Vaccination is the administration of antigenic material (a vaccine) to
stimulate an individual's immune system to develop adaptive immunity
to a pathogen.
Vaccines can prevent or ameliorate infectious disease.
When a sufficiently large percentage of a population has been
vaccinated, herd immunity results. The effectiveness of vaccination
has been widely studied and verified.
Vaccination is the most
effective method of preventing infectious diseases; widespread
immunity due to vaccination is largely responsible for the worldwide
eradication of smallpox and the elimination of diseases such as polio,
measles, and tetanus from much of the world.
Smallpox was most likely the first disease people tried to prevent by
inoculation. and was the first disease for which a vaccine was
produced. The smallpox vaccine was invented in 1796 by the British
Edward Jenner and although at least six people had used the
same principles years earlier he was the first to publish evidence
that it was effective and to provide advice on its production.
Louis Pasteur furthered the concept through his work in microbiology.
The immunization was called vaccination because it was derived from a
virus affecting cows (Latin: vacca 'cow').
Smallpox was a
contagious and deadly disease, causing the deaths of 20–60% of
infected adults and over 80% of infected children. When smallpox
was finally eradicated in 1979, it had already killed an estimated
300–500 million people in the 20th century.
In common speech, vaccination and immunization have a similar meaning.
This distinguishes it from inoculation, which uses unweakened live
pathogens, although in common usage either can refer to an
Vaccination efforts have been met with some controversy
on scientific, ethical, political, medical safety, and religious
grounds. In rare cases, vaccinations can injure people. In the
United States, people may receive compensation for those injuries
under the National
Vaccine Injury Compensation Program. Early success
brought widespread acceptance, and mass vaccination campaigns have
greatly reduced the incidence of many diseases in numerous geographic
1 Mechanism of function
Vaccination versus inoculation
2 Side effects
4 Society and culture
4.1 Opposition to vaccination
4.1.1 Vaccination-autism controversy
5 Routes of administration
6 Global trends in vaccination
6.1 United States
7 See also
9 Further reading
10 External links
Mechanism of function
Polio vaccination started in Sweden in 1957.
Generically, the process of artificial induction of immunity, in an
effort to protect against infectious disease, works by 'priming' the
immune system with an 'immunogen'. Stimulating immune responses with
an infectious agent is known as immunization.
various ways of administering immunogens.
Some vaccines are administered after the patient already has
contracted a disease.
Vaccines given after exposure to smallpox,
within the first three days, are reported to attenuate the disease
considerably, and vaccination up to a week after exposure probably
offers some protection from disease or may reduce the severity of
disease. The first rabies immunization was given by Louis Pasteur
to a child after he was bitten by a rabid dog. Since then, it has been
found that, in people with healthy immune systems, four doses of
rabies vaccine over 14 days, wound care, and treatment of the bite
with rabies immune globulin, commenced as soon as possible after
exposure, is effective in preventing rabies in humans. Other
examples include experimental AIDS, cancer and Alzheimer's disease
vaccines. Such immunizations aim to trigger an immune
response more rapidly and with less harm than natural
Most vaccines are given by hypodermic injection as they are not
absorbed reliably through the intestines. Live attenuated polio, some
typhoid, and some cholera vaccines are given orally to produce
immunity in the bowel. While vaccination provides a lasting effect, it
usually takes several weeks to develop, while passive immunity (the
transfer of antibodies) has immediate effect.
Vaccination versus inoculation
The term inoculation is often used interchangeably with vaccination.
However, some argue that the terms are not synonymous. Dr Byron Plant
Vaccination is the more commonly used term, which actually
consists of a 'safe' injection of a sample taken from a cow suffering
from cowpox... Inoculation, a practice probably as old as the disease
itself, is the injection of the variola virus taken from a pustule or
scab of a smallpox sufferer into the superficial layers of the skin,
commonly on the upper arm of the subject. Often inoculation was done
'arm to arm' or less effectively 'scab to arm'..." Inoculation
oftentimes caused the patient to become infected with smallpox, and in
some cases the infection turned into a severe case.
Vaccinations began in the 18th century with the work of Edward Jenner
and the smallpox vaccine.
Vaccine controversy and
The Centers for
Disease Control and Prevention (CDC) has compiled a
list of vaccines and their possible side effects. Allegations of
vaccine injuries in recent decades have appeared in litigation in the
U.S. Some families have won substantial awards from sympathetic
juries, even though most public health officials have said that the
claims of injuries were unfounded. In response, several vaccine
makers stopped production, which the US government believed could be a
threat to public health, so laws were passed to shield manufacturers
from liabilities stemming from vaccine injury claims. The safety
and side effects of multiple vaccines have been tested in order to
uphold the viability of vaccines as a barrier against disease. The
Influenza vaccine was tested in controlled trials and proven to have
negligible side effects equal to that of a placebo. Some concerns
from families might have arisen from social beliefs and norms that
cause them to mistrust or refuse vaccinations, contributing to this
discrepancy in side effects that were unfounded.
See also: Inoculation
Handwritten draft of Edward Jenner's first vaccination. The document
is held at the
Royal College of Surgeons in London
It is known that the process of inoculation was used by Chinese
physicians in the 10th century. Scholar Ole Lund comments: "The
earliest documented examples of vaccination are from India and China
in the 17th century, where vaccination with powdered scabs from people
infected with smallpox was used to protect against the disease.
Smallpox used to be a common disease throughout the world and 20 to
30% of infected persons died from the disease.
responsible for 8 to 20% of all deaths in several European countries
in the 18th century. The tradition of vaccination may have originated
in India in AD 1000." The mention of inoculation in the Sact'eya
Ayurvedic text, was noted by the French scholar Henri
Marie Husson in the journal Dictionaire des sciences médicales.
However, the idea that inoculation originated in India has been
challenged, as few of the ancient
Sanskrit medical texts described the
process of inoculation. Accounts of inoculation against smallpox
in China can be found as early as the late 10th century and was
reportedly widely practised in China in the reign of the Longqing
Emperor (r. 1567–72) during the
Ming Dynasty (1368–1644). Two
reports on the Chinese practice of inoculation were received by the
Royal Society in London in 1700; one by Dr.
Martin Lister who received
a report by an employee of the
East India Company
East India Company stationed in China
and another by Clopton Havers. According to
Voltaire (1742), the
Turks derived their use of inoculation to neighbouring Circassia.
Voltaire does not speculate on where the Circassians derived their
technique from, though he reports that the Chinese have practiced it
"these hundred years". The Greek physicians Emmanuel Timonis
(1669–1720) from the island of
Chios and Jacob Pylarinos
Cephalonia practised smallpox inoculation at
Constantinople in the beginning of 18th century and published
their work in Philosophical Transactions of the
Royal Society in
1714. This kind of inoculation and other forms of variolation
were introduced into England by Lady Montagu, a famous English
letter-writer and wife of the English ambassador at Istanbul between
1716 and 1718, who almost died from smallpox as a young adult and was
physically scarred from it.
Inoculation was adopted both in England
and in America nearly half a century before Jenner's famous smallpox
vaccine of 1796 but the death rate of about 2% from this method
meant that it was mainly used during dangerous outbreaks of the
disease and remained controversial. It was noticed during the 18th
century that people who had suffered from the less virulent cowpox
were immune to smallpox, and the first recorded use of this idea was
by a farmer
Benjamin Jesty at
Yetminster in Dorset, who had suffered
the disease and transmitted it to his own family in 1774, his sons
subsequently not getting the mild version of smallpox when later
inoculated in 1789.
Jenner's 1802 testimonial to the efficacy of vaccination, signed by
112 members of the Physical Society, London
Dr Jenner performing his first vaccination on James Phipps, a boy of
age 8. May 14th, 1796. Painting by Ernest Board (early 20th century).
It was Edward Jenner, a doctor in Berkeley in Gloucestershire, who
established the procedure by introducing material from a cowpox
vesicle on Sarah Nelmes, a milkmaid, into the arm of a boy named James
Phipps. Two months later he inoculated the boy with smallpox and the
disease did not develop. In 1798 Jenner published An Inquiry into the
Causes and Effects of the Variolae Vacciniae, which coined the term
vaccination and created widespread interest. He distinguished 'true'
and 'spurious' cowpox (which did not give the desired effect) and
developed an "arm-to-arm" method of propagating the vaccine from the
vaccinated individual's pustule. Early attempts at confirmation were
confounded by contamination with smallpox, but despite controversy
within the medical profession and religious opposition to the use of
animal material, by 1801 his report was translated into six languages
and over 100,000 people were vaccinated.
Since then vaccination campaigns have spread throughout the globe,
sometimes prescribed by law or regulations (See
Vaccines are now used against a wide variety of diseases. Louis
Pasteur further developed the technique during the 19th century,
extending its use to killed agents protecting against anthrax and
rabies. The method Pasteur used entailed treating the agents for those
diseases so they lost the ability to infect, whereas inoculation was
the hopeful selection of a less virulent form of the disease, and
Jenner's vaccination entailed the substitution of a different and less
dangerous disease. Pasteur adopted the name vaccine as a generic term
in honour of Jenner's discovery.
A doctor performing a typhoid vaccination in Texas, 1943
Maurice Hilleman was the most prolific vaccine inventor, developing
successful vaccines for measles, mumps, hepatitis A, hepatitis B,
chickenpox, meningitis, pneumonia and 'Haemophilus influenzae'.
In modern times, the first vaccine-preventable disease targeted for
eradication was smallpox. The
World Health Organization
World Health Organization (WHO)
coordinated this global eradication effort. The last naturally
occurring case of smallpox occurred in
Somalia in 1977. In 1988, the
governing body of WHO targeted polio for eradication by 2000. Although
the target was missed, eradication is very close.
In 2000, the Global Alliance for
established to strengthen routine vaccinations and introduce new and
under-used vaccines in countries with a per capita GDP of under US
Society and culture
Poster for vaccination against smallpox
To eliminate the risk of outbreaks of some diseases, at various times
governments and other institutions have employed policies requiring
vaccination for all people. For example, an 1853 law required
universal vaccination against smallpox in England and Wales, with
fines levied on people who did not comply. Common contemporary U.S.
vaccination policies require that children receive recommended
vaccinations before entering public school.
Beginning with early vaccination in the nineteenth century, these
policies were resisted by a variety of groups, collectively called
antivaccinationists, who object on scientific, ethical, political,
medical safety, religious, and other grounds. Common objections are
that vaccinations do not work, that compulsory vaccination constitutes
excessive government intervention in personal matters, or that the
proposed vaccinations are not sufficiently safe. Many modern
vaccination policies allow exemptions for people who have compromised
immune systems, allergies to the components used in vaccinations or
strongly held objections.
In countries with limited financial resources, limited vaccination
coverage results in greater morbidity and mortality due to infectious
disease. More affluent countries are able to subsidize
vaccinations for at-risk groups, resulting in more comprehensive and
effective coverage. In Australia, for example, the Government
subsidizes vaccinations for seniors and indigenous Australians.
Public Health Law Research, an independent US based organization,
reported in 2009 that there is insufficient evidence to assess the
effectiveness of requiring vaccinations as a condition for specified
jobs as a means of reducing incidence of specific diseases among
particularly vulnerable populations; that there is sufficient
evidence supporting the effectiveness of requiring vaccinations as a
condition for attending child care facilities and schools; and
that there is strong evidence supporting the effectiveness of standing
orders, which allow healthcare workers without prescription authority
to administer vaccine as a public health intervention.
Opposition to vaccination
James Gillray's The Cow-Pock—or—the Wonderful Effects of the New
Inoculation!, an 1802 caricature of vaccinated patients who feared it
would make them sprout cowlike appendages.
Opposition to vaccination, from a wide array of vaccine critics, has
existed since the earliest vaccination campaigns. Although the
benefits of preventing serious illness and death from infectious
diseases greatly outweigh the risks of rare serious adverse effects
following immunization, disputes have arisen over the morality,
ethics, effectiveness, and safety of vaccination. Some vaccination
critics say that vaccines are ineffective against disease or that
vaccine safety studies are inadequate. Some religious groups do
not allow vaccination, and some political groups oppose mandatory
vaccination on the grounds of individual liberty. In response,
concern has been raised that spreading unfounded information about the
medical risks of vaccines increases rates of life-threatening
infections, not only in the children whose parents refused
vaccinations, but also in those who cannot be vaccinated due to age or
immunodeficiency, who could contract infections from unvaccinated
carriers (see herd immunity). Some parents believe vaccinations
cause autism, although there is no scientific evidence to support this
idea. In 2011, Andrew Wakefield, a leading proponent of one of the
main controversies regarding a purported link between autism and
vaccines, was found to have been financially motivated to falsify
research data and was subsequently stripped of his medical
license. In the United States people who refuse vaccines for
non-medical reasons have made up a large percentage of the cases of
measles, and subsequent cases of permanent hearing loss and death
caused by the disease.
MMR vaccine controversy
MMR vaccine controversy, a fraudulent 1998 paper by Andrew
Wakefield, originally published in The Lancet, presented falsified
evidence that the
MMR vaccine (an immunization against measles, mumps
and rubella that is typically first administered to children shortly
after their first birthday) was linked to the onset of autism spectrum
disorders. The article was widely criticized for lack of
scientific rigour, partially retracted in 2004 by Wakefield's
co-authors, and was fully retracted by
The Lancet in 2010.
Wakefield was struck off the UK's medical registry for the fraud.
This Lancet article has sparked a much greater anti-vaccination
movement, primarily in the United States. Even though the article was
fraudulent and was retracted, 1 in 4 parents still believe vaccines
can cause autism. Many parents do not vaccinate their children
because they feel that diseases are no longer present due to
vaccination. This is a false assumption, since diseases held in
check by immunization programs can and do still return if immunization
is dropped. These pathogens could possibly infect vaccinated people,
due to the pathogen's ability to mutate when it is able to live in
unvaccinated hosts. In 2010, California had the worst
whooping cough outbreak in 50 years. A possible contributing factor
was parents choosing not to vaccinate their children. There was
also a case in
Texas in 2012 where 21 members of a church contracted
measles because they chose not to immunize.
Routes of administration
Air France Vaccinations Centre in the 7th arrondissement of Paris
A vaccine administration may be oral, by injection (intramuscular,
intradermal, subcutaneous), by puncture, transdermal or
intranasal. Several recent clinical trials have aimed to deliver
the vaccines via mucosal surfaces to be up-taken by the common mucosal
immunity system, thus avoiding the need for injections.
Global trends in vaccination
World Health Organization
World Health Organization (WHO) estimate that vaccination averts
2-3 million deaths per year (in all age groups), and up to 1.5 million
children die each year due to diseases which could have been prevented
by vaccination. They estimate that 29% of deaths of children under
five years old in 2013 were vaccine preventable. In other developing
parts of the world, they are faced with the challenge of having a
decreased availability of resources and vaccinations. Countries such
as those in Sub-Saharan Africa cannot afford to provide the full range
of childhood vaccinations.
Vaccination in art
La vaccine or Le préjugé vaincu by Louis-Léopold Boilly, 1807
A doctor vaccinating a small girl, other girls with loosened blouses
wait their turn apprehensively by Lance Calkin
German caricature showing von Behring extracting the serum with a tap.
Les Malheurs de la
Vaccine (The history of vaccination seen from an
economic point of view: A pharmacy up for sale; an outmoded inoculist
selling his premises; Jenner, to the left, pursues a skeleton with a
Vaccines have led to major decreases in the prevalence of infectious
diseases in the United States . In 2007, studies regarding the
effectiveness of vaccines on mortality or morbidity rates of those
exposed to various diseases have shown almost 100% decreases in death
rates, and about a 90% decrease in exposure rates. This has
allowed specific organizations and states to adopt standards for
recommended early childhood vaccinations. Lower income families who
are unable to otherwise afford vaccinations are supported by these
organizations and specific government laws. The
Vaccine for Children
Program and the Social Security Act are two major players in
supporting lower socioeconomic groups.
H5N1 clinical trials
Immunization during pregnancy
List of vaccine topics
Vaccination and religion
Vaccination of dogs
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