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Chapter 118: Immunization Principles and Vaccine Use

Nancy Messonnier; Anne Schuchat; Lisa A. Jackson

INTRODUCTION

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 118-1), and most vaccine-preventable diseases of childhood are at historically low levels (Table 118-2). 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.

TABLE 118-1Diseases Preventable with Vaccines Routinely Administered in the United States to Children and/or Adults
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TABLE 118-1 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 and high-risk adults
Haemophilus influenzae type b infection Children
Hepatitis A Children
Influenza Children, adolescents, adults
Varicella Children
Pneumococcal disease Children, older adults
Meningococcal disease Adolescents and high-risk adults
Rotavirus infection Infants
Human papillomavirus infection, cervical and anogenital cancers Adolescents and young adults
Zoster Older adults
TABLE 118-2Decline in Vaccine-Preventable Diseases in the United States Following Widespread Implementation of National Vaccine Recommendations
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TABLE 118-2 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 2016a REDUCTION (%) IN CASES AFTER WIDESPREAD VACCINATION
Smallpox 29,005 0 100
Diphtheria 21,053 0 100
Measles 530,217 69 >99
Mumps 162,344 5311 97
Pertussis 200,752 15,737 92
Polio (paralytic) 16,316 0 100
Rubella 47,745 5 >99
Congenital rubella syndrome 152 1 99
Tetanus 580 33 94
Haemophilus influenzae type b infection 20,000 22b >99
Hepatitis A 117,333 2500c 98
Hepatitis B (acute) 66,232 19,200c 71
Invasive pneumococcal infection: all ages 63,067 29,000d 54
Varicella 4,085,120 126,639e 97

a2016 reported cases unless otherwise specified. bAn additional 11 type b infections are estimated to have occurred among 222 reports of H. influenzae infection caused by unknown types among children <5 years of age. cData are from the CDC’s Viral Hepatitis Surveillance, 2014. dData are from the CDC’s Active Bacterial Core Surveillance 2015 Provisional Report. eData are from Morb Mortal Wkly Rep 65:1306, 2016 (2015 final data).

Source: Adapted from SW Roush et al: JAMA 298:2155, 2007 and Morb Mortal Wkly Rep 65:924, 2017.

VACCINE IMPACT

Direct and Indirect Effects

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 ...

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