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Vaccination: How Millions of Lives Have Been Saved - Perhaps Yours

Vaccination: How Millions of Lives Have Been Saved - Perhaps Yours

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Vaccination: How Millions of Lives Have Been Saved - Perhaps Yours

181 pagine
2 ore
Aug 9, 2016


The author, a physician epidemiologist, reviews the history and current status of vaccines developed over the past 220 years, starting with smallpox vaccine. He describes the impact of these vaccines on human health, not only with regard to the prevention of infections but also, in the cases of two vaccines, the prevention of cancer.
Aug 9, 2016

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Vaccination - M. Ward Hinds

Vaccination: How Millions of Lives Have Been Saved - Perhaps Yours

Vaccination: How Millions of Lives Have Been Saved - Perhaps Yours

Copyright © 2019 by M. Ward Hinds MD MPH

All rights reserved. This book or any portion thereof may not be reproduced or used in any manner whatsoever without the express written permission of the publisher except for the use of brief quotations in a book review or scholarly journal.

ISBN 978-1-365-31885-6


There are now over 7 billion humans on this planet.  All humans alive today, by virtue of being here, have direct ancestors who survived the infectious disease epidemics of past centuries, at least to an age that allowed successful reproduction.  However, many millions of humans did not survive these epidemics, and the majority of these died early in life, before they had reached reproductive age.  None of these unfortunates are your ancestors.

Had it not been for the successful development of multiple effective vaccines over the past 220 years, it is certain that many would not have lived and reproduced.  Would you be living on our planet now if vaccines had not been available when your great-grandparents or grandparents or parents were young or when you were young?  While the answer to these questions cannot be precisely determined, there is no doubt that many millions of persons alive today owe their lives to vaccines.  It is very possible that at least one of your ancestors lived to reproductive age due to a vaccine, thus meaning that you owe your life to that vaccine.  Young people living today, particularly those under age 20, have the greatest probability of an ancestor who survived to reproduce only because he or she was saved from an infectious disease death due to vaccination.  Even some persons born before 1920, however, owe their lives to a smallpox or rabies vaccination received by one of their ancestors.

In 1990, Drs. Marcia Inhorn and Peter Brown stated in the Annual Review of Anthropology that, Infectious diseases... have likely claimed more lives than all wars, noninfectious diseases, and natural disasters taken together.  Infectious diseases are our oldest, deadliest foe.  Vaccination has proved to be our most effective tool to prevent many infections and save lives.

In the 26 years since 1990, the number of lives saved by vaccination has only increased.  In addition to saved lives, there have been millions more who have avoided crippling, chronic conditions caused by vaccine-preventable infections.  This book will look at some of the diseases brought largely under control by vaccines, as well as the small number of diseases completely or largely eliminated from our planet.

Vaccination Basics

Over the course of the past 200 years, there has been a short list of major advances that have caused mortality rates to fall and average lifespans to lengthen.  On this short list, one might reasonably include:

●       Clean food and clean drinking water,

●       Antibiotics,

●       Better nutrition,

●       Reduced tobacco use,

●       Industrial safety rules, and

●       Safer automobiles, especially seatbelts and airbags.

Some might include additional advances, but almost everyone in the medical and scientific fields would include vaccines near the top of their list.

Vaccination is widely regarded as one of the most effective and beneficial tools for protecting people from a variety of infectious diseases, especially person-to-person transmitted diseases.

Vaccination programs have resulted in the worldwide eradication of smallpox (see chapter on smallpox) and the near eradication of polio (see chapter on polio).  Many other once-common, often debilitating and sometimes deadly diseases, such as diphtheria and measles, have become rare.

The terms vaccine and vaccination are derived from the scientific name of the cowpox virus, Variolae vaccinae.  These are the terms devised by Edward Jenner to denote his use of cowpox infection to produce some level of immunity to smallpox in 1798.   Later, in 1881, to honor Jenner, Louis Pasteur proposed that the terms vaccine and vaccination should be extended to cover all new protective inoculations, including his successful rabies vaccine.

Although the term vaccination is sometimes used interchangeably with the term immunization, the terms are not entirely synonymous.  Vaccination refers only to immunity induced by a vaccine, while immunization refers to immunity induced by either the natural infection or by vaccination.

Basic definition: A vaccine is a biological preparation that induces active, acquired immunity to a particular disease. Active acquired immunity refers to immunity produced by an individual’s immune system.

A vaccine typically contains components that mimic a disease-causing microorganism and is often made from weakened or killed forms of the whole microbe, or its toxins, or one of its component proteins. These vaccine components are generally referred to as antigens.  Antigens stimulate the body's immune system to recognize the agent as a threat, develop antibodies and other immune system responses and, perhaps most importantly, develop an immunologic memory, so that the immune system can more easily recognize and destroy any of these microorganisms that later invade the body.

So how do vaccines work?  The  immune system contains several types of  specialized cells for fighting infection. These cells consist primarily of:

●       B-lymphocytes (B-cells),

●       T-lymphocytes (T-cells), and

●       Macrophages.

Vaccines cause the development of acquired immunity to a disease by imitating an infection and causing the immune system to produce T-lymphocytes and antibodies that are specific for that infection.

Macrophages ingest viruses or other antigens and display the antigens on their cell surface, where they cause activation of helper T-cells, that next activate T-lymphocytes (creating cytotoxic T-cells) and B-lymphocytes (B-cells). Antibodies are produced by plasma cells derived from B-lymphocytes. The immune system keeps a supply of millions and possibly billions of different antibodies in its memory to be prepared for any foreign invader.  There are millions of B-lymphocytes in circulation at all times and almost every B-lymphocyte produces a unique antibody that it displays on its surface.  When B-lymphocytes come into contact with their matching microbial antigen, they are stimulated to divide into many larger cells, called plasma cells, which secrete mass quantities of antibodies to bind to the matching microbe.

The antibodies secreted by plasma cells circulate throughout the human body and attack the microbes that have not yet infected any cells but are in the blood plasma or the extravascular spaces between cells. When antibodies gather on the surface of a microbe, it becomes unable to function. Antibodies then signal macrophages to come kill and consume the microbe.

T-lymphocytes attack cells in the body that have already been infected. Because they have been programmed by their exposure to the microbe’s antigen, these cytotoxic T-lymphocytes, also called cytotoxic or killer T-cells, can sense diseased cells that are harboring the microbe. The killer T-cells latch onto these cells and release chemicals that destroy the infected cells and the microbes inside.

Every microbe carries its own unique set of antigens, which are central to creating vaccines.  Macrophages digest most parts of the microbes but save the antigens and carry them back to the lymph nodes, which are bean-sized organs scattered throughout your body in which immune system cells congregate. In these lymph nodes, macrophages sound the alarm by regurgitating the antigens, displaying them on their surfaces so other specialized defensive white blood cells, the B-lymphocytes and T-lymphocytes, can recognize them.

After vaccination or infection, the body keeps a few T-lymphocytes (known as memory cells) that remember the infectious microbe in case it invades again.  These memory cells can multiply and go into action quickly if the body encounters the same microbe in the future. When the familiar antigens are detected, B-lymphocytes are also activated to become plasma cells and produce the specific antibodies needed to destroy the microbe.

Today there are five main types of vaccines:

●       ­Toxoid vaccines. These are among the simplest vaccines to make and they have not changed much in 80 years.  They are single antigen vaccines created by converting toxins produced by certain bacteria into harmless toxoids that produce an immune response, but cause no damage. Examples are diphtheria and tetanus vaccines.

●       ­Live, attenuated virus vaccines. Many of these are living viruses that have been passed through multiple cell cultures under conditions that disable their virulent properties through mutation.  In the case of smallpox, the live vaccine is a closely related but less dangerous organism (cowpox). Examples of attenuated live viral vaccines are the chickenpox, rotavirus, and measles-mumps-rubella (MMR) vaccines.

●       Inactivated vaccines.  Examples of inactivated vaccines are the influenza, pertussis, and hepatitis A vaccines.  The microbe has been killed in such a way that it cannot cause infection, but still produces an immune response.

●       Subunit vaccines. The hepatitis B and human papillomavirus (HPV) vaccines are examples of vaccines wherein only part of the virus is used as an antigen. This has been made possible due to recombinant DNA technology.

●       Conjugate vaccines.  A molecule which stimulates antigen formation may be attached (in a process called conjugation) to the inactivated microbe, or part of the microbe, to greatly increase the body’s immune response.  Examples are the Haemophilus influenzae b, pneumococcal, and meningococcal vaccines.

All of these vaccine examples are discussed in more detail in later chapters.

Multiple doses, usually two or three, are almost always required for most vaccines in order to develop a highly protective immune response.  For some vaccines, such as those for pertussis and tetanus, the protective immune response can wane after a decade or more, so additional doses are required for continuing good protection.

Sometimes getting a vaccine can cause minor symptoms, such as low-grade fever and tenderness and swelling at the injection site. Such minor symptoms are part of a normal immune response and should be expected as the body builds immunity.

Vaccination, like infection, produces memory T-cells and antibody-producing B-cells.  Following vaccination, the body is left with a supply of memory T-lymphocytes, as well as B-lymphocytes that will remember how to produce antibodies to fight that infection in the future. However, it typically takes a few weeks for the body to produce T-lymphocytes and B-lymphocytes after vaccination. For some vaccines, a high level of protection requires as many as three doses, or sometimes more.  Therefore, it is possible that a person who was infected just before or just after vaccination, or who has not completed a series of required doses, could still develop disease, because the vaccine has not had enough time to provide protection.

Today, fully vaccinated children in the United States and many other Western countries will normally receive 14 different vaccines by the time they reach their teens, whereas 100 years ago, they would have received only one (smallpox).  However, today’s vaccines have been purified to contain relatively few protein or polysaccharide antigens- a fact that will be discussed further in this and subsequent chapters.

Smallpox vaccine in the early 20th century contained 200 different protein antigens.  Today’s 14 childhood vaccines contain a total of only 160 different antigens.  Because smallpox vaccine is no longer given to children, the level of antigen exposure from today’s 14 childhood vaccines is lower than it was 100 years ago.  It is also important to note that these 160 vaccine antigens are many, many fewer than the thousands and thousands of antigens that a small child encounters in their environment starting from the moment of birth.  Our immune systems have evolved to successfully deal with exposure to huge numbers of antigens.

Vaccine Safety

In the United States, the Immunization Safety Review Committee was established in 2001 by the Institute of Medicine, part of The National Academy of Sciences,  to evaluate the evidence for possible causal associations between immunizations and adverse health outcomes.  However, even before this committee was established, the Institute of Medicine issued dozens of reports on vaccine safety, starting in 1977 with polio

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