Immunization

III

Immunization Recommendations

More than 50 vaccines for preventable diseases are licensed in the United States. The American Academy of Pediatrics and the U.S. Public Health Service recommend a series of immunizations beginning at birth. The initial series for children is complete by the time they reach the age of two, but booster vaccines are required for certain diseases, such as diphtheria and tetanus, in order to maintain adequate protection. When new vaccines are introduced, it is uncertain how long full protection will last. Recently, for example, it was discovered that a single injection of measles vaccine, first licensed in 1963 and administered to children at the age of 15 months, did not confer protection through adolescence and young adulthood. As a result, in the 1980s a series of measles epidemics occurred on college campuses throughout the United States among students who had been vaccinated as infants. To forestall future epidemics, health authorities now recommend that a booster dose of the measles, mumps, and rubella (also known as German measles) vaccine be administered at the time a child first enters school.

Not only children but also adults can benefit from immunization. Many adults in the United States are not sufficiently protected against tetanus, diphtheria, measles, mumps, and German measles. Health authorities recommend that most adults 65 years of age and older, and those with respiratory illnesses, be immunized against influenza (yearly) and pneumococcus (once).

IV

History of Immunization

The use of immunization to prevent disease predated the knowledge of both infection and immunology. In China in approximately 600 bc, smallpox material was inoculated through the nostrils. Inoculation of healthy people with a tiny amount of material from smallpox sores was first attempted in England in 1718 and later in America. Those who survived the inoculation became immune to smallpox. American statesman Thomas Jefferson traveled from his home in Virginia to Philadelphia, Pennsylvania, to undergo this risky procedure.

A significant breakthrough came in 1796 when British physician Edward Jenner discovered that he could immunize patients against smallpox by inoculating them with material from cowpox sores. Cowpox is a far milder disease that, unlike smallpox, carries little risk of death or disfigurement. Jenner inserted matter from cowpox sores into cuts he made on the arm of a healthy eight-year-old boy. The boy caught cowpox. However, when Jenner exposed the boy to smallpox eight weeks later, the child did not contract the disease. The vaccination with cowpox had made him immune to the smallpox virus. Today we know that the cowpox virus antigens are so similar to those of the smallpox virus that they trigger the body's defenses against both diseases.

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In 1885 Louis Pasteur created the first successful vaccine against rabies for a young boy who had been bitten 14 times by a rabid dog. Over the course of ten days, Pasteur injected progressively more virulent rabies organisms into the boy, causing the boy to develop immunity in time to avert death from this disease.

Another major milestone in the use of vaccination to prevent disease occurred with the efforts of two American physician-researchers. In 1954 Jonas Salk introduced an injectable vaccine containing an inactivated virus to counter the epidemic of poliomyelitis. Subsequently, Albert Sabin made great strides in the fight against this paralyzing disease by developing an oral vaccine containing a live weakened virus. Since the introduction of the polio vaccine, the disease has been nearly eliminated in many parts of the world.

As more vaccines are developed, a new generation of combined vaccines are becoming available that will allow physicians to administer a single shot for multiple diseases. Work is also under way to develop additional orally administered vaccines and vaccines for sexually transmitted infections. Possible future vaccines may include, for example, one that would temporarily prevent pregnancy. Such a vaccine would still operate by stimulating the immune system to recognize and attack antigens, but in this case the antigens would be those of the hormones that are necessary for pregnancy.

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