Immunizations

Contents

Foreword: Immunizations as the Nucleus of Prevention xi

Joel J. Heidelbaugh

Preface xiii

Marc Altshuler and Edward M. Buchanan

How the Immune Response to Vaccines is Created, Maintained and Measured:Addressing Patient Questions About Vaccination 581

Barbara Watson and Kendra Viner

This article gives an overview of the immune response to vaccines, includ-ingways inwhich it ismeasured and/or augmented to enhance its effective-ness. A brief description is given of the immune response, adaptiveimmunity, immunologic memory, antibodies, and adjuvants. Given thatmany young parents and physicians have never witnessed the ravages ofvaccine-preventable diseases, it is hoped this article will aid the many peo-ple involved in the prevention of infectious disease to understand better theconcepts and practicalities of immunization and vaccine development.

Routine Pediatric Immunization, Special Cases in Pediatrics: Prematurity,Chronic Disease, Congenital Heart Disease: Recent Advancements/Changesin Pediatric Vaccines 595

Daniel Walmsley

Vaccination is a powerful and dynamicweapon in reducing the impact of in-fectious diseases in children. The field and schedules are constantly evolv-ing, with significant changes resulting in new and exciting vaccines almostyearly. Special cases in pediatrics represent unique challenges and differ-ences in vaccinations. Health care providers need to be knowledgableabout the current vaccines and to remain up to date with the constant evo-lution, as well as be aware of the latest recommendations, warnings, andnews about vaccines and their use. This article updates and discussescurrent but ever-changing routine pediatric vaccination programs.

Adult Vaccination 611

Christina M. Hillson, Joshua H. Barash, and Edward M. Buchanan

Immunization has effectively decreased the burden of disease on society.Nevertheless, over 50,000 deaths occur annually in the United States fromvaccine-preventable disease, and nearly all of these occur in adults. It isessential for primary care physicians to be knowledgeable about theunique immunization-related needs of adults and to be aware of thefactors that determine the need for vaccination.

Vaccine-Preventable Diseases and Foreign-Born Populations 633

Giang T. Nguyen and Marc Altshuler

According to themost recent census data, foreign-born individuals accountfor more than 12% of the US population. Because many vaccine-

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preventable outbreaks in the United States have been correlated with dis-ease importation, Congress has mandated vaccinations for numerous im-migrant populations. It is essential for primary care physicians to beknowledgeable about the unique immunization-related needs of foreign-born individuals to recognize some of the cultural and linguistic challengesthat immigrants have accessing health care and to remember to use eachmedical encounter as an opportunity to provide necessary vaccinations.

Immunization in Travel Medicine 643

Suzanne Moore Shepherd and William Hudson Shoff

The specialty of travel medicine encompasses a broad and dynamic prac-tice. A thorough pretravel consultation provides an individual with a com-prehensive, evidence-based, contextual discussion of the risk profile forspecific itinerary-based, travel-related illness and injury, allowing the trav-eler to use this information in conjunction with his or her personal healthbelief model, risk tolerance, and experience to decide on an informedmanagement plan. This article focuses on the pretravel consultation withemphasis on the contribution of immunization to traveler’s health.

Passive Immunization 681

Christopher P. Raab

Passive immunization employs preformed antibodies provided to an indi-vidual that can prevent or treat infectious diseases. There are several sit-uations in which passive immunization can be used: for persons withcongenital or acquired immunodeficiency, prophylactic administrationwhen there is a likelihood of exposure to a particular infection, or treatmentof a disease state already acquired by the individual. Passive immunizationis limited by short duration (typically weeks to months), variable response,and adverse reactions. This article focuses on specific immunoglobulinsfor preventing or treating infectious diseases, as these are the most likelyscenarios one might encounter in primary care practice.

The Course and Management of the 2009 H1N1 Pandemic Influenza 693

Sanford R. Kimmel

The 2009 influenza A (H1N1) pandemic provided a major test to the publichealth system in the United States and abroad. Although the virus was rap-idly identified, it took longer than expected to bring an effective vaccine tomarket. During the interim the virus demonstrated a predilection for infect-ing younger persons, particularly those with medical conditions such asasthma or pregnancy, placing them at risk. Early treatment with neuramin-idase inhibitors was found to be of some benefit. When the 2009 H1N1influenza A vaccine became available, there were distribution issues inmatching the number of doses to areas of need.

Cancer Vaccines 703

Christopher V. Chambers

The term cancer vaccines encompasses 2 different types of vaccines.Prophylactic vaccines block infection by viruses that can alter host DNAand result in cancer. The hepatitis B vaccine and the human papillomavirus

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vaccines are examples of prophylactic vaccines that can prevent cancerfrom developing. More recently, therapeutic vaccines have been devel-oped and used as adjunctive therapy in patients who have already beendiagnosed with cancer. Therapeutic vaccines stimulate the host’s immunesystem to recognize cancer cells as foreign and to attack them. Most of thetherapeutic vaccines being studied are used in combination with otherforms of cancer therapy.

Vaccination Refusal: Ethics, Individual Rights, and the Common Good 717

Jason L. Schwartz and Arthur L. Caplan

Among the obstacles to the success of vaccination programs is the appar-ent recent increase in hesitancy and outright resistance to the recommen-ded vaccination schedule by some parents and patients. This articlereviews the spectrum of patient or parental attitudes that may be de-scribed as vaccine refusal, explores related ethical considerations in thecontext of the doctor-patient relationship and public health, and evaluatesthe possible responses of physicians when encountering resistance tovaccination recommendations. Health care providers should view individ-uals hesitant about or opposed to vaccines not as frustrations or threats topublic health, but as opportunities to educate and inform.

Office Immunization 729

Gary A. Emmett and Melissa Schneider

Nothing has improved disease control as thoroughly as immunizations. Inwell-immunized populations, there is no flaccid paralysis (polio), almost noepiglottitis or postmeningitis deafness (Haemophilus influenzae), and littlepostviral male sterility (mumps). Immunizations are not perfect; they maycause side effects, some of which have led to the discontinuation of thevaccine when side effects have outweighed the vaccine’s protective ef-fects. However, immunization works best not by the protection it providesthe individual but by the protection provided to the population at risk. Thisarticle discusses the currently available vaccines along with recommenda-tions for their use.

Keeping Up-to-Date with Immunization Practices 747

Donald B. Middleton, Richard K. Zimmerman, Judith A. Troy, andRobert M. Wolfe

This article presents sources of information for those in practice, adminis-tration, or education to stay up-to-date in vaccine recommendations.Web-based repositories predominate in the provision of information. Othersources include newsletters, conferences, journals, expert opinion, com-munity organizations, and books. The promise of the electronic healthrecord remains unfulfilled but improving.

Q & A: Patient to Physician FAQs: Answers to Common Patient Questions AboutVaccinations 763

Kathryn P. Trayes and Kathryn M. Conniff

This article outlines common questions about vaccinations that patientsask their physicians and provides answers to those questions.

Index 777