Infectious Diseases in an Age of Change The Impact of Human Ecology and Behavior on Disease Transmission (1995) / Chapter Skim
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Quest for Life-Long Protection by Vaccination
Quest for Life-Long Protection by Vaccination
Pages 235-248
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Successful vaccination programs have led to marked reductions in disease, disability, and death (1~. The successes of our current vaccination efforts raise the question of how we can eliminate the disease burdens that remain.
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individual protection assuring a life-long immune response capable of repelling challenges individuals may receive at any time in their lives, and (ii) community protection reducing or even eliminating the possibility that nonimmune individuals will be exposed to the infectious agent.
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While there is no absolute level of population immunity short of 100% that will guarantee elimination of disease transmission, it is clear that the higher the level of immunity, the lower the probability of significant transmission (19~. For example, use of acellular pertussis vaccines in Japan among 2-year-old children led to marked reductions of pertussis among younger children who were not targets for vaccination (20~.
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There have been no cases of paralytic polio caused by indigenously acquired wild viruses since 1979 in the United States. There has been an annual average of approximately 8 vaccine-associated polio cases (29~.
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First, vaccination of the approximately 4 million children added to the United States population each year is no simple task. Full protection before 2 years of age requires that each child receive a complicated series of 1~15 doses of vaccines in four to five visits to a health care provider (15, 2~28~.
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As to the final point, the absence of a single health infrastructure to assure vaccination of those <2 years of age means that the full responsibility for vaccination rests with the parents, who are frequently poorly informed about the needs for early vaccination. In contrast to the United Kingdom, where providers are held accountable for immunizing their patients, most providers in the United States do not receive rewards or suffer consequences depending upon the immunization status of their patients (34~.
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Perhaps less well known was the high human toll associated with routine vaccination against smallpox. In the United States in 1968 alone, 9 people died from complications of primary vaccination; >8000 had complications requiring medical attention, and >200 were hospitalized, 4 being permanently disabled (36~.
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Much more help is needed from the developed world if the eradication effort is to succeed. Specific polio eradication efforts, including vaccine production and distribution, disease surveillance, and laboratory networks cost money.
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For example, mass campaigns vaccinating all children between 9 months and 14 years of age (regardless of prior vaccination history) in the English-speaking Caribbean and multiple Latin American countries have led to virtual elimination in many areas (46~.
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Any disease of sufficient public health importance to warrant routine vaccination is also of sufficient importance to warrant reasonable attempts at eradication. SUGARY Life-long protection from disease through immunization can be accomplished through individual or community protection.
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Any disease of sufficient public health importance to warrant routine vaccination is of sufficient importance to warrant eradication wherever judged to be possible.
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(1973) in International Symposium on Vaccination Against Communicable Diseases, Monaco, March 1~17, 1973, Immunobiological Standardization Symposia Series, ed.
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46. Pan American Health Organization (1990)
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