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Immunization 

Immunization

Chapter:
Immunization
Author(s):

D. Goldblatt

and M. Ramsay

DOI:
10.1093/med/9780199204854.003.0703_update_001

Update:

T cell subsets and vaccine response—roles of T helper 2 cells, follicular helper T cells, and Th17 cells.

Discovery of vaccine antigens—‘reverse vaccinology’, starting with the pathogen genome.

HIV vaccines—disappointing results of phase III clinical trials apart from modest protection by RV144 vaccine in Thailand.

TB vaccines—several recombinant and other new vaccines under clinical trial.

Adjuvants—effectiveness with papilloma and H1N1 influenza vaccines, but does MF-59 trigger narcolepsy?

Poliomyelitis eradication—persistence in several African and Asian countries.

Meningococcal and pneumococcal conjugate vaccine programmes—positive and negative impacts.

Updated on 31 May 2012. The previous version of this content can be found here.
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date: 25 March 2017

Immunization is one of the most successful medical interventions ever developed: it prevents infectious diseases worldwide.

Mechanism of effect—the basis for the success of immunization is that the human immune system is able to respond to vaccines by producing pathogen-specific antibody and memory cells (both B and T cells) which protect the body should the pathogen be encountered.

Clinical practicalities—most currently licensed vaccines contain live or killed bacterial or viral constituents, bacterial polysaccharides, or bacterial toxoids, while new types of vaccines are being developed that contain DNA. Most vaccines are delivered directly into skin or muscle via needles, or they are administered orally. New edible vaccines and vaccines delivered via the skin without the use of needles are being developed.

Who should be immunized?—vaccines can be used in a targeted way, i.e. only for those at high risk, or they can be recommended for mass immunization of whole populations. The latter approach may eventually lead to complete eradication of an infectious disease, as was the case with smallpox: polio eradication is the next global challenge. Vaccines that are able to interrupt the transmission of a pathogen between individuals are able to provide indirect protection, with the benefit of vaccination extending beyond the vaccinated population, e.g. infant immunization with pneumococcal vaccine has reduced the burden of disease in adults.

Global perspective—the Expanded Program on Immunization, set up by the World Health Organization to define which vaccines should be delivered in resource poor countries, has done much to increase coverage of vaccination amongst infants most at risk of infectious diseases. The evaluation of immunization programmes includes measurement of vaccine coverage, continuing surveillance for vaccine preventable infections, seroprevalence studies to assess population immunity, and systems for monitoring and reporting adverse events.

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