancy (such as women who are international travelers who use illicit drugs [injected or not] who may be exposed at work who anticipate close personal contact with an international adopted child or who are homeless) or who are at risk of getting very sick or dying of hepatitis A virus infection (such as women who have chronic liver disease or HIV infection)









Hepatitis B




Adults who have not been vaccinated and who are at increased risk such as the following:





Health care custodial or public safety workers




Travelers to areas where the infection is common




People with a chronic liver disorder or high levels of certain liver enzymes in their blood




People with kidney failure including those who need dialysis




People who inject illegal drugs




People who have several sex partners




People who need to be evaluated or treated for a sexually transmitted disease




Men who have sex with men




Sex partners and household contacts of people known to be carriers of hepatitis B




People with HIV infection




People who are under 60 and have diabetes and sometimes people who are age 60 and older who have diabetes




People who have spent time (as patients residents or employees) in correctional facilities or in facilities that provide services for people at high risk of hepatitis B (such as drug-abuse treatment centers sites for injection drug use hemodialysis centers institutions for developmentally disabled people and places where people with sexually transmitted diseases or HIV infection are tested and treated)




Pregnant women if they are at risk of getting the infection or of getting very sick or dying of hepatitis B infection (such as women who have chronic liver disease or HIV infection)









Human papillomavirus (HPV)




All males and females who have not been previously vaccinated (typically at age 11 or 12 years) through age 26 years



All adults aged 27 to 45 years should talk with their doctor about whether they should be vaccinated






Influenza




All people over age 6 months






Measles




All adults born in or after 1957 unless they have documentation of vaccination with one or more doses of the measles mumps and rubella (MMR) vaccine or laboratory tests detect evidence of measles immunity



Always given as a combination vaccine with mumps and rubella (not available as a single vaccine)






Meningococcal meningitis




Certain people over age 55



People 16 to 23 years of age who want it



People at increased risk such as the following:





People who do not have a functioning spleen (including sickle cell disease)




People with HIV infection




People with certain immunodeficiency disorders




People who take eculizumab or ravulizumab (drugs that block the complement system)




Microbiologists who are routinely exposed to the bacteria




Adolescents if they have not already been vaccinated




First-year college students who live in dormitories who are 21 years old or younger and who have not been given a dose of the vaccine on or after their 16th birthday




Military recruits




Travelers to or residents of areas where the infection is common




People who have been exposed during a meningitis outbreak









Mumps




All adults born in or after 1957 unless they have documentation of vaccination with one or more doses of the MMR vaccine or laboratory tests detect evidence of mumps immunity



Always given as a combination vaccine with measles and rubella (not available as a single vaccine)






Pertussis (whooping cough)




All adults (usually given as a combination vaccine with tetanus and diphtheria as Tdap) if they have not already been vaccinated



Pregnant women during each pregnancy






Pneumococcal infections (such as meningitis and pneumonia)




All people aged 65 years and over



Adults at increased risk such as the following:





People with a chronic heart lung (including asthma and emphysema) kidney or liver disorder




People with diabetes




People with a cerebrospinal fluid leak




People with a weakened immune system (including those with HIV infection leukemia lymphoma or cancer those who take drugs that suppress the immune system [immunosuppressants] and those who have had certain organ transplants)




People who do not have a functioning spleen (including those with sickle cell disease)




People who have a cochlear implant




People who have an alcohol use disorder




Adults who smoke cigarettes









Polio




Adults at increased risk such as





Travelers to areas where polio is common




Laboratory workers who work with the polio virus




People who treat people who may have polio









Rabies




People who have been bitten by certain animals



People who may be at increased risk of exposure to infected animals such as





Veterinarians and animal handlers




Laboratory workers who handle animals that may be rabid




People who explore bat caves




People who live or stay more than 30 days in developing countries where rabies in dogs is widespread









Rubella (German measles)




All adults born in or after 1957 unless they have documentation of vaccination with one or more doses of the MMR vaccine or laboratory tests detect evidence of rubella immunity



Women who are planning on becoming pregnant and do not have immunity to rubella



Always given as a combination vaccine with measles and mumps (not available as a single vaccine)






Shingles (herpes zoster)




People aged 50 and over






Smallpox




Not currently recommended except for people at high risk of being exposed to the smallpox virus such as laboratory workers who directly handle the virus and related materials






Tetanus




All adults every 10 years (usually as a combination vaccine with tetanus and diphtheria as Td or also with pertussis as Tdap) if they have not already been vaccinated



Pregnant women should receive Tdap during each pregnancy






Typhoid




People traveling to areas where the infection is common



People who have close contact with a typhoid carrier



Laboratory workers who work with the bacteria that cause typhoid fever






Yellow fever




People traveling to certain parts of Africa and South America where the infection is common








* Vaccines are available in the United States for these infections.






HIV = human immunodeficiency virus; Td = tetanus-diphtheria; Tdap = tetanus-diphtheria-pertussis.
















Vaccine Administration











Vaccines and antibodies are usually given by injection into a muscle (intramuscularly) or under the skin (subcutaneously). Antibodies are sometimes injected into a vein (intravenously). One type of influenza vaccine is sprayed into the nose.



More than one vaccine may be given at a time—in one combination vaccine or in separate injections at different injection sites (see Use of several vaccines at the same time).



Some vaccines are given routinely—for example the tetanus toxoid is given to adults preferably every 10 years. Some vaccines are routinely given to children (see figure Routine Vaccinations for Infants Children and Adolescents).



Other vaccines are usually given mainly to specific groups of people. For example the yellow fever vaccine is given only to people traveling to certain parts of Africa and South America. Still other vaccines are given after possible exposure to a specific disease. For example the rabies vaccine may be given to a person who has been bitten by a dog.


simple explanation



Immunization enables the body to better defend itself against diseases caused by certain bacteria or viruses. Immunity (the ability of the body to defend itself against diseases caused by certain bacteria or viruses) may occur naturally (when people are exposed to bacteria or viruses) or doctors may provide it through vaccination. When people are immunized against a disease they usually do not get the disease or get only a mild form of the disease. However because no vaccine is 100% effective some people who have been immunized still may get the disease.


In communities and countries where vaccines are widely used many diseases that were once common and/or fatal (such as polio and diphtheria) are now rare or under control. One disease smallpox has been completely eliminated by vaccination. Vaccines have been very effective in preventing serious disease and in improving health worldwide. However effective vaccines are not yet available for many important infections including most sexually transmitted diseases (such as HIV infection syphilis gonorrhea and chlamydial infections) infections caused by ticks (such as Lyme disease) and many tropical diseases (such as malaria).


Following recommendations for vaccination is very important for people's own health and for the health of their family and the people in their community. Many of the diseases prevented by vaccination are easily spread from person to person. Many of them are still present in the United States and remain common in other parts of the world. These diseases can spread rapidly among unvaccinated children who because of the ease of modern travel can be exposed even if they live in areas where a disease is not common.


Vaccines available today are highly reliable and most people tolerate them well. They rarely have side effects.


There are two types of immunization:


Active immunization


Passive immunization


In active immunization vaccines are used to stimulate the body’s natural defense mechanisms (the immune system). Vaccines are preparations that contain one of the following:


Noninfectious fragments of bacteria or viruses


A usually harmful substance (toxin) that is produced by a bacteria but has been modified to be harmless—called a toxoid


Weakened (attenuated) live whole organisms that do not cause illness


The body’s immune system responds to a vaccine by producing substances (such as antibodies and white blood cells) that recognize and attack the specific bacteria or virus contained in the vaccine. Then whenever the person is exposed to the specific bacteria or virus the body automatically produces these antibodies and other substances to prevent or lessen illness. The process of giving a vaccine is called vaccination although many doctors use the more general term immunization.


Vaccines that contain live but weakened organisms include


Bacille Calmette-Guérin (BCG—for tuberculosis)


Chickenpox (varicella)


Cholera (certain vaccines given by mouth)


Ebola


Influenza (only the nasal spray vaccine)


Measles-mumps-rubella


Polio (only the oral vaccine)


Rotavirus


Typhoid (only the oral vaccine)


Shingles (only one of the two available vaccines)


Yellow fever


Some vaccines contain a weakened but living form of the microorganism that they protect against.


In passive immunization antibodies against a specific infectious organism are given directly to a person. These antibodies are obtained from several sources:


The blood (serum) of animals (usually horses) that have been exposed to a particular organism or toxin and have developed immunity


Blood collected from a large group of people—called pooled human immune globulin


People known to have antibodies to a particular disease (that is people who have been immunized or who are recovering from the disease)—called hyperimmune globulin—because these people have higher levels of antibodies in their blood


Antibody-producing cells (usually taken from mice) grown in a laboratory


Passive immunization is used for people whose immune system does not respond adequately to an infection or for people who acquire an infection before they can be vaccinated (for example after being bitten by an animal with rabies).


Passive immunization can also be used to prevent disease when people are likely to be exposed and do not have time to get or complete a vaccination series. For example a solution containing gamma globulin that is active against chickenpox virus can be given to a pregnant woman who does not have immunity to the virus and has been exposed to it. The chickenpox virus can harm the fetus and cause serious complications (such as pneumonia) in the woman.


Passive immunization lasts for only a few weeks until the body eliminates the injected antibodies.


Vaccines and antibodies are usually given by injection into a muscle (intramuscularly) or under the skin (subcutaneously). Antibodies are sometimes injected into a vein (intravenously). One type of influenza vaccine is sprayed into the nose.


More than one vaccine may be given at a time—in one combination vaccine or in separate injections at different injection sites (see Use of several vaccines at the same time).


Some vaccines are given routinely—for example the tetanus toxoid is given to adults preferably every 10 years. Some vaccines are routinely given to children (see figure Routine Vaccinations for Infants Children and Adolescents).


Other vaccines are usually given mainly to specific groups of people. For example the yellow fever vaccine is given only to people traveling to certain parts of Africa and South America. Still other vaccines are given after possible exposure to a specific disease. For example the rabies vaccine may be given to a person who has been bitten by a dog.


For many vaccines the only reason for not being vaccinated is


A serious life-threatening allergic reaction (such as an anaphylactic reaction) to the vaccine or to one of its components


Egg allergy is common in the US. Some vaccines including most influenza vaccines contain very small amounts of material from eggs. Thus there is concern about using such vaccines in people who are allergic to eggs. However the Centers for Disease Control and Prevention (CDC) states that although mild reactions may occur serious allergic reactions (anaphylaxis) are unlikely. Recommendations for the influenza vaccine vary according to the severity of the allergic reaction to eggs and the vaccine. If people who had a severe life-threatening allergic reaction after they were given the influenza vaccine or eggs they should not be given the influenza vaccine. If people had only a rash after exposure to eggs or the vaccine they may be given the vaccine. If people had a more serious reaction such as facial swelling difficulty breathing or dizziness or reactions that required an injection of the drug epinephrine or other emergency treatment they should get the vaccine in a medical setting supervised by a clinician who has experience recognizing and managing severe allergic reactions.


Vaccines that contain live organisms should not be used or should be delayed in people with certain conditions such as


Use of drugs that suppress the immune system (immunosuppressants) such as corticosteroids and chemotherapy drugs


A disorder that weakens the immune system such as AIDS


Pregnancy


Development of Guillain-Barré syndrome within 6 weeks after a previous dose of the vaccine


If people stop taking the drugs that suppress their immune system or if their weakened immune system recovers sufficiently giving them vaccines that contain live virus may be safe.


Children typically are given a number of vaccines according to a standard schedule (see figure Routine Vaccinations for Infants Children and Adolescents and Centers for Disease Control and Prevention: Immunization Schedules). If vaccines are missed most can be given later according to a catch-up schedule.


Disease


When Do Vaccinations Typically Start


Chickenpox (varicella)


Age 12–15 months


Diphtheria


Age 2 months


Haemophilus influenzae type b infections (such as meningitis)


Age 2 months


Hepatitis A


Age 12–23 months


Hepatitis B


Birth


Human papillomavirus (HPV)


Age 11–12 years (can start at age 9 years)


Influenza


Age 6 months


Measles


Age 12–15 months


Meningococcal meningitis


Age 11–12 years


Age 2 to 9 months for children at high risk


Mumps


Age 12–15 months


Pertussis


Age 2 months


Pneumococcal infections


Age 2 months


Polio


Age 2 months


Rotavirus infection


Age 2 months


Rubella (German measles)


Age 12–15 months


Tetanus


Age 2 months


Adults may also be advised to receive certain vaccines (see also Centers for Disease Control and Prevention: Immunization Schedule for Adults). When advising adults about vaccination a doctor considers the person’s age health history childhood vaccinations occupation geographic location travel plans and other factors.


Disease*


Who Should Be Vaccinated


Anthrax


People who have been exposed to anthrax


People who may be exposed to anthrax such as the following:


Some military personnel


Some laboratory workers


Veterinarians


Chickenpox (varicella)


All adults who have not had the vaccine or chickenpox


Diphtheria


All adults (usually as a combination vaccine with tetanus as Td or also with pertussis as Tdap) if they have not already been vaccinated


Pregnant women should receive Tdap during each pregnancy


Haemophilus influenzae type b infections (such as meningitis)


Adults who have not been vaccinated and who are at increased risk such as the following:


People who do not have a functioning spleen


People who have a weakened immune system (such as those with AIDS)


People who have had chemotherapy for cancer


People who have had stem cell transplantation


Hepatitis A


Adults who have not been vaccinated and who are at increased risk such as the following:


People who travel to or work in areas where the infection is common


People who use illegal drugs (such as methamphetamine)


Men who have sex with men


People who have a chronic liver disorder or high levels of certain liver enzymes in their blood


Healthy adults 40 years or under who have recently been exposed to hepatitis A virus


People who anticipate close contact with an adopted child during the first 60 days after the child arrives in the United States from an area where hepatitis A is common


People who are homeless


Pregnant women who are identified to be at risk of getting hepatitis A infection during pregnancy (such as women who are international travelers who use illicit drugs [injected or not] who may be exposed at work who anticipate close personal contact with an international adopted child or who are homeless) or who are at risk of getting very sick or dying of hepatitis A virus infection (such as women who have chronic liver disease or HIV infection)


Hepatitis B


Adults who have not been vaccinated and who are at increased risk such as the following:


Health care custodial or public safety workers


Travelers to areas where the infection is common


People with a chronic liver disorder or high levels of certain liver enzymes in their blood


People with kidney failure including those who need dialysis


People who inject illegal drugs


People who have several sex partners


People who need to be evaluated or treated for a sexually transmitted disease


Men who have sex with men


Sex partners and household contacts of people known to be carriers of hepatitis B


People with HIV infection


People who are under 60 and have diabetes and sometimes people who are age 60 and older who have diabetes


People who have spent time (as patients residents or employees) in correctional facilities or in facilities that provide services for people at high risk of hepatitis B (such as drug-abuse treatment centers sites for injection drug use hemodialysis centers institutions for developmentally disabled people and places where people with sexually transmitted diseases or HIV infection are tested and treated)


Pregnant women if they are at risk of getting the infection or of getting very sick or dying of hepatitis B infection (such as women who have chronic liver disease or HIV infection)


Human papillomavirus (HPV)


All males and females who have not been previously vaccinated (typically at age 11 or 12 years) through age 26 years


All adults aged 27 to 45 years should talk with their doctor about whether they should be vaccinated


Influenza


All people over age 6 months


Measles


All adults born in or after 1957 unless they have documentation of vaccination with one or more doses of the measles mumps and rubella (MMR) vaccine or laboratory tests detect evidence of measles immunity


Always given as a combination vaccine with mumps and rubella (not available as a single vaccine)


Meningococcal meningitis


Certain people over age 55


People 16 to 23 years of age who want it


People at increased risk such as the following:


People who do not have a functioning spleen (including sickle cell disease)


People with HIV infection


People with certain immunodeficiency disorders


People who take eculizumab or ravulizumab (drugs that block the complement system)


Microbiologists who are routinely exposed to the bacteria


Adolescents if they have not already been vaccinated


First-year college students who live in dormitories who are 21 years old or younger and who have not been given a dose of the vaccine on or after their 16th birthday


Military recruits


Travelers to or residents of areas where the infection is common


People who have been exposed during a meningitis outbreak


Mumps


All adults born in or after 1957 unless they have documentation of vaccination with one or more doses of the MMR vaccine or laboratory tests detect evidence of mumps immunity


Always given as a combination vaccine with measles and rubella (not available as a single vaccine)


Pertussis (whooping cough)


All adults (usually given as a combination vaccine with tetanus and diphtheria as Tdap) if they have not already been vaccinated


Pregnant women during each pregnancy


Pneumococcal infections (such as meningitis and pneumonia)


All people aged 65 years and over


Adults at increased risk such as the following:


People with a chronic heart lung (including asthma and emphysema) kidney or liver disorder


People with diabetes


People with a cerebrospinal fluid leak


People with a weakened immune system (including those with HIV infection leukemia lymphoma or cancer those who take drugs that suppress the immune system [immunosuppressants] and those who have had certain organ transplants)


People who do not have a functioning spleen (including those with sickle cell disease)


People who have a cochlear implant


People who have an alcohol use disorder


Adults who smoke cigarettes


Polio


Adults at increased risk such as


Travelers to areas where polio is common


Laboratory workers who work with the polio virus


People who treat people who may have polio


Rabies


People who have been bitten by certain animals


People who may be at increased risk of exposure to infected animals such as


Veterinarians and animal handlers


Laboratory workers who handle animals that may be rabid


People who explore bat caves


People who live or stay more than 30 days in developing countries where rabies in dogs is widespread


Rubella (German measles)


All adults born in or after 1957 unless they have documentation of vaccination with one or more doses of the MMR vaccine or laboratory tests detect evidence of rubella immunity


Women who are planning on becoming pregnant and do not have immunity to rubella


Always given as a combination vaccine with measles and mumps (not available as a single vaccine)


Shingles (herpes zoster)


People aged 50 and over


Smallpox


Not currently recommended except for people at high risk of being exposed to the smallpox virus such as laboratory workers who directly handle the virus and related materials


Tetanus


All adults every 10 years (usually as a combination vaccine with tetanus and diphtheria as Td or also with pertussis as Tdap) if they have not already been vaccinated


Pregnant women should receive Tdap during each pregnancy


Typhoid


People traveling to areas where the infection is common


People who have close contact with a typhoid carrier


Laboratory workers who work with the bacteria that cause typhoid fever


Yellow fever


People traveling to certain parts of Africa and South America where the infection is common


* Vaccines are available in the United States for these infections.


HIV = human immunodeficiency virus; Td = tetanus-diphtheria; Tdap = tetanus-diphtheria-pertussis.


In the United States the Centers for Disease Control and Prevention (CDC) monitors the safety of vaccines. Doctors must report certain problems that occur after routine vaccination to the CDC's Vaccine Adverse Event Reporting System (VAERS) and Vaccine Safety Datalink (VSD). If any health problem happens after vaccination anyone—doctors nurses or any member of the general public—can submit a report to VAERS. VAERS reports cannot determine whether a health problem was caused by the vaccine.


Before a new vaccine can be licensed it like any medical product is tested in controlled clinical trials. Such trials compare the new vaccine to a placebo or to a previously existing vaccine for the same disease. Such trials show whether the vaccine is effective and identify common side effects. However some side effects are too rare to be detected in any reasonably sized clinical trial and do not become apparent until after a vaccine is used routinely in many people. Thus a surveillance system called the Vaccine Adverse Event Reporting System was created to monitor the safety of vaccines that are used in the general public. VAERS collects reports from people who believe that they had a side effect after a recent vaccination and from health care practitioners who identify certain possible side effects after a vaccine was given even if they are unsure the effects are related to the vaccine. Thus the existence of a VAERS report is not proof that a vaccine caused a certain side effect. VAERS is simply a system for collecting data about things that might be side effects. Then the Food and Drug Administration (FDA) can further evaluate the concern by comparing how often the possible side effect occurred in people who were vaccinated to how often it occurred in people who were not vaccinated.


Vaccines usually cause no problems although mild side effects such as soreness or redness at the injection site may occur. Nonetheless many parents remain concerned about the safety of childhood vaccines and their possible side effects.


One of parents' main concerns has been


That certain vaccines such as the measles-mumps-rubella (MMR) vaccine or vaccines that contain thimerosal (a mercury-based preservative) may increase the risk of autism


Many different groups of scientists have studied these concerns and have completely disproved the supposed relationship between vaccines and autism (see Childhood Vaccination Concerns in THE MANUAL and FAQs About Vaccine Safety at the CDC web site).


Nevertheless most manufacturers have developed thimerosal-free vaccines for use in infants and adults. Information about vaccines that currently contain low levels of thimerosal is available at the Food and Drug Administration's web site (Thimerosal and Vaccines).


Residents of the United States may be required to receive specific vaccines before traveling to areas that have infectious diseases not normally found in the United States (see table Vaccines for International Travel). Recommendations change frequently in response to disease outbreaks.


The CDC provides the most up-to-date information on vaccination requirements in their Travelers’ Health section. Also the CDC has a 24-hour telephone service (1-800-232-4636 [CDC-INFO]) that provides information.


The following are some English-language resources that may be useful. Please note that THE MANUAL is not responsible for the content of these resources.


Centers for Disease Control and Prevention (CDC): Child and adolescent immunization schedule for ages 18 years or younger


CDC: Adult immunization schedule for ages 19 years and older


CDC: FAQs about vaccine safety for parents and caregivers


CDC: Travelers’ Health: Information about travel health notices and about what vaccines to get depending on destination


Food and Drug Administration (FDA): Thimerosal and Vaccines: Comprehensive information about thimerosal—what it is why it is used in vaccines why it is safe and how many vaccines are now made without it


Vaccine Adverse Event Reporting System (VAERS): Where and how to report side effects of vaccines


Vaccine Safety Datalink (VSD): A collaborative organization that monitors and evaluates the safety of vaccines
  • The Author: wikbe
 
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