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Vaccine Hesitancy and Behavioral Factors Associated With Vaccine Uptake

While vaccine development, manufacturing, and delivery remain important components of a robust immunization system, vaccines only provide individual and societal benefits if eligible individuals can access and accept them. Therefore, it is important to understand and focus on the behavioral factors associated with vaccine uptake, in addition to addressing practical barriers. According to WHO Strategic Advisory Group of Experts working group on vaccine hesitancy, “Vaccine hesitancy…

Vaccine Safety

During the past 100 years, pharmaceutical companies have made vaccines against diphtheria, tetanus, pertussis, polio, measles, mumps, rubella, varicella, hepatitis A, hepatitis B, Haemophilus influenzae type B (Hib), pneumococcus, meningococcus, rotavirus, and human papillomavirus, among others ( Table 83.1 ) and ( Table 83.2 ). As a consequence, the number of children in the United States killed by pertussis decreased from 8000 each year in the…

Regulation of Vaccines in Low- and Middle-Income Countries

The World Health Organization (WHO) supports member states in strengthening their regulatory systems by setting norms and standards, promoting smart regulation, identifying strengths and gaps, providing specialized technical assistance, and capacity-building opportunities and advising on quality assurance of medicines for national and international markets. Regulatory alignment and collaboration are some of the key components that will help facilitate equitable access to safe and effective vaccines that…

Regulation of Vaccines in Europe

## Vaccines are complex biological medicinal products developed using increasingly varied and/or novel sophisticated technologies. They can contain live or attenuated infectious agents, recombinant pathogen proteins, and other types of components, such as adjuvants. Because of the major individual and population benefits, immunization with certain vaccines is mandatory in many European countries, and any safety hazard could affect a large number of persons. In this context,…

Regulation and Testing of Vaccines in the US

## Vaccines are one of the most significant achievements of science and public health. As a result of successful vaccination programs and campaigns, many vaccine-preventable diseases are now uncommon in the United States. Vaccines for the prevention of infectious diseases are regulated by the U.S. Food and Drug Administration (FDA), and the legal framework for regulation is derived from Section 351 of the Public Health Service…

Economic Analyses of Vaccine Policies

At the time of writing this chapter, COVID-19 is the pandemic of the century, globally affecting macro and micro-economies. Recognition of the economic disruption from outbreaks on the regional level (Ebola viral disease) and global level (COVID-19) has led to justifying novel financial mechanisms to address the macroeconomic impact of uncontrolled communicable diseases. New national and international mechanisms of global collaborations have been established to mitigate…

Community Protection

Vaccines are given to people to protect them against disease. They are also given to reduce transmission of infection, thereby preventing disease even in nonvaccinated persons, and thus protecting communities. The extension of perspective from individuals to their communities is the business of public health. The use of an increasing number of different vaccines, in all populations of the world, represents a major, evolving, and highly…

Immunization in Low- and Middle-Income Countries

Since the late 1970s, childhood immunization has been one of the most effective and cost-effective public health preventive measures for all countries. Amongst low- and middle-income countries (LMICs) (a categorization based on income used by World Bank instead of “developing countries”), immunization prevented an estimated 37 million deaths from 2000 through 2019. The history of immunization in low-income countries can be traced back to the birth…

Immunization and Vaccine-Preventable Diseases in the Asia-Pacific Region

In the 20th century, the development, licensing, and implementation of vaccines as part of large, systematic immunization programs, aimed to address health inequities that existed globally. Yet access to vaccines that prevent life-threatening infectious diseases remains unequal among infants, children, and adults worldwide. This is a problem globally that governments and partner agencies are working hard to address. In recent years, the World Health Organization (WHO)…

Immunization in Europe

Europe is composed of a diverse group of countries and the extent of diversity depends on the definition of the boundaries of Europe. The European Union (EU) comprises 27 Member States of Austria, Belgium, Bulgaria, Croatia, Cyprus, Czechia, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Ireland, Italy, Latvia, Lithuania, Luxembourg, Malta, the Netherlands, Poland, Portugal, Romania, Slovakia, Slovenia, Spain, and Sweden. The EU together with the…

Immunization in the United States

A strong immunization program is critical to ensure vaccines are given at the recommended ages to all children, adolescents, and adults in the United States. The immunization system in the United States is a public- and private-sector partnership, including federal agencies, state and local health departments, healthcare providers, and vaccine manufacturers, that works toward common immunization goals and objectives. The U.S. immunization system has a formal…

Vaccination of Pregnant Women

WHY MATERNAL VACCINATION? The term “maternal immunization” has been used to describe vaccination of women prior to, during, and after pregnancy. In this chapter, we use the term maternal immunization to refer to vaccination of women during pregnancy and/or in the immediate postpartum period. Maternal vaccination can be used for the benefit of the mother, for the benefit of the infant, or for the benefit of…

Vaccines for Healthcare Personnel

Healthcare personnel (HCP) are at risk of exposure to infectious agents in the workplace setting. The risks and methods of preventing occupational acquisition of infection by HCP have been reviewed. Minimizing the risk of disease acquisition is based on correct and consistent adherence to five key recommended interventions: (a) adherence to Standard Precautions when providing patient care, especially the performance of appropriate hand hygiene before and…

Vaccines for International Travel

INTERNATIONAL TRAVEL People travel for many reasons, including tourism, business, educational experiences, or to flee from war, famine, or other intolerable situations. In 2019, international tourist arrivals reached 1.4 billion and were predicted by The World Tourism Organization to exceed 1.8 billion by 2030 before the COVID pandemic halted a 9-year trend of sustained growth in tourism. International migrants, a category of traveler not captured in…

Vaccination of Immunocompromised Hosts

INTRODUCTION Over the past decades, the number of immunocompromised patients has increased rapidly. These patients are vulnerable to several infections against which vaccines exist. New vaccines have been developed such as the subunit zoster vaccine. The two recent pandemics; the 2009 H1N1 influenza A pandemic and the ongoing COVID-19 pandemic have also shown the importance of rapid design of vaccination strategies in the immunocompromised patient populations.…

Technologies to Improve Immunization

NEW TECHNOLOGIES NEEDED TO REDUCE IMMUNIZATION LOGISTICS HURDLES Immunization can be described as the process of delivering carefully packaged antigen to the appropriate destination in a vaccine recipient to produce a desired immune response. In this sense, immunization programs are package delivery systems: they manage the flow of antigens, which are formulated in vaccines and packaged in different presentations, between the point of origin at the…

Genetic-Based Vaccine Vectors

INTRODUCTION The adoption and establishment of new vaccine platforms usually takes decades. The concept of delivering a recombinant virus whose payload is not the virus itself but rather the genetic instructions encoded within the viral genome originated in the 1980s with recombinant poxviral vaccine vectors. The approach mimicked live-attenuated vaccines (LAV), but provided a vision to replace the empiric and difficult strategy of viral attenuation through…

Technologies for Making New Vaccines

INTRODUCTION The technological approaches for making new vaccines have been growing rapidly in recent decades owing to significant advances in a broad range of interrelated fields, including next-generation sequencing and antibody repertoire analysis, molecular and structural biology, genetics (reverse vaccinology, synthetic biology), protein and polysaccharide chemistry, immunology, virology, bacteriology, fermentation, and macromolecular purification and formulation. An unprecedented leap forward was catalyzed by the COVID-19 pandemic, for…

Zoster Vaccines

Myron J. Levin, BA, MD Professor Pediatrics and Medicine University of Colorado Denver and Health Sciences Center, Aurora Colorado United States INTRODUCTION Herpes zoster (HZ), also called shingles, is a dermatomal vesicular disease. A dermatome is the area of skin innervated by one sensory nerve, and thus has bilateral symmetry and does not cross the midline. Fig. 66.1 depicts the right C4–C5 cervical nerve dermatome. The…

Zika Virus Vaccines

INTRODUCTION In 2016, the World Health Organization (WHO) declared Zika Virus (ZIKV) a Public Health Emergency of International Concern (PHEIC). This was in response to the association of ZIKV infection with an increased frequency of infants born with microcephaly and cases of Guillain-Barre syndrome (GBS) in adults. In response to this declaration, the development of vaccines for ZIKV proceeded with unprecedented speed. Multiple vaccine candidates utilizing…