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Upon completion of the chapter, the reader will be able to:

  1. Define vaccination and immunization.

  2. Classify each of the routine vaccines as an inactivated, polysaccharide, conjugate, toxoid, or subunit vaccine.

  3. Describe the effect of each routine vaccine on preventing infection.

  4. Recommend an immunization schedule for a child, including immunocompromised children.

  5. Recommend an immunization schedule for an adult based on comorbid conditions and lifestyle issues.

  6. Evaluate an adverse reaction and its probable association with a vaccine.




  • Image not available. Vaccines provide active immunity against viral and bacterial pathogens.

  • Image not available. Polysaccharide vaccines are poorly immunogenic in children younger than 2 years of age.

  • Image not available. Combination vaccines decrease the number of injections and increase the likelihood of completing the immunization schedule.

  • Image not available. Healthcare professionals should report vaccine-adverse events.

  • Image not available. Live virus vaccines should not be given to an immunocompromised host.

  • Image not available. Vaccines are cost effective in preventing disease.


The development and widespread use of vaccines is one of the greatest public health achievements of the 20th century. Other than safe drinking water, no other modality has had a greater impact on reducing mortality from infectious diseases. The first accounts of deliberate inoculation to prevent disease date back as far as the 10th century. However it wasn't until 1798 that Edward Jenner published his work on inoculation of natural cowpox as a means to prevent infection with smallpox. This was the first scientific attempt to prevent infection by inoculation. Since 1900, vaccines have been developed against more than 20 diseases, with half of these recommended for routine use. The widespread use of vaccines has resulted in the eradication of smallpox worldwide and wild-type poliovirus from the Western hemisphere. There have also been dramatic declines in the incidence of diphtheria, pertussis, tetanus, measles, mumps, rubella, and Haemophilus influenzae type b.


Image not available. Vaccines have traditionally been preparations of killed or attenuated microorganisms that provide active immunity against a variety of viral and bacterial infections. Most vaccines are designed to prevent acute infections that can be rapidly controlled and cleared by the immune system. Successful immunization involves activation of antigen-presenting cells with processing of the antigen by lysosomal or cytoplasmic pathways. T and B lymphocytes will be activated to replicate and differentiate to form large pools of memory cells for protection against subsequent exposure to the antigen.1


Vaccines against viral infections may be attenuated live viruses or inactivated viral particles. Attenuation may be accomplished by several methods to decrease the viruses' virulence while retaining their immunogenicity. Bacterial vaccines utilize antigenic particles of the outer membrane to elicit an immune response. Image not available. Outer membrane polysaccharides are poorly immunogenic in children younger than 2 years of age unless conjugated with a carrier protein. Also, bacterial toxins may undergo chemical treatment to render them nontoxic to form toxoids against infectious agents.


Often the terms vaccination and immunization are used interchangeably even though they are ...

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