Vaccination Develops Immunity Against Many Diseases

In 1790, Edward Jenner was the original developer of vaccines. Jenner inoculated an eight-year-old boy, James Phipps, with deoxyribonucleic acid (DNA) from a cowpox lesion. Jenner exposed Phipps with smallpox DNA six weeks later and Phipps did not acquire the disease. In a non-immune, naïve individual, the exposure would cause the smallpox disease. This demonstrated the vaccine concept of providing an individual with exposure to an infectious agent. In 1885, Louis Pasteur developed the rabies vaccine. Pasteur is known for referring to vaccines as suspension of live or inactivated antigens to induce immunity.

1. Vaccine development has grown exponentially. When serious disease outbreak occurs, research is conducted to aim to create vaccines to decrease transmission and lessen the severity. According to the Centers for Disease Control and Prevention (CDC) in United States, it is recommended that fifteen diseases have vaccines to provide direct protection. The fifteen diseases may have recommendations to have one or multiple doses of a vaccine to develop an effective immune response.

2. The physiology of how vaccines work is an essential concept to understand. Vaccines activate both innate and adaptive immune responses. Innate immunity is the first line defense against infection. It is present at birth and provides immediate protection. Such defenses include physical barriers, cellular defenses, physiological barriers and interferons. The effector cells of innate immunity are neutrophils, macrophages, dendritic cells and natural killer cells. Adaptive immunity is an acquired, specific and protective response of lymphocytes that occurs from the memory of a previous encounter. Lymphocytes multiple and differentiate upon initial exposure.
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   This allows lymphocytes to have the memory capacity to target a specific antigen and provide an adequate response. Lymphocytes are capable of distinguishing millions of antigen fragments. They can differentiate between self and foreign antigens.

3. Adaptive immunity has the capability to maintain long-term memory. The memory component provides the foundation for vaccines. Vaccines create an adaptive immune response to provide highly specific antibodies to a pathogen. This produces memory against a potential future exposure to enhance performance. Adaptive immunity responds more effectively after each successive exposure; therefore, certain vaccinations should be repeated.
4. Herd immunity is the indirect protection of an unimmunized person that prevents infectious disease transmission due to community vaccination.
5. Vaccinations decrease complications of life-threatening diseases, including morbidity and mortality. In the results section, the incidence and prevalence of specific diseases prior to and post vaccination introduction will be discussed. However, vaccinations are still a controversial topic in the social community without regards to the medical recommendations. There are many misconceptions regarding vaccinations. The most common misconceptions include the following; multiple vaccines overload the immune system, a person may still get the disease after prior vaccination, a natural infection is better than vaccine-induced immunity, eradication of disease excludes the need to vaccinate and vaccines cause a febrile-illness
6. There is a speculation that a possible etiology of autism spectrum disorder is the MMR vaccine. There is a speculation that a possible etiology of multiple sclerosis is the hepatitis B vaccine. From a public health perspective, reviews of research regarding the misconceptions and disease-associations are beneficial. The healthcare obstacle is that misconceptions are more concerning than infectious disease outbreak. Refusing to vaccinate potentially places oneself and others at risk for vaccine-preventable diseases. Non-vaccinated individuals are causing a community numerical decline, which is creating a threat to breach the herd immunity threshold. Herd immunity threshold varies depending on the specific disease. Once the threshold is reached, the risk of disease incidence increases tremendously.
7. Educating parents, patients, and the public on vaccination recommendations, effectiveness, safety, and the importance for immunity is essential for infectious disease prevention. Methods A literature review was conducted using medical journal databases, such as PubMed Health, National Library of Medicine (NCBI), Center for Disease Control and Prevention (CDC), and Google Scholar. Advanced search engines were used with keyword combinations including the following; vaccinations and misconceptions, hepatitis B vaccine and multiple sclerosis, MMR vaccine and autism, and herd immunity. A mixed method of qualitative and quantitative approach was used. For each search, studies were filtered based on full-text access, English text, date publication within the last twenty years, and the validity of the study. To obtain superior evidence-based studies, randomized double-blind placebo-controlled studies, cohort studies, meta-analyses and systematic reviews were selected when available. The gold standard for evidence based articles is double-blinded randomized controlled studies.
8. These studies were chosen when available. Most studies selected were retrospective cohort studies due to the infectious disease involvement and herd immunity safety. Specific methods of data collection include academic journals, public health journals, evidence-based meta-analysis, computer-based simulation study, and psychiatry journals. Otto and colleagues conducted a randomized control study of 662 children, born between January 1995 and December 1996. One group received their first serial vaccines at 2 months, and the other group received their first vaccine at 3 months. Mothers kept a daily journal to record symptomology. Study limitations include maternal recording bias of the symptoms. A total of 116 children were excluded from the population due to not getting vaccinated on time.
9. To access the possible link between multiple sclerosis and hepatitis B vaccine, an advanced search in PubMed was utilized with keywords including: multiple sclerosis and hepatitis B vaccine. There were 124 articles retrieved, and filtered based on publication within the last decade (2008-2018), resulting in 30 articles. A systematic review and meta-analysis article were chosen. Farez and colleagues reviewed 2804 references with 13 studies with a control group. The study reviewed publications in MEDLINE (1966-2011), EMBASE (1977-2011) and the Cochrane Central Register of Controlled Trials (CENTRAL) (1961-2011). Randomized clinical trials and non-randomized studies were used.
10. Mikaeloff and colleagues conducted a meta-analysis of cohort study and a case-control study, by a French Neuropediatric study group (KIDSEP)
11. Langer and colleagues created a case-control study using complete electronic health records through Kaiser Permanente Southern California (KPSC) members between the years of 2008 and 2011. Medical records were reviewed from a multiple sclerosis specialist. There were 5 controls per case matched on age, sex and zip code.
12. Mouchet and colleagues conducted a systematic and meta-analysis of 2804 references reviewed with 13 studies with a control group. In 1998, The Lancet published a case-study article, by Andrew Wakefield and colleagues, that raised suspicion of MMR vaccine and autism.
13. To assess the possible link between MMR and autism, an advanced search in PubMed within the last 10 years was utilized with key words including: MMR vaccine and autism. The results showed 73 articles.
14. Fombonne and colleagues conducted a cohort study in United Kingdom consisting of 96 children born between 1992 and 1995. All patients were assessed with the standardized Autism Diagnostic Interview (ADI). Blood work exclusion criteria included abnormalities in fragile X karyotype, complete blood count, urea and electrolytes, creatinine, liver function test, serum calcium, thyroid stimulating hormone, thyroxine, creatinine kinase, plasma and urine amino acid chromatogram, urine organic acid, electroencephalogram, and a computed tomography scan or magnetic reasoning imaging when clinically indicated.
15. To find research articles on herd immunity, an advanced search included “herd immunity” and “vaccination” and 1,270 articles were found. Articles were filtered due to date of publication within the last 15 years. An agent-based simulation study was chosen. It specifically was intended to show the likelihood and severity of an uncontrolled measles outbreak with the introduction of one measles case. The agent-based simulation model involves the model of measles transmission using the Framework for Reconstructing Epidemiological Dynamics (FRED).
16. Literature restrictions of misconceptions include limited data regarding religious stance on exemption to vaccinate. It was difficult to obtain research information regarding religious beliefs to not vaccinate. Results Common Misconceptions Overview Overloading the immune system with multiple vaccines A common misconception is that multiple vaccinations overload a child’s immune system. In 1980, infants received vaccines against only four diseases: diphtheria, tetanus, pertussis, and polio. Today, the CDC vaccination schedule recommends 15 doses of five vaccines to protect against seven diseases by 6 months of age and up to 20 doses of seven vaccines to protect against 11 diseases by 2 years of age. The increasing number of vaccines has led to parental concerns about overloading the immune system.2 This belief may be attributable to the increase of vaccination recommendations to the schedule at one visit. The recommendations are based on an age-based immune system’s capability when the child will receive the most protection benefit.. The CDC vaccination schedule is tailored to the developmental timeline of an infant immune system. For example, MMR and varicella are live attenuated vaccines and are given at 12-15 months of age since that is when their immune system can handle it. Combination vaccinations, such as the dTaP vaccine, are efficient by incorporating four antigens into a single injection to make it less traumatic for the child.
17.  There is no evidence that numerous vaccines overload or weaken the infant immune system. Infants have an enormous capacity to respond safely and effectively to multiple vaccines.
18. A randomized control study conducted by Otto and colleagues, divided 496 children into two groups. One group (n=201) received diphtheria, pertussis, tetanus, Haemophilus influenzae type B, and poliomyelitis vaccines at 2-months of age. The other group received the same vaccines at 3-months of age (n=295). There was a statistical significance (p24 weeks of age, there was a significantly lower risk of temperature >38 degrees Celsius via rectal route in the acetaminophen group (13% vs. 25%; p=0.03).