Vaccines For Adults Increasing Opportunities For Health
Historically, vaccines were deemed to be only for children. However, vaccines for adults are becoming increasingly common and necessary. Most adults think only of the tetanus booster recommended every 10 years and even then, many adults only get the vaccine if they injure themselves. In 2005, the Tdap vaccine was licensed as an improved version of the typical tetanus booster, Td. The newer version also contains a component to protect against pertussis . All adults, especially those who are going to be around young infants, should get the Tdap vaccine. Adults often unwittingly pass pertussis to young infants for whom the disease can be fatal. In 2012, the CDC recommended that pregnant women get a dose of Tdap during each pregnancy between 27 and 36 weeks gestation. In 2019, the CDC recommended that Tdap or Td vaccine could be used for booster dosing every 10 years.
Influenza vaccines, available since the 1940s, are now recommended for most adults. Vaccines like MMR and chickenpox are recommended for adults who have not had the diseases, and vaccines including hepatitis A, hepatitis B, pneumococcus, and meningococcus are recommended for sub-groups of the adult population. The HPV vaccine became available in 2006. In 2018, the license was expanded to include people up to 45 years of age.
The first formal adult immunization schedule was published in 2002 and is updated annually.
Different Types Of Vaccine
Smallpox vaccines produced and successfully used during the intensified eradication program are called first generation vaccines in contrast to smallpox vaccines developed at the end of the eradication phase or thereafter and produced by modern cell culture techniques. Second generation smallpox vaccines use the same smallpox vaccine strains employed for manufacture of first generation vaccines or clonal virus variants plaque purified from traditional vaccine stocks, whereas third generation smallpox vaccines represent more attenuated vaccine strains specifically developed as safer vaccines at the end of the eradication phase by further passage in cell culture or animals. Second and third generation vaccines are produced using modern cell culture techniques and current standards of Good Manufacturing Practices .
The need for WHO to maintain an emergency reserve of smallpox vaccine following eradication was recognized in 1980 when WHO was given a set of formal responsibilities for maintaining capacity and expertise to respond to a re-emergence of smallpox in the post-eradication era as both a component of a preparedness strategy and a possible deterrent to intentional release. The Smallpox Vaccine Emergency Stockpile was originally created by consolidating WHO Member State donations given in support of the Intensified Smallpox Eradication Programme.
Variolation And Early Attempts Of Treatment
It was common knowledge that survivors of smallpox became immune to the disease. As early as 430 BC, survivors of smallpox were called upon to nurse the afflicted . Man had long been trying to find a cure for the speckled monster. During medieval times, many herbal remedies, as well as cold treatment and special cloths, were used to either prevent or treat smallpox. Dr. Sydenham treated his patients by allowing no fire in the room, leaving the windows permanently open, drawing the bedclothes no higher than the patient’s waist, and administering twelve bottles of small beer every twenty-four hours .
Inoculation, hereafter referred to as variolation, was likely practiced in Africa, India, and China long before the 18th century, when it was introduced to Europe . In 1670, Circassian traders introduced variolation to the Turkish Ottoman Empire. Women from the Caucasus, who were in great demand in the Turkish sultan’s harem in Istanbul because of their legendary beauty, were inoculated as children in parts of their bodies where scars would not be seen. These women must also have brought the practice of variolation to the court of the Sublime Porte .
Lady Mary Wortley Montague . Photo courtesy of the National Library of Medicine.
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Vaccine Development Of Louis Pasteur
In the early 1870s Pasteur had already acquired considerable renown and respect in France, and in 1873 he was elected as an associate member of the Académie de Médecine. Nonetheless, the medical establishment was reluctant to accept his germ theory of disease, primarily because it originated from a chemist. However, during the next decade, Pasteur developed the overall principle of vaccination and contributed to the foundation of immunology.
Pasteurs first important discovery in the study of vaccination came in 1879 and concerned a disease called chicken cholera. Pasteur said, Chance only favours the prepared mind, and it was chance observation through which he discovered that cultures of chicken cholera lost their pathogenicity and retained attenuated pathogenic characteristics over the course of many generations. He inoculated chickens with the attenuated form and demonstrated that the chickens were resistant to the fully virulent strain. From then on, Pasteur directed all his experimental work toward the problem of immunization and applied this principle to many other diseases.
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From The Cuckoos Trick To The Mystery Of Milkmaids
As a child, Jenner had a passion for observing nature. His first scientific achievement was to discover how the cuckoo is able to get its chicks raised by birds of other species. He was also one of the first to study bird migration and to travel in a balloon, which he built himself. He was also a poet, musician and dinosaur fossil hunter. With such a résumé, Captain Cook was quick to offer him the position of naturalist on his second expedition, but fortunately for humanity Jenner turned down the job, focused on his studies and returned to his village as a family doctor. He was then confronted with the case of the milkmaids.
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He observed that those who milked cows contracted cowpox, a much milder variant they only got a few pustules on their hands, which healed in a matter of weeks. After that, they became actually protected against human smallpox. Jenner put the pieces together and on May 14th, 1796, he was confident enough in his theory to inject a child with material from a cowpox sore on a milkmaids hand. After young James recovered from cowpox, Jenner injected him again, but this time with the more dangerous human smallpox. The boy had no symptoms of the terrible disease he was immunised.
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Vaccines For Adolescents: A New Generation Of Vaccines
Adolescents, like adults, were recommended to get tetanus boosters every 10 years most requiring their first booster dose around age 11. Other than this, however, most adolescents did not require additional vaccines unless they missed one in childhood. By 2005, vaccines specifically recommended for adolescents were only recommended for sub-groups based on where they lived or medical conditions that they had. However, a new group of vaccines became available in the latter part of the decade.
- New vaccines: Tdap, 2005, meningococcal conjugate , HPV , meningococcal serogroup B vaccine
- Additional recommendations for existing vaccines: HPV , intranasal influenza vaccine
- New versions of existing vaccines: HPV
- Discontinuation of vaccine: intranasal influenza vaccine
2000
Pneumococcus
The Eradication Of Smallpox
In 1798 Jenner finally published his findings and by the early 1800s the practice of vaccination was accepted and Jenner received funding from Parliament and the Royal Society. The method soon spread through Europe as well as the Spanish and British colonies and by the end of the 19th century vaccination was made compulsory in almost every European country. In the 1950s after implementation of even more rigorous control measures smallpox was eradicated in most parts of the western world and in 1967 the WHO started a global campaign for the worldwide eradication of smallpox. On October 26, 1977 the last naturally occurring case of smallpox was detected in Somalia and on May 8, 1980 the World Health Assembly declared the global eradication of smallpox. Edward Jenners work is now said to have “”saved more lives than the work of any other human”” and one is inclined to agree.
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The Deadliness Of Smallpox
You don’t hear much about smallpox today. According to the CDC, nobody has died of smallpox since 1978. This is a recent phenomenon, as the the BBC points out, which makes it easy to forget that smallpox was easily one of the deadliest scourges to ever face the human race, ripping through countless populations at a level far greater than the plague, and killing countless people for thousands upon thousands of years. Evidence of deaths by smallpox go back to 1157 BCE, and it continued wiping away populations up through the 11th and 12th centuries, where it was carried through Europe by soldiers returning from the crusades. The death of the Aztecs, as well, may have had less to do with any successful tactics by the Spanish invaders, but rather, the fact that these Europeans carried smallpox with them, which the Aztecs had not developed any immunity from.
The point is, smallpox has been around for much of human existence, and nothing ever halted it … until vaccines. The degree to which vaccines turned the tide cannot be underestimated. And a great deal of the credit for spreading the knowledge about inoculation, as it happens, should go to a 1700s woman named Lady Mary Montagu.
Early Smallpox Vaccine Is Tested
Edward Jenner, an English country doctor from Gloucestershire, administers the worlds first vaccination as a preventive treatment for smallpox, a disease that had killed millions of people over the centuries.
While still a medical student, Jenner noticed that milkmaids who had contracted a disease called cowpox, which caused blistering on cows udders, did not catch smallpox. Unlike smallpox, which caused severe skin eruptions and dangerous fevers in humans, cowpox led to few ill symptoms in these women.
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On May 14, 1796, Jenner took fluid from a cowpox blister and scratched it into the skin of James Phipps, an eight-year-old boy. A single blister rose up on the spot, but James soon recovered. On July 1, Jenner inoculated the boy again, this time with smallpox matter, and no disease developed. The vaccine was a success. Doctors all over Europe soon adopted Jenners innovative technique, leading to a drastic decline in new sufferers of the devastating disease.
In the 19th and 20th centuries, scientists following Jenners model developed new vaccines to fight numerous deadly diseases, including polio, whooping cough, measles, tetanus, yellow fever, typhus, and hepatitis B and many others. More sophisticated smallpox vaccines were also developed and by 1970 international vaccination programs, such as those undertaken by the World Health Organization, had eliminated smallpox worldwide.
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Rare Severe Vaccine Responses
These responses also occur as the immune system responds to the vaccine. They include responses such as a severe allergic reaction to an ingredient in the vaccine, or a low platelet count , febrile seizures, HHE , or prolonged crying.
Anaphylaxis can be treated and is therefore rarely life threatening. Other severe responses may or may not require treatment to help them resolve and rarely result in any long-term consequences.
Duration Of Immunity Provided By Vaccines
The duration of immunity varies with different diseases and different vaccines. Lifelong immunity is not always provided by either natural infection or vaccination. The recommended timing of vaccine doses aims to achieve the best immune protection to cover the period in life when vulnerability to the disease is highest.
- Many vaccines used today are relatively new and data concerning the length of time that they give protection is continually being updated
- For many diseases immunity wanes following natural infection
- The duration of immunity provided by vaccines varies depending on a range of factors, particularly the vaccine itself
- Live vaccines generally induce longer lived immunity than sub unit vaccines
- Sub unit vaccines frequently require primary courses and boosters
- Polysaccharide vaccines do not generate long-lived memory cells
- If the interval between doses is too short the duration of immunity can be affected. Hence minimum intervals are required
- In the very young and very old the duration of immunity can be limited
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Jenner Didn’t Seek To Make Any Money From His Vaccine He Wasn’t Interested In Patenting It Owen Gower
Nevertheless, Jenner realised that his smallpox vaccine the name derived from the Latin for cowpox, vaccinia had the potential to transform medicine and save lives. But he also knew he would only halt the disease if he could vaccinate as many people as possible.
Jenner didn’t seek to make any money from his vaccine, he wasn’t interested in patenting it, says Gower. He just wanted people to know about it and he wanted to share it.
He converted a rustic summerhouse in his garden into his Temple of Vaccinia and invited local people to be vaccinated after church on Sunday.
He wrote to other physicians offering them samples of the vaccine material and encouraging them to do it themselves so that people were vaccinated by their own local trusted health professional, Gower says. It’s a theme that we see now in terms of vaccine advocacy and ensuring acceptance of a vaccine is the right message delivered by the right person.
In the 19th Century, smallpox is thought to have killed 400,000 people a year in Europe alone
After Jenner published his findings, news of the discovery spread across Europe. And then, thanks to the support of the King of Spain, around the world.
In 1803, the ship sailed for South America. On board were 22 orphans to act as vaccine carriers.
The children were cared for on the journey by the orphanage director, Isabel de Zendala y Gomez, who also brought along her own son to contribute to the mission.
Edward Jenner And The Smallpox Vaccine
Smallpox was a highly infectious disease that was endemic around the world. The disease began with a fever and a red rash that spread all over the body. After a few days the rash turned into opaque pustules that formed scabs. The scabs fell off, often leaving deeply pock-marked skin.
In about 510% of cases a malignant form of smallpox was fatal. This is why people were so willing to inoculate their children.
The English physician Edward Jenner inoculated patients at his Gloucestershire practice.
Clinical practice proved Jenners vaccine successful, but neither he nor anyone else knew why it worked. An explanation had to wait for the science of bacteriology to develop at the end of the 1800s.
The French scientist Louis Pasteur believed that germs were responsible for infectious diseases such as smallpox. He tested his ‘germ theory of disease’ on anthrax, an infectious disease of people and animals.
Through his microscope, he identified a microorganism in infected blood, which he believed was responsible for the disease. Pasteur developed a solution containing a weakened form of the bacteria, which he could use as an inoculating agent. He was able to measure the success of his experiment by the absence of bacteria in the inoculated host.
Pasteur called the process vaccination in honour of Jenners work on smallpox, and vaccination became the generic term for the technique.
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Lady Mary Montagu Pushed For Change
Mary Montagu, according to Time, faced smallpox firsthand. It killed her brother, scarred her face, and left a profound impact on her future. Later, though, when she went to Turkey, she was astonished to witness an old woman who would go to families wherein one person had smallpox, carrying “a nut-shell full of the matter of the best sort of small-pox:” once there, the woman would inject this matter into the other family members with needles. This was, clearly, an early form of inoculation.
To be clear, variolation of various sorts had been practiced in a number of ancient societies, but had never gone widespread, and while this old woman remains anonymous, she inspired Mary Montagu to have her own children inoculated, and then with great effort to convince others in Great Britain to do the same. This was no easy task. Mary’s arguments were met with widespread mockery by the medical community, who couldn’t believe the gall of a woman challenging male thinking, to say nothing of the money they made ripping people off with pointless smallpox “treatments.” However, Lady Mary didn’t back down, and when another smallpox epidemic emerged in London, she made a point to publicize the inoculation of her daughter, welcoming visitors to see the results, and changing minds across the city.
Development Of Pv Vaccines
In 1935, Brodie tried an inactivated vaccine with 10% formalin suspension of PV taken from infected monkey spinal cord he tried it first on 20 monkeys, then on 3000 Californian children. The results were poor and additional human studies were never performed. In the same year, Kollmer tried a live attenuated virus consisting of a 4% suspension of PV from infected monkey spinal cord, treated with sodium ricinoleate. He used it on monkeys and then on several thousand children. The acute paralysis occurred in about 1/1000 vaccines shortly after administration and some cases were fatal.
The discovery that the various antigenic strains of PVs could be grouped into three distinct viral types and the propagation of the PV in vitro led to the development of the vaccines against poliomyelitis: the formalin-inactivated vaccine by Jonas Salk and the live-attenuated vaccines by Albert Sabin .
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The Significance Of Herd Immunity
When a high percentage of the population is protected through vaccination, it becomes difficult for a disease to spread because there are so few susceptible people left to infect. This is called herd immunity.Herd immunity is crucial for protecting people who cannot be vaccinated, such as babies and people with compromised or ineffective immune systems.
In several countries, reductions in the use of some vaccines have been followed by increases in the number of cases of potentially lethal diseases, as herd immunity begins to break down. People can lose confidence in a vaccine for a number of reasons.
In the mid-1970s, a report from the Great Ormond Street Hospital for Sick Children in London alleged that 36 children suffered neurological conditions after having the DTP vaccine. Television documentaries and newspaper reports drew public attention to the controversy.
As a result, uptake of the DTP vaccine in the UK fell from 81% to 31%, and whooping cough epidemics followed, leading to the deaths of several children.
Public confidence was only restored after a national study identified every child between 2 and 36 months hospitalized in the UK for neurological illness, and determined that the risk was very low. DTP vaccine uptake eventually increased to levels above 90%, and disease incidence declined dramatically.
The MMR vaccine used to protect against measles, mumps and rubella.