Vaccines: What Everyone Needs To Know

Cover......Page 1
Vaccines......Page 4
Copyright......Page 5
Dedication......Page 6
Contents......Page 8
Acknowledgments......Page 16
Abbreviations......Page 18
Introduction......Page 20
1. What Is a Vaccine and How Do Vaccines Work?......Page 22
What happens when the immune system is confronted by an antigen?......Page 23
Which is better, natural immunity or immunity after vaccination?......Page 24
What is the real risk of vaccine-​preventable diseases?......Page 25
What is herd immunity?......Page 26
How large are most outbreaks?......Page 27
What are the different types of vaccines?......Page 28
Why are there so many types of vaccines?......Page 30
Besides antigens, what else are vaccines made of?......Page 31
Even if these substances are necessary, are they safe?......Page 33
Why was thimerosal removed from vaccines in 2001?......Page 34
Do some vaccines contain animal products?......Page 35
Do vaccines use cells from aborted fetuses?......Page 36
When was the first vaccination delivered in the United States?......Page 38
What is inoculation?......Page 39
How did we get from inoculation to vaccination?......Page 40
When did smallpox vaccine come to the United States?......Page 41
What was the public response to the new vaccine?......Page 42
How did the public health community make early vaccines safer?......Page 45
How did vaccine development begin to take off?......Page 46
What were some other important developments for making vaccines?......Page 47
What about vaccine introduction in other countries?......Page 49
3. Vaccine Development......Page 52
What factors influence which vaccines get developed?......Page 53
Once a decision to proceed with vaccine development is made, what are the steps needed to bring a vaccine from an idea to production?......Page 55
What is required for clinical studies?......Page 56
Is there a similar process in other countries?......Page 58
Are there protections for people who participate in clinical trials?......Page 59
How many people are involved in vaccine trials?......Page 60
What happens after clinical development is complete?......Page 61
How long does this whole process take—​from the first exploratory study to licensure of a new vaccine?......Page 62
Is a vaccine ever approved or used without following these steps?......Page 63
Who is involved in all of these steps from conceptualization  
to development?......Page 64
How many vaccine manufacturers are there?......Page 66
What actually happens in vaccine manufacturing?......Page 67
What quality controls govern vaccine manufacturing?......Page 68
Who pays for vaccine development?......Page 69
How do manufacturers know how much vaccine to make?......Page 70
What happens when there are vaccine shortages?......Page 71
How are vaccines distributed once they are licensed?......Page 72
Are there other vaccines used in some places but not others?......Page 73
How much do vaccines actually cost for immunization programs?......Page 74
Who decides which vaccine should be distributed?......Page 75
What is the National Vaccine Advisory Committee?......Page 77
What is the National Vaccine Plan?......Page 78
What are the Decade of Vaccines and the Global Vaccine Action Plan?......Page 79
Once a vaccine is added to an immunization program, how does it get to the people who need it?......Page 80
What is required to be able to deliver vaccines in a clinic or community setting?......Page 81
How are vaccines purchased through public insurance?......Page 82
Who purchases most of the vaccines in the United States?......Page 84
What is the Expanded Program on Immunization?......Page 85
How does the World Health Organization support other countries?......Page 86
How are vaccines made more accessible to lower income countries?......Page 87
What is a vaccine adverse event?......Page 90
How can one determine whether an adverse event is really caused by a vaccine?......Page 91
How is safety monitored after a vaccine is licensed?......Page 92
Who can report to VAERS?......Page 93
What happens when VAERS finds a signal?......Page 94
What are active surveillance networks?......Page 95
What kind of reactions can occur after vaccination?......Page 96
How often do adverse events really occur?......Page 98
Is Guillain–​Barré syndrome associated with vaccines?......Page 99
What are precautions?......Page 100
If a person is immunocompromised because of chemotherapy or an organ transplant, can he or she receive any vaccines?......Page 101
Should pregnant women receive vaccines?......Page 102
Do live attenuated (weakened virus or bacteria) vaccines ever cause problems in healthy individuals?......Page 103
What is the National Vaccine Injury Compensation Program?......Page 104
Which vaccines are covered by NVICP?......Page 105
How does one qualify for compensation within NVICP?......Page 106
What is the NVICP vaccine injury table and what is in it?......Page 107
Who is responsible for updating the NVICP injury table?......Page 108
How many individuals have received compensation from NVICP?......Page 109
Has NVICP compensated any autism claims?......Page 111
How is information about vaccine safety from NVICP communicated?......Page 112
Who evaluates the reliability of vaccine safety studies?......Page 113
What is the National Academy of Medicine?......Page 114
Who makes the immunization schedule?......Page 116
When was ACIP first established?......Page 117
How are ACIP members selected?......Page 119
How does ACIP make decisions about the immunization schedule?......Page 120
What happens after a recommendation is made?......Page 122
Why is there only one recommended schedule?......Page 123
What is wrong with following a different schedule, such as spreading out vaccines, rather than following the recommended vaccine schedule?......Page 124
How do we know the recommended schedule is safe?......Page 125
How do immunization programs keep track of who needs what?......Page 126
What is vaccine policy?......Page 128
What are the historical and legal precedents for mandatory vaccination?......Page 129
What are the basic arguments against immunization requirements?......Page 131
What kinds of vaccine requirements are employed in the United States?......Page 132
What are the benefits of school-​entry requirements?......Page 133
How does one opt out of school-​entry requirements?......Page 134
What impact do exemption policies have on immunization rates?......Page 136
What has happened with vaccine-​exemption legislation since the 2015 measles outbreak?......Page 137
What are other types of mandatory immunization policies?......Page 138
Do any other settings require immunizations?......Page 139
Are there other countries that have mandatory immunization policies?......Page 140
What do health care providers do if patients or families refuse 
a vaccine?......Page 141
Can health care providers ask a patient or family to leave the practice if they refuse vaccines?......Page 142
Why would different providers have different immunization policies, especially if there is one routine recommended schedule?......Page 143
Are individuals who choose not to vaccinate themselves or their children ever held responsible for exposing other people to 
vaccine-​preventable diseases?......Page 144
8. Vaccine Hesitancy......Page 146
What is vaccine hesitancy?......Page 147
How does vaccine hesitancy manifest?......Page 148
What is the difference between vaccine hesitancy and the anti-​vaccine movement?......Page 149
How is vaccine hesitancy measured?......Page 150
Which individuals may be more or less likely to be vaccine hesitant?......Page 151
What are the implications of vaccine hesitancy?......Page 152
What are the practical and economic costs associated with disease outbreaks that result from vaccine hesitancy?......Page 153
How can vaccine hesitancy be addressed?......Page 154
Where do people get information about vaccines?......Page 155
What are the most reliable sources of information related to vaccines?......Page 156
How can one evaluate the reliability of information?......Page 157
What new vaccines are under development?......Page 160
Why are group B streptococcus and respiratory syncytial virus vaccines being developed for pregnant women?......Page 161
Will we be ready for the next outbreak or pandemic for emerging infections such as Ebola and Zika viruses?......Page 162
Will there be a new vaccine for Zika virus?......Page 164
What is the difference between an epidemic and a pandemic?......Page 165
How does antigenic drift and shift occur? Why does this not occur with other viruses or bacteria?......Page 166
Are we getting any closer to an influenza vaccine that does not have to be changed every year?......Page 167
Are we getting closer to a vaccine to prevent human immunodeficiency virus?......Page 168
Are vaccines being developed that can treat rather than prevent illnesses?......Page 169
What is an endemic disease?......Page 170
How do we achieve elimination or eradication of infectious diseases?......Page 171
What is the Global Polio Eradication Initiative?......Page 172
Can we expect eradication or near eradication of any other vaccine-​preventable diseases in the next 20 years?......Page 174
Appendix......Page 176
Selected Bibliography......Page 188
Index......Page 196