Table Of ContentEpidemiology and Prevention
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Vaccine-Preventable Diseases
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Department of Health and Human Services
Centers for Disease Control and Prevention
Epidemiology and Ppovention
of
Vaccine-Ppoventable Diseases
DITION NATIONAL INSTITUTES OF HEALTH
NIH LIBRARY
JANUARY JUL2
2006
BLDG 10, 10 CENTER DR
BETHESDA, MD, 20892-1150
Edited by: WilliamAtkinson, MD, MPH
Jennifer Hamborsky, MPH, CHES
Lynne McIntyre, MALS
Charles [Skip] Wolfe
Layout and Design: Susie P. Childrey
ThisbookwasproducedbytheEducation,InformationandPartnershipBranch,NationalImmunizationProgram,CentersforDisease
ControlandPrevention,whoissolelyresponsibleforitscontent. ItwasprintedanddistributedbythePublicHealthFoundation. For
additionalcopies,contactthePublicHealthFoundationat877-252-1200orwebsitehttp://bookstore.phf.org/.
Suggested Citation:
CentersforDiseaseControlandPrevention.EpidemiologyandPreventionofVaccine-PreventableDiseases.AtkinsonW,HamborskyJ,
McIntyreL,WolfeS,eds.Sthed.WashingtonDC;PublicHealthFoundation,2006.
Useoftrade namesandcommercial sources isforidentificationonlyanddoes not implyendorsement
bythe PublicHealthServicesorthe U.S. DepartmentofHealthand HumanServices.
Referencestonon-CDCsiteson theInternetareprovidedasaserviceto readersand donotconstituteorimply
endorsementoftheseorganizationsortheirprogramsbyCDCortheU.S. DepartmentofHealthand Human Services.
CDC isnot responsibleforthecontentofthesesites. URLaddresseswerecurrentasofthedateofpublication.
Department of Health and Human Services
Centers for Disease Control, and prevention
On
the Cover
A montage of images from the
history of immunization.
Clockwise from upper
left:
John Enders, who with his
colleagues Thomas Weller
and Fred Robbins first grew
poliovirus in human cell culture
in 1948; the May 1980 edition
of World Health magazine
announcing the eradication
of smallpox; a vaccine jet
injector, developed in 1967;
a molecule of immunoglobulin
G
type (IgG), a critical
component of the receptor
theory of immunity developed
MMR
by Paul Ehrlich in 1897;
vaccine, first licensed in 1971;
an influenza warning poster
developed by the Chicago
Public Health Department
in 1918; Edward Jenner, who
developed the first vaccine
(smallpox) in 1796; a Polio
Pioneer button, given to the
children who volunteered for
the Francis Field Trial of poliovirus vaccine in 1954; a Drinker respirator (iron lung),
which saved the lives of thousands of people paralyzed by polio in the 1940s and
1950s; and Hippocrates, a Greek physician who described diphtheria, epidemic
jaundice (probably hepatitis A), and other diseases in the 5th century BCE. He was
—
said to have originated the medical maxim primum non nocere first, do no harm.
... .
i!
ij
Table Contents
1 Principles of Vaccination
immunologyandVaccine-Preventable Diseases ....1
Classification ofVaccines ....4
Selected References ....8
2 General Recommendations on Immunization
Timing and Spacing ofVaccines ....9
Adverse Reactions FollowingVaccination ...15
Contraindications and Precautions toVaccination .. ...IB
Invalid ContraindicationstoVaccination ... 22
Screening forContraindications and Precautions ... 25
Selected References . ..26
3 Immunization Strategies for
Healthcare Practices and Providers
The Need forStrategies to Increase
Immunization Levels .. .29
TheAFIXApproach ...31
Other Essential Strategies . ..36
Selected References ...41
4
Vaccine Safety
The Importance ofVaccineSafetyPrograms . ..43
Sound Immunization Recommendations and Policy. . ...44
Methods ofMonitoringVaccineSafety . ..45
Vaccine InjuryCompensation ...5D
The Immunization Provider’s Role ...5D
Selected References ...55
5 Diphtheria
Carynebacteriumdiphtheriae 57
...
Pathogenesis 57
.. .
Clinical Features .. .57
Complications 59
.. .
LaboratoryDiagnosis .. .59
Medical Management 6D
.. .
Epidemiology . .61
SecularTrends inthe United States ...62
Diphtheria Toxoid ...63
Vaccination Schedule and Use 64
...
Adverse Reactions FollowingVaccination 65
.. .
Contraindications and PrecautionstoVaccination . ....65
Vaccine Storage and Handling 66
.. .
Suspect Case Investigation and Control ...66
Selected References 67
. ..
6
Tetanus
Clostridiumtetani ..69
Pathogenesis 70
.. .
Clinical Features ...70
Milestones in the History of Vaccination
400bce 1100s 1721 1796
Hippocratesdescribesdiphtheria, Variolationforsmallpoxfirst Variolationintroduced EdwardJennerinoculatesJamesPhipps
epidemicjaundice,and reportedinChina intoGreatBritain withcowpox,and callstheprocedure
otherconditions vaccination [“vacca”is Latinforcow].
Ill
Table of Contents
Complications 71
LaboratoryDiagnosis 71
Medical Management 71
Wound Management 72
Epidemiology 72
SecularTrends in the United States 73
I
Tetanus Toxoid 74 I
Vaccination Schedule and Use 75
Adverse Reactions Following Vaccination 76
Contraindications and Precautions toVaccination 77
Vaccine Storage and Handling 77
Selected References 78
7
Pertussis
Bordetellapertussis 79
Pathogenesis 79
Clinical Features 79
Complications 80
Laboratory Diagnosis 81
Medical Management 82
Epidemiology 83
SecularTrends in the United States 83
Case Definition 84
PertussisVaccines 85
Vaccination Schedule and Use 87
CombinationVaccines Containing DTaP 89
OtherOTaP Issues 91
Adverse Reactions FollowingVaccination 92
Contraindications and PrecautionstoVaccination 94
Vaccine Storage and Handling 95
Selected References 95
8
Poliomyelitis
Poliovirus 97
Pathogenesis 97
Clinical Features 98
Laboratory Diagnosis 99
Epidemiology 99
I
SecularTrends in the United States 100
PoliovirusVaccines 101
I
Vaccination Schedule and Use 103
PolioVaccination ofAdults 104
Adverse Reactions FollowingVaccination 106
Contraindications and PrecautionstoVaccination 107
VaccineStorage and Handling 107
Outbreak Investigation and Control 108 i
Polio Eradication 108
Postpolio Syndrome 109
Selected References 109
Milestones in the History of Vaccination
1870 1884 1885 1887 1900
LouisPasteurcreatesthe Pasteurcreatesthefirst Pasteurfirstuses InstitutPasteur Paul Ehrlichformulates
firstliveattenuatedbacterial liveattenuatedviralvaccine rabiesvaccineinahuman established receptortheoryofimmunity!
vaccine[chickencholera] [rabies]
IV
Table of Contents
9 Haemophilus influenzaeType b (Hib)
Haemophilusinfluenzae in
Pathogenesis 112
Clinical Features 113
LaboratoryDiagnosis 113
Medical Management 114
Epidemiology 114
SecularTrends in the United States 115
Haemophilusinfluenzaetype bVaccines 117
Vaccination Schedule and Use 118
CombinationVaccines 120
Adverse Reactions FollowingVaccination 122
Contraindications and Precautions toVaccination 122
VaccineStorage and Handling 123
Surveillance and Reporting ofHib Disease 123
Selected References 123
10 Measles
MeaslesVirus 125
Pathogenesis 125
Clinical Features 126
Complications 126
LaboratoryDiagnosis 128
Epidemiology 129
SecularTrends in the United States 130
Classification ofMeasles Cases 133
MeaslesVaccine 134
Vaccination Schedule and Use 135
Adverse Reactions FollowingVaccination 139
Contraindications and Precautions toVaccination 140
VaccineStorage and Handling 143
Selected References 144
Mumps
1 1
MumpsVirus 145
Pathogenesis 145
Clinical Features 145
Complications 146
LaboratoryDiagnosis 147
Epidemiology 147
SecularTrends in the United States 148
Case Definition 149
MumpsVaccine 149
VaccinationSchedule and Use 149
Adverse Reactions FollowingVaccination 151
Contraindications and PrecautionstoVaccination 152
VaccineStorage and Handling 153
Selected References 154
Milestones in the History of Vaccination J
1901 1909 1919 1923 1926
FirstNobelPrizeinMedicine TheobaldSmithdiscoversa CalmetteandGuerincreateBCG, Firstwhole-cellpertussisvaccinetested RamonandChristianZoeller
tovonBehringfor methodforinactivating thefirstliveattenuated GastonRamondevelops developtetanustoxoid
diphtheriaantitoxin diphtheriatoxin bacterialvaccineforhumans diphtheriatoxoid
V
Table of Contents
12 Rubella
Rubella Virus 155
i
Pathogenesis 155
Clinical Features 155
Complications 156
Congenital Rubella Syndrome 156
Laboratory Diagnosis 157
Epidemiology 159
SecularTrends inthe United States 159
Classification of Rubella Cases 160
RubellaVaccine 161
Vaccination Schedule and Use 162
Rubella Immunity 164 iI
Adverse Reactions FollowingVaccination 165
Contraindications and PrecautionstoVaccination 166
RubellaVaccination ofWomen ofChildbearingAge 167
Vaccine Storage and Handling 168
Strategiesto Decrease Rubella and CRS 169
Selected References 169
13 Varicella
Varicella ZosterVirus 171
Pathogenesis 171
Clinical Features 171
Complications 173
LaboratoryDiagnosis 175
Epidemiology 176
SecularTrends inthe United States 177
VaricellaVaccine 178
Vaccination Schedule and Use 18D
Varicella Immunity 182
Adverse Reactions FollowingVaccination 183
Contraindications and Precautions toVaccination 184
Transmission ofVaricellaVaccineVirus 186 t1
VaccineStorage and Handling 186
Varicella ZosterImmuneGlobulin [VZIG] 188
SpecialVaricella ExposureSituations 19D
AntiviralTherapy 19D
Selected References 191
14 Hepatitis A •1I
HepatitisAVirus 193
Pathogenesis 193
Clinical Features 194
Complications 194
LaboratoryDiagnosis 194
Medical Management 195
Epidemiology 195
SecularTrends inthe UnitedStates 197
wiiic9wuii«;a in i.nt; nia»Eury ui unwincitiun
Sb-
1927 1931 1936 1948 1954
Yellowfevervirusisolated Goodpasturedescribesa ThomasFrancisandThomasMagill JohnEndersandcolleagues EndersandPeeblesisolatemeaslesvisru^^
techniqueforviralculturein developthefirst isolateLansingTypeIIpoliovirus FrancisFieldTrial 9
hens'eggs inactivatedinfluenzavaccine inhumancellline ofinactivatedpoliovaccine
vi
Table of Contents
Case Definition 198
HepatitisAVaccine 198
r Vaccination Schedule and Use 199
I Adverse Reactions FollowingVaccination 203
Contraindications and PrecautionstoVaccination 203
!
Vaccine Storage and Handling 204
I Postexposure Managementwith Immune Glohulin 204
i
j Selected References 205
IS Hepatitis B
i
Hepatitis BVirus 207
ij
Clinical Features 208
Complications 209
I
LaboratoryDiagnosis 209
j Medical Management 211
I
Epidemiology 211
j' SecularTrends inthe United States 213
Hepatitis R Prevention Strategies 215
Hepatitis RVaccine 215
{
Vaccination Schedule and Use 218
I
OtherGroupsWho May Be
Candidates forHepatitis BVaccine 223
SerologicTesting ofVaccine Recipients 224
j
Postexposure Management 226
Adverse Reactions Following Vaccination 229
Contraindications and Precautions toVaccination 230
Vaccine Storage and Handling 230
j
Selected References 230
16 Influenza
i
Influenza Virus 233
I
Pathogenesis 235
Clinical Features 235
Complications 236
Impactof Influenza 236
Laboratory Diagnosis 237
Epidemiology 238
SecularTrends in the United States 239
InfluenzaVaccine 239
Vaccination Schedule and Use 241
Adverse Reactions FollowingVaccination 246
Contraindications and Precautions toVaccination 248
Vaccine Storage and Handling 249
Year2010 Objectives and Coverage Levels 250
Strategies for Improving InfluenzaVaccine Coverage. ..250
Antiviral Agents for Influenza 251
Nosocomial Influenza Control 252
Influenza Surveillance 252
Selected References 252
Milestones in the History of Vaccination
1955 1961 1963 1965 1966
Inactivatedpoliovaccine Humandiploidcellline Measlesvaccinelicensed Bifurcatedneedlefor WorldHealthAssemblycallsfor
licensed developed Trivalentoralpoliovaccinelicensed smallpoxvaccinelicensed globalsmallpoxeradication
Table of Contents
17 Pneumococcal Disease
Streptococcuspneumoniae 255
Clinical Features 256
Laboratory Diagnosis 258
Medical Management 258
Epidemiology 259
SecularTrends in the United States 259
Pneumococcal Vaccines 260
Vaccination Schedule and Use 262
Adverse Reactions Following Vaccination 265
Contraindications and Precautions toVaccination 266
Vaccine Storage and Handling 266
Goals and Coverage Levels 267
Selected References 267
18 Meningococcal Disease
Neisseriameningitidis 269
Pathogenesis 270
Clinical Features 270
Laboratory Diagnosis 271
Medical Management 272
4
Epidemiology 272
SecularTrends in the United States 273
Meningococcal Vaccines 274
Vaccination Schedule and Use 275
Adverse Reactions Following Vaccination 277
Contraindications and Precautions toVaccination 278
Vaccine Storage and Handling 278
Surveillance and Reporting of Meningococcal Disease. . 278
Antimicrobial Chemoprophylaxis 278
Selected References 279
19 Smallpox
Variola and OtherOrthopoxviruses 281
Pathogenesis 282
Clinical Features 282
Complications 286
Differential Diagnosis 286
Laboratoryand Pathology Diagnosis 289
Medical Management 291 I
Epidemiology 292 f
)
I
SecularTrends 293
Smallpox Eradication 293
Case Definition 294
I
Smallpox [Vaccinia]Vaccine 295
Vaccination Schedule and Use 298
Adverse Reactions FollowingVaccination 299
Contraindications and Precautions toVaccination 302
Milestones in the History of Vaccination
1967 1969 1971 1977 1979
MauriceHillemandevelops StanleyPlotkindevelops RA23/7 MMRvaccinelicensed Lastindigenouscaseofsmallpox Lastwild poliovirus
Jeryl Lynnstrainofmumpsvirus strainofrubellavirus [Somalia] transmissionintheU.S.
viii
