Imunizare in infectii

Goal
Increase immunization rates and reduce preventable infectious diseases.
Overview
The increase in life expectancy during the 20th century is largely due to improvements in child
survival; this increase is associated with reductions in infectious disease mortality, due largely to
immunization.1 However, infectious diseases remain a major cause of illness, disability, and
death. Immunization recommendations in the United States currently target 17 vaccine-
preventable diseases across the lifespan.
Healthy People 2020 goals for immunization and infectious diseases are rooted in evidence-
based clinical and community activities and services for the prevention and treatment of
infectious diseases. Objectives new to Healthy People 2020 focus on technological
advancements and ensuring that States, local public health departments, and nongovernmental
organizations are strong partners in the Nation’s attempt to control the spread of infectious
diseases. Objectives for 2020 reflect a more mobile society and the fact that diseases do not stop
at geopolitical borders. Awareness of disease and completing prevention and treatment courses
remain essential components for reducing infectious disease transmission.
Why Are Immunization and Infectious Diseases Important?
People in the United States continue to get diseases that are vaccine preventable. Viral hepatitis,
influenza, and tuberculosis (TB) remain among the leading causes of illness and death in the
United States and account for substantial spending on the related consequences of infection.
The infectious disease public health infrastructure, which carries out disease surveillance at the
Federal, State, and local levels, is an essential tool in the fight against newly emerging and re-
emerging infectious diseases. Other important defenses against infectious diseases include:
 Proper use of vaccines
 Antibiotics
 Screening and testing guidelines
 Scientific improvements in the diagnosis of infectious disease-related health concerns
Understanding Immunization and Infectious Diseases
Immunization
Vaccines are among the most cost-effective clinical preventive services and are a core
component of any preventive services package. Childhood immunization programs provide a very
high return on investment. For example, for each birth cohort vaccinated with the routine
immunization schedule (this includes DTap, Td, Hib, Polio, MMR, Hep B, and varicella vaccines),
society:

 Saves 33,000 lives.
 Prevents 14 million cases of disease.
 Reduces direct health care costs by $9.9 billion.
 Saves $33.4 billion in indirect costs.
Despite progress, approximately 42,000 adults and 300 children in the United States die each
year from vaccine-preventable diseases.*Communities with pockets of unvaccinated and
undervaccinated populations are at increased risk for outbreaks of vaccine-preventable diseases.
In 2008, imported measles resulted in 140 reported cases—nearly a 3-fold increase over the
previous year. The emergence of new or replacement strains of vaccine-preventable disease can
result in a significant increase in serious illnesses and death.
Surveillance
The Nation’s public health goals focus on reducing illness, hospitalization, and death from
vaccine-preventable diseases and other infectious diseases; expanding surveillance is crucial to
those ends. Further efforts to improve disease surveillance will allow for earlier detection of the
emergence and spread of diseases. Increased surveillance will save lives by allowing the
maximum time possible for public health responses, including vaccine production and
development of evidence-based recommendations on disease prevention and control.
Surveillance enables rapid information sharing and facilitates the timely identification of people in
need of immediate treatment. Increasing laboratory capacity is essential for these efforts.
Respiratory Diseases
Acute respiratory infections, including pneumonia and influenza, are the 8th leading cause of
death in the United States, accounting for 56,000 deaths annually. Pneumonia mortality in
children fell by 97 percent in the last century, but respiratory infectious diseases continue to be
leading causes of pediatric hospitalization and outpatient visits in the United States. On average,
influenza leads to more than 200,000 hospitalizations and 36,000 deaths each year. The 2009
H1N1 influenza pandemic caused an estimated 270,000 hospitalizations and 12,270 deaths
(1,270 of which were of people younger than age 18) between April 2009 and March 2010.†
Hepatitis and Tuberculosis
Viral hepatitis and TB can be prevented, yet health care systems often do not make the best use
of their available resources to support prevention efforts. Because the U.S. health care system
focuses on treatment of illnesses, rather than health promotion, patients do not always receive
information about prevention and healthy lifestyles. This includes advancing effective and
evidence-based viral hepatitis and TB prevention priorities and interventions.
Emerging Issues in Immunization and Infectious Diseases
In the coming decade, the United States will continue to face new and emerging issues in the
area of immunization and infectious diseases. The public health infrastructure must be capable of
responding to emerging threats. State-of-the-art technology and highly skilled professionals need

to be in place to provide rapid response to the threat of epidemics. A coordinated strategy is
necessary to understand, detect, control, and prevent infectious diseases.2 Below are some
specific emerging issues.
 Providing culturally appropriate preventive health care is an immediate responsibility that will
grow over the decade. As the demographics of the population continue to shift, public health and
health care systems will need to expand their capacity to protect the growing needs of a diverse
and aging population.
 New infectious agents and diseases continue to be detected. Infectious diseases must be looked
at in a global context due to increasing:
o International travel and trade
o Migration
o Importation of foods and agricultural practices
o Threats of bioterrorism
 Inappropriate use of antibiotics and environmental changes multiply the potential for worldwide
epidemics of all types of infectious diseases.2
Infectious diseases are a critical public health, humanitarian, and security concern; coordinated
efforts will protect people across the Nation and around the world.

Overview of
Immunization
By Margot L. Savoy, MD, MPH, Chair and Associate Professor,
Department ofFamily and Community Medicine,Lewis Katz
School of Medicine at Temple University
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NOTE: This is the Consumer Version. DOCTORS:
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Immunization
Overview of Immunization
Diphtheria-Tetanus-Pertussis Vaccine
Haemophilus influenzae Type b Vaccine
Hepatitis A Vaccine
Hepatitis B Vaccine
Herpes Zoster Vaccine
Human Papillomavirus (HPV) Vaccine
Influenza Vaccine
Measles, Mumps, and Rubella Vaccine
Meningococcal Vaccine
Pneumococcal Vaccine
Polio Vaccine
Rotavirus Vaccine
Smallpox Vaccine
Tetanus-Diphtheria Vaccine
Varicella Vaccine

Immunizationenablesthebody to better defend itself against diseases
caused by certainbacteria or viruses. Immunity(the abilityofthe body to
defend itself against diseasescaused bycertainbacteria or viruses) may
occur naturally(when people areexposed to bacteriaor viruses), or
doctorsmay provideit through vaccination. Whenpeopleare immunized
against a disease, they usually do not get the disease or get only a mild
form of the disease. However, becauseno vaccineis 100% effective, some
people who have been immunized stillmay get the disease.
In communitiesand countrieswherevaccinesarewidely used, many
diseasesthat were once commonand/or fatal (such as polio, measles,
and diphtheria) arenow rareor under control. One disease, smallpox,
has been completelyeliminated by vaccination. Vaccineshavebeen very
effectivein preventing serious diseaseand in improving health
worldwide. However, effectivevaccinesarenot yet availablefor many
important infections, including Ebola virusinfection, most sexually
transmitted diseases(such as HIV infection, syphilis, gonorrhea, and
chlamydialinfections), and manytropicaldiseases(such as malaria).

Following recommendationsfor vaccinationisvery important for
people's own health and for the health of their family and the people in
their community. Manyof the diseasesprevented by vaccinationare
easily spread from person to person. Manyof them are still present in the
United Statesand remaincommonin other partsof the world. These
diseasescan spread rapidlyamong unvaccinatedchildren, who, because
of theease of modern travel, can be exposed even if they live in areas
where a diseaseis not common.
Vaccinesavailabletodayarehighlyreliable, and most people tolerate
them well. They rarely have side effects.
Types of Immunization
There are two types of immunization:
•   Activeimmunization 
•   Passiveimmunization 
Active immunization
In activeimmunization, vaccinesareused to stimulatethebody’s natural
defense mechanisms(the immunesystem). Vaccinesarepreparations
that containone of the following:
•   Noninfectiousfragmentsof bacteriaor viruses 
•   A usually harmfulsubstance(toxin) that isproduced by a bacteriabut
has been modified tobe harmless—called a toxoid 
•   Weakened (attenuated), livewhole organismsthat do not cause
illness 
The body’s immunesystem respondsto a vaccineby producing
substances(such as antibodies and whiteblood cells) that recognizeand
attackthespecific bacteriaor virus contained inthe vaccine. Then
whenever the person is exposed to thespecific bacteriaor virus, thebody
automaticallyproducesthese antibodiesand other substancestoprevent
or lessen illness. The process of giving a vaccineis called vaccination,
although manydoctorsuse the moregeneral term immunization.
Vaccines that contain live but weakened organisms virusinclude
•   Bacille Calmette-Guérin (BCG—for tuberculosis) 
•   Chickenpox (varicella) 
•   Cholera (certainvaccinesgiven by mouth) 
•   Influenza nasal vaccine(but not recommended for any group during
the 2017–2018flu season)

•   Measles-mumps-rubella 
•   Polio (only the oral vaccine) 
•   Rotavirus 
•   Typhoid (only the oral vaccine) 
•   Shingles (only one of the twoavailablevaccines) 
•   Yellow fever 
Did You Know...
  Some vaccines
contain a weakened
but living form of the
microorganism that
they protect against. 
Passive immunization
In passiveimmunization, antibodiesagainsta specific infectious
organism are given directlytoa person. These antibodiesareobtained
from several sources:
•   The blood (serum) of animals(usually horses) that havebeen exposed
to a particularorganismor toxinand have developed immunity 
•   Blood collected from a largegroup of people—called pooled human
immuneglobulin 
•   People known to have antibodiestoa particulardisease(that is,
people who have been immunized or who are recovering from the
disease)—called hyperimmuneglobulin—becausethesepeople have
higher levels of antibodiesintheir blood 
•   Antibody-producingcells (usually takenfrom mice) grown in a
laboratory 
Passiveimmunizationisused for people whose immunesystem does not
respond adequatelytoan infectionor for people who acquireaninfection
before they canbe vaccinated (for example, after being bittenbyan
animalwith rabies).
Passiveimmunizationcanalso be used to prevent diseasewhen people
are likely to beexposed and do not have timeto get or completea
vaccinationseries. For example, a solution containing gamma globulin
that is activeagainst chickenpox virus canbegiven to a pregnant woman
who does not have immunitytothevirus and has been exposed to it. The
chickenpox viruscanharm the fetus and cause seriouscomplications

(such as pneumonia) inthe woman.
Passiveimmunizationlastsfor only a few weeks, until thebody
eliminatestheinjected antibodies.
Vaccine Administration
Vaccinesand antibodiesareusuallygiven by injectionintoa muscle
(intramuscularly) or under the skin (subcutaneously). Antibodiesare
sometimesinjected intoa vein (intravenously). One type of influenza
vaccineis sprayed into thenose.
More thanone vaccinemay be given at a time—inone combination
vaccineor in separateinjectionsat different injectionsites(see Use of
several vaccinesat the same time).
Some vaccinesaregiven routinely—for example, the tetanustoxoid is
given to adults, preferablyevery 10 years. Somevaccinesare routinely
given to children(see figure Vaccinating Infantsand Children).
Other vaccinesare usually given mainlyto specific groupsof people. For
example, the yellow fever vaccine isgiven only to people traveling to
certainpartsofAfrica and South America. Stillother vaccinesaregiven
after possible exposureto a specific disease. For example, the rabies
vaccine maybe given to a person who has been bittenby a dog.
Vaccination Restrictions and
Precautions
For many vaccines, the only reason for not being vaccinated is
•   A serious, life-threatening allergicreaction(such as an anaphylactic
reaction) tothe vaccineor to one of its components 
Egg allergy iscommonin the US. Some vaccines, including most
influenza vaccines, containvery small amountsof materialfrom eggs.
Thus, thereis concern about using such vaccinesin people who are
allergic to eggs. However, the Center for DiseaseControl and Prevention
(CDC) statesthat although mild reactionsmayoccur, serious allergic
reactions(anaphylaxis) areunlikely. Recommendationsfor the influenza
vaccinevary according totheseverity of the allergic reactiontoeggs and
the vaccine. If people who had a severe, life-threatening allergic reaction
after they were given the influenza vaccineor eggs, they should not be
given the influenza vaccine. If people had only a rash after exposureto

eggs or the vaccine, theymay be given the vaccine. If people had a more
serious reactionsuch asfacialswelling, difficultybreathing, or dizziness,
they should get the vaccineina medicalfacilitycapableoftreating such a
reaction.
Vaccines that contain live organisms should not be used or should
be delayed in people with certainconditions, such as
•   Use of drugs that suppressthe immunesystem
(immunosuppressants), such ascorticosteroidsand chemotherapy
drugs 
•   A disorder that weakensthe immunesystem, such as AIDS 
•   Pregnancy 
•   Development of Guillain-Barrésyndromewithin6 weeks after a
previousdose of thevaccine 
If people stop taking thedrugsthat suppress theimmunesystem or if
their weakened immune system recovers sufficiently, giving them
vaccinesthat containlive virusmay be safe.
Common Vaccinations in Children
Children typicallyaregiven a number of vaccinesaccordingtoa standard
schedule (see figure Vaccinating Infantsand Children and Centers for
Disease Control and Prevention: ImmunizationSchedules). If vaccines
are missed, most can be given later, according toa catch-up schedule.
Common Vaccinations in Adults
Adults may also be advised to receive certainvaccines(see also Centersfor Disease Control and
Prevention:Immunization Schedulesfor Adults). When advising adults about vaccination, a
doctor considersthe person’s age, health history, childhoodvaccinations, occupation, geographic
location, travelplans, and other factors.
Vaccine Safety
In the United States, the Centers for Disease Control and Prevention (CDC) monitors
the safety of vaccines. Doctors must report certain problems that occur after routine
vaccination to the CDC's Vaccine Adverse Event Reporting System (VAERS) and
Vaccine Safety Datalink (VSD). If any health problem happens after vaccination,
anyone—doctors, nurses, or any member of the general public—can submit a report
to VAERS. VAERS reports cannot determine whether a health problem was caused by
the vaccine.
For additional information about the safety of individual vaccines, see Vaccine
Safety at the CDC web site.

Vaccines usually cause no problems, although mild side effects, such as soreness or
redness at the injection site, may occur. Nonetheless, many parents remain
concerned about the safety of childhood vaccines and their possible side effects.
One of parents' main concerns has been
 That certain vaccines, such as the measles-mumps-rubella (MMR) vaccine or
vaccines that contain thimerosal (a mercury-based preservative), may increase
the risk of autism
Many different groups of scientists have studied these concerns and have completely
disproved the supposed relationship between vaccines and autism (see Vaccination
Concerns in The Merck Manual and FAQs About Vaccine Safety at the CDC web site).
Nevertheless, most manufacturers have developed thimerosal-free vaccines for use in
infants and adults. Information about vaccines that currently contain low levels of
mercury or thimerosal is available at the Institute for Vaccine Safety web site.
Vaccination Before Foreign Travel
Residents of the United States may be required to receive specific vaccines before
traveling to areas that have infectious diseases not normally found in the United
States (see table Vaccines for International Travel). Recommendations change
frequently in response to disease outbreaks.
The CDC provides the most up-to-date information on vaccination requirements in
their Travelers’Health section. Also, the CDC has a 24-hour telephone service (1-
800-232-4636 [CDC-INFO]) that provides information.
The diphtheria, tetanus, and pertussis vaccine is a combination vaccine that protectsagainst these
three diseases:
 Diphtheria usually causes inflammation of the throat and mucous membranes of the
mouth. However, the bacteriathat cause diphtheria produce a toxinthat can damage the
heart, kidneys, and nervoussystem. Diphtheria was once a leading cause of death in
children.
 Tetanus(lockjaw) causes severe muscle spasms, which result from a toxinproducedby
bacteria. The bacteriausually enter the body through a wound.
 Pertussis (whooping cough) is a very contagiousrespiratory infectionthat is particularly
dangerous to children younger than 2 yearsold and to people who have a weakened
immune system.
For more information, see the Tdap (Tetanus, Diphtheria, Pertussis) vaccine information
statement.
The vaccine has two forms:

 DTaP for children under 7 years
 Tdapfor adolescents and adults
Tdaphas lower dosesof diphtheria and pertussis vaccine, indicatedby the lower case d and p.
The lower doses are adequate for adolescentsand adults. There is also a vaccine that contains
only the tetanus and diphtheria components(tetanus-diphtheria vaccine).
Administration
The diphtheria-tetanus-pertussis vaccine is given as an injection into a muscle. As a part
of routine childhood vaccination, five injectionsof DTaP are given: typically at age 2 months, 4
months, 6 months, 15 to 18months, and 4 to 6 years.
Because pertussis is becoming more common among adults, a booster with Tdap is recommended
at age 11 to 12 yearsto be followedby a tetanus-diphtheria booster every 10 years.
Adults who missed the series of vaccinationsgivenduring childhoodshould get it as adults. If
adults did not receive Tdapat age 11 to 12 yearsor are unsure about whether they were
vaccinated, doctorsgive themone dose of Tdap.
Pregnant women are givena dose of Tdapduring each pregnancy.
Certain conditions may affect whether and when people are vaccinated(see also CDC: Who
Should NOT Get VaccinatedWith These Vaccines?). If people have a temporary illness, doctors
usually wait to give the vaccine until the illness resolves.
Side Effects
The injection site may become sore, swollen, and red. Serious side effectsare rare. They include
high fever, inconsolable crying, seizures, and a severe allergic reaction.
Serious side effectsusually result from the pertussis part of the vaccine. If they occur, the vaccine
that contains pertussis is not used again. Instead, the tetanus-diphtheria vaccine (which does not
contain the pertussis component) is used to complete the vaccinationseries.
The DTaP or Tdapvaccine is not repeatedif seizures or other signs of brain malfunction occur
within 7 daysafter the vaccine is given.
Haemophilus influenzae
Type b Vaccine

Immunization
Hepatitis A Vaccine
Hepatitis B Vaccine
Influenza Vaccine
Polio Vaccine
Rotavirus Vaccine
Smallpox Vaccine
Varicella Vaccine

The Haemophilusinfluenzae typeb (Hib) vaccinehelps protect against
bacterialinfectionsdueto Hib, such as pneumonia and meningitis. These
infectionsmaybe serious in children. Use of the vaccinehas decreased
the incidenceof seriousHib infectionsin childrenby 99%. These
infectionsareuncommonin adultswith a healthy immunesystem and a
functioning spleen.
Different formulationsof the vaccineareavailable.
For more information, seethe HaemophilusInfluenzae Type b (Hib)
vaccineinformationstatement.
Administration
The Hib vaccineisgiven as an injectionintoa muscle. As a part of
routinechildhood vaccination, dosesaregiven at age 2 monthsand 4
monthsor at age2 months, 4 months, and 6 months, depending on
which formulationisused. In either case, a finaldose is given at age 12 to
15 months (for a totalof threeor four doses).

All childrenshould be vaccinated.
The Hib vaccineisalso recommended for adultswho were not vaccinated
as childrenand who are at increased riskof these infections, such as the
following:
•   People who do not have a functioning spleen 
•   People who have a weakened immunesystem (such as those with
AIDS) 
•   People who have had chemotherapyfor cancer 
•   People who have had stem cell transplantation 
If people have a temporaryillness, doctorsusually wait togive the
vaccineuntilthe illness resolves (see also CDC: Who Should NOT Get
Vaccinated WithTheseVaccines?).
Side Effects
Occasionally, the injectionsitebecomessore, swollen, and red. After
being vaccinated, childrenmayhavea fever, cry, and be irritable.
Administration
Side Effects
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ImmunodeficiencyVirus (HIV)Additional ContentMedical NewsHepatitis
A VaccineByMargot L. Savoy, MD, MPH, Chair and Associate
Professor,Departmentof Family and Community Medicine, Lewis Katz
Schoolof Medicine at Temple UniversityNOTE: This is the Consumer
Version. DOCTORS:Click here for the Professional
VersionImmunizationOverviewof ImmunizationDiphtheria-Tetanus-
Pertussis VaccineHaemophilus influenzae Type b VaccineHepatitis A

VaccineHepatitis B VaccineHerpes ZosterVaccineHuman
Papillomavirus (HPV) VaccineInfluenzaVaccineMeasles,Mumps, and
Rubella VaccineMeningococcalVaccinePneumococcalVaccinePolio
VaccineRotavirus VaccineSmallpoxVaccineTetanus-Diphtheria
VaccineVaricellaVaccineThe hepatitis A vaccine helps protectagainst
hepatitis A. Typically, hepatitis A is less serious than hepatitis B.
Hepatitis A often causes no symptoms,although it can cause fever,
nausea, vomiting, and jaundice and, rarely, leads to severe liver failure
and death. Hepatitis A does not lead to chronic hepatitis.Use of the
vaccine has reduced the number of people who becomeinfected.For
more information, see the Hepatitis A vaccine information
statement.AdministrationThe hepatitis A vaccine is given as an injection
into a muscle.As a part of routine childhood vaccination, two doses are
given to all children: typically at age 12 to 23 months and 6 to 18 months
later. Afterthe first dose,people are fulled protected for6 to 12 months,
and after the second dose,children are protected at least 14 to 20 years.
Adults who completed the vaccine series as children are protected at
least 20 years.The hepatitis A vaccine is also recommendedforany
adult who wishes protection from hepatitis A and for adults at increased
risk of the infection, such as the following:Travelers to areas where the
disease is commonPeople who inject illegal drugsMen who have sex
with menPeople who have a chronic liver disorderor blood clotting
disorderHealthy adults who have recently beenexposed to hepatitis A
virusPeople who anticipate close contact with an adopted child during
the first 60 days after the child arrives in the United States from an area
where hepatitis A is commonIfpeople have a temporary illness, doctors
usually wait to give the vaccine until the illness resolves (see also CDC:
Who Should NOT Get Vaccinated With These Vaccines?).Side
EffectsSometimes the injection site is sore, red, and swollen. No serious
side effects have been reported.
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Hepatitis A Vaccine
The hepatitisA vaccinehelps protect against hepatitisA. Typically,
hepatitisA isless serious than hepatitisB. HepatitisA often causes no
symptoms, although it can causefever, nausea, vomiting, and jaundice
and, rarely, leads to severe liver failure and death. HepatitisA does not
lead to chronic hepatitis.
Use of the vaccinehas reduced thenumber of people who become
infected.
For more information, seethe HepatitisA vaccineinformation
statement.
Administration
The hepatitisA vaccineisgiven as an injectionintoa muscle. As a part of
routinechildhood vaccination, twodosesare given to all children:
typicallyat age 12 to 23 months and 6 to 18 monthslater. After the first
dose, people arefulled protected for 6 to 12 months, and after the second
dose, children areprotected at least 14 to 20 years. Adultswho completed
the vaccineseriesas childrenare protected at least 20 years.
The hepatitisA vaccineisalso recommended for any adult who wishes
protectionfrom hepatitisA and for adultsat increased riskof the
infection, such as the following:
  Travelers to areaswherethe disease is common 
  People who inject illegal drugs 
  Men who have sex with men

People who have a chronic liver disorder or blood clotting disorder 
  Healthy adultswho have recentlybeen exposed to hepatitisA virus 
  People who anticipateclosecontact with anadopted child during the
first 60 days after the child arrivesin the United States from an
area where hepatitisA iscommon 
Side Effects
Sometimestheinjectionsiteissore, red, and swollen. Noserious side
effects have been reported.
Administration
Side Effects
Medical Dictionary
ImmunodeficiencyVirus (HIV)Additional ContentMedical NewsHepatitis
B VaccineByMargot L. Savoy, MD, MPH, Chair and Associate
Professor,Departmentof Family and Community Medicine, Lewis Katz
Schoolof Medicine at Temple UniversityNOTE: This is the Consumer
Version. DOCTORS:Click here for the Professional

VaccineVaricellaVaccineThe hepatitis B vaccine helps protectagainst
hepatitis B and its complications (chronic hepatitis, cirrhosis, and liver
cancer). Generally, hepatitis B is more serious than hepatitis A and is
occasionally fatal. Symptoms can be mild or severe. They include
decreasedappetite,nausea, and fatigue. In 5 to 10% of people,hepatitis
B becomes chronic and can lead to cirrhosis and liver cancer.For more
information, see the Hepatitis B vaccine information
statement.AdministrationThe hepatitis B vaccine is typically given in a
series of three injections into a muscle. However, if people who have
been vaccinated are exposed to the virus, a doctor measures their
antibody levels against hepatitis B. If the antibody levels are low, they
may need another injection of hepatitis B vaccine.As a part of routine
childhood vaccination, all children are typically given three doses:at
birth, at age 1 to 2 months, and at 6 to 18 months.Vaccination is also
recommended forany adult who wishes protectionfrom hepatitis B and
all unvaccinated adults who are at increased risk of getting hepatitis B,
such as the following:Health care workersTravelers to areas where the
disease is commonPeople with a chronic liver disorderor blood clotting
disorderPeople with kidney failure, including those who need
dialysisPeople who inject illegal drugsPeople who have several sex
partnersPeople who need to be evaluated or treated for a sexually
transmitted diseaseMenwho have sex with menSex partners and
household contacts of people known to be carriers of hepatitis BPeople
with HIV infectionPeople who are under 60 and have diabetesPeople
who are given care in places where there are people at high risk of
hepatitis B (such as places where people with sexually transmitted
diseases are treated, drug-abuse treatment and prevention services,
hemodialysis centers, institutions for developmentallydisabled people,
correctional facilities, health care settings for injection drug users, men
who have sex with men, and HIV testing and treatment)If people have a
temporary illness, doctors usually wait to give the vaccine until the illness
resolves (see also CDC: Who Should NOT Get Vaccinated With These
Vaccines?).SideEffectsOccasionally,the injection site becomes sore,
and a mild fever develops.Peoplewith a history of severe allergic
reaction to baker’s yeast, which is used in the productionof the hepatitis
B vaccine, should not be given the vaccine.
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Hepatitis B Vaccine
• Immunization
• Overview of Immunization
• Diphtheria-Tetanus-Pertussis Vaccine
• Haemophilus influenzae Type b Vaccine
• Hepatitis A Vaccine
• Hepatitis B Vaccine
• Herpes Zoster Vaccine
• Human Papillomavirus (HPV) Vaccine
• Influenza Vaccine
• Measles, Mumps, and Rubella Vaccine
• Meningococcal Vaccine
• Pneumococcal Vaccine
• Polio Vaccine
• Rotavirus Vaccine
• Smallpox Vaccine
• Tetanus-Diphtheria Vaccine
• Varicella Vaccine

The hepatitisBvaccinehelps protect against hepatitisBand its
complications(chronic hepatitis, cirrhosis, and liver cancer). Generally,
hepatitisBis more seriousthan hepatitisA and is occasionallyfatal.
Symptomscanbe mild or severe. They include decreased appetite,
nausea, and fatigue. In 5 to 10% of people, hepatitisB becomeschronic
and canlead to cirrhosisand liver cancer.
For more information, seethe HepatitisB vaccineinformation
statement.
Administration
The hepatitisBvaccineis typicallygiven in a seriesof three injections
into a muscle. However, if people who have been vaccinated areexposed
to the virus, a doctor measurestheir antibodylevels against hepatitisB. If
the antibodylevels arelow, they may need another injectionof hepatitis
B vaccine.
As a part of routinechildhood vaccination, allchildrenare typicallygiven
three doses: at birth, at age1 to 2 months, and at 6 to 18 months.

Vaccinationisalso recommended for any adult who wishesprotection
from hepatitisBand all unvaccinated adultswhoareat increased riskof
getting hepatitisB, such as the following:
  Health careworkers 
  Travelers to areaswherethe disease is common 
  People with a chronic liver disorder or blood clotting disorder 
  People with kidney failure, including those who need dialysis 
  People who inject illegal drugs 
  People who have several sex partners 
  People who need to be evaluated or treated for a sexually transmitted
disease 
  Men who have sex with men 
  Sex partnersand household contactsofpeople known to be carriers
of hepatitisB 
  People with HIV infection 
  People who are under 60 and have diabetes 
  People who are given carein placeswhere there arepeople at high
risk of hepatitisB(such as places wherepeople with sexually
transmitted diseasesaretreated, drug-abusetreatment and
preventionservices, hemodialysiscenters, institutionsfor
developmentally disabled people, correctionalfacilities, health care
settingsfor injectiondrug users, men who have sex with men, and
HIV testing and treatment) 
Side Effects
Occasionally, the injectionsitebecomessore, and a mild fever develops.
People with a historyof severe allergic reactiontobaker’syeast, which is
used in the productionofthe hepatitisBvaccine, should not be given the
vaccine.

(Shingles Vaccine)
Immunization
Hepatitis A Vaccine
Hepatitis B Vaccine
Influenza Vaccine
Polio Vaccine
Rotavirus Vaccine
Smallpox Vaccine
Varicella Vaccine

There aretwo herpes zoster vaccines. The newer herpeszoster vaccineis
preferred over theolder herpes zoster vaccinebecauseit providesbetter
and longer-lasting protection
•   The newer vaccinecontainsonly noninfectivepieces of the virus
(called a recombinantvaccine). 
•   The older vaccinecontainslive, weakened (attenuated) virus. 
These vaccineshelp reducethe risk of shingles (herpes zoster) and the
severe residualpainit cancause (postherpetic neuralgia).
For more information, seethe Recombinant shinglesvaccineinformation
statement and the Live shingles vaccineinformationstatement.
The herpes zoster virus is thesame virus that causes chickenpox. After
chickenpox resolves, the virus remainsinthe body. It can be reactivated
years later and causeshingles, which is a painfulrash, usually on only
one part of the body. The rash resolves after several weeks, but
postherpetic neuralgia, which causesseverechronic pain, can last for
monthsor years. Herpes zoster canalso increasetherisk of having a

stroke and other problemsdue to malfunctionof the nervous system
(such as problemswith vision, hearing, or balance).
Administration
The newer recombinant herpeszoster vaccineis givenin two doses,
injected intoa muscle. The doses aregiven 2 to 6 months apart and at
least 2 monthsafter the older herpes zoster vaccine.
The newer recombinant vaccineisrecommended for people aged 50 and
over whether or not they have ever had shingles or been given the older
herpes zoster vaccine.
Certainconditionsmayaffect whether and when people arevaccinated
(see also CDC: Who Should NOT Get VaccinatedWith TheseVaccines?).
vaccineuntilthe illness resolves.
Side Effects
The most common sideeffects of the newer (recombinant) herpes zoster
vaccinearepain, soreness, redness, and swelling at the injectionsiteand
headache, fatigue, musclepain, shivering, fever, and digestiveupset.
The most common sideeffects of the older (live-attenuated) herpes
zoster vaccinearesoreness, redness, swelling, and itching at theinjection
site and headache.
(HPV) Vaccine
Administration
Side Effects
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Overview of Human ImmunodeficiencyVirus (HIV)Additional
ContentMedical NewsHuman Papillomavirus (HPV) VaccineByMargot L.
Savoy, MD, MPH, Chair and Associate Professor,Departmentof Family
and Community Medicine, Lewis Katz Schoolof Medicine at Temple
UniversityNOTE: This is the ConsumerVersion. DOCTORS:Click here
for the ProfessionalVersionImmunizationOverviewof
ImmunizationDiphtheria-Tetanus-Pertussis VaccineHaemophilus
influenzae Type b VaccineHepatitis A VaccineHepatitis B VaccineHerpes
ZosterVaccineHuman Papillomavirus (HPV) VaccineInfluenza
VaccineMeasles,Mumps, and Rubella VaccineMeningococcal
VaccinePneumococcalVaccinePolio VaccineRotavirus VaccineSmallpox
VaccineTetanus-DiphtheriaVaccineVaricella VaccineThe human
papillomavirus (HPV) vaccine helps protectagainst infectionby the
strains of HPV that are most likely to cause the following:Cervical cancer,
vaginal cancer, and vulvar cancer in womenPenile cancer in menAnal
cancer, throat cancer, and genital warts in both sexesThesedisorders
are caused by the human papillomavirus.The HPV vaccine contains only
certain parts of the virus. The vaccine does not contain any live virus and
thus cannot cause HPV infection.Formore information, see the HPV
(Human Papillomavirus) vaccine information statement.There are three
vaccines for HPV:Nine-valent: Protects against nine types of
HPVQuadrivalent: Protects against four types of HPVBivalent: Protects
against two types of HPVAll three HPV vaccines protectagainst the two
types of HPV (types 16 and 18) that cause about 70% of cervical
cancers. The nine-valent vaccine and quadrivalent vaccine protect
against the two types of HPV (types 6 and 11) that cause more than 90%
of genital warts, in addition to protecting against types 16 and 18. Only
the nine-valent vaccine and quadrivalent vaccine are recommended for
boys and men.Only the nine-valent vaccine is currently available in the
United States.AdministrationThe HPV vaccine is given as an injection
into a muscle in a 2-dose or a 3-dose schedule.If the initial dose of the
HPV vaccination is given at age 9 to 14 yr, a 2-dose series is given. If the
initial dose of the HPV vaccination is given at age 15 yr or older, a 3-
dose series is given.The vaccine is recommendedforAllfemales at age
11 to 12 (but can be started at age 9 and be given to previously
unvaccinated girls and women through age 26 years)All males at age 11
to 12 (can be given to previously unvaccinated males through age 21
years)All previously unvaccinated males aged 22 to 26 years if they have
sex with men or have HIV infection or another condition that weakens
their immune systemThe HPV vaccine can be given to all men aged 22
to 26 years if they have not been previously vaccinated, although it is
more effective when given at a younger age. If such men are interested
in getting the vaccine, they should talk to their doctor.If people have a

Vaccines?).SideEffectsThe injectionsite sometimesbecomes sore,
swollen, and red. No serious side effectshave been reported.
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• Medical News
Human Papillomavirus
(HPV) Vaccine
• Immunization

• Polio Vaccine
The humanpapillomavirus(HPV) vaccinehelpsprotect against infection
by the strainsof HPV that aremost likely to causethe following:
  Cervicalcancer, vaginalcancer, and vulvar cancer in women 
  Penile cancer inmen 
  Anal cancer, throat cancer, and genitalwarts inboth sexes

These disordersare caused by the humanpapillomavirus.
The HPV vaccinecontainsonly certainpartsofthe virus. The vaccine
does not containany live virusand thus cannot causeHPV infection.
For more information, seethe HPV (HumanPapillomavirus) vaccine
informationstatement.
There arethree vaccinesfor HPV:
•   Nine-valent: Protectsagainstnine types of HPV 
•   Quadrivalent: Protectsagainstfour types of HPV 
•   Bivalent: Protectsagainst twotypesof HPV 
All threeHPV vaccinesprotect againstthetwotypes of HPV (types 16
and 18) that causeabout 70% of cervicalcancers. Thenine-valent vaccine
and quadrivalent vaccineprotect against thetwotypes of HPV (types 6
and 11) that causemore than90% of genitalwarts, inadditionto
protecting against types16 and 18. Only thenine-valent vaccineand
quadrivalent vaccinearerecommendedfor boys and men.
Only the nine-valent vaccineis currentlyavailablein the United States.
Administration
The HPV vaccineisgiven as an injectionintoa muscle in a 2-dose or a 3-
dose schedule. If the initialdoseof the HPV vaccinationisgivenat age9
to 14 yr, a 2-dose series is given. If the initialdoseof the HPV vaccination
is given at age 15 yr or older, a 3-dose seriesis given.
The vaccineis recommended for
•   All females at age11 to 12 (but can be started at age9 and be given to
previously unvaccinated girlsand womenthrough age26 years) 
•   All males at age11 to 12 (canbe given to previously unvaccinated
males through age21 years) 
•   All previously unvaccinatedmalesaged 22 to 26 years if they have sex
with men or have HIV infectionor another conditionthat weakens
their immunesystem 
The HPV vaccinecanbe givento all men aged 22 to 26 years if they have
not been previously vaccinated, although it ismoreeffective when given
at a younger age. If such men are interested ingetting thevaccine, they
should talk to their doctor.

Side Effects
The injectionsitesometimesbecomessore, swollen, and red. No serious
side effects have been reported.
Influenza Vaccine
Immunization
Hepatitis A Vaccine
Hepatitis B Vaccine
Influenza Vaccine
Polio Vaccine
Rotavirus Vaccine
Smallpox Vaccine
Varicella Vaccine

The influenza virus vaccinehelps protect against influenza. Two types of
influenza virus, type A and type B, regularlycauseseasonal epidemicsof
influenza in the United States. Thereare manydifferent strainswithin
each type. The strainsof virus that causeinfluenza outbreakschange
each year. Thus, a new vaccineis needed each year. Each year'svaccineis
directed againstthe3 or 4 strainsthat scientistspredict willbe most
commonin the coming year.
Influenza canbe mild, causing fever, aches, and fatigue, but it canbe
serious. Influenza can causesevere pneumonia, worsening of chronic
heart and lung disorders, organfailure, and death. The number of deaths
caused by influenza variesgreatly from year to year. It rangesfrom
30,000 to 50,000 deathsannuallyin the United States. Occasionally,
severe outbreaks, called pandemics, causeeven more deaths, especially
among young people. In 1918, influenza killed millions of people
worldwide.
For more information, seethe Live, IntranasalInfluenza vaccine
informationstatementand Inactivated Influenza vaccineinformation

statement.
Administration
The influenza vaccineis recommended for
•   All people aged 6 months and over 
Influenza vaccineisusually given as an injectionofinactivatedvirusinto
the muscle. It is also availableas a nasal spray, which containslive but
weakened (attenuated) virus. Use of the nasal spraywas not
recommended for the 2017–2018flu season, but it canbe used for the
2018–2019 flu season.
Influenza epidemicsusuallybeginin late December or midwinter.
Therefore, the best timeto get the vaccineis in September through
November. A vaccineagainst avianinfluenza (bird flu) has been
developed in case that virusbecomesable to spread from person to
person.
An influenza vaccinethat hasa higher dose of inactivatedvirusis
recommended for people aged 65 and older. It is given as an injection.
The mainreason for not giving either influenza vaccinetosomeone is
•   A serious, life-threatening allergicreaction(such as an anaphylactic
reaction) tothe vaccineor to one of its components 
Certainother conditionsmayaffect whether and when people are
vaccinated (seealso CDC: WhoShould NOT Get Vaccinated With These
Vaccines?). For example, the nasal sprayvaccine, which contains
weakened live virus, is not given to the following:
•   Children ageunder age2 years or people over age 50 years 
•   People with a weakened immunesystem, such as those with HIV
infection 
•   Pregnant women 
•   Children or adolescentstaking aspirinor other drugsthat contain
salicylates 
•   People in close contact with or caring for a person with a severely
weakened immunesystem (unless contact isavoided for 7 days
after being given the vaccine) 
•   Children aged 2 to 4 years if they have asthma or have had wheezing
or asthma episodesin the past 12 months

The influenza vaccinemaycontainsmall amountsof egg becausemanyof
the formulationsaremadefrom virusesgrown in eggs.
Recommendationsfor giving thevaccineto people with an egg allergy
vary according totheseverity of theallergy:
  If the only reactionpeoplehave had is a rash (hives), a doctor can
give them the influenza vaccine. 
  If people have had other reactionsto eggs(such as swelling under the
skin (angioedema), difficultybreathing, light-headedness, repeated
vomiting, and reactionsthat required anepinephrineshot or other
emergencytreatment), theycanget the influenza vaccineas long as
it is given in a health carefacilitywherea health carepractitioner
who has experiencerecognizing and managing allergic reactionsis
present. 
  If people have a severe allergic reactionafter they aregiven the
influenza vaccine, they arenot given the influenza vaccineagain. 
Did You Know...
•   People with a
severe egg allergy may
have an allergic
reaction to the
influenza vaccine
because it is made
from viruses grown in
eggs. 
Side Effects
Occasionally, the injectionsitebecomessore. Fever and muscle aches
occur uncommonly.
Whether theinfluenza vaccineincreasesthe riskof developing Guillain-
Barrésyndrome, a progressivenerve disorder, is unclear. However, if this
raresyndrome develops within6 months after influenza vaccination,
people should talkto their doctor about whether futurevaccinationsare
advisable.

The live-virus nasal sprayvaccinesometimescausesa runny nose, sore
throat, and mild wheezing.
Measles, Mumps, and
Rubella Vaccine
Immunization
Hepatitis A Vaccine
Hepatitis B Vaccine
Influenza Vaccine
Polio Vaccine
Rotavirus Vaccine
Smallpox Vaccine
Varicella Vaccine

The measles, mumps, and rubella (MMR) vaccineis a combination
vaccinethat helps protect against thesethreeseriousviral infections. The
vaccinecontainslive but weakened measles, mumps, and rubella viruses.
The combinationvaccineisused becauseanyone who needs protection
against oneof these infectionsalso needs protectionagainst theother
two. Separatevaccinesarenot available.
These infectionscancauseserious problems:
•   Measles causesa rash, fever, and cough. It affectsmainly childrenand
canbe very serious. It canlead to braindamage, pneumonia, and
sometimesdeath. 
•   Mumps causesthe salivaryglands to swell and becomepainful.
Mumpscanaffect the testes, brain, and pancreas, especiallyin
adults. Mumpsis more seriousin adults. 
•   Rubella (Germanmeasles) causes a runny nose, swollen lymph nodes,
and a rash with a light reddening of theskin, especiallythe face. In
adults, it maycausejoint pain. If pregnant women get rubella, they
may miscarry, thefetusmay die, or the babymayhave very severe
birth defects.

The MMRvaccineand the varicella (chickenpox) vaccine arealso
availableas a combined vaccine(MMRV vaccine).
For more information, see the MMR (Measles, Mumps, and Rubella)
vaccineinformationstatement.
Administration
The MMRvaccineis given as an injectionunder theskin.
As a part of routinechildhood vaccination, twodoses aregiven: at age 12
to 15 months and typicallyat age4 to 6 years.
All adultswho were born in or after 1957 should be given one dose of the
vaccineunless they have documentationofvaccinationwith oneor more
doses of MMRor unless laboratorytestsshow they are immune.
Birth before 1957 is generally considered sufficient evidenceof immunity
to measles, mumps, and rubella, except for health care workers. Health
careworkers arevaccinated or have laboratorytestsdone to check for
evidence of immunity.
Rubella infectionduring pregnancycanhavesevere consequencesfor the
fetus such as miscarriageor severe birth defects. Therefore, all women
who could becomepregnant, regardlessof their birth year, should be
tested for immunitytorubella. If women have no evidence of immunity,
those who are not pregnant should be vaccinated, and pregnant women
should be vaccinated promptlyafter thepregnancyiscompleted.
Adultswho arelikely to be exposed to these diseasesshould get a second
dose of the vaccine. These people includethose who
•   Workin health carefacilities 
•   Go to college or other educationalinstitutionsafter high school 
•   Travel internationally 
•   Have HIV infectionunless their immunesystem is severely
weakened 
A second dose of the MMRvaccineshould also be given to people who
live in thesame house as a person with a severely weakened immune
system.
Pregnant womenand people who are have had serious allergic reactions

to gelatinor to certainantibiotics(particularlyneomycin) should not be
given thisvaccine.
Certainother conditionsmayaffect whether and when people are
vaccinated (seealso CDC: WhoShould NOT Get Vaccinated With These
Vaccines?).
Side Effects
Some people have mild side effects, such as a fever, a general feeling of
illness (malaise), and a rash. Jointsmay becometemporarilystiffand
painful, usually in teenagegirlsand women.
Evidence indicatesthat theMMRvaccinedoesnot cause autism (seealso
MMRvaccineand autism and CDC: VaccinesDoNot CauseAutism).
Immunization
Hepatitis A Vaccine
Hepatitis B Vaccine
Influenza Vaccine

Polio Vaccine
Rotavirus Vaccine
Smallpox Vaccine
Varicella Vaccine
The meningococcalvaccineprotectsagainst infectionscaused bythe
bacteria, Neisseriameningitidis (meningococci). Meningococcal
infections canlead to meningitis, dangerouslylow blood pressure
(shock), and death. These bacteriaaretheleading causeof bacterial
meningitis inchildrenand the second leading causeof bacterial
meningitisinadults. The infectioncancausethe following symptoms:
•   Initially, fever, nausea, headache, and leg pain 
•   Later, a rash, decreased blood pressure, and cold handsand feet 
•   Progression from feeling well to being very sickwithinhours 
•   Shockand death

For more information, seethe Meningococcalvaccineinformation
statement.
There areseveral groupsof Neisseria meningitidis. Current vaccinesare
directed againstsomebut not all of these groups. Threeformulationsof
the meningococcalvaccineareavailableinthe United States:
•   The conjugatevaccine(MCV4) ispreferred for people aged 9 months
to 55 years and is used for routinechildhood vaccination. 
•   The polysaccharidevaccine(MPSV4) isused only in certainpeople
over age55. 
•   Meningococcalgroup B vaccine(MenB) is availableto prevent
infectionby one type of meningitisbacteria thathasbecome
commonin outbreaksamong college students. 
Administration
The meningococcalvaccineisgiven in one dose as an injectionunder the
skin or into a muscle.
As a part of routinechildhood vaccination, theMCV4 meningococcal
vaccineis recommended for all childrenat age 11 to 12 years, with a
booster at age16 years.
The vaccineis also recommended for younger childrenwho areat
increased riskof meningococcalinfection, such asthose without a
functioning spleen and those with certainimmunodeficiencydisorders.
The minimum agefor the vaccinevariesfrom 6 weeks to 9 months,
depending on the formulationused.
The meningococcalvaccineisalso recommended for the following
adolescentsand adults:
•   People who do not have a functioning spleen 
•   People with HIV infection 
•   People with certainimmunodeficiencydisorders 
•   People who take eculizumab (a drug that blocksthe complement
system) 
•   Microbiologistswhoareroutinely exposed to the bacteria 
•   Adolescentsif they have not alreadybeen vaccinated 
•   All first-year college studentswho live in dormitoriesand who have
not been given a dose of the vaccineon or after their 16th birthday 
•   All militaryrecruits 
•   Travelers to or residentsof areas wherethe disease is common

•   People who have been exposed during a meningitisoutbreak 
Side Effects
The injectionsitemaybecomesore, swollen, and red. Some people have
headachesand feel tired. A few people have a fever.
Immunization
Hepatitis A Vaccine
Hepatitis B Vaccine
Influenza Vaccine
Polio Vaccine
Rotavirus Vaccine
Smallpox Vaccine

Varicella Vaccine
Pneumococcalvaccineshelp protect againstbacterialinfectionscaused
by Streptococcuspneumoniae(pneumococci). Pneumococcalinfections
include ear infections, sinusitis, pneumonia, bloodstreaminfections, and
meningitis.
For more information, seethe PneumococcalConjugate(PCV13) vaccine
informationstatementand PneumococcalPolysaccharidevaccine
There aremore than90 different types of pneumococci. Vaccinesare
directed againstmanyof the types most likely to cause seriousdisease.
Two types of pneumococcalvaccinesareavailable.
•   The conjugatevaccine(PCV13) protectsagainst 13types of
pneumococcalbacteria(pneumococci). 
•   The polysaccharidevaccine(PPSV23) protectsagainst 23typesof
pneumococci.

Administration
The conjugate vaccine (PCV13) is routinely recommended for
•   All children: Given typicallyat age2 months, 4 months, 6 months,
and 12 to 15 monthsas a part of routinechildhood vaccination 
•   All people aged 65 years and over 
The conjugatevaccineisalso recommended for people aged 6 to 64 who
are at high risk of developing pneumococcalinfections. Thesepeople
include
•   Those with chronic kidney failure or nephrotic syndrome 
•   Those with a cerebrospinalfluid leak 
•   Those with a weakened immunesystem (including thosewith HIV
infection) 
•   Those who do not have a functioning spleen(including those with
sickle cell disease) 
•   Those with a cochlear implant 
If people were given one or more doses of thepolysaccharidevaccine,
doctorswait at least 1 year before giving them the conjugatevaccine.
The polysaccharide vaccine (PPSV23) is routinely recommended for
  All people aged 65 years and over 
If people aged 65 years and over got their first dose of polysaccharide
vaccinewhen they were under 65 and it hasbeen 5 or more years since
the first dose, they aregiven a second dose, at least 5 years after the first.
For example, if they were given the first dose at age64, they are given the
second dose at age69 or later.
The polysaccharidevaccineisalso recommended for people aged 2 to 64
who are at high risk of developing pneumococcalinfections. Thesepeople
includethe following:
•   Groupsthat are listed for the conjugatevaccine(above) 
•   People with a chronic heart disorder, lung disorder (including asthma
and emphysema), or liver disorder 
•   Those with diabetes 
•   Alcoholics 
•   Adultswho smoke cigarettes 
The polysaccharidevaccineiseffectivein about two of threeadults,

although it is less effective in debilitated older people. It is moreeffective
in preventing some of the serious complicationsofpneumococcal
pneumonia (such as meningitisand bloodstream infections) thanin
preventing the pneumonia itself. If people are givenpneumococcal
vaccinefor the first timeat age 65, they aregiven the conjugatevaccine
first and the polysaccharidevaccine1year later.
Side Effects
Occasionally, the injectionsitebecomespainfuland red. Other side
effects includefever, irritability, drowsiness, loss of appetite, and
vomiting.
Administration
Side Effects
Medical Dictionary
ImmunodeficiencyVirus (HIV)Additional ContentMedical NewsPolio
VaccineByMargot L. Savoy, MD, MPH, Chair and Associate Professor,
Department of Family and Community Medicine, Lewis Katz School of
Medicine at Temple UniversityNOTE: This is the ConsumerVersion.
DOCTORS:Click here for the Professional

VaccineVaricellaVaccineThe polio vaccine protects against polio, a very
contagious viral infection that affects the spinal cord and brain. Polio can
cause permanent muscle weakness, paralysis, and sometimes
death.Two formulations are available:One that contains killed virus and is
injectedOne that contains live, weakened (attenuated) virus and is taken
by mouthThe live-virus vaccine is no longer available in the United
States because it can mutate to a strain that causes polio in about 1 of
every 2.4 million people who receive the vaccine.The polio vaccine may
be combined with other vaccines, such as the diphtheria, tetanus, and
pertussis vaccine and sometimeshepatitis B vaccine or Haemophilus
influenzae vaccine.For more information, see the Polio vaccine
information statement.AdministrationAs a part of routine childhood
vaccination, the polio vaccine is given in four doses:at age 2 months, 4
months, 6 to 18 months, and 4 to 6 years.Because polio is now so rare in
the United States, unvaccinated people over 18 years are not given the
vaccine unless they are likely to be exposed to the polio virus—for
example, if they are traveling to an area where polio is common(see
CDC: Travelers' Health), working in a laboratory with materials that may
contain the virus, or treating people who may have polio.If people have a
Vaccines?).SideEffectsPeople who have allergies to the antibiotics
streptomycin,neomycin, or polymyxin B may have an allergic reaction to
the polio vaccine. The vaccine may contain small amounts of these
antibiotics.
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Polio Vaccine
• Immunization
• Polio Vaccine

The polio vaccineprotectsagainst polio, a very contagiousviralinfection
that affectsthe spinalcord and brain. Polio cancausepermanent muscle
weakness, paralysis, and sometimesdeath.
Two formulationsareavailable:
  One that containskilled virus and is injected 
  One that containslive, weakened (attenuated) virusand is takenby
mouth 
The live-virus vaccineis no longer availablein the United Statesbecause
it can mutatetoa strainthat causespolio in about 1 of every 2.4 million
people who receivethe vaccine.
The polio vaccinemaybe combined with other vaccines, such as the
diphtheria, tetanus, and pertussisvaccineand sometimeshepatitisB
vaccineor Haemophilusinfluenzae vaccine.
For more information, seethe Polio vaccineinformationstatement.

Administration
As a part of routinechildhood vaccination, thepolio vaccineisgiven in
four doses: at age2 months, 4 months, 6 to 18 months, and 4 to 6 years.
Becausepolio is now so rarein the United States, unvaccinated people
over 18 years are not given thevaccineunless they arelikely to be
exposed to thepolio virus—for example, if they are traveling toan area
where polio is common(see CDC: Travelers' Health), working in a
laboratorywith materialsthat maycontainthevirus, or treating people
who may have polio.
Side Effects
People who have allergies to the antibioticsstreptomycin, neomycin, or
polymyxinB may have an allergic reactiontothepolio vaccine. The
vaccinemaycontainsmall amountsof these antibiotics.
Rotavirus Vaccine
Immunization
Hepatitis A Vaccine
Hepatitis B Vaccine

Influenza Vaccine
Polio Vaccine
Rotavirus Vaccine
Smallpox Vaccine
Varicella Vaccine
The rotavirusvaccineisa live-virus vaccinethat helps protect against
gastroenteritis caused byrotavirus, which causesvomiting, diarrhea,
and, if symptomspersist, dehydrationand organdamage.
Two formulationsof rotavirusvirusareavailable. Both containlive but
weakened (attenuated) rotavirus.

For more information, seethe Rotavirusvaccineinformationstatement.
Administration
The rotavirusvaccineispart of the recommended vaccinationschedule
for children. This vaccineis given by mouth. Two or threedoses are
given, depending on the formulation: at age2 monthsand 4 months or at
2 months, 4 months, and 6 months.
People who have had seriousallergic reactionstoa previous dose of the
vaccineor to a vaccinecomponent should not be given therotavirus
vaccine.
For example, rotavirusvaccineshould not be givento infants who have
certain immunodeficiencydisorders or who have had intussusception
(when one segment of theintestineslides into another).
If people have a temporaryillness, doctorsusually wait to give the
Side Effects
Infants mayhave mild, temporarydiarrheaor vomiting. Theymay
becomeirritable.
When an older rotavirusvaccinewasused, the riskof intussusception
was increased. In intussusception, theintestineisblocked becauseone
segment of the intestineslidesinto another, much like the partsof a
telescope. The older vaccinewastaken off themarket in the United
States. Thenewer vaccines, when given as recommended, mayincrease
the risk of intussusception, but only slightly.
Smallpox Vaccine

In the United States, routinevaccinationwith thesmallpox vaccinewas
stopped in 1972 becausesmallpox had been eliminated. Becausethe
vaccine’sprotectiveeffectswear off after about 10 years, most people are
now susceptibleto smallpox.
Recent fearsabout the possible use of smallpox by terroristshaveled to
the suggestionthat smallpox vaccinationresume. If smallpox vaccination
is resumed, it is likely to be recommended only for people in thearea of a
smallpox outbreak. Somemilitarypersonnel arenow vaccinated(based
on their riskof exposureif smallpox were to be used as a biological
weapon), and enough smallpox vaccinehas been prepared tovaccinate
everyone in the United Statesifneeded.
The smallpox vaccinecontainslive vaccinia virus, which isrelated to and
providesimmunityagainst thesmallpox virus.
The vaccineis most effective when given very early after exposure.
However, thevaccinemay also be beneficialifgiven in the first days after
symptomsappear. Thereis no proven treatment for smallpox, but some

antiviraldrugs(such as cidofovir) mayhelp treat it or prevent it from
getting worse.
For more information, see CDC: Smallpox: Preventionand Treatment.
Administration
To administer thesmallpox vaccine, doctors rapidlyjab a small area 15
timeswith a speciallydesigned needle that has been dipped in the
vaccine. Then the vaccinesiteis covered with a dressing to prevent the
vaccina virusfrom spreading toother body sites or to other people.
Vaccinationisconsidered successfulif a small blister develops about 7
days later. If vaccinationissuccessful, only one dose is given. If it is not,
people are given another dose.
Side Effects
The smallpox vaccineis generally safe. Fever, a generalfeeling of being ill
(malaise), and muscle achesare commonthe week after vaccination.
Seriousside effects occur inabout 1 of every 10,000 previously
unvaccinated people, and death occursin 1 or 2 per million. The risk of
serious sideeffects and death is lower in previously vaccinated people.
Tetanus-Diphtheria
Vaccine
Immunization

Hepatitis A Vaccine
Hepatitis B Vaccine
Influenza Vaccine
Polio Vaccine
Rotavirus Vaccine
Smallpox Vaccine
Varicella Vaccine
The tetanus-diphtheria (Td) vaccineprotectsagainsttoxinsproduced by
the tetanusand diphtheria bacteria, not against thebacteriaitself. There
is also a combinationvaccinethat addsprotectionagainstpertussis

(diphtheria-tetanus-pertussisvaccine).
Typically, the tetanus bacteriaenter thebody through a wound and begin
to grow and producethe toxin. The toxincausessevere musclespasms
and canbe fatal. Therefore, vaccinationisparticularlyimportant.
Diphtheria usuallycausesinflammationofthe throat and mucous
membranesof the mouth. Also, the bacteriathat causediphtheria
producea toxinthat candamagetheheart, kidneys, and nervous system.
Before routinevaccinationbecameavailable, diphtheriawasa leading
causeof death in children.
For more information, seethe Td (Tetanus, Diphtheria) vaccine
Administration
A diphtheria-tetanus-pertussisvaccine (DTaP) istypicallygivenduring
childhood. This combinationvaccineisgivenin five injections(at age2,
4, 6, and 12 to 18 monthsand at age4 to 6 years), followed by a booster
(Tdap) that containsthesameamount of tetanusvaccinebut a smaller
amount of diphtheria and pertussisvaccine. Thebooster is given at age11
to 12 years. Becauseimmunityagainstpertussisisdecreasing, people
over age16 should receive the Tdap booster if they have not received it
previously.
The tetanus-diphtheria (Td) vaccineisgiven as a booster every 10 years
after the diphtheria-tetanus-pertussisbooster isgiven at age11 to 12
years. Also, people sometimesneed to be vaccinatedafter aninjurythat
breaksthe skin.
Side Effects
Sometimestheinjectionsiteissore, swollen, and red. Serioussideeffects
are rareand includesevere allergic reactions.
If Guillain-Barrésyndrome developed within6 weeks after a tetanus
vaccinewasgiven, people should talk to their doctor about whether
futurevaccinationsareadvisable.

Varicella Vaccine
Immunization
Hepatitis A Vaccine
Hepatitis B Vaccine
Influenza Vaccine
Polio Vaccine
Rotavirus Vaccine
Smallpox Vaccine
Varicella Vaccine

The varicella vaccinehelps protect against chickenpox (varicella), a very
contagiousinfectioncaused bythevaricella-zoster virus. It causesan
itchyrash that looks like small blisterswith a red base. In some people,
the brain, lungs, and heart can becomeinfected, resulting inserious
illness or death. The virus remainsinthe body after the illness has
resolved. If it is reactivated, it cancause shingles years later.
For more information, seethe Chickenpox vaccineinformation
statement.
Administration
Vaccinationagainst varicella ispart of the routinevaccinationschedule
recommended for children. The vaccineisgiven as an injectionunder the
skin. Two doses are given: at age 12 to 15 monthsand at age 4 to 6 years.
It is also recommended for all adolescentsand adultswho have not had
the vaccineor the disease. It is given to them in two doses 4 to 12 weeks
apart.

Becausethe vaccinecontainslive virus, it is not given to pregnant
women, people with a weakened immunesystem, or people with cancer
of thebone marrow or lymphatic system.
Side Effects
The varicella vaccineis very safe, and commonside effects aremild. They
includepain, swelling, and redness at the injectionsiteand fever and
temporaryjoint painand stiffness.
Very occasionally, a chickenpox-likerash develops. People who develop
thisrash after the vaccineshould diligentlyavoid contact with people
who have a weakened immunesystem until after the rash resolves.
Taking aspirinand related drugs(salicylates) after vaccinationcancause
a rarebut serious disorder called Reye syndrome in childrenunder 16
years old. Thus, such childrenshould not be given these drugsfor 6
weeks after vaccination.

Imunizare in infectii

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