Immunization Campaigns

How Many Immunizations Does It Take To Protect Your Child?

Poster

By: California Department of Health Services

Date: The poster first appeared in the early 1980s as part of a public health campaign. The exact date is uncertain.

Source: California Department of Health Services. National Library of Medicine. "How Many Immunizations Does It Take To Protect Your Child?" Available online at 〈http://profiles.nlm.nih.gov/VC/B/B/C/G/〉 (accessed June 2, 2005).

About the Author: As with most state health agencies, the California Department of Health Services (CDHS), also previously known as the California department of Health, is charged with the mission to protect and improve the health of citizens. The department promotes public health through programs that offer direct care and education. Services offered by the CDHS include medical care, public health education, preventive medical services, environmental health programs, and special needs programs.

INTRODUCTION

Public health is a branch of preventative medicine concerned with the physical, mental, social, and environmental health of the community as a whole. From everyday lifestyle needs such as food and workplace safety to proper childhood care, public health professionals apply scientific principles to analyze a community environment and institute measures that promote community well-being.

Most developed countries support national public health institutions that research current health trends, and rely on information provided to them by smaller, local public health centers throughout the country to help predict future trends. For instance, the Centers for Disease Control and Prevention (CDC) in the Unites States, among its other functions, collect and analyze data provided by state and local health departments. Special methods of information gathering regarding disease prevalence, along with methods to recognize patterns and institute control measures for significant findings, form the basis of epidemiology. Epidemiologists use statistics to find relationships between the incidence of disease and correlating factors, such as diet, lifestyle patterns, and the environment.

Actual health care and many public education programs designed to prevent illness are operated by state and local health agencies. Regardless of the level of the organization, public health agencies assist the government involved to enact temporary measures, or pass legislation to protect the health of the population at large.

Vaccination helps the immune system prepare defenses that protect against specific severe or lethal diseases. Both medically and socially significant, vaccines offer protection from a range of diseases.

Vaccination specifically refers to a procedure in which the presence of an antigen (a foreign substance that stimulates an immune response) stimulates the formation of antibodies that are designed to destroy the antigen. In a properly functioning immune system, the exposure to a less potent (also known as attenuated) form of an antigen in a vaccine helps the immune system prepare antibodies that can then attack more potent forms of the antigen (or the antigen carrier, such as a virus). Antibodies act to protect the host from future exposure to the antigen.

Techniques of vaccination have been practiced since early in the eighteenth century when a common practice in Turkey was to expose uninfected individuals to scrapings of a lesion from those infected with smallpox. This exposure to the antigen allowed the buildup of immunity that in many cases protected the vaccinated individual from contracting the disease. Subsequently, in 1796, the English physician Edward Jenner (1749–1823) refined the technique and produced a vaccine for cowpox.

In addition to medical significance, the advancement of vaccines has carried significant social impact. For example, poliomyelitis, commonly known as polio, an infectious viral disease of childhood that often resulted in severe muscle paralysis, created a lingering atmosphere of fear in the United States during the first half of the twentieth century. Mothers isolated their children from both playmates and public locations to prevent exposure to the disease. By 1954, American physician Jonas Salk (1914–1995) tested his polio vaccine made from the killed virus, and Americans eagerly waited in lines at public health centers (many of these were makeshift sites in schools or auditoriums) by the thousands to inoculate their children. Polio is now on the brink of global extinction, with vaccination routine in the developed world, and efforts to vaccinate those in remote areas continuing.

The schedule at which a vaccine is administered is important for its effectiveness. Often, vaccines require a series of inoculations given at specific intervals. The need to follow a specific vaccination schedule represents the main thrust of the poster illustrated, and is found as a common component of many such public health awareness posters.

The poster titled, "How Many Immunizations Does It Take To Protect Your Child?" represents a class of publications promoted by public health officials who are charged with protecting and improving the physical, mental, social, and environmental health of the community.

Public education programs, exemplified by the poster, are designed to prevent illness and to protect the health of the population at large.

PRIMARY SOURCE

IMMUNIZATION CAMPAIGNS

See primary source image.

SIGNIFICANCE

During the late 1970s and early 1980s, the rise of individualism and the popularity of self-help movements in the United States and Western Europe provided a new challenge to public health officials. Individuals began to take control of their own heath care and, in essence, some control and responsibility was wrested away from the physician and other health care workers. This presented a special challenge to public health agencies who now had to turn from campaigns that simply encouraged people to see their physician (or warned them against certain behaviors), to public awareness campaigns that provided specific and detailed information such as the course of childhood vaccinations and the schedule for those vaccinations.

Public health agencies used posters to appeal to a population increasingly dependent on visual media as a format that could inexpensively capture attention and convey vital information.

The development of vaccines that offer protection from a range of diseases, including polio, smallpox, and measles, is considered among the most significant of accomplishments of medical science. Current research continues to develop vaccines against diseases such as acquired immune deficiency syndrome (AIDS), additional types of influenza, and certain types of cancer.

Vaccination is currently carried out by a variety of methods, such as injection, inhalation, or oral ingestion.

The material used for vaccination can be divided into four classes.

Vaccines with living, but weakened, viruses are termed attenuated vaccines. The attenuated virus does not cause a severe infection, but does present the body with sufficient challenge to mount and thus "learn" an immune response. The MMR vaccine (the common abbreviation for the measles, mumps, and rubella vaccine), such as mentioned in the poster, is an example of an attenuated vaccine.

Vaccination can also involve the use of dead viruses and bacteria. The antigen, usually a specific molecule that resides on the surface of the cell, is sufficient alone to provoke an immune response that subsequently provides protection against live bacteria or virus carrying the same surface molecule.

The third type of vaccination uses toxin produced by the living bacterium, but not the bacteria themselves. Diphtheria and tetanus vaccines are examples of toxoid vaccines promoted by the poster.

The fourth class of vaccine is engineered, or uses a chemical compound formed from the fusion of portions of two antigens. The Haemophilus influenzae type b (Hib) vaccine, promoted in the poster, is such a biosynthetic vaccine.

The emphasis on proper vaccinations for children is especially important because during the first two years of life, it is important to develop immune protection against a number of viral and bacterial diseases, including, polio, hepatitis B, MMR, pertussis (also called whooping cough), diphtheria, tetanus, Haemophilus influenzae type b, and certain pneumococcal infections.

Often, a single exposure or vaccination will not produce the desired level of immune protections and so repeated exposure is provided by following an optimal vaccination schedule. For example, the vaccination against diphtheria, tetanus, and pertussis (DTP) is typically administered, as depicted in the poster, at two, four, and six months of age, again at fifteen to eighteen months, then at four to six years of age.

The duration of protection from disease varies according to the disease. In some cases there is lifelong immunity, but others such as tetanus require repeated exposure via "booster" vaccinations. Although vaccination carries a slight risk of complications ranging from soreness at the injection site to, rarely, illness and death, the risks of not being vaccinated are shown statistically as far more dangerous.

In addition to oversight of adequate production and distribution of vaccines, public health officials at the local, national, and international level are charged with the responsibility to educate the public regarding vaccines available, and the proper course of administration. Public health achievements such as the promotion of vaccination through health education programs have benefited millions throughout the world. As a result of global vaccination efforts, eighty percent of the world's children are vaccinated against major childhood diseases such as diphtheria, pertussis, measles, polio, and tetanus, and, globally, child mortality has decreased since 1980.

The political realities of the twenty-first century create new concerns for public health officials and vaccination education programs. For example, the last known case of smallpox occurred in Africa in 1977, and smallpox vaccinations are no longer routinely necessary as the disease is considered eradicated. However, recent concerns regarding the potential for deliberate use of smallpox virus as a bioterror weapon force government and public health officials to continue to prepare for a smallpox outbreak. The stockpile of smallpox vaccine in the United States in 2005 was estimated at only 15 million doses. Even if diluted to minimal levels that provide clinical effectiveness, the vaccine supply would be sufficient for less than half the population of the United States. In case of mass exposure to smallpox or an outbreak, the current strategy calls for using the vaccine supply for those affected and to create a ring of protection in the population surrounding the outbreak. The level of protection still offered to older Americans by virtue of their own childhood smallpox vaccination remains a question of scientific interest and debate.

FURTHER RESOURCES

Books

Hopkins, D. R. The Greatest Killer: Smallpox in History. Chicago: University of Chicago Press, 2002.

Koop, C. Everett. Critical Issues in Global Health. Hoboken, N.J.: John Wiley & Sons, 2002.

Link, Kurt, The Vaccine Controversy: The History, Use, and Safety of Vaccinations. Westport, Conn.: Praeger, 2005.

Preston, Richard. The Demon in the Freezer. New York: Random House, 2002.

Periodicals

Henderson, D. A., et al. "Smallpox as a Biological Weapon: Medical and Public Health Management." Journal of the American Medical Association 281 (1999): 2127-2137.

Rosenthal, S. R., M. Merchlinsky, C. Kleppinger, et. al. "Developing New Smallpox Vaccines." Emerging Infectious Diseases 7 (2001): 920-926.

Web sites

Centers for Disease Control and Prevention. "Smallpox Factsheet: Vaccine Overview." Public Health Emergency Preparedness and Response. December 9, 2002. 〈http://www.bt.cdc.gov/agent/smallpox/vaccination/facts.asp〉 (accessed June 2, 2005).

National Library of Medicine. "History of Medicine." 〈http://www.nlm.nih.gov/hmd/index.html〉 (accessed June 2, 2005).