Vaccines do not guarantee complete protection from a disease. 1 Sometimes this is because the host’s immune system simply doesn’t respond adequately or at all. This may be due to a lowered immunity in general (diabetes, steroid use, HIV infection) or because the host’s immune system does not have a B cell capable of generating antibodies to that antigen.
Even if the host develops antibodies, the human immune system is not perfect and in any case the immune system might still not be able to defeat the infection.
Adjuvants are typically used to boost immune response.2 Most often aluminium adjuvants are used, but adjuvants like squalene are also used in some vaccines and more vaccines with squalene and phosphate adjuvants are being tested. The efficacy or performance of the vaccine is dependent on a number of factors:
– the disease itself (for some diseases vaccination performs better than for other diseases)
– the strain of vaccine (some vaccinations are for different strains of the disease) 3
– whether one kept to the timetable for the vaccinations
– some individuals are ‘non-responders’ to certain vaccines, meaning that they do not generate antibodies even after being vaccinated correctly
– other factors such as ethnicity or genetic predisposition
When a vaccinated individual does develop the disease vaccinated against, the disease is likely to be milder than without vaccination.
The following are important considerations in the effectiveness of a vaccination program:
– 1.careful modeling to anticipate the impact that an immunization campaign will have on the epidemiology of the disease in the medium to long term
– 2.ongoing surveillance for the relevant disease following introduction of a new vaccine and
– 3.maintaining high immunization rates, even when a disease has become rare.
In 1958 there were 763,094 cases of measles and 552 deaths in the United States. 4, 5 With the help of new vaccines, the number of cases dropped to fewer than 150 per year (median of 56). 5 In early 2008, there were 64 suspected cases of measles. 54 out of 64 infections were associated with importation from another country, although only 13% were actually acquired outside of the United States; 63 of these 64 individuals either had never been vaccinated against measles, or were uncertain whether they had been vaccinated. 5
1.Grammatikos AP, Mantadakis E, Falagas ME. Meta-analyses on pediatric infections and vaccines. Infect Dis Clin North Am. 2009; 23(2):431-57.[PMID 19393917]
2.Van Sant JE (2008). “The Vaccinators: Smallpox, Medical Knowledge, and the ‘Opening’ of Japan”. J Hist Med Allied Sci 63 (2): 276–9. doi:10.1093/jhmas/jrn014.
3.Dudgeon JA (1963). “Development of smallpox vaccine in England in the eighteenth and nineteenth centuries”. BMJ (5342): 1367–72. doi:10.1136/bmj.1.5342.1367.
4.Orenstein WA, Papania MJ, Wharton ME (2004). “Measles elimination in the United States”. J Infect Dis 189 (Suppl 1): S1–3. doi:10.1086/377693. PMID 15106120. http://www.journals.uchicago.edu/doi/full/10.1086/377693.
5.”Measles–United States, January 1-April 25, 2008″. MMWR Morb. Mortal. Wkly. Rep. 57 (18): 494–8. May 2008. PMID 18463608. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5718a5.htm.
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