Immunization is widely recognized as one of the greatest public health achievements of modern times. Largely as a consequence of immunization, the annual incidences of diphtheria, paralytic poliomyelitis, measles, mumps, rubella, and Haemophilus influenzae type b (Hib) in the United States have fallen by more than 99% compared with the average annual incidences of these diseases in the 20th century. Invasive pneumococcal disease in children less than 5 years of age has declined steeply since routine pneumococcal vaccination began in 2000. Similarly, rotavirus vaccination has been associated with substantial declines in hospitalizations and emergency department visits for diarrheal illnesses in young children. Childhood immunization has also led, through herd immunity, to significant decreases in several infectious illnesses in adults, including pneumococcal, rotavirus, and varicella disease. Through routine vaccination, children and adolescents can now receive protection against at least 16 different diseases, and many new vaccines are under development.
Every year, roughly 4 million children are born in the United States, and successful immunization of each birth cohort requires the concerted effort of healthcare providers, public health officials, vaccine manufacturers, and the public. Public perceptions about immunizations, particularly routine childhood immunizations, are generally positive. However, parent concerns about the safety of vaccines have risen in recent years, in part fueled by unfounded speculation about an association between various vaccines or vaccine components and autism. Modern vaccines have a high degree of safety, and serious adverse events following vaccination are rare. Nonetheless, healthcare providers need to be prepared to discuss the benefits and risks of vaccination with uncertain parents, providing factual information in a clear and empathic fashion.
This chapter starts with general principles regarding immunizations and the recommended pediatric and adolescent vaccination schedules, followed by a discussion of vaccine safety. Each routinely recommended vaccine is then discussed further. Vaccines that are only given in special circumstances are discussed in the final section. Several abbreviations that are commonly used in this and other vaccine-related publications are summarized in Table 10–1.
Table 10–1.Vaccine-related abbreviations. |Favorite Table|Download (.pdf) Table 10–1. Vaccine-related abbreviations.
|ACIP ||Advisory Committee on Immunization Practices |
|BCG ||Bacillus Calmette-Guérin vaccine against tuberculosis |
|CDC ||Centers for Disease Control and Prevention |
|CI CISA ||Confidence interval Clinical Immunization Safety Assessment Network |
|DT ||Pediatric diphtheria and tetanus toxoids |
|DTaP ||Pediatric diphtheria and tetanus toxoids and acellular pertussis vaccine |
|DTP ||Pediatric diphtheria and tetanus toxoids and whole-cell pertussis vaccine |
|HBIG ||Hepatitis B immune globulin |
|HBsAg ||Hepatitis B surface antigen |
|HepA ||Hepatitis A vaccine |
|HepB ||Hepatitis B vaccine |
|Hib ||Haemophilus influenzae type b |
|Hib-MenCY-TT ||Hib, meningococcal C and Y, tetanus toxoid vaccine |
|HIV ||Human immunodeficiency virus |
|HPV ||Human papillomavirus |
|HPV2 ||HPV vaccine, bivalent |
|HPV4 ||HPV vaccine, quadrivalent |
|Ig ||Immunoglobulin |
|IPV ||Inactivated poliovirus vaccine |
|LAIV ||Live attenuated influenza vaccine |
|MCV4 ||Meningococcal conjugate vaccine |
|MMR ||Measles-mumps-rubella vaccine |
|MMRV ||Measles-mumps-rubella-varicella vaccine |
|MPSV4 ||Meningococcal polysaccharide vaccine |
|OPV ||Oral poliovirus vaccine |
|PCV ||Pneumococcal conjugate vaccine |
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