Immunization

I

Introduction

Immunization, also called vaccination or inoculation, a method of stimulating resistance in the human body to specific diseases using microorganisms—bacteria or viruses—that have been modified or killed. These treated microorganisms do not cause the disease, but rather trigger the body's immune system to build a defense mechanism that continuously guards against the disease. If a person immunized against a particular disease later comes into contact with the disease-causing agent, the immune system is immediately able to respond defensively.

Immunization has dramatically reduced the incidence of a number of deadly diseases. For example, a worldwide vaccination program resulted in the global eradication of smallpox in 1980, and in most developed countries immunization has essentially eliminated diphtheria, poliomyelitis, and neonatal tetanus. The number of cases of Haemophilus influenzae type b meningitis in the United States has dropped 95 percent among infants and children since 1988, when the vaccine for that disease was first introduced. In the United States, more than 90 percent of children receive all the recommended vaccinations by their second birthday. About 85 percent of Canadian children are immunized by age two.

II

Types of Immunization

Scientists have developed two approaches to immunization: active immunization, which provides long-lasting immunity, and passive immunization, which gives temporary immunity. In active immunization, all or part of a disease-causing microorganism or a modified product of that microorganism is injected into the body to make the immune system respond defensively. Passive immunity is accomplished by injecting blood from an actively immunized human being or animal.

A

Active Immunization

Vaccines that provide active immunization are made in a variety of ways, depending on the type of disease and the organism that causes it. The active components of the vaccinations are antigens, substances found in the disease-causing organism that the immune system recognizes as foreign. In response to the antigen, the immune system develops either antibodies or white blood cells called T lymphocytes, which are special attacker cells. Immunization mimics real infection but presents little or no risk to the recipient. Some immunizing agents provide complete protection against a disease for life. Other agents provide partial protection, meaning that the immunized person can contract the disease, but in a less severe form. These vaccines are usually considered risky for people who have a damaged immune system, such as those infected with the virus that causes acquired immunodeficiency syndrome (AIDS) or those receiving chemotherapy for cancer or organ transplantation. Without a healthy defense system to fight infection, these people may develop the disease that the vaccine is trying to prevent. Some immunizing agents require repeated inoculations—or booster shots—at specific intervals. Tetanus shots, for example, are recommended every ten years throughout life.

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In order to make a vaccine that confers active immunization, scientists use an organism or part of one that has been modified so that it has a low risk of causing illness but still triggers the body’s immune defenses against disease. One type of vaccine contains live organisms that have been attenuated—that is, their virulence has been weakened. This procedure is used to protect against yellow fever, measles, smallpox, and many other viral diseases. Immunization can also occur when a person receives an injection of killed or inactivated organisms that are relatively harmless but that still contain antigens. This type of vaccination is used to protect against bacterial diseases such as poliomyelitis, typhoid fever, and diphtheria.

Some vaccines use only parts of an infectious organism that contain antigens, such as a protein cell wall or a flagellum. Known as acellular vaccines, they produce the desired immunity with a lower risk of producing potentially harmful immune reactions that may result from exposure to other parts of the organism. Acellular vaccines include the Haemophilus influenzae type B vaccine for meningitis and newer versions of the whooping cough vaccine. Scientists use genetic engineering techniques to refine this approach further by isolating a gene or genes within an infectious organism that code for a particular antigen. The subunit vaccines produced by this method cannot cause disease and are safe to use in people who have an impaired immune system. Subunit vaccines for hepatitis B and pneumococcus infection, which causes pneumonia, became available in the late 1990s.

Active immunization can also be carried out using bacterial toxins that have been treated with chemicals so that they are no longer toxic, even though their antigens remain intact. This procedure uses the toxins produced by genetically engineered bacteria rather than the organism itself and is used in vaccinating against tetanus, botulism, and similar toxic diseases.

B

Passive Immunization

Passive immunization is performed without injecting any antigen. In this method, vaccines contain antibodies obtained from the blood of an actively immunized human being or animal. The antibodies last for two to three weeks, and during that time the person is protected against the disease. Although short-lived, passive immunization provides immediate protection, unlike active immunization, which can take weeks to develop. Consequently, passive immunization can be lifesaving when a person has been infected with a deadly organism.

Occasionally there are complications associated with passive immunization. Diseases such as botulism and rabies once posed a particular problem. Immune globulin (antibody-containing plasma) for these diseases was once derived from the blood serum of horses. Although this animal material was specially treated before administration to humans, serious allergic reactions were common. Today, human-derived immune globulin is more widely available and the risk of side effects is reduced.

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