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Immunizations and Vaccinations

The U.S. Centers for Disease Control and Prevention lists vaccinations at the top of the list of 10 great public health achievements of the 20th century. Vaccinations have been responsible for incredible (>99%) reductions in a host of infectious diseases and their complications. The system of vaccination depends on the integrity of the family function, for much of routine vaccination requires vaccination of infants, children, and adolescents. In the United States, by the time a child has reached his or her 2nd birthday, the child should have received 27 or 28 doses of vaccines, some of which may be given in combination to reduce the number to as few as 20 doses. While states mandate vaccines for day care and school attendance, almost all permit some form of parental refusal. The United States, like many developed countries around the world, does not require vaccination. Families must weigh the benefits of vaccination against the potential harms. Particularly, as the diseases to which the vaccines are directed become less common, public health programs strive to educate families on the evidence for the benefits for the vaccines as well as the evidence of their safety. This entry discusses the types of immunizations and obstacles to their use.

Types of Immunizations

At the core of families' concerns with vaccines is the very nature of the vaccines. Vaccines are one form of immunizations, and immunizations are biologic rather than pharmaceutical. Immunizations come from materials such as cells, tissues, or living organisms, unlike pharmaceuticals that come from chemical reactions and distillations of purified chemical reagents.

Immunizations consist of a wide variety of biologics but form two major categories related to their mechanisms of action. Immunizations are either active or passive. Active immunizations stimulate immune reactions resulting in persisting immunity. Passive immunizations provide temporarily materials that otherwise would be produced by immune reactions.

Both mimic a natural process that occurs when the body recognizes foreign materials or antigens. These are usually part of the surface structure of germs, such as bacteria or virus. These antigens are specific to the type of germ. They stimulate the immune systems to manufacture antibodies (or immunoglobulins). Antibodies are special proteins that interact with disease-specific antigens carried by the germs themselves. That interaction leads to further immunologic activity against the antigens and the bacteria or viruses presenting the antigen, which leads to the destruction or neutralization of that bacteria or virus.

Passive Immunization

Passive immunization provides the specific antibodies an individual can use to bind the antigens of germs to assist the body in fighting those germs. These antibodies interact only with the specific germ in question and are usually collected from a living organism, human or otherwise, already immune to the germ. The antibodies are pieces of protein and as such eventually degrade and disappear. The immunity that results from these antibodies can be incredibly effective but remains only temporary, limiting their use to specific exposures. Examples of antibodies given as passive immunization include rabies immunoglobulin given for exposure to possibly rabid animals and respiratory syncytial virus (RSV) immunoglobulin given to extremely premature infants during RSV season.

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