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CHAPTER 5: IMMUNIZATION PRINCIPLES AND VACCINE USE

Anne Schuchat; Lisa A. Jackson

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INTRODUCTION

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Few medical interventions of the past century can rival the effect that immunization has had on longevity, economic savings, and quality of life. Seventeen diseases are now preventable through vaccines routinely administered to children and adults in the United States (Table 5-1), and most vaccine-preventable diseases of childhood are at historically low levels (Table 5-2). Health care providers deliver the vast majority of vaccines in the United States in the course of providing routine health services and therefore play an integral role in the nation’s public health system.

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TABLE 5-1DISEASES PREVENTABLE WITH VACCINES ROUTINELY ADMINISTERED IN THE UNITED STATES TO CHILDREN AND/OR ADULTS
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TABLE 5-1 DISEASES PREVENTABLE WITH VACCINES ROUTINELY ADMINISTERED IN THE UNITED STATES TO CHILDREN AND/OR ADULTS
CONDITION TARGET POPULATION(S) FOR ROUTINE USE
Pertussis Children, adolescents, adults
Diphtheria Children, adolescents, adults
Tetanus Children, adolescents, adults
Poliomyelitis Children
Measles Children
Mumps Children
Rubella, congenital rubella syndrome Children
Hepatitis B Children
Haemophilus influenzae type b infection Children
Hepatitis A Children
Influenza Children, adolescents, adults
Varicella Children
Invasive pneumococcal disease Children, older adults
Meningococcal disease Adolescents
Rotavirus infection Infants
Human papillomavirus infection, cervical and anogenital cancers Adolescents and young adults
Zoster Older adults
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TABLE 5-2DECLINE IN VACCINE-PREVENTABLE DISEASES IN THE UNITED STATES FOLLOWING WIDESPREAD IMPLEMENTATION OF NATIONAL VACCINE RECOMMENDATIONS
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TABLE 5-2 DECLINE IN VACCINE-PREVENTABLE DISEASES IN THE UNITED STATES FOLLOWING WIDESPREAD IMPLEMENTATION OF NATIONAL VACCINE RECOMMENDATIONS
CONDITION ANNUAL NO. OF PREVACCINE CASES (AVERAGE) NO. OF CASES REPORTED IN 2012A REDUCTION (%) IN CASES AFTER WIDESPREAD VACCINATION
Smallpox 29,005 0 100
Diphtheria 21,053 1 ≥99
Measles 530,217 55 ≥99
Mumps 162,344 229 ≥99
Pertussis 200,752 48,277 76
Polio (paralytic) 16,316 0 100
Rubella 47,745 9 >99
Congenital rubella syndrome 152 2 99
Tetanus 580 37 94
Haemophilus influenzae type b infection 20,000 30b 99
Hepatitis A 117,333 2,890c 98
Hepatitis B (acute) 66,232 18,800c 72
Invasive pneumococcal infection: all ages 63,067 31,600d 50
Invasive pneumococcal infection: <5 years of age 16,069 1,800d 89
Varicella 4,085,120 216,511 95

aExcept for cases of hepatitis A and hepatitis B, for which 2011 figures are shown.

bAn additional 13 type b infections are estimated to have occurred among 210 reports of H. influenzae infection caused by unknown types among children <5 years of age.

cData are from the CDC’s Viral Hepatitis Surveillance, 2011.

dData are from the CDC’s Active Bacterial Core Surveillance 2012 Provisional Report.

Source: Adapted from SW Roush et al: JAMA 298:2155, 2007; and MMWR 62(33);669, 2013.

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VACCINE IMPACT

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Direct and indirect effects

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Immunizations against specific infectious diseases protect individuals against infection and thereby prevent symptomatic illnesses. Specific vaccines may blunt the severity of clinical illness (e.g., rotavirus vaccines and severe gastroenteritis) or reduce complications (e.g., zoster ...

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