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{{Vaccination}}
A '''vaccine''' is a biological [[Dosage form|preparation]] that provides active [[acquired immunity]] to a particular [[infectious disease|infectious]] or [[cancer|malignant]] disease.<ref name="iac39">{{cite journal |title=Expanded Practice Standards |journal=Iowa Administrative Code |date=2019 |url=https://www.legis.iowa.gov/docs/iac/rule/02-27-2019.657.39.11.pdf |access-date=2023-01-16 |archive-date=2023-01-19 |archive-url=https://web.archive.org/web/20230119023633/https://www.legis.iowa.gov/docs/iac/rule/02-27-2019.657.39.11.pdf |url-status=live }}</ref><ref>{{Cite web|title=Immunization: The Basics|url=https://www.cdc.gov/vaccines/vac-gen/imz-basics.htm|website=Centers for Disease Control and Prevention|date=22 November 2022
Vaccines can be [[prophylaxis|prophylactic]] (to prevent or
The administration of vaccines is called [[vaccination]]. Vaccination is the most effective method of preventing infectious diseases;<ref>*United States Centers for Disease Control and Prevention (2011). [https://www.cdc.gov/oid/docs/ID-Framework.pdf ''A CDC framework for preventing infectious diseases.''] {{webarchive|url=https://web.archive.org/web/20170829133723/https://www.cdc.gov/oid/docs/ID-Framework.pdf |date=2017-08-29 }} Accessed 11 September 2012. "Vaccines are our most effective and cost-saving tools for disease prevention, preventing untold suffering and saving tens of thousands of lives and billions of dollars in healthcare costs each year."
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Limitations to their effectiveness, nevertheless, exist.<ref name="pmid19393917">{{cite journal | vauthors = Grammatikos AP, Mantadakis E, Falagas ME | title = Meta-analyses on pediatric infections and vaccines | journal = Infectious Disease Clinics of North America | volume = 23 | issue = 2 | pages = 431–457 | date = June 2009 | pmid = 19393917 | doi = 10.1016/j.idc.2009.01.008 }}</ref> Sometimes, protection fails for vaccine-related reasons such as failures in vaccine attenuation, vaccination regimens or administration.<ref name="wied"/>
Failure may also occur for host-related reasons if the host's immune system does not respond adequately or at all. Host-related lack of response occurs in an estimated 2-10% of individuals, due to factors including genetics, immune status, age, health and nutritional status.<ref name="wied"/> One type of [[primary immunodeficiency]] disorder resulting in genetic failure is [[X-linked agammaglobulinemia]], in which the absence of an enzyme essential for [[B cell]] development prevents the host's immune system from generating [[Antibody|antibodies]] to a [[pathogen]].<ref>{{cite book |last1=Justiz Vaillant |first1=AA |last2=Ramphul |first2=K |title=Antibody Deficiency Disorder |location=Treasure Island, FL |publisher=StatPearls Publishing |date=January 2022 |pmid=29939682 |url=https://www.ncbi.nlm.nih.gov/books/NBK507905/ |access-date=18 April 2022}}</ref><ref name="Reda">{{cite journal |last1=Reda |first1=Shereen M. |last2=Cant |first2=Andrew J. |title=The importance of vaccination and immunoglobulin treatment for patients with primary immunodeficiency diseases (PIDs) – World PI Week April 22–29, 2015: FORUM |journal=European Journal of Immunology |date=May 2015 |volume=45 |issue=5 |pages=1285–1286 |doi=10.1002/eji.201570054 |pmid=25952627 |s2cid=1922332
Host–pathogen interactions and responses to infection are dynamic processes involving multiple pathways in the immune system.<ref name="Jo">{{cite journal |last1=Jo |first1=Eun-Kyeong |title=Interplay between host and pathogen: immune defense and beyond |journal=Experimental & Molecular Medicine |date=December 2019 |volume=51 |issue=12 |pages=1–3 |doi=10.1038/s12276-019-0281-8 |pmid=31827066 |pmc=6906370 |language=en |issn=2092-6413}}</ref><ref name="Janeway">{{cite journal |last1=Janeway |first1=Charles A Jr. |last2=Travers |first2=Paul |last3=Walport |first3=Mark |last4=Shlomchik |first4=Mark J. |title=The Humoral Immune Response |journal=Immunobiology: The Immune System in Health and Disease|edition=5th |date=2001 |url=https://www.ncbi.nlm.nih.gov/books/NBK10752/ |access-date=18 April 2022 |language=en |archive-date=2 January 2021 |archive-url=https://web.archive.org/web/20210102142711/https://www.ncbi.nlm.nih.gov/books/NBK10752/ |url-status=live }}</ref> A host does not develop antibodies instantaneously: while the body's [[innate immunity]] may be activated in as little as twelve hours, [[adaptive immunity]] can take 1–2 weeks to fully develop. During that time, the host can still become infected.<ref>{{cite book |last1=Grubbs |first1=Hailey |last2=Kahwaji |first2=Chadi I. |title=Physiology, Active Immunity |location=Treasure Island, FL |publisher=StatPearls Publishing |date=January 2022 |pmid=29939682 |url=https://www.ncbi.nlm.nih.gov/books/NBK513280/ |access-date=18 April 2022 |archive-date=12 November 2021 |archive-url=https://web.archive.org/web/20211112145718/https://www.ncbi.nlm.nih.gov/books/NBK513280/ |url-status=live }}</ref>
Once antibodies are produced, they may promote immunity in any of several ways, depending on the class of antibodies involved. Their success in clearing or inactivating a pathogen will depend on the amount of antibodies produced and on the extent to which those antibodies are effective at countering the strain of the pathogen involved, since different strains may be differently susceptible to a given immune reaction.<ref name="Janeway"/>
In some cases vaccines may result in partial immune protection (in which immunity is less than 100% effective but still reduces risk of infection) or in temporary immune protection (in which immunity wanes over time) rather than full or permanent immunity. They can still raise the reinfection threshold for the population as a whole and make a substantial impact.<ref name="Gomes">{{cite journal |last1=Gomes |first1=M. Gabriela M. |last2=White |first2=Lisa J. |last3=Medley |first3=Graham F. |title=Infection, reinfection, and vaccination under suboptimal immune protection: epidemiological perspectives |journal=Journal of Theoretical Biology |date=21 June 2004 |volume=228 |issue=4 |pages=539–549 |doi=10.1016/j.jtbi.2004.02.015 |pmid=15178201 |bibcode=2004JThBi.228..539G |hdl=10400.7/53 |
Those who are older often display less of a response than those who are younger, a pattern known as [[Immunosenescence]].<ref name="Frasca">{{cite journal |last1=Frasca |first1=Daniela |last2=Diaz |first2=Alain |last3=Romero |first3=Maria |last4=Garcia |first4=Denisse |last5=Blomberg |first5=Bonnie B. |title=B Cell Immunosenescence |journal=Annual Review of Cell and Developmental Biology |date=6 October 2020 |volume=36 |issue=1 |pages=551–574 |doi=10.1146/annurev-cellbio-011620-034148 |pmid=33021823 |pmc=8060858
[[Immunologic adjuvant|Adjuvants]] commonly are used to boost immune response, particularly for older people whose immune response to a simple vaccine may have weakened.<ref name="neighmond2010">{{cite news | url=https://www.npr.org/templates/story/story.php?storyId=123406640 | title=Adapting Vaccines For Our Aging Immune Systems | date=2010-02-07 | work=Morning Edition | publisher=NPR | access-date=2014-01-09 | last=Neighmond | first=Patti | name-list-style = vanc | url-status=live | archive-url=https://web.archive.org/web/20131216191614/http://www.npr.org/templates/story/story.php?storyId=123406640 | archive-date=2013-12-16
The [[vaccine efficacy|efficacy]] or performance of the vaccine is dependent on several factors:
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# maintenance of high immunization rates, even when a disease has become rare
In 1958, there were 763,094 cases of measles in the United States; 552 deaths resulted.<ref name="pmid15106120">{{cite journal | vauthors = Orenstein WA, Papania MJ, Wharton ME | title = Measles elimination in the United States | journal = The Journal of Infectious Diseases | volume = 189 | issue = Suppl 1 | pages = S1–3 | date = May 2004 | pmid = 15106120 | doi = 10.1086/377693 | doi-access = free }}</ref><ref name="pmid18463608">{{cite journal | vauthors = <!--staff--> | title = Measles – United States, January 1 – April 25, 2008 | journal = MMWR. Morbidity and Mortality Weekly Report | volume = 57 | issue = 18 | pages = 494–498 | date = May 2008 | pmid = 18463608 | url = https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5718a5.htm | archive-url = https://web.archive.org/web/20171011235122/https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5718a5.htm | url-status=live | archive-date = October 11, 2017
Vaccines led to the eradication of [[smallpox]], one of the most contagious and deadly diseases in humans.<ref>{{cite web|url=https://www.who.int/csr/disease/smallpox/en/|title=WHO {{!}} Smallpox|website=WHO|publisher=[[World Health Organization]]|access-date=2019-04-16|archive-date=2007-09-22|archive-url=https://web.archive.org/web/20070922184729/http://www.who.int/csr/disease/smallpox/en/|url-status=live}}</ref> Other diseases such as rubella, [[poliomyelitis|polio]], measles, mumps, [[chickenpox]], and [[typhoid fever|typhoid]] are nowhere near as common as they were a hundred years ago thanks to widespread vaccination programs. As long as the vast majority of people are vaccinated, it is much more difficult for an outbreak of disease to occur, let alone spread. This effect is called [[herd immunity]]. Polio, which is transmitted only among humans, is targeted by an extensive [[Poliomyelitis eradication|eradication campaign]] that has seen endemic polio restricted to only parts of three countries (Afghanistan, Nigeria, and Pakistan).<ref name="eradication1">{{cite web| url =http://www.searo.who.int/mediacentre/releases/2014/pr1569/en/| title =WHO South-East Asia Region certified polio-free| publisher =WHO| date =27 March 2014| access-date =November 3, 2014
Vaccines also help prevent the development of antibiotic resistance. For example, by greatly reducing the incidence of pneumonia caused by ''[[Streptococcus pneumoniae]]'', vaccine programs have greatly reduced the prevalence of infections resistant to penicillin or other first-line antibiotics.<ref>{{cite web|url=https://www.nature.com/articles/d41586-017-01711-6|archive-url=https://web.archive.org/web/20170722121157/http://www.nature.com/articles/d41586-017-01711-6
The measles vaccine is estimated to prevent a million deaths every year.<ref name="sullivan2005">{{cite news | last=Sullivan | first=Patricia | name-list-style = vanc | date=2005-04-13 | url=https://www.washingtonpost.com/wp-dyn/articles/A48244-2005Apr12.html | title=Maurice R. Hilleman dies; created vaccines | work=Wash. Post | access-date=2014-01-09 | url-status=live | archive-url=https://web.archive.org/web/20121020102622/http://www.washingtonpost.com/wp-dyn/articles/A48244-2005Apr12.html | archive-date=2012-10-20
===Adverse effects===
{{main|Adverse vaccine event}}
Vaccinations given to children, adolescents, or adults are generally safe.<ref>{{Cite journal|last1=Dudley|first1=Matthew Z|last2=Halsey|first2=Neal A|last3=Omer|first3=Saad B|last4=Orenstein|first4=Walter A|last5=O'Leary|first5=Sean T|last6=Limaye|first6=Rupali J|last7=Salmon|first7=Daniel A|date=May 2020|title=The state of vaccine safety science: systematic reviews of the evidence
Host-("vaccinee")-related determinants that render a person susceptible to infection, such as [[genetics]], health status (underlying disease, nutrition, pregnancy, [[Hypersensitivity|sensitivities]] or [[Allergy|allergies]]), [[Immunocompetence|immune competence]], age, and [[Economic impact of the COVID-19 pandemic|economic impact]] or [[Synthetic psychological environment|cultural environment]] can be primary or secondary factors affecting the severity of infection and response to a vaccine.<ref name="wied">{{Cite journal|last1=Wiedermann|first1=Ursula|last2=Garner-Spitzer|first2=Erika|last3=Wagner|first3=Angelika|year=2016|title=Primary vaccine failure to routine vaccines: Why and what to do?|journal=Human Vaccines & Immunotherapeutics|volume=12|issue=1|pages=239–243|doi=10.1080/21645515.2015.1093263|issn=2164-554X|pmc=4962729|pmid=26836329|name-list-style=vanc}}</ref> Elderly (above age 60), [[Type I hypersensitivity|allergen-hypersensitive]], and [[Obesity|obese]] people have susceptibility to compromised [[immunogenicity]], which prevents or inhibits vaccine effectiveness, possibly requiring separate vaccine technologies for these specific populations or repetitive [[Booster dose|booster vaccinations]] to limit [[Transmission (medicine)|virus transmission]].<ref name="wied" />
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Severe side effects are extremely rare.<ref name=Mag2014/> [[Varicella vaccine]] is rarely associated with complications in [[immunodeficient]] individuals, and [[rotavirus vaccine]]s are moderately associated with [[intussusception (medical disorder)|intussusception]].<ref name=Mag2014/>
At least 19 countries have no-fault compensation programs to provide compensation for those with severe adverse effects of vaccination.<ref>{{cite journal |last1=Looker |first1=Clare|last2= Heath|first2= Kelly | name-list-style = vanc |title=No-fault compensation following adverse events attributed to vaccination: a review of international programmes |journal=Bulletin of the World Health Organization|year=2011 |volume=89|issue=5|pages=371–378|url=https://www.who.int/bulletin/volumes/89/5/10-081901/en/ |archive-url=https://web.archive.org/web/20130811171023/http://www.who.int/bulletin/volumes/89/5/10-081901/en/
==Types==
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{{main|Toxoid}}
[[Toxoid]] vaccines are made from inactivated toxic compounds that cause illness rather than the micro-organism.<ref
===Subunit===
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{{main|Conjugate vaccine}}
Certain bacteria have a
===Outer membrane vesicle===
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=== Genetic vaccine ===
{{main|Genetic vaccine}}
Genetic vaccines are based on the principle of uptake of a nucleic acid into cells, whereupon a protein is produced according to the nucleic acid template. This protein is usually the immunodominant antigen of the pathogen or a surface protein that enables the formation of neutralizing antibodies. The subgroup of genetic vaccines encompass viral vector vaccines, RNA vaccines and DNA vaccines.{{citation needed|date=January 2024}}
==== Viral vector ====
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{{main|DNA vaccine}}
A DNA vaccine uses a [[DNA]] [[plasmid]] (pDNA)) that encodes for an antigenic protein originating from the pathogen upon which the vaccine will be targeted. pDNA is inexpensive, stable, and relatively safe, making it an excellent option for vaccine delivery.<ref>{{Cite web |last=Cuffari |first=Benedette |date=17 March 2021 |title=What is a DNA Vaccine? |url=https://www.news-medical.net/health/What-is-a-DNA-based-vaccine.aspx |access-date=2024-01-14 |website=News-Medical.net |language=en}}</ref>
This approach offers a number of potential advantages over traditional approaches, including the stimulation of both B- and T-cell responses, improved vaccine stability, the absence of any infectious agent and the relative ease of large-scale manufacture.<ref>{{Cite web |title=DNA Vaccines |url=https://www.who.int/teams/health-product-policy-and-standards/standards-and-specifications/vaccines-quality/dna |access-date=2024-01-14 |website=World Health Organization |language=en}}</ref>
===Experimental===
Many innovative vaccines are also in development and use.
* Dendritic cell vaccines combine [[dendritic cell]]s with antigens to present the antigens to the body's white blood cells, thus stimulating an immune reaction. These vaccines have shown some positive preliminary results for treating brain tumors<ref>{{cite journal | vauthors = Kim W, Liau LM | title = Dendritic cell vaccines for brain tumors | journal = Neurosurgery Clinics of North America | volume = 21 | issue = 1 | pages = 139–157 | date = January 2010 | pmid = 19944973 | pmc = 2810429 | doi = 10.1016/j.nec.2009.09.005 }}</ref> and are also tested in malignant melanoma.<ref name="pmid24872109">{{cite journal | vauthors = Anguille S, Smits EL, Lion E, van Tendeloo VF, Berneman ZN | title = Clinical use of dendritic cells for cancer therapy | journal = The Lancet. Oncology | volume = 15 | issue = 7 | pages = e257–267 | date = June 2014 | pmid = 24872109 | doi = 10.1016/S1470-2045(13)70585-0 }}</ref>
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* [[Vector (epidemiology)|Bacterial vector]] – Similar in principle to [[viral vector vaccine]]s, but using bacteria instead.<ref name="vaccinology-guide"/>
* [[Antigen-presenting cell vaccine|Antigen-presenting cell]]<ref name="vaccinology-guide"/>
* Technologies which may allow rapid vaccine deployment in response to a [[Emerging infectious disease|novel pathogen]] include the use of [[Virus-like particle|virus-like particles]]<ref>{{Cite web |last1=Chang |first1=Lee-Jah |last2=Blair |first2=Wade |date=11 December 2023 |title=Mimicking nature: Virus-like particles and the next generation of vaccines |url=https://www.astrazeneca.com/what-science-can-do/topics/technologies/virus-like-particles-next-generation-vaccines.html |website=AstraZeneca}}</ref> or protein nanoparticles.<ref>{{Cite web |last=Cambridge |first=University of |title='Quartet Nanocage' vaccine found effective against coronaviruses that haven't even emerged yet |url=https://phys.org/news/2024-05-quartet-nanocage-vaccine-effective-coronaviruses.html |access-date=2024-05-06 |website=phys.org |language=en}}</ref>
While most vaccines are created using inactivated or attenuated compounds from micro-organisms, [[synthetic vaccine]]s are composed mainly or wholly of synthetic peptides, carbohydrates, or antigens.{{Cn|date=May 2024}}
==Valence==
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=== Interactions ===
When two or more vaccines are mixed in the same formulation, the two vaccines can interfere. This most frequently occurs with live attenuated vaccines, where one of the vaccine components is more robust than the others and suppresses the growth and immune response to the other components.<ref>{{cite journal |last1=Gizurarson |first1=Sveinbj??rn |title=Clinically Relevant Vaccine-Vaccine Interactions: A Guide for Practitioners |journal=BioDrugs |date=1998 |volume=9 |issue=6 |pages=443–453 |doi=10.2165/00063030-199809060-00002|pmid=18020577 |doi-access=free }}</ref>
This phenomenon was first{{when
==Other contents==
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===Preservatives===
Vaccines may also contain preservatives to prevent contamination with [[bacteria]] or [[fungi]]. Until recent years, the preservative [[thiomersal]] ({{a.k.a.}} ''Thimerosal'' in the US and Japan) was used in many vaccines that did not contain live viruses. As of 2005, the only childhood vaccine in the U.S. that contains thiomersal in greater than trace amounts is the influenza vaccine,<ref>{{cite web|title=Institute for Vaccine Safety – Thimerosal Table|url=http://www.vaccinesafety.edu/thi-table.htm|url-status=live|archive-url=https://web.archive.org/web/20051210210622/http://www.vaccinesafety.edu/thi-table.htm|archive-date=2005-12-10}}</ref> which is currently recommended only for children with certain risk factors.<ref>Wharton, Melinda E.; National Vaccine Advisory committee [https://www.hhs.gov/nvpo/vacc_plan/ "U.S.A. national vaccine plan"] {{webarchive|url=https://web.archive.org/web/20160504053302/http://www.hhs.gov/nvpo/vacc_plan|date=2016-05-04}}</ref> Single-dose influenza vaccines supplied in the UK do not list thiomersal in the ingredients. Preservatives may be used at various stages of the production of vaccines, and the most sophisticated methods of measurement might detect traces of them in the finished product, as they may in the environment and population as a whole.<ref>{{cite web|title=Measurements of Non-gaseous air pollutants > Metals|url=http://www.npl.co.uk/environment/vam/nongaseouspollutants/ngp_metals.html
Many vaccines need preservatives to prevent serious adverse effects such as ''[[Staphylococcus]]'' infection, which in one 1928 incident killed 12 of 21 children inoculated with a [[diphtheria]] vaccine that lacked a preservative.<ref>{{cite web|date=2007-09-06|title=Thimerosal in vaccines|url=https://www.fda.gov/BiologicsBloodVaccines/SafetyAvailability/VaccineSafety/UCM096228|url-status=live|archive-url=https://web.archive.org/web/20130106215029/https://www.fda.gov/BiologicsBloodVaccines/SafetyAvailability/VaccineSafety/UCM096228|archive-date=2013-01-06|access-date=2007-10-01|publisher=Center for Biologics Evaluation and Research, U.S. Food and Drug Administration}}</ref> Several preservatives are available, including thiomersal, [[phenoxyethanol]], and [[formaldehyde]]. Thiomersal is more effective against bacteria, has a better shelf-life, and improves vaccine stability, potency, and safety; but, in the U.S., the [[European Union]], and a few other affluent countries, it is no longer used as a preservative in childhood vaccines, as a precautionary measure due to its [[Mercury (element)|mercury]] content.<ref>{{cite journal|vauthors=Bigham M, Copes R|year=2005|title=Thiomersal in vaccines: balancing the risk of adverse effects with the risk of vaccine-preventable disease|journal=Drug Safety|volume=28|issue=2|pages=89–101|doi=10.2165/00002018-200528020-00001|pmid=15691220|s2cid=11570020}}</ref> Although [[Thiomersal controversy|controversial claims]] have been made that thiomersal contributes to [[autism spectrum disorder|autism]], no convincing scientific evidence supports these claims.<ref>{{cite journal|author-link=Paul Offit|vauthors=Offit PA|date=September 2007|title=Thimerosal and vaccines – a cautionary tale|journal=The New England Journal of Medicine|volume=357|issue=13|pages=1278–1279|doi=10.1056/NEJMp078187|pmid=17898096|s2cid=36318722|doi-access=free}}</ref> Furthermore, a 10–11-year study of 657,461 children found that the MMR vaccine does not cause autism and actually reduced the risk of autism by seven percent.<ref>{{Cite news|date=2019-03-05|title=Another study, this one of 657k kids, finds MMR vaccine doesn't cause autism |newspaper=National Post|url=https://nationalpost.com/news/world/the-largest-ever-study-has-shown-the-measles-mumps-and-rubella-vaccine-is-linked-to-lower-rates-of-autism|access-date=2019-03-13}}</ref><ref>{{Cite news|last=Hoffman|first=Jan|date=2019-03-05|title=One More Time, With Big Data: Measles Vaccine Doesn't Cause Autism|work=The New York Times|url=https://www.nytimes.com/2019/03/05/health/measles-vaccine-autism.html|access-date=2019-03-13|issn=0362-4331|name-list-style=vanc|archive-date=2019-03-12|archive-url=https://web.archive.org/web/20190312175816/https://www.nytimes.com/2019/03/05/health/measles-vaccine-autism.html|url-status=live}}</ref>
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* [[Formaldehyde]] is used to inactivate bacterial products for toxoid vaccines. Formaldehyde is also used to inactivate unwanted viruses and kill bacteria that might contaminate the vaccine during production.
* [[Monosodium glutamate]] (MSG) and 2-[[phenoxyethanol]] are used as stabilizers in a few vaccines to help the vaccine remain unchanged when the vaccine is exposed to heat, light, acidity, or humidity.
* [[Thiomersal]] is a mercury-containing antimicrobial that is added to vials of vaccines that contain more than one dose to prevent contamination and growth of potentially harmful bacteria. Due to the controversy surrounding thiomersal, it has been removed from most vaccines except multi-use influenza, where it was reduced to levels so that a single dose contained less than a microgram of mercury, a level similar to eating ten grams of canned tuna.<ref name="FDA">The mercury levels in the table, unless otherwise indicated, are taken from [https://www.fda.gov/Food/FoodborneIllnessContaminants/Metals/ucm115644.htm Mercury Levels in Commercial Fish and Shellfish (
==Nomenclature==
Various fairly standardized abbreviations for vaccine names have developed, although the standardization is by no means centralized or global. For example, the vaccine names used in the United States have well-established abbreviations that are also widely known and used elsewhere. An extensive list of them provided in a sortable table and freely accessible is available at a US [[Centers for Disease Control and Prevention]] web page.<ref name="CDC_US_vaccine_names">{{Citation |author=Centers for Disease Control and Prevention |title=U.S. Vaccine Names |date=12 November 2020 |url=https://www.cdc.gov/vaccines/terms/usvaccines.html |access-date=2021-08-21 |postscript=. |archive-date=2021-08-21 |archive-url=https://web.archive.org/web/20210821174655/https://www.cdc.gov/vaccines/terms/usvaccines.html |url-status=live }}</ref> The page explains that "The abbreviations [in] this table (Column 3) were standardized jointly by staff of the Centers for Disease Control and Prevention, [[Advisory Committee on Immunization Practices|ACIP]] Work Groups, the editor of the ''[[Morbidity and Mortality Weekly Report]]'' (MMWR), the editor of ''Epidemiology and Prevention of Vaccine-Preventable Diseases'' (the Pink Book), ACIP members, and liaison organizations to the ACIP."<ref name="CDC_US_vaccine_names"/>
Some examples are "[[DTaP]]" for diphtheria and tetanus toxoids and
Another list of established vaccine abbreviations is at the CDC's page called "Vaccine Acronyms and Abbreviations", with abbreviations used on U.S. immunization records.<ref name="CDC_US_vaccine_abbreviations">{{Citation |author=Centers for Disease Control and Prevention |title=Vaccine Acronyms and Abbreviations [Abbreviations used on U.S. immunization records] |url=https://www.cdc.gov/vaccines/terms/vacc-abbrev.html |access-date=2017-05-22 |postscript=. |url-status=live |archive-url=https://web.archive.org/web/20170602192710/https://www.cdc.gov/vaccines/terms/vacc-abbrev.html |archive-date=2017-06-02 |date=2018-02-02 }}</ref> The [[United States Adopted Name]] system has some conventions for the [[word order]] of vaccine names, placing [[head (linguistics)|head nouns]] first and [[postpositive adjective|adjectives postpositively]]. This is why the USAN for "[[polio vaccine|OPV]]" is "poliovirus vaccine live oral" rather than "oral poliovirus vaccine".
==Licensing==
{{also|Vaccine trial}}
A vaccine ''licensure'' occurs after the successful conclusion of the development cycle and further the clinical trials and other programs involved through [[Phases of clinical research|Phases]]{{spaces}}I–III demonstrating safety, immunoactivity, immunogenetic safety at a given specific dose, proven effectiveness in preventing infection for target populations, and enduring preventive effect (time endurance or need for revaccination must be estimated).<ref name="who-vacc">{{cite web|date=1 April 2014|title=Principles and considerations for adding a vaccine to a national immunization programme|url=https://apps.who.int/iris/bitstream/handle/10665/111548/9789241506892_eng.pdf|url-status=live|archive-url=https://web.archive.org/web/20200929164919/https://apps.who.int/iris/bitstream/handle/10665/111548/9789241506892_eng.pdf|archive-date=29 September 2020|access-date=17 August 2020|publisher=World Health Organization}}</ref> Because preventive vaccines are predominantly evaluated in healthy population cohorts and distributed among the general population, a high standard of safety is required.<ref>{{cite journal |last1=Bok |first1=Karin |last2=Sitar |first2=Sandra |last3=Graham |first3=Barney S. |author4-link=John R. Mascola |last4=Mascola |first4=John R. |title=Accelerated COVID-19 vaccine development: milestones, lessons, and prospects |journal=Immunity |date=August 2021 |volume=54 |issue=8 |pages=1636–1651 |doi=10.1016/j.immuni.2021.07.017|pmid=34348117 |pmc=8328682 }}</ref> As part of a multinational licensing of a vaccine, the World Health Organization ''Expert Committee on Biological Standardization'' developed guidelines of international standards for manufacturing and [[quality control]] of vaccines, a process intended as a platform for national regulatory agencies to apply for their own licensing process.<ref name="who-vacc" /> Vaccine manufacturers do not receive licensing until a complete clinical cycle of development and trials proves the vaccine is safe and has long-term effectiveness, following scientific review by a multinational or national regulatory organization, such as the [[European Medicines Agency]] (EMA) or the US [[Food and Drug Administration]] (FDA).<ref name="wijnans">{{cite journal|last1=Wijnans|first1=Leonoor|last2=Voordouw|first2=Bettie|date=11 December 2015|title=A review of the changes to the licensing of influenza vaccines in Europe|journal=Influenza and Other Respiratory Viruses|volume=10|issue=1|pages=2–8|doi=10.1111/irv.12351|issn=1750-2640|pmc=4687503|pmid=26439108}}</ref><ref name="chop">{{cite web|last=Offit|first=Paul A.|year=2020|title=Making vaccines: Licensure, recommendations and requirements|url=https://www.chop.edu/centers-programs/vaccine-education-center/making-vaccines/licensure-recommendations-and-requirements|url-status=live|archive-url=https://web.archive.org/web/20200908060918/https://www.chop.edu/centers-programs/vaccine-education-center/making-vaccines/licensure-recommendations-and-requirements|archive-date=8 September 2020|access-date=20 August 2020|publisher=Children's Hospital of Philadelphia}}</ref>
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===United States===
Under the FDA, the process of establishing evidence for vaccine clinical safety and efficacy is the same as for [[Drug approval|the approval process for prescription drugs]].<ref name="fda-vacc">{{cite web|date=30 January 2020|title=Vaccine product approval process|url=https://www.fda.gov/vaccines-blood-biologics/development-approval-process-cber/vaccine-product-approval-process
===India===
Drugs Controller General of India is the head of department of the Central Drugs Standard Control Organization of the Government of India responsible for approval of licences of specified categories of drugs such as vaccines AND others like blood and blood products, IV fluids, and sera in India.<ref>{{cite web |url=https://cdsco.gov.in/opencms/opencms/en/Home/ |title=home |publisher=Cdsco.gov.in |date=2021-04-15 |
===Postmarketing surveillance===
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The large number of vaccines and boosters recommended (up to 24 injections by age two) has led to problems with achieving full compliance. To combat declining compliance rates, various notification systems have been instituted and many combination injections are now marketed (e.g., [[Pentavalent vaccine]] and [[MMRV vaccine]]), which protect against multiple diseases.
Besides recommendations for infant vaccinations and boosters, many specific vaccines are recommended for other ages or for repeated injections throughout life{{snd}}most commonly for measles, tetanus, influenza, and pneumonia. Pregnant women are often screened for continued resistance to rubella. The [[human papillomavirus]] vaccine is recommended in the U.S. (as of 2011)<ref>{{cite web | title=HPV Vaccine Safety | url=https://www.cdc.gov/vaccinesafety/Vaccines/HPV/Index.html | publisher=Centers for Disease Control and Prevention (CDC) | date=2013-12-20<!--last update--> | access-date=2014-01-10 | url-status=live | archive-url=https://web.archive.org/web/20091110193757/http://www.cdc.gov/vaccinesafety/Vaccines/HPV/Index.html | archive-date=2009-11-10 }}</ref> and UK (as of 2009).<ref>{{cite news | title=HPV vaccine in the clear | author=<!--staff--> | url=http://www.nhs.uk/news/2009/09September/Pages/Cervical-cancer-vaccine-QA.aspx | work=NHS choices | date=2009-10-02 | access-date=2014-01-10 | url-status=live | archive-url=https://web.archive.org/web/20140110093039/http://www.nhs.uk/news/2009/09September/Pages/Cervical-cancer-vaccine-QA.aspx | archive-date=2014-01-10
Scheduling and dosing of a vaccination may be tailored to the level of immunocompetence of an individual<ref>{{Cite journal|last=Dooling|first=Kathleen|date=2021-08-13|title=The Advisory Committee on Immunization Practices' Updated Interim Recommendation for Allocation of COVID-19 Vaccine – United States, December 2020|url=https://www.cdc.gov/vaccines/acip/meetings/downloads/slides-2021-08-13/02-COVID-Dooling-508.pdf|journal=CDC the Advisory Committee on Immunization Practices.|volume=69|issue=5152|pages=1657–1660|pmid=33382671|pmc=9191902|access-date=2021-08-17|archive-date=2021-08-19|archive-url=https://web.archive.org/web/20210819101406/https://www.cdc.gov/vaccines/acip/meetings/downloads/slides-2021-08-13/02-COVID-Dooling-508.pdf|url-status=live}}</ref> and to optimize population-wide deployment of a vaccine when it supply is limited,<ref>{{Cite journal|last=Hunziker|first=Patrick|date=2021-07-24|title=Personalized-dose Covid-19 vaccination in a wave of virus Variants of Concern: Trading individual efficacy for societal benefit|url=https://precisionnanomedicine.com/article/26101-personalized-dose-covid-19-vaccination-in-a-wave-of-virus-variants-of-concern-trading-individual-efficacy-for-societal-benefit|journal=Precision Nanomedicine|volume=4|issue=3|pages=805–820|language=en|doi=10.33218/001c.26101|issn=2639-9431|doi-access=free|access-date=2021-08-17|archive-date=2021-10-09|archive-url=https://web.archive.org/web/20211009194402/https://precisionnanomedicine.com/article/26101-personalized-dose-covid-19-vaccination-in-a-wave-of-virus-variants-of-concern-trading-individual-efficacy-for-societal-benefit|url-status=live}}</ref> e.g. in the setting of a pandemic.
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[[File:Preparation of measles vaccines.jpg|thumb| ]]
Vaccine production is fundamentally different from other kinds of manufacturing{{snd}}including regular [[pharmaceutical manufacturing]]{{snd}}in that vaccines are intended to be administered to millions of people of whom the vast majority are perfectly healthy.<ref name="Plotkin_Page_45">{{cite book |last1=Gomez |first1=Phillip L. |last2=Robinson |first2=James M. |last3=Rogalewicz |first3=James |editor1-last=Plotkin |editor1-first=Stanley A. |editor2-last=Orenstein |editor2-first=Walter A. |editor3-last=Offit |editor3-first=Paul A. |title=Vaccines |date=2008 |publisher=Saunders Elsevier |location=New York |isbn=978-
Depending upon the antigen, it can cost anywhere from US$50 to $500 million to build a vaccine production facility, which requires highly specialized equipment, [[Cleanroom|clean rooms]], and containment rooms.<ref name="Plotkin_2017">{{cite journal |last1=Plotkin |first1=Stanley |last2=Robinson |first2=James M. |last3=Cunningham |first3=Gerard |last4=Iqbal |first4=Robyn |last5=Larsen |first5=Shannon |title=The complexity and cost of vaccine manufacturing – An overview |journal=Vaccine |date=24 July 2017 |volume=35 |issue=33 |pages=4064–4071 |doi=10.1016/j.vaccine.2017.06.003 |pmid=28647170 |pmc=5518734 }}</ref> There is a global scarcity of personnel with the right combination of skills, expertise, knowledge, competence and personality to staff vaccine production lines.<ref name="Plotkin_2017" /> With the notable exceptions of Brazil, China, and India, many developing countries' educational systems are unable to provide enough qualified candidates, and vaccine makers based in such countries must hire expatriate personnel to keep production going.<ref name="Plotkin_2017" />
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===Vaccine manufacturers===
The companies with the highest market share in vaccine production are [[Merck & Co.|Merck]], [[Sanofi]], [[GlaxoSmithKline]], [[Pfizer]] and [[Novartis]], with 70% of vaccine sales concentrated in the EU or US (2013).<ref name=plotkin2017>{{Cite book|title= Vaccines|first1= Stanley A. | last1=Plotkin| first2=Walter A. |last2 =Orenstein| first3= Paul A. |last3=Offit |first4=Kathryn M. |last4=Edwards |publisher=Elsevier |year=2017|isbn=978-
==Delivery systems==
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A microneedle approach, which is still in stages of development, uses "pointed projections fabricated into arrays that can create vaccine delivery pathways through the skin".<ref>{{cite journal | vauthors = Giudice EL, Campbell JD | title = Needle-free vaccine delivery | journal = Advanced Drug Delivery Reviews | volume = 58 | issue = 1 | pages = 68–89 | date = April 2006 | pmid = 16564111 | doi = 10.1016/j.addr.2005.12.003 }}</ref>
An experimental needle-free<ref>[[World Health Organization|WHO]] to trial Nanopatch needle-free delivery system| [[ABC News (Australia)|ABC News]], 16 Sep 2014| {{cite news |url=http://www.abc.net.au/news/2014-09-16/vaxxas-says-needle-free-polio-vaccine-a-game-changer/5748072 |title=Needle-free polio vaccine a 'game-changer' |newspaper=ABC News |access-date=2015-09-15 |url-status=live |archive-url=https://web.archive.org/web/20150402210010/http://www.abc.net.au/news/2014-09-16/vaxxas-says-needle-free-polio-vaccine-a-game-changer/5748072 |archive-date=2015-04-02 |date=2014-09-16 }}</ref> vaccine delivery system is undergoing animal testing.<ref>{{cite news|title=Australian scientists develop 'needle-free' vaccination|url=http://www.smh.com.au/technology/sci-tech/needleless-trial-set-for-start-20130417-2i0qw.html|newspaper=[[The Sydney Morning Herald]]|date=18 August 2013|url-status=live|archive-url=https://web.archive.org/web/20150925012246/http://www.smh.com.au/technology/sci-tech/needleless-trial-set-for-start-20130417-2i0qw.html|archive-date=25 September 2015}}</ref><ref>{{cite web |url=http://www.brw.com.au/p/tech-gadgets/brisbane_nanopatch_the_reverse_brain_DPyEGHC1ih6919r8X37SdO |website=Business Review Weekly |title=Vaxxas raises $25m to take Brisbane's Nanopatch global |access-date=2015-03-05
==In veterinary medicine==
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==History==
{{Further|Vaccination#History|Inoculation#Origins}}
[[File:Inoculation day 16.png|thumb|Comparison of [[smallpox]] (left) and [[cowpox]]
Prior to the introduction of vaccination with material from cases of cowpox (heterotypic immunisation), smallpox could be prevented by deliberate [[variolation]] with smallpox virus. The earliest hints of the practice of variolation for smallpox in China come during the tenth century.<ref name="needham volume 6 part 6 154">{{cite book|last=Needham|first=Joseph |title=Science and Civilisation in China: Volume 6, Biology and Biological Technology, Part 6, Medicine|publisher=Cambridge University Press|year=2000|isbn=978-
[[File:Jenner and his two colleagues seeing off three anti-vaccinat Wellcome V0011075.jpg|thumb|left|An early 19th-century satire of antivaxxers by [[Isaac Cruikshank]]]]
[[Mary Wortley Montagu]], who had witnessed variolation in Turkey, had her four-year-old daughter variolated in the presence of
[[File:Centenaire de la découverte de la vaccine par Jenner CIPB0429.jpg|thumb|right|French print in 1896 marking the centenary of Jenner's vaccine]]
Following on from Jenner's work, the second generation of vaccines was introduced in the 1880s by [[Louis Pasteur]] who developed vaccines for [[chicken cholera]] and [[anthrax]],<ref name="Pasteur1881" /> and from the late nineteenth century vaccines were considered a matter of national prestige. National [[vaccination policies]] were adopted and compulsory vaccination laws were passed.<ref name="Stern-Markel" /> In 1931 [[Alice Miles Woodruff]] and [[Ernest Goodpasture]] documented that the [[fowlpox]] virus could be grown in [[embryonated]] chicken [[egg]]. Soon scientists began cultivating other viruses in eggs. Eggs were used for virus propagation in the development of a [[yellow fever vaccine]] in 1935 and an [[influenza vaccine]] in 1945. In 1959 [[growth media]] and [[cell culture]] replaced eggs as the standard method of virus propagation for vaccines.<ref>{{Cite book|title=Essential Human Virology |last1=Louten |first1=Jennifer |publisher=Academic Press|year=2016|isbn=978-
Vaccinology flourished in the twentieth century, which saw the introduction of several successful vaccines, including those against [[diphtheria]], [[measles]], [[mumps]], and [[rubella]]. Major achievements included the development of the [[polio vaccine]] in the 1950s and the [[eradication of smallpox]] during the 1960s and 1970s. [[Maurice Hilleman]] was the most prolific of the developers of the vaccines in the twentieth century. As vaccines became more common, many people began taking them for granted. However, vaccines remain elusive for many important diseases, including [[herpes|herpes simplex]], [[malaria]], [[gonorrhea]], and [[HIV]].<ref name="Stern-Markel" /><ref name="BaardaSikora2015">{{cite journal|vauthors=Baarda BI, Sikora AE|year=2015|title=Proteomics of Neisseria gonorrhoeae: the treasure hunt for countermeasures against an old disease|journal=Frontiers in Microbiology|volume=6|page=1190|doi=10.3389/fmicb.2015.01190|pmc=4620152|pmid=26579097|postscript=;|doi-access=free}}
===Generations of vaccines===
[[File:Smallpox and anthrax vaccines of 447th Expeditionary Medical Squadron.jpg|thumb| ]]
First generation vaccines are whole-organism vaccines{{snd}}either live and [[Attenuated virus|weakened]], or killed forms.<ref name="Alarcon1999">{{cite book|title=Advances in Parasitology Volume 42|vauthors=Alarcon JB, Waine GW, McManus DP|year=1999|isbn=978-
Second generation vaccines were developed to reduce the risks from live vaccines. These are subunit vaccines, consisting of specific [[protein]]
[[RNA vaccine]]s and [[DNA vaccine]]s are examples of third generation vaccines.<ref name="Alarcon1999" /><ref name="Robinson2000">{{cite book|title=DNA vaccines for viral infections: basic studies and applications|vauthors=Robinson HL, Pertmer TM|year=2000|isbn=978-
==Trends==
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===Plants as bioreactors for vaccine production===
The idea of vaccine production via [[transgenic plants]] was identified as early as 2003. Plants such as [[tobacco]], [[potato]], [[tomato]], and [[banana]] can have genes inserted that cause them to produce vaccines usable for humans.<ref name="pmid12531364">{{cite journal | vauthors = Sala F, Manuela Rigano M, Barbante A, Basso B, Walmsley AM, Castiglione S | title = Vaccine antigen production in transgenic plants: strategies, gene constructs and perspectives | journal = Vaccine | volume = 21 | issue = 7–8 | pages = 803–808 | date = January 2003 | pmid = 12531364 | doi = 10.1016/s0264-410x(02)00603-5 }}</ref> In 2005, bananas were developed that produce a human vaccine against [[hepatitis B]].<ref>{{cite journal | vauthors = Kumar GB, Ganapathi TR, Revathi CJ, Srinivas L, Bapat VA | title = Expression of hepatitis B surface antigen in transgenic banana plants | journal = Planta | volume = 222 | issue = 3 | pages = 484–493 | date = October 2005 | pmid = 15918027 | doi = 10.1007/s00425-005-1556-y | bibcode = 2005Plant.222..484K | s2cid = 23987319 }}</ref>
== Vaccine hesitancy ==
[[File:202003- Cumulative county COVID-19 death rates - by share of votes for Donald Trump.svg |thumb |After the December 2020 introduction of COVID vaccines, a partisan gap in death rates developed, indicating the effects of vaccine skepticism.<ref name=NYTimes_20240311/> As of March 2024, more than 30 percent of Republicans had not received a Covid vaccine, compared with less than 10 percent of Democrats.<ref name=NYTimes_20240311>{{cite news |last1=Leonhardt |first1=David |title=The Fourth Anniversary of the Covid Pandemic |url=https://www.nytimes.com/2024/03/11/briefing/covid-pandemic-anniversary.html |newspaper=The New York Times |date=March 11, 2024 |archive-url=https://archive.today/20240311124758/https://www.nytimes.com/2024/03/11/briefing/covid-pandemic-anniversary.html |archive-date=March 11, 2024 |url-status=live }} "Data excludes Alaska. Sources: C.D.C. Wonder; Edison Research. (Chart) By The New York Times. Source credits chart to Ashley Wu.</ref>]]
[[Vaccine hesitancy]] is a delay in acceptance, or refusal of vaccines despite the availability of vaccine services. The term covers outright refusals to vaccinate, delaying vaccines, accepting vaccines but remaining uncertain about their use, or using certain vaccines but not others.<ref>{{Cite journal |last=The Lancet Child & Adolescent Health |year=2019 |title=Vaccine hesitancy: a generation at risk |journal=The Lancet |volume=3 |issue=5 |page=281 |doi=10.1016/S2352-4642(19)30092-6 |pmid=30981382 |s2cid=115201206|doi-access=free }}</ref><ref name="Smith2015">{{Cite journal |last=Smith |first=MJ |date=November 2015 |title=Promoting Vaccine Confidence |journal=Infectious Disease Clinics of North America |type=Review |volume=29 |issue=4 |pages=759–69 |doi=10.1016/j.idc.2015.07.004 |pmid=26337737}}</ref><ref name="Larson2014">{{Cite journal |last1=Larson |first1=HJ |last2=Jarrett |first2=C |last3=Eckersberger |first3=E |last4=Smith |first4=DM |last5=Paterson |first5=P |date=April 2014 |title=Understanding vaccine hesitancy around vaccines and vaccination from a global perspective: a systematic review of published literature, 2007–2012. |journal=Vaccine |volume=32 |issue=19 |pages=2150–59 |doi=10.1016/j.vaccine.2014.01.081 |pmid=24598724}}</ref><ref>{{Cite journal |last1=Cataldi |first1=Jessica |last2=O'Leary |first2=Sean |date=2021 |title=Parental vaccine hesitancy: scope, causes, and potential responses |url=https://journals.lww.com/co-infectiousdiseases/Fulltext/2021/10000/Parental_vaccine_hesitancy__scope,_causes,_and.19.aspx |journal=Current Opinion in Infectious Diseases |volume=34 |issue=5 |pages=519–526 |doi=10.1097/QCO.0000000000000774 |pmid=34524202 |s2cid=237437018 |access-date=2022-06-24 |archive-date=2023-12-24 |archive-url=https://web.archive.org/web/20231224041931/https://journals.lww.com/co-infectiousdiseases/abstract/2021/10000/parental_vaccine_hesitancy__scope,_causes,_and.19.aspx |url-status=live }}</ref> There is an overwhelming [[scientific consensus]] that vaccines are generally safe and effective.<ref>{{Cite journal |date=October 2017 |title=Communicating science-based messages on vaccines |journal=Bulletin of the World Health Organization |volume=95 |issue=10 |pages=670–71 |doi=10.2471/BLT.17.021017 |pmc=5689193 |pmid=29147039}}</ref><ref>{{Cite news |title=Why do some people oppose vaccination? |work=Vox |url=https://www.vox.com/2018/8/21/17588104/vaccine-opposition-anti-vaxxer |access-date=2018-11-26 |archive-date=2019-09-21 |archive-url=https://web.archive.org/web/20190921013342/https://www.vox.com/2018/8/21/17588104/vaccine-opposition-anti-vaxxer |url-status=live }}</ref><ref>{{Cite news |last=Ceccarelli |first=Leah |name-list-style=vanc |title=Defending science: How the art of rhetoric can help |language=en |work=The Conversation |url=http://theconversation.com/defending-science-how-the-art-of-rhetoric-can-help-68210 |access-date=2018-11-26 |archive-date=2019-11-05 |archive-url=https://web.archive.org/web/20191105052610/https://theconversation.com/defending-science-how-the-art-of-rhetoric-can-help-68210 |url-status=live }}</ref><ref>{{Cite web |last=U.S. Department of Health and Human Services |title=Vaccines.gov |url=https://www.vaccines.gov/basics/safety/index.html |access-date=2018-08-05 |website=Vaccines.gov |language=en-us |archive-date=2019-03-13 |archive-url=https://web.archive.org/web/20190313190815/https://www.vaccines.gov/basics/safety/index.html |url-status=live }}</ref> Vaccine hesitancy often results in disease [[outbreak]]s and deaths from [[vaccine-preventable diseases]].<ref>{{Cite web |title=Frequently Asked Questions (FAQ) |url=http://www.childrenshospital.org/centers-and-services/division-of-infectious-diseases/faq-resurgence-of-measles |archive-url=https://web.archive.org/web/20131017113035/http://www.childrenshospital.org/centers-and-services/division-of-infectious-diseases/faq-resurgence-of-measles |archive-date=October 17, 2013 |access-date=February 11, 2014 |website=[[Boston Children's Hospital]]}}</ref><ref name="auto1">{{Cite journal |vauthors=Phadke VK, Bednarczyk RA, Salmon DA, Omer SB |date=March 2016 |title=Association Between Vaccine Refusal and Vaccine Preventable Diseases in the United States: A Review of Measles and Pertussis |journal=JAMA |volume=315 |issue=11 |pages=1149–58 |doi=10.1001/jama.2016.1353 |pmc=5007135 |pmid=26978210}}</ref><ref name="wolfesharp">{{Cite journal |vauthors=Wolfe R, Sharp L |year=2002 |title=Anti-vaccinationists past and present |url=http://bmj.bmjjournals.com/cgi/content/full/325/7361/430 |journal=BMJ |volume=325 |issue=7361 |pages=430–2 |doi=10.1136/bmj.325.7361.430 |pmc=1123944 |pmid=12193361 |access-date=2008-01-14 |archive-date=2006-08-25 |archive-url=https://web.archive.org/web/20060825024043/http://bmj.bmjjournals.com/cgi/content/full/325/7361/430 |url-status=live }}</ref><ref name="AgeOld">{{Cite journal |vauthors=Poland GA, Jacobson RM |date=January 2011 |title=The age-old struggle against the antivaccinationists
==See also==
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{{wikiquote|Vaccines}}
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