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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…

Yellow Fever Vaccine

Yellow fever virus (YFV) is the prototype member of the Flaviviridae (Latin flavus , “yellow,” after the jaundice seen with the disease) family of viruses. The virus causes a viral hemorrhagic fever, a systemic illness characterized by high viremia, hepatic, renal, and myocardial injury; hemorrhage; and high lethality. A highly effective vaccine (17D), developed in 1936, is widely used to protect travelers to and residents of…

Varicella Vaccines

Maria. A. Nagel, MD Professor Neurology University of Colorado School of Medicine, Aurora Colorado United States Professor Ophthalmology University of Colorado School of Medicine, Aurora Colorado United States INTRODUCTION History of Disease Varicella zoster virus (VZV) is an exclusively human alphaherpesvirus that produces varicella (chickenpox) on primary infection, establishes latency in ganglionic neurons, then reactivates later in life to produce herpes zoster (HZ; shingles). Historically, varicella…

Typhoid Fever Vaccines

INTRODUCTION History of Disease Typhoid fever is an acute generalized infection of the mononuclear phagocyte system, intestinal lymphoid tissue, and gallbladder caused by Salmonella enterica serovar Typhi. A broad spectrum of clinical illness can ensue, with more severe forms being characterized by persisting high fever, abdominal discomfort, malaise, and headache. In the preantibiotic era, the disease ran its course over several weeks and was accompanied by…

Tuberculosis Vaccines

Bacille Calmette-Guérin (BCG) is currently the only licensed vaccine available against tuberculosis (TB). The vaccine has been given to over 4 billion people; yet, TB still poses a major public health threat globally. Approximately 25% of the world’s population has evidence of current or prior infection with Mycobacterium tuberculosis , with an estimated 10 million new cases of TB disease and 1.4 million deaths in 2019…

Tickborne Encephalitis Vaccines

Tickborne encephalitis virus (TBEV) is a member of the genus Flavivirus , family Flaviviridae, which comprises approximately 70 viruses that cause many serious diseases, including dengue, Japanese encephalitis, West Nile virus neuroinvasive disease, and yellow fever. TBEV is one of the major human pathogenic flaviviruses, with the disease being caused by three subtypes termed European or Central European (TBEV-Eu), Far Eastern or Russian Spring Summer encephalitis…

Tetanus Toxoid

INTRODUCTION History of Disease Tetanus is unique among vaccine-preventable diseases in that it is not communicable. Clostridium tetani , the causative agent of tetanus, is widespread in the environment; many animals, in addition to humans, can harbor and excrete the organism and its spores. When spores of C. tetani are introduced into the anaerobic conditions found in devitalized tissue or punctures, they germinate to vegetative bacilli…

Streptococcus Group B Vaccines

HISTORY OF DISEASE In 1887, Nocard and Mollereau were first to distinguish streptococci that caused epidemics of mastitis in dairy cattle as Streptococcus agalactiae (“without milk”). Decades later, in 1933, Lancefield classified β-hemolytic streptococci into groups based on cell wall carbohydrate antigens and later demonstrated that S. agalactiae from bovine and human sources, although phenotypically and biochemically distinct, belonged to group B. A scant 5 years…

Streptococcus Group A Vaccines

INTRODUCTION Streptococcus pyogenes (group A β-hemolytic Streptococcus [GAS]) is a Gram-positive bacterial pathogen that has presented an ongoing challenge to scientists and clinicians throughout modern medical history. Descriptions of epidemics of fulminant illnesses in previously healthy individuals date back to the 1600s. , Until the early 1900s, scarlet fever and acute rheumatic fever (ARF) were major causes of child death in the United States and Europe.…

Staphylococcus aureus Vaccines

# Attempts to reduce Staphylococcus aureus disease through vaccination date back to at least 1902, but this pathogen may be unrivaled among others in the sheer scale and scope of unsuccessful vaccine attempts. These challenges have inevitably led many to wonder whether a vaccine against Staphylococcus aureus is an attainable goal. This chapter will discuss the clinical importance of this major bacterial pathogen, the urgent need…