Revisiting Vaccines

MELODIE J. KOLMETZ, MPAS, PA-C, DFAAPA, NRP-CP-C

Learning Outcomes

Learning Outcomes

• At the conclusion of this session, learners will be able to:
• Differentiate between active and passive immunity.
• Explain the importance of vaccination in the control of infectious disease.
• Identify the various types of vaccines.
• Utilize the current Advisory Committee on Immunization Practices (ACIP) immunization recommendations across the lifespan to select appropriate vaccinations for a patient.
• Recognize attitudinal, knowledge, and other barriers contributing to suboptimal vaccination rates.

Historical Context

Dedication

Smallpox Vaccine

• Chinese employed smallpox inoculation (AKA variolation) as early as 1000 CE.
• Edward Jenner’s used cowpox material in 1796 to create immunity to smallpox
• His method underwent medical and technological changes over the next 200 years and eventually resulted in the eradication of smallpox

​

Rabies Vaccine

• Louis Pasteur developed rabies vaccine in 1885
• Other developments rapidly followed as we understood bacteriology
• Antitoxins and vaccines against diphtheria, tetanus, anthrax, cholera, plague, typhoid, tuberculosis, and more were developed through the 1930s

​

Vaccines Save Lives

• Between 2014 and 2019, roughly 1900 cases of measles, a disease that was declared by the United States to be eradicated in 2000, have been recorded
• Estimated cost to contain each case (including follow-up) was $140,000
• Total cost to stop the spread of measles was approximately $266 million
• The US spends nearly $27 billion treating adults for diseases that could have been prevented with vaccinations

A Little Immunology

Immunization

PASSIVE

• Protection transferred from another person or animal
• Methods of acquisition include:
• Natural maternal antibodies
• Antitoxins
• Immune globulins
• Effects are only temporary

​

​

ACTIVE

• Relatively permanent
• Methods of acquisition include:
• Natural infection
• Vaccines
• Toxoids

​

Passive Immunization

When is it warranted?

• Deficiency in synthesis of antibodies (congenital or acquired)
• Disease exposure with immediate complications
• Disease is already present

​

Common Agents for Passive Immunizations

Passive Immunization

• Key Facts
• Transfer of antibodies does not “trigger” the immune system
• There will not be any memory cells
• Can cause hypersensitivity reactions (remember those Mast cells?)

​

​

Active Immunization

• Key Facts
• Stimulates the proliferation of B and T cells resulting in memory cells
• After the immune system clears the invading organism, it rests, but it remembers its target until the next time
• More permanent effects

​

Immunology of Vaccines

Toxoids

• They are prepared by detoxifying the exotoxins of some bacteria rendering them antigenic but not pathogenic. Adjuvant (e.g. alum precipitation) is used to increase the potency of vaccine.

​

• The antibodies produces in the body as a consequence of toxoid administration neutralize the toxic moiety produced during infection rather than act upon the organism itself. In general toxoids are highly efficacious and safe immunizing agents.

Whole Pathogen Vaccines

• Use entire pathogens that have been killed or weakened so that they cannot cause disease
• Types:
• Live Attenuated
• contain a version of the living microbe that has been weakened in the laboratory
• Inactivated
• produced by killing the pathogen with chemicals, heat or radiation

Live vaccines

• Live vaccines are made from live infectious agents without any amendment.
• The only live vaccine is “Variola” small pox vaccine, made of live vaccinia cow-pox virus (not variola virus) which is not pathogenic but antigenic, giving cross immunity for variola.

Live attenuated (avirulent) vaccines

• Virulent pathogenic organisms are treated to become attenuated and avirulent but antigenic. They have lost their capacity to induce full-blown disease but retain their immunogenicity.
• Live attenuated vaccines should not be administered to persons with suppressed immune response due to:
• Leukemia and lymphoma
• Other malignancies
• Receiving corticosteroids and anti-metabolic agents
• Radiation
• pregnancy

Inactivated (killed) vaccines

• Organisms are killed or inactivated by heat or chemicals but remain antigenic. They are usually safe but less effective than live attenuated vaccines. The only absolute contraindication to their administration is a severe local or general reaction to a previous dose.

Subunit Vaccines

• Include only the components, or antigens, that best stimulate the immune system
• Can make vaccines safer and easier to produce
• Often requires the incorporation of adjuvants to elicit a strong protective immune response
• Can minimize side effects
• Types
• Toxoid
• Polysaccharide
• Conjugate
• Recombinant protein

Polysaccharide and polypeptide (cellular fraction) vaccines

• They are prepared from extracted cellular fractions e.g. meningococcal vaccine from the polysaccharide antigen of the cell wall, the pneumococcal vaccine from the polysaccharide contained in the capsule of the organism, and hepatitis B polypeptide vaccine.

​

• Their efficacy and safety appear to be high.

Nucleic Acid Vaccines

• 1. DNA plasmid vaccines comprise a small circular piece of DNA called a plasmid that carries genes encoding proteins from the pathogen of interest.
• SARS coronavirus (SARS-CoV) in 2003
• H5N1 avian influenza in 2005, H1N1 pandemic influenza in 2009
• Zika virus in 2016.
• 2. Messenger RNA (mRNA) vaccines are delivered into cells
• An experimental mRNA vaccine that protected mice and monkeys against Zika virus infection after a single dose
• SARS-CoV19
• 3. Recombinant vector vaccines (common in veterinary medicine) use a harmless virus or bacterium as a vector, or carrier, to introduce genetic material into cells
• Developing HIV, Zika virus and Ebola virus vaccines

​

Types of vaccines

Routes of administration

Scheme of immunization

Vaccine Storage

Misconceptions

MYTH: MMR causes autism

• Many large, well-designed studies have found no link between MMR and autism
• Autism usually becomes apparent around the same time MMR is given – no evidence of causality
• Autism probably has multiple components, including genetics (e.g., one study found that if one identical twin had autism, the chance that the second twin had autism was greater than 90%, but with fraternal twins the chance was less than 10%.)
• The 1998 study by Andrew Wakefield that started this concern was based on 12 children who were preselected for study
• In 2004, 10 of the 13 authors of this study retracted the study’s interpretation
• In 2010, the editors of The Lancet retracted the paper following the ruling of the U.K.’s General Medical Council that stated the primary author’s conduct regarding his research was “dishonest” and “irresponsible” and that he had shown a “callous disregard” for the suffering of children involved in his studies. Wakefield was subsequently removed from the U.K medical register and is no longer licensed to practice medicine
• In January 2011, the BMJ published a series of articles showing Wakefield’s work was not just bad science, but deliberate fraud

​

​

31

MYTH: Thimerosal causes autism

• The form of mercury found in thimerosal is ethyl mercury (EM), not methylmercury (MM). MM is the form that has been shown to damage the nervous system
• Although no evidence of harm has ever been demonstrated, thimerosal was taken out of vaccines as a precaution
• Since 2001, except a few influenza vaccine products, thimerosal has not been used as a preservative in any routinely recommended childhood vaccines.
• Multiple studies have shown that thimerosal in vaccines does not cause autism
• Studies of three countries compared the incidence of autism before and after thimerosal was removed from vaccines (in 1992 in Europe and 2001 in the U.S.), and there was no decrease in autism with the switch to thimerosal-free vaccines

​

32

MYTH: Ingredients in vaccines are harmful

Aluminum

• Aluminum is used in some vaccines as an adjuvant – an ingredient that improves the immune response. They have been used for this purpose for more than 70 years
• Aluminum is the most common metal found in nature. It is in the air and food and drink. Infants get more aluminum through breast milk or formula than vaccines
• Most of the aluminum taken into the body is quickly eliminated

33

MYTH: Ingredients in vaccines are harmful (cont.)

Formaldehyde

• Formaldehyde is used to detoxify diphtheria and tetanus toxins or to inactivate a virus
• The tiny amount that may be left over from these steps in making vaccines is safe
• Formaldehyde is also found in products like paper towels, mascara, and carpeting
• Humans normally have formaldehyde in their blood streams at levels higher than is found in vaccines

​

34

MYTH: Ingredients in vaccines are harmful (cont.)

Miscellaneous

• Antibiotics are present in some vaccines to prevent bacterial contamination when the vaccine is made
• Additives such as gelatin, albumin, sucrose, lactose, MSG, and glycine help the vaccine stay effective while being stored
• Trying to make vaccines without adjuvants, additives, and preservatives is difficult – these ingredients keep vaccine safe and effective

​

35

MYTH: Abortions are required to produce vaccines

• Production of varicella, rubella, rabies, and hepatitis A vaccines involves growing viruses in human cell culture
• Two human cell lines provide these cultures; they were developed from two legally aborted fetuses in the 1960s
• The donor fetuses were not aborted for the purpose of obtaining these cells
• The same cell lines have been used for more than 40 years – no new fetal tissue is required

​

36

MYTH: VAERS data prove that vaccines are dangerous

VAERS data cannot “prove” anything.

• Anyone can report anything…not proof of causality is required
• Only reports of special interest (e.g., hospitalizations) are verified
• Reports include many non-serious reactions
• The number of reported adverse events is influenced by publicity
• VAERS is properly used to detect early warning signals

​

37

Types of Vaccines

What are Vaccine-Preventable Diseases?

Chickenpox (Varicella) Dengue

Diphtheria

Flu (Influenza)

Hepatitis A Hepatitis B

Hib (Haemophilus influenzae type b)

HPV (Human Papillomavirus) Measles

Meningococcal Mumps

Pneumococcal Polio (Poliomyelitis)

Whooping Cough (Pertussis )

​

​

Infants, children, adolescents, teens and adults need different vaccinations, depending on their age, location, job, lifestyle, travel schedule, health conditions or previous vaccination

Rotavirus

RSV (Respiratory Syncytial Virus)

Rubella (German Measles)

Shingles (Herpes Zoster)

Tetanus (Lockjaw)

Non-Routine Vaccines

• Adenovirus
• Anthrax
• Cholera
• Japanese Encephalitis (JE)

that are no longer common in the U.S

• Rabies
• Smallpox
• Tuberculosis
• Typhoid Fever
• Yellow Fever

People in certain research jobs and travel situations may be exposed to dangerous or deadly diseases

https://www.historyofvaccines.org/index.php/content/articles/different-types-vaccines

Individual Vaccines

A Photo Collection of �Vaccine-Preventable Diseases��Created by the �Immunization Action Coalition��

February 2020 ▪ Item #S8010

Diseases for which vaccination is routinely recommended

Diphtheria

Haemophilus influenzae type b (Hib)

Hepatitis A

Hepatitis B

Herpes zoster (shingles)

Human papillomavirus (HPV)

Influenza

Measles

Meningococcal disease

​

​

​

​

Mumps

Pertussis

Pneumococcal disease

Polio

Rotavirus

Rubella

Tetanus

Varicella (chickenpox)

​

Diphtheria

Note the thick gray coating over the back of the throat

Complications from respiratory diphtheria may include:

• Airway blockage
• Damage to the heart muscle (myocarditis)
• Nerve damage (polyneuropathy)
• Loss of the ability to move (paralysis)
• Kidney failure

Even with treatment, about 1 in 10 patients with respiratory diphtheria die.

Without treatment, up to half of patients can die from the disease.

​

46

Photo courtesy of the Centers for Disease Control and Prevention (CDC)

Diphtheria

• This child has a swollen neck (sometimes referred to as bull neck) due to diphtheria infection.

47

Photo courtesy of the Centers for Disease Control and Prevention (CDC)

Diphtheria

• Four kinds of vaccines used today protect against diphtheria, all of which also protect against other diseases:
• Diphtheria and tetanus (DT) vaccines
• Diphtheria, tetanus, and pertussis (DTaP) vaccines
• Tetanus and diphtheria (Td) vaccines
• Tetanus, diphtheria, and pertussis (Tdap) vaccines

​

• Babies and children younger than 7 years old receive DTaP or DT, while older children and adults receive Tdap and Td.

​

48

Haemophilus influenzae type b (Hib)

• This girl is hospitalized with Hib infection, shown here involving the deep tissue of her face.
• Hib disease can also lead to brain damage, seizures, paralysis, hearing loss, and death.

49

Photo courtesy of the Children’s Immunization Project, Saint Paul, MN

Haemophilus influenzae type b (Hib)

50

CDC recommends Hib vaccination for:

• All children younger than 5 years old
• Unvaccinated older children and adults with certain medical conditions
• People who receive a bone marrow transplant

​

The FDA licensed 4 Hib vaccines for use in the United States. Three of the vaccines protect against Hib disease only, while one vaccine includes protection against other diseases. 

Hepatitis A

• Hepatitis A virus infection has caused jaundice.
• Other symptoms of hepatitis A can include:
• loss of appetite
• abdominal pain
• nausea or vomiting
• fever
• headaches
• pale, clay-colored stool
• dark urine

51

Photo courtesy of the Centers for Disease Control and Prevention (CDC)

Hepatitis A

• There are two types of hepatitis A vaccine.
• The first type, the single-dose hepatitis A vaccine, is given as a series of 2 vaccinations, 6 months apart, and both are needed for long-term protection against hepatitis A.
• The other type is a combination vaccine that protects against both hepatitis A and hepatitis B.

​

52

Hepatitis B

• This woman died from liver cancer caused be chronic hepatitis B four months after arriving at a refugee resettlement camp.
• The likelihood of carrying the virus for life (chronic infection) depends on a person’s age when infected:
• 2 of 100 adults
• 30 of 100 children age 3–5 years
• 90 of 100 infants
• About 1 out of 4 persons who become chronically infected during childhood die prematurely from cirrhosis (scarring) of the liver or liver cancer. 

​

53

Photo courtesy of Patricia Walker, MD, Regions Hospital, MN

Hepatitis B

• Hepatitis B vaccine is usually given as 2, 3, or 4 shots.
• Infants should get their first dose of hepatitis B vaccine at birth and will usually complete the series at 6 months of age

​

54

Herpes zoster (shingles)

• Shingles is a painful rash that usually develops on one side of the body, often the face or torso.
• The rash consists of blisters that typically scab over in 7 to 10 days and clears up within 2 to 4 weeks. Some people describe the pain as an intense burning sensation.
• Some people develop long-lasting pain called postherpetic neuralgia (PHN), and it is the most common complication of shingles.
• Shingles infection of the eye can lead to a loss of vision.
• Without vaccination, about 1 in 3 people who have been infected with chickenpox will later develop shingles.

​

55

Photo courtesy of www.webmd.com

Herpes zoster (shingles)

• CDC recommends that healthy adults 50 years and older get two doses of the shingles vaccine
• Called Shingrix (recombinant zoster vaccine)
• Separated by 2 to 6 months.

​

56

Human Papillomavirus (HPV)

• HPV is the most common sexually transmitted infection in the U.S.
• Approximately 79 million Americans are infected.
• Most sexually active men and women will get at least 1 type of HPV at some point in their lives.
• Persistent infection with high-risk types of HPV is associated with almost all cervical cancers.
• An estimated 44,000 HPV-associated cancers occur annually in the U.S.

​

57

Photo courtesy of the Centers for Disease Control and Prevention (CDC)

Cervical cancer

Human Papillomavirus (HPV)

• Two doses of HPV vaccine are recommended for children at ages 11–12; the vaccine can be given starting at age 9 years.
• Children who start the HPV vaccine series on or after their 15th birthday need three doses given over 6 months.

​

58

Influenza

• This photo shows how the influenza virus can spread through the air when someone coughs.

59

Photo courtesy of the Centers for Disease Control and Prevention (CDC)

Influenza

• The 1918 influenza pandemic killed at least 50 million people worldwide.

60

Emergency hospital at Camp Funston, Kansas,

during the 1918 influenza pandemic

Photo courtesy of the National Museum of Health and Medicine, Armed Forces Institute of Pathology

Influenza

• Multiple options available:
• inactivated influenza vaccine [IIV]
• recombinant influenza vaccine [RIV]
• live attenuated influenza vaccine (LAIV)

​

• Both trivalent (three-ingredient) and quadrivalent (four-ingredient) influenza vaccines are available.

61

Measles

• This child has a severe measles rash, as well as red eyes, a runny nose, and a fever.
• Measles can cause pneumonia, seizures, brain damage, and even death.
• Death from measles occurs in 2–3 per 1,000 reported cases in the U.S.

62

Photo courtesy of the Centers for Disease Control and Prevention (CDC)

Measles

• Young boy with characteristic measles rash

63

Photo courtesy of the Centers for Disease Control and Prevention (CDC)

Measles

• Young boy with measles
• Blotchy macular rash on face, arms, and neck

64

Photo courtesy of the Centers for Disease Control and Prevention (CDC)

Measles

65

The CDC recommends children get two doses of MMR vaccine, starting with the first dose at 12 through 15 months of age, and the second dose at 4 through 6 years of age. Teens and adults should also be up to date on their MMR vaccination.

​

Two doses of MMR vaccine are about 97% effective at preventing measles; one dose is about 93% effective.

​

Children may also get MMRV which protects against measles, mumps, rubella, and varicella (chickenpox). This vaccine is only licensed for use in children who are 12 months through 12 years of age.

Meningococcal Disease

• Meningococcal disease is a sudden, life-threatening illness caused by bacteria that infect the blood (septicemia) or the brain and spinal cord (a type of meningitis).
• Meningococcal disease can cause shock, coma, and death within hours of the first symptom. Even with proper treatment, 10–15% of people with meningococcal disease die.
• Of people who survive, as many as 20% suffer from some serious complication such as loss of an arm or leg, brain damage, or permanent hearing loss.

66

Photo courtesy of the Centers for Disease Control and Prevention (CDC)

Meningococcal Disease

• This 4-month-old infant has gangrene of her hands and lower extremities as a result of meningococcemia.

67

Photo courtesy of the Centers for Disease Control and Prevention (CDC)

Meningococcal Disease

• There are 2 types of meningococcal vaccines available in the United States:
• Meningococcal conjugate or MenACWY vaccines (Menactra^® and Menveo^®)
• Serogroup B meningococcal or MenB vaccines (Bexsero^® and Trumenba^®)

68

Mumps

• This child’s jaw and cheek are swollen from mumps.
• Mumps often leads to painful swelling of the salivary glands.
• Mumps can lead to painful swelling of the testicles in males, deafness, and brain damage.

69

Photo courtesy of the Centers for Disease Control and Prevention (CDC)

Mumps

• A young child with characteristic swelling of the front of the neck due to enlargement of the submaxillary salivary glands brought on by a mumps infection. 

70

Photo courtesy of the Centers for Disease Control and Prevention (CDC)

Pertussis (whooping cough)

• This child has pertussis, a highly contagious respiratory disease caused by the bacterium Bordetella pertussis.
• Pertussis is known for uncontrollable, violent coughing which often makes it hard to breathe. After coughing fits, someone with pertussis often needs to take deep breaths, which result in a “whooping” sound.
• Pertussis can affect people of all ages, but can be very serious, even deadly, for babies less than a year old.

71

Photo courtesy of the Centers for Disease Control and Prevention (CDC)

Pertussis (whooping cough)

• This child has broken blood vessels in his eyes and bruising on his face as a result of coughing from pertussis.

72

Photo courtesy of the Centers for Disease Control and Prevention (CDC)

Pertussis (whooping cough)

73

There are 6 pediatric DTaP vaccines licensed and currently used in the United States: Daptacel®, Infanrix®, Kinrix®, Pediarix®, Pentacel®, and Quadracel®. 

​

There are two Tdap vaccines used in the United States: Adacel® and Boostrix®.

Pneumococcal Disease

• This is a photo of the brain of a person who died from pneumococcal meningitis. Note the purulence that covers the brain surface.
• Pneumococcal disease is caused by bacteria that can lead to serious infections in the lungs (pneumonia), blood (sepsis), or brain (meningitis).

74

Photo courtesy of the Centers for Disease Control and Prevention (CDC)

Pneumococcal Disease

• Pneumococcal conjugate vaccine
• PCV15
• PCV20
• PCV21
• Pneumococcal polysaccharide vaccine
• PPSV23

​

75

Pneumococcal Disease

• CDC recommends  Pneumococcal vaccination for:
• Adults age 50 and older
• Specific guidance is available about choice of vaccine
• Particularly important for the immunocompromised, those with cochlear implants, or with CSF fluid leaks

​

76

Polio

• This photo of a Los Angeles hospital respiratory ward in 1952 shows polio patients in iron lung machines.

77

Photo courtesy of the Centers for Disease Control and Prevention (CDC)

Polio

• This child has a severely deformed leg caused by polio.
• Although polio has been eliminated from most of the world, until poliovirus transmission is interrupted in every county, all countries remain at risk of importation of polio.

78

Photo courtesy of the World Health Organization (WHO)

Polio

• CDC recommends that children get polio vaccine to protect against polio
• Inactivated polio vaccine (IPV) is the only polio vaccine that has been given in the United States since 2000
• Oral polio vaccine (OPV) is used in other countries.
• CDC recommends that children get four doses of polio vaccine. They should get one dose at each of the following ages: 2 months old, 4 months old, 6 through 18 months old, and 4 through 6 years old.

79

Rotavirus

• Doctor examining child dehydrated from rotavirus infection.
• In developing countries, rotavirus causes about half a million deaths each year in children younger than 5 years of age.
• Almost all unvaccinated children get infected with rotavirus before reaching age 5.

80

Photo courtesy of World Health Organization, photo credit Dr. D. Mahalanabis

Rotavirus

• Two rotavirus vaccines are currently licensed for infants in the United States:
• RotaTeq® (RV5) is given in 3 doses at ages 2 months, 4 months, and 6 months
• Rotarix® (RV1) is given in 2 doses at ages 2 months and 4 months
• The first dose of either vaccine should be given before a child is 15 weeks of age. Children should receive all doses of rotavirus vaccine before they turn 8 months old.

​

81

Rubella

• This teen has a rash from rubella.
• The rash is not as prominent as the measles rash and is often missed in diagnosis.
• Rubella in pregnant women can lead to miscarriage as well as severe medical problems in their newborns.

82

Photo courtesy of the Centers for Disease Control and Prevention (CDC)

Rubella

• This infant was born with rubella.
• Babies whose mothers were infected with rubella during pregnancy can be born with deafness, blindness, heart damage, and intellectual disability.

83

Photo courtesy of the Centers for Disease Control and Prevention (CDC)

Tetanus

• This baby has neonatal tetanus. His body is rigid.
• Most newborns who get tetanus die.
• Infection can occur if a mother is unimmunized against tetanus and the baby’s newly-cut umbilical cord is exposed to dirt.
• Neonatal tetanus can be prevented through hygienic delivery practices and/or immunizing mothers against tetanus.

84

Photo courtesy of the Centers for Disease Control and Prevention (CDC)

Tetanus

• This person has tetanus. The muscles in his body are in spasm, making it nearly impossible for him to move.
• Tetanus bacilli live in the soil, and many types of injuries can allow the bacteria to enter the body.

85

Photo courtesy of the Centers for Disease Control and Prevention (CDC)

Tetanus

• Four kinds of vaccines used today protect against tetanus, all of which also protect against other diseases:
• Diphtheria and tetanus (DT) vaccines
• Diphtheria, tetanus, and pertussis (DTaP) vaccines
• Tetanus and diphtheria (Td) vaccines
• Tetanus, diphtheria, and pertussis (Tdap) vaccines
• Babies and children younger than 7 years old receive DTaP or DT, while older children and adults receive Tdap and Td.

86

Varicella (Chickenpox)

• Many cases of chickenpox are mild, but deaths from this disease can occur.
• Before vaccines became available, about 100 previously healthy people died from chickenpox every year in the U.S.

87

Photo courtesy of the Centers for Disease Control and Prevention (CDC)

Varicella (Chickenpox)

• This newborn has a secondary bacterial infection, which is a complication following infection with varicella (chickenpox) virus.
• He contracted chickenpox from his infected mother.

88

Source: Unknown

Varicella (Chickenpox)

The CDC recommends two doses of the chickenpox vaccine for children, adolescents, and adults who have never had chickenpox and have not received any previous vaccinations.

Children are routinely recommended to receive the first dose at age 12 through 15 months and the second dose at age 4 through 6 years.

• Varivax^®
• Contains only chickenpox vaccine
• Is licensed for use in children age 12 months and older, adolescents, and adults
• Can be given to children for their routine two doses of chickenpox vaccine at age 12 through 15 months and age 4 through 6 years
• ProQuad^®
• Contains a combination of measles, mumps, rubella, and varicella (chickenpox) vaccines, which is also called MMRV
• Is only licensed for use in children age 12 months through 12 years

​

89

Other diseases for which vaccines are used in special situations

• Adenovirus
• Anthrax
• Cholera
• Japanese encephalitis
• Rabies
• Smallpox
• Typhoid fever
• Yellow fever

90

Adenovirus

• Adenoviruses are common causes of respiratory illness, but most infections are not severe.
• They can cause:
• Cold-like symptoms
• Sore throat
• Bronchitis
• Pneumonia
• Diarrhea
• Pink eye (conjunctivitis)
• A vaccine against adenovirus types 4 and 7 is approved by FDA for U.S. military personnel only.

​

​

91

Photo courtesy of the Centers for Disease Control and Prevention (CDC)

Adenovirus

• There is currently no adenovirus vaccine available to the general public.
• Adenovirus vaccine contains live adenovirus Type 4 and Type 7. It will prevent most illness caused by these two virus types.
• The vaccine comes as two tablets, taken orally (by mouth) at the same time. The tablets should be swallowed whole, not chewed or crushed.
• The vaccine is approved for military personnel 17 through 50 years of age.
• It is recommended by the Department of Defense for military recruits entering basic training. It may also be recommended for other military personnel at high risk for adenovirus infection.
• Adenovirus vaccine may be given at the same time as other vaccines.

​

92

Anthrax

• Anthrax is a serious disease caused by Bacillus anthracis, a bacterium that forms spores.
• Three types of anthrax exist:
• Skin (cutaneous)
• Lungs (inhalation)
• Digestive (gastrointestinal)
• Humans can become infected with anthrax by handling products from infected animals, breathing in anthrax spores, or eating infected meat.

93

Photo courtesy of the Centers for Disease Control and Prevention (CDC)

Anthrax

• CDC recommends anthrax vaccination for three groups of adults 18 through 65 years old who may be at risk of coming in contact with anthrax because of their job:
• Certain laboratory workers who work with anthrax
• Some people who handle animals or animal products, such as veterinarians who handle infected animals
• Certain U.S. military personnel
• There is one anthrax vaccine licensed for use in the United States by the Food and Drug Administration (BioThrax)
• It is given to people 18 through 65 years old at increased risk of exposure in five doses, with a booster dose each year thereafter for those that continue to be at increased risk of exposure.
• It is given, in combination with antibiotics, as a three-dose primary series after exposure.

​

94

Cholera

• Cholera is an acute diarrheal illness caused by infection of the intestine with the bacterium Vibrio cholerae.
• An estimated 3–5 million cases and over 100,000 deaths occur each year around the world.
• This infection is often mild, but it can cause life-threatening dehydration.
• FDA approved Vaxchora for people ages 2-to-64 years traveling to an area where cholera is present. The vaccine, a single dose taken by mouth, should be given at least 10 days before traveling.

95

Photo courtesy of the Centers for Disease Control and Prevention (CDC)

Japanese Encephalitis

• The Japanese Encephalitis virus is transmitted by the bites of infected mosquitoes. This is an image of a Culex mosquito laying eggs.
• Japanese encephalitis is the most common vaccine-preventable cause of encephalitis (inflammation of the brain) in Asia.
• Most infections are mild (e.g., fever and headache) without apparent symptoms.
• However, about 1 in 200 infections results in severe disease characterized by rapid onset of high fever, headache, neck stiffness, disorientation, coma, seizures, spastic paralysis, and death.

96

Photo courtesy of the Centers for Disease Control and Prevention (CDC)

Japanese Encephalitis

• Inactivated Vero cell culture-derived Japanese encephalitis (JE) vaccine (manufactured as IXIARO) is the only JE vaccine licensed and available in the United States.
• Approved in 2009 for use in people aged 17 years and older and in 2013 for use in children 2 months through 16 years of age.
• Other JE vaccines are manufactured and used in other countries but are not licensed for use in the United States.
• IXIARO is given as a two-dose series, with the doses spaced 28 days apart. Adults aged 18–65 years can get the second dose as early as 7 days after the first dose. The last dose should be given at least 1 week before travel. A booster dose (third dose) should be given if a person has received the two-dose primary vaccination series one year or more previously and there is a continued risk for JE virus infection or potential for reexposure.

97

Rabies

• Bites from wild animals such as raccoons, bats, and skunks account for the majority of rabies cases in the U.S.
• Rabies is caused by a virus that invades the central nervous system and disrupts its functioning. The virus is transmitted in the saliva of infected animals.
• Prompt postexposure treatment is generally effective. Once symptoms appear, the disease is almost always fatal.

​

98

Photo courtesy of the Centers for Disease Control and Prevention (CDC)

Rabies

• This dog was suspected of being rabid. It exhibited signs of restlessness and overall uncharacteristic aggressive behavior, which are two symptoms of rabies.
• Other symptoms of rabies in pets may include impaired walking, eating, and drinking.

​

99

Photo courtesy of the Centers for Disease Control and Prevention (CDC)

Rabies

• People at high risk of exposure to rabies should be offered pre-exposure rabies vaccination, including:
• Veterinarians, animal handlers, and veterinary students, rabies laboratory workers
• Spelunkers (people who explore caves), and
• Persons who work with live vaccine to produce rabies vaccine and rabies immune globulin
• For pre-exposure protection, 3 doses of rabies vaccine are recommended. People who may be repeatedly exposed to rabies virus should receive periodic testing for immunity, and booster doses might be necessary.
• For post-exposure protection:
• A person who is exposed and has never been vaccinated against rabies should get 4 doses of rabies vaccine. The person should also get another shot called rabies immune globulin (RIG).
• A person who has been previously vaccinated should get 2 doses of rabies vaccine and does not need Rabies Immune Globulin.

​

100

Smallpox (Variola)

• A worldwide smallpox vaccination program led to the eradication of smallpox in 1979. The smallpox virus no longer exists in nature.
• The eradication of smallpox ranks as one of the greatest achievements in the history of medicine.

101

Photo courtesy of the Centers for Disease Control and Prevention (CDC)

Smallpox (Variola)

• Made from vaccinia, a poxvirus similar to smallpox, but less harmful.
• Is a live virus vaccine, but the vaccine does not contain the smallpox virus and cannot give you smallpox.
• Smallpox vaccination can protect you from smallpox for about 3 to 5 years. After that time, its ability to protect you decreases. If you need long-term protection, you may need to get a booster vaccination.
• Routine smallpox vaccination among the American public stopped in 1972 after the disease was eradicated in the United States.
• If you are a lab worker who works with virus that causes smallpox or other viruses that are similar to it, you should still get the vaccine.
• Because of concern that variola virus might be used as an agent of bioterrorism, the U.S. government has stockpiled enough smallpox vaccine to vaccinate everyone who would need it if a smallpox outbreak were to occur.

​

102

Typhoid Fever

• This serious disease is caused by the bacteria Salmonella typhi. It is transmitted through the ingestion of food or drink which has been contaminated by the feces of an infected person.
• Typhoid can cause a high fever, weakness, headache, loss of appetite, stomach pains, and a rash of flat, rose-colored spots.
• If the disease is not treated, it can kill up to 20% of people who get infected. It can be treated with antibiotics, but antibiotic-resistant strains are a growing problem.
• Typhoid fever is still common in low-income countries.

103

Photo courtesy of the Centers for Disease Control and Prevention (CDC)

Typhoid Fever

CDC recommends vaccination for people traveling to places where typhoid fever is common, such as South Asia, especially India, Pakistan, or Bangladesh.

Two typhoid fever vaccines are available in the United States.

• Oral vaccine: Can be given to people at least 6 years old. It consists of four pills taken every other day and should be finished at least 1 week before travel.
• Injectable vaccine: Can be given to people at least 2 years old and should be given at least 2 weeks before travel.
• Typhoid vaccines are not 100% effective. The injectable vaccine requires a booster every 2 years, and the oral vaccine requires a booster every 5 years.

104

Yellow Fever

• This female Aedes aegypti mosquito can transmit the viruses that cause Dengue fever, Zika, and yellow fever. These viruses are transferred to the host when bitten by a female mosquito.
• The word “yellow” in the name refers to the jaundice that affects some patients. The virus is endemic in tropical areas of Africa and Latin America.
• There is an effective yellow fever vaccine, but there is no cure for the disease.
• Most infected patients improve after 3 to 4 days. However, 15% of patients enter a second, more toxic phase of the disease, about half of whom die within 10–14 days.

105

Photo courtesy of the Centers for Disease Control and Prevention (CDC)

Yellow Fever

• Yellow fever virus is found in tropical and subtropical areas in South America and Africa.
• Anyone 9 months or older who travels to areas where yellow fever vaccine is should be vaccinated against yellow fever at least 10 days before travel.
• Vaccine must be given by a special yellow fever vaccine provider.
• After getting vaccinated, you will receive a signed and stamped “yellow card,” known as an International Certificate of Vaccination or Prophylaxis (or ICVP), which you should bring with you on your trip. Some countries require all travelers to show proof of yellow fever vaccination before they can enter the country.
• For most travelers, a single dose of yellow fever vaccine provides lifelong protection.
• Reactions to yellow fever vaccine are generally mild. They may include headaches, muscle aches, and low-grade fevers. However, in rare cases, the yellow fever vaccine can have serious and sometimes fatal side effects.
• Infants 6 to 8 months old, adults 60 years or older, and people with weakened immune systems might be at higher risk of developing serious side effects. There are special concerns for pregnant and nursing women.

​

​

106

Resources

For more information on any of these diseases and the vaccines that can prevent them:

• www.immunize.org

​

• www.vaccineinformation.org

​

​

107

For more information on any of these diseases and the vaccines that can prevent them, go to:

• www.immunize.org
• www.vaccineinformation.org

​

For information on traveler’s health, go to:

• https://wwwnc.cdc.gov/travel

​

​

​

​

108

Yellow Fever

Vaccine Schedules

ACIP

There’s an app for that…

• Download “CDC Vaccine Schedules” free for iOS and Android devices.
• Access the Schedules on the Web

https://www.cdc.gov/vaccines/index.html

​

Vaccine Hesitancy

Vaccine Hesitancy

• The World Health Organization defines vaccine hesitancy as a “delay in acceptance or refusal of vaccines despite availability of vaccination services.
• Decision making around vaccination entails a complex mix of cultural, psychosocial, spiritual, political, and cognitive factors.
• Reasons for vaccine hesitancy fit into 3 categories:
• 1. lack of confidence (in effectiveness, safety, the system, or policy makers)
• 2. complacency (perceived low risk of acquiring VPDs)
• 3. lack of convenience (in the availability, accessibility, and appeal of immunization services, including time, place, language, and cultural contexts)

Vaccine Hesitancy-Lack of Confidence 1

• 1. Tuskegee Syphilis Study
• 1932-600 Black men were enrolled in a study on the progression of syphilis under the guise of receiving free medical care for their condition.
• Some men began to die, go blind or develop other severe health conditions due to their untreated syphilis but researchers continued the experiment for 40 more years.
• The exploitation of these patients has become known as one of the most infamous displays of medical racism in history.

Vaccine Hesitancy-Lack of Confidence 2

• 2. “Mississippi Appendectomy”
• 1920s-1980s
• Medical practice that provided involuntary hysterectomies and sterilization on women of color.
• Term coined by Fannie Lou Hammer, who was a civil rights activist who went into the hospital to have a tumor removed but was instead sterilized. 

Vaccine Hesitancy-Lack of Confidence 3

• 3. Henrietta Lacks
• a Black mother of five who died in 1951 from an aggressive cervical cancer at the age of 31
• Her cancer cells were taken without her knowledge or consent and have been involved in numerous medical advancements in cancer, immunology and infectious disease ever since.
• Companies that profited from her cells failed to inform or compensate her family for decades.

Vaccine Hesitancy-Complacency

• 1. Actually is a result of successful immunization programs
• 2. Many Americans have never seen a child struggling to breathe from whooping cough or unable to walk from polio
• 3. The things that frightened our parents and grandparents are invisible to us
• 4. “It can’t happen to me”

​

Vaccine Hesitancy-Convenience

• 1. Physical availability
• 2. Affordability and willingness to pay
• 3. Geographical accessibility
• 4. Ability to understand
• 5. Appeal of immunization services

The Results of Vaccine Hesitancy

• As of March 27, 2025, a total of 483 confirmed* measles cases were reported by 20 jurisdictions: Alaska, California, Florida, Georgia, Kansas, Kentucky, Maryland, Michigan, Minnesota, New Jersey, New Mexico, New York City, New York State, Ohio, Pennsylvania, Rhode Island, Tennessee, Texas, Vermont, and Washington.

​

• There have been 5 outbreaks (defined as 3 or more related cases) reported in 2025, and 93% of confirmed cases (447 of 483) are outbreak-associated. For comparison, 16 outbreaks were reported during 2024 and 69% of cases (198 of 285) were outbreak-associated.

​

• https://www.cdc.gov/measles/data-research/

​

Measles Internationally

Infection Prevention for Measles

https://www.who.int/emergencies/disease-outbreak-news

​

Hazards of Immunization

Adverse Reactions to Vaccines

Reactions Inherent of Inoculation

Reactions Due to Faulty Techniques

Reactions Due to Hypersensitivity

Neurological Involvement

• Neurological manifestations may be observed after the administration of serum or vaccine.
• Well-known examples are the postvaccine encephalitis and encephalopathy following the administration of anti-rabies and smallpox vaccines.
• Guillain­ Barre syndrome in association with the swine influenza vaccine is another example.

​

Provocative Reactions

• Occasionally following immunization there may occur a disease totally unconnected with the immunizing agent (e.g., provocative polio after DPT or DT administration against diphtheria).
• The mechanism seems to be that the individual is harboring the infectious agent, and the administration of the vaccine shortens the incubation period and produces the disease or what may have been otherwise only a latent infection is converted into a clinical attack.

Other Reactions

• These may comprise damage to the fetus (e.g., with rubella vaccination); displacement in the age-distribution of a disease (e.g., a potential problem in mass vaccination against measles, rubella and mumps).

Conclusion

https://www.forbes.com/sites/matthewherper/2013/02/19/a-graphic-that-drives-home-how-vaccines-have-changed-our-world/?sh=65018dd03302

vaccine infographic created by Leon Farrant

In Memoriam

Thank you!

Melodie J. Kolmetz, MPAS, PA-C, DFAAPA, NRP, CP-C

melodie@amedicaltypeperson.com

www.amedicaltypeperson.com

References

• https://www.historyofvaccines.org/content/blog/1902-anti-vaccine-invitation
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC88952/
• https://www.vaccines.gov/basics/types
• https://www.who.int/news-room/feature-stories/detail/the-race-for-a-covid-19-vaccine-explained
• https://www.niaid.nih.gov/research/vaccines
• https://immunize.org/
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6515949/
• https://www.cdc.gov/vaccines/index.html
• https://connect.uclahealth.org/2020/12/15/covid-19-vaccine-hesitancy-in-communities-of-color/
• https://www.cdc.gov/vaccines/pubs/pinkbook/downloads/appendices/B/us-vaccines.pdf

​

​

​

​

​

​

​

​