Vaccine history

Vaccines are used in either the general population of children or adults or for special groups. Recommendations for vaccine usage are made by the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control. The Committee on Infectious Diseases of the American Academy of Pediatrics (Redbook Committee) also makes recommendations for infants through adolescents, and the American Academy of Family Physicians makes recommendations for adults. An excellent review of vaccine history, development, usage, and related regulatory issues is available (2). 

Empirical therapy should be directed at the most likely pathogen (s) for a specific patient, taking into account age, risk factors for infection (including underlying disease and immune dysfunction, vaccine history, and recent exposures), CSF Gram stain results, CSF antibiotic penetration, and local antimicrobial resistance patterns. 

Rubella component Administer 1 dose of MMR vaccine to women whose rubella vaccination history is unreliable or who lack laboratory evidence of immunity. For women of childbearing age, regardless of birth year, routinely determine rubella immunity and oounsel women regarding congenital rubella syndrome. Women who do not have evidence of immunity should receive MMR vaccine upon completion or termination of pregnancy and before discharge from the health-care facility. 

Sabin, A.B., Oral poliovirus vaccine. History of its development and prospects for eradication of poliomyelitis. Jama, 1965. 194(8) 872-6. 

Tetanus vaccination history (full course = 5 injections before the age of 18)... 

Varicella vaccine. Varicella vaccine is recommended at any visit at or after age 12 months for susceptible children, ie, those who lack a reliable history of chickenpox. Susceptible persons aged >13 years should receive two doses, given at least 4 weeks apart. 

Immunosera, which were once very widely used in the prophylaxis and treatment of many infections, are little used today, as vaccines have made some immunosera unnecessary and lack of proven therapeutic benefit has caused others to be relegated to immunological history. Tetanus antitoxin is an exception in that it is a very effective prophylactic that is still used in countries where there are inadequate supplies of tetanus immunoglobulin. Human immunoglobulins have important but limited uses. 

Tetanus, reduced diphtheria, acellular pertussis Tdap 0.5 mL Intramuscular History of Guillain-Barre syndrome Systemic neurologic reaction from previous vaccine... 

CDC Case Definition A mosquito-borne viral illness characterized by acute onset and constitutional symptoms followed by a brief remission and a recurrence of fever, hepatitis, albuminuria, and symptoms and, in some instances, renal failure, shock, and generalized hemorrhages. Laboratory criteria for diagnosis is (1) fourfold or greater rise in yellow fever antibody titer in a patient who has no history of recent yellow fever vaccination and cross-reactions to other flaviviruses have been excluded or (2) demonstration of yellow fever virus, antigen, or genome in tissue, blood, or other body fluid. 

Adults with uncertain histories of a complete primary vaccination series with tetanus and diphtheria toxoid-containing vaccines should begin or complete a primary vaccination series. A primary series for adults is 3 doses of tetanus and diphtheria toxoid-containing vaccines administerthe first2 doses at least 4 weeks apart and the third dose 6-12 months after the second. However, Tdap can substitute for any one of the doses of Td in the 3-dose primary series. The booster dose of tetanus and diphtheria toxoid-containing vaocine should be administered to adults who have completed a primary series and if the last vaccination was received >10 years previously. Tdap or Td vaccine may be used, as indicated. 

HPV vaccination is recommended for all females aged <26 years who have not completed the vaccine series. History of genital warts, abnormal Papanicolaou test, or positive HPV DNAtest is not evidence of prior infection with all vaccine HPV types HPV vaccination is still recommended for these persons. 

General contraindications to vaccine administration include a history of anaphylactic reaction to a previous dose or an unexplained encephalopathy occurring within 7 days of a dose of pertussis vaccine. Immunosuppression and pregnancy are temporary contraindications to live vaccines. Whenever possible, transplant patients should be immunized before transplantation. Live vaccines generally are not given after transplantation. 

The vaccine should not be given to immunosuppressed patients (except those infected with HIV) or pregnant women. HIV-infected persons who have never had measles or have never been vaccinated should be given measles-containing vaccine unless there is evidence of severe immunosuppression. The vaccine should not be given within 1 month of any other live vaccine unless the vaccine is given on the same day (as with the MMR vaccine). Measles vaccine is indicated in all persons born after 1956 or in those who lack documentation of wild virus infection either by history or antibody titers. 

The regulation of biologically derived therapeutics actually has a long history, and has also continued to evolve (see Table 12.4) (Weissinger, 1989, Korwek, 1997). This history led to the PHS Act providing a somewhat mixed description of the products under its authority, which in turn serves to define biologies for CBER [A biologic is] any virus, therapeutic serum, toxin, antitoxin, vaccine, blood, blood... 

In addition to the chemotherapeutic approaches, the industry, again in collaboration with university colleagues, has been working on an effective vaccine for fhis disease. The history of viral disease has been one in which vaccines have been much more successful fhan chemofherapeutic agenfs, whereas, to date, the reverse is the case with AIDS. 

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