EPIDEMIOLOGY AND PREVENTION OFVACCINE- PREVENTABLE DISEASES
SES13TH EDITIONThis book was produced by the Communication and Education Branch, National Center for Immunizationand Respiratory Diseases, Centers for Disease Control and Prevention, who is solely responsible for itscontent. It was printed and distributed by the Public Health Foundation. For additional copies, contact thePublic Health Foundation at 877–252–1200 or website http://bookstore.phf.org/.Slide sets to accompany this book are available on the CDC Vaccines and Immunization website html.E-mail address for comments, questions or suggestions about the contents of this book: nipinfo@cdc.gov.Edited by:Jennifer Hamborsky, MPH, MCHESAndrew Kroger, MD, MPHCharles (Skip) WolfeU.S.Department ofHealth and Human ServicesCenters for DiseaseControl and PreventionApril, 2015
On the coverThis illustration depicts the influenza virus.Graphic created by Dan J. Higgins, Division of Communication Services, CDCSuggested Citation:Centers for Disease Control and Prevention.Epidemiology and Prevention of Vaccine-Preventable Diseases.Hamborsky J, Kroger A, Wolfe S, eds. 13th ed. Washington D.C.Public Health Foundation, 2015.Use of trade names and commercial sources is for identification only and does not imply endorsement by thePublic Health Services or the U.S. Department of Health and Human Services. References to non-CDC siteson the Internet are provided as a service to readers and do not constitute or imply endorsement of theseorganizations or their programs by CDC or the U.S. Department of Health and Human Services. CDC is notresponsible for the content of these sites. URL addresses were current as of the date of publication.The editors would like to thank Dr. William L. Atkinson, who summarized, standardized and compiledCDC’s vaccine-preventable disease and vaccine teaching materials to create the Pink Book.“He just thought it up and did it.” – Apocalypse NowMilestones in the History of Vaccination400BCEHippocrates describesdiphtheria, epidemic jaundice,and other conditionsii1100sVariolation for smallpox firstreported in China1721Variolation introducedinto Great Britain1796Edward Jenner inoculates James Phipps withcowpox, and calls the procedure vaccination("vacca" is Latin for cow)
Table of Contents1 Principles of VaccinationImmunology and Vaccine-Preventable Diseases. . . . . . . . . . . . . . . . 1Classification of Vaccines. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4Selected References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72 General Recommendations on ImmunizationTiming and Spacing of Vaccines. . . . . . . . . . . . . . . . . . . . . . . . . . . . 9Adverse Reactions Following Vaccination . . . . . . . . . . . . . . . . . . . 15Contraindications and Precautions to Vaccination . . . . . . . . . . . . 17Invalid Contraindications to Vaccination. . . . . . . . . . . . . . . . . . . . 24Screening for Contraindications and Precautions to Vaccination. . . 28Selected References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 313 Immunization Strategies for Healthcare Practicesand ProvidersThe Need for Strategies to Increase Immunization Levels. . . . . . . . 33The AFIX Approach . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34Other Essential Strategies. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39Selected References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 454 Vaccine SafetyThe Importance of Vaccine Safety Programs. . . . . . . . . . . . . . . . . 47Sound Immunization Recommendations and Policy . . . . . . . . . . . 49Assessing and Monitoring Safety of Vaccines. . . . . . . . . . . . . . . . . 50Vaccine Injury Compensation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54The Immunization Provider’s Role . . . . . . . . . . . . . . . . . . . . . . . . 55Selected References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 605 Storage and HandlingVaccine Storage and Handling . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63Receiving and Unpacking Vaccine Deliveries . . . . . . . . . . . . . . . . . 66Vaccine Storage and Temperature Monitoring Equipment. . . . . . . 67Vaccine and Diluent Placement and Labeling. . . . . . . . . . . . . . . . . 70Vaccine Storage Troubleshooting. . . . . . . . . . . . . . . . . . . . . . . . . . 71Vaccine and Diluent Inventory Control . . . . . . . . . . . . . . . . . . . . . 73Selected References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 776 Vaccine AdministrationStaff Training and Education. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79Patient Care Before Administering Vaccine . . . . . . . . . . . . . . . . . . 80Patient Care During Vaccine Administration. . . . . . . . . . . . . . . . . 83Infection Control. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87Vaccine Preparation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88Milestones in the History of Vaccination1870Louis Pasteur creates thefirst live attenuated bacterialvaccine (chicken cholera)1884-85Pasteur creates the firstlive attenuated viral vaccine foruse in humans1900Paul Ehrlich formulatesreceptor theory of immunity1901First Nobel Prize in Medicineto von Behring fordiphtheria antitoxin1909Theobald Smith discovers amethod for inactivatingdiphtheria toxiniii
Table of ContentsRoute and Site. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91Nonstandard Administration. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99Managing Acute Vaccine Reactions. . . . . . . . . . . . . . . . . . . . . . . 100Documentation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101Strategies to Prevent Administration Errors. . . . . . . . . . . . . . . . . 102Vaccine Adverse Event Reporting System (VAERS). . . . . . . . . . . . 104Selected References and Resources . . . . . . . . . . . . . . . . . . . . . . . 1047 DiphtheriaCorynebacterium diphtheriae. . . . . . . . . . . . . . . . . . . . . . . . . . . . 107Pathogenesis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107Clinical Features. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108Complications. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109Laboratory Diagnosis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110Medical Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110Epidemiology. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111Secular Trends in the United States. . . . . . . . . . . . . . . . . . . . . . . 112Diphtheria Toxoid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113Vaccination Schedule and Use. . . . . . . . . . . . . . . . . . . . . . . . . . . 114Contraindications and Precautions to Vaccination . . . . . . . . . . . 115Adverse Events Following Vaccination. . . . . . . . . . . . . . . . . . . . . 115Adverse Reactions Following Vaccination . . . . . . . . . . . . . . . . . . 115Vaccine Storage and Handling. . . . . . . . . . . . . . . . . . . . . . . . . . . 116Suspect Case Investigation and Control. . . . . . . . . . . . . . . . . . . . 116Selected References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1178 Haemophilus influenzaeHaemophilus influenzae . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119Pathogenesis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 120Clinical Features. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121Laboratory Diagnosis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121Medical Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 122Epidemiology. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123Secular Trends in the United States. . . . . . . . . . . . . . . . . . . . . . . 123Haemophilus influenzae type b Vaccines. . . . . . . . . . . . . . . . . . . 125Vaccination Schedule and Use. . . . . . . . . . . . . . . . . . . . . . . . . . . 126Monvalent Vaccines. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 128Combination Vaccines. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 130Contraindications and Precautions to Vaccination . . . . . . . . . . . 131Adverse Reactions Following Vaccination . . . . . . . . . . . . . . . . . . 132Vaccine Storage and Handling. . . . . . . . . . . . . . . . . . . . . . . . . . . 132Surveillance and Reporting of Hib Disease . . . . . . . . . . . . . . . . . 132Selected References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 132Milestones in the History of Vaccination1919Calmette and Guerin createBCG, the first live attenuatedbacterial vaccine for humansiv1923First whole-cell pertussisvaccine testedGaston Ramon developsdiphtheria toxoid1926Ramon and Christian Zoellerdevelop tetanus toxoid1931Goodpasture describes atechnique for viral culturein hens’ eggs1936Thomas Francis and ThomasMagill develop the firstinactivated influenza vaccine
Table of Contents9 Hepatitis AHepatitis A Virus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135Pathogenesis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135Clinical Features. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 136Complications. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 136Laboratory Diagnosis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 136Medical Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137Epidemiology. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137Secular Trends in the United States. . . . . . . . . . . . . . . . . . . . . . . 139Case Definition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141Hepatitis A Vaccine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141Vaccination Schedule and Use. . . . . . . . . . . . . . . . . . . . . . . . . . . 142Contraindications and Precautions to Vaccination . . . . . . . . . . . 146Adverse Reactions Following Vaccination . . . . . . . . . . . . . . . . . . 147Vaccine Storage and Handling. . . . . . . . . . . . . . . . . . . . . . . . . . . 147Postexposure Prophylaxis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147Selected References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14710 Hepatitis BHepatitis B Virus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 149Clinical Features. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 150Complications. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151Laboratory Diagnosis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 152Medical Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 154Epidemiology. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 154Secular Trends in the United States. . . . . . . . . . . . . . . . . . . . . . . 156Hepatitis B Prevention Strategies. . . . . . . . . . . . . . . . . . . . . . . . . 157Hepatitis B Vaccine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 158Vaccination Schedule and Use. . . . . . . . . . . . . . . . . . . . . . . . . . . 161Serologic Testing of Vaccine Recipients. . . . . . . . . . . . . . . . . . . . 166Postexposure Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 168Contraindications and Precautions to Vaccination . . . . . . . . . . . 172Adverse Events Following Vaccination. . . . . . . . . . . . . . . . . . . . . 172Adverse Reactions Following Vaccination . . . . . . . . . . . . . . . . . . 172Vaccine Storage and Handling. . . . . . . . . . . . . . . . . . . . . . . . . . . 173Selected References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17311 Human PapillomavirusHuman Papillomavirus. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 175Pathogenesis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 175Clinical Features. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 176Laboratory Diagnosis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 176Medical Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 177Epidemiology. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 177Disease Burden in the United States . . . . . . . . . . . . . . . . . . . . . . 178Prevention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 178Milestones in the History of Vaccination1948John Enders and colleaguesisolate Lansing Type IIpoliovirus in human cell line 1954Enders and Peeblesisolate measles virusFrancis Field Trial of inactivatedpolio vaccine1955Inactivated polio vaccinelicensed1961Human diploid cell linedeveloped1963Measles vaccine licensedTrivalent oral poliovaccine licensedv
Table of ContentsHuman Papillomavirus Vaccine. . . . . . . . . . . . . . . . . . . . . . . . . . 179Vaccination Schedule and Use. . . . . . . . . . . . . . . . . . . . . . . . . . . 181Contraindications and Precautions to Vaccination . . . . . . . . . . . 183Adverse Reactions Following Vaccination . . . . . . . . . . . . . . . . . . 184Vaccine Storage and Handling. . . . . . . . . . . . . . . . . . . . . . . . . . . 184Selected References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18512 InfluenzaInfluenza Virus. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 187Pathogenesis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 190Clinical Features. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 190Complications. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 190Impact of Influenza . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 191Laboratory Diagnosis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 192Epidemiology. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 192Secular Trends in the United States. . . . . . . . . . . . . . . . . . . . . . . 193Influenza Vaccines . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 193Vaccination Schedule and Use. . . . . . . . . . . . . . . . . . . . . . . . . . . 196Contraindications and Precautions to Vaccination . . . . . . . . . . . 199Adverse Events Following Vaccination. . . . . . . . . . . . . . . . . . . . . 200Adverse Reactions Following Vaccination . . . . . . . . . . . . . . . . . . 201Vaccine Storage and Handling. . . . . . . . . . . . . . . . . . . . . . . . . . . 203Strategies for Improving Influenza Vaccine Coverage. . . . . . . . . . 203Antiviral Agents for Influenza. . . . . . . . . . . . . . . . . . . . . . . . . . . . 204Nosocomial Influenza Control. . . . . . . . . . . . . . . . . . . . . . . . . . . 205Influenza Surveillance. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 206Selected References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20613 MeaslesMeasles Virus. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 209Pathogenesis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 209Clinical Features. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 210Complications. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 210Laboratory Diagnosis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 212Epidemiology. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 213Secular Trends in the United States. . . . . . . . . . . . . . . . . . . . . . . 214Measles Vaccine. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 217Vaccination Schedule and Use. . . . . . . . . . . . . . . . . . . . . . . . . . . 218Contraindications and Precautions to Vaccination . . . . . . . . . . . 222Adverse Events Following Vaccination. . . . . . . . . . . . . . . . . . . . . 225Adverse Reactions Following Vaccination . . . . . . . . . . . . . . . . . . 226Vaccine Storage and Handling. . . . . . . . . . . . . . . . . . . . . . . . . . . 227Selected References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 228Milestones in the History of Vaccination1965Bifurcated needle forsmallpox vaccine licensedvi1966World Health Assemblycalls for global smallpoxeradication1967Maurice Hilleman developsJeryl Lynn strain ofmumps virus1969Stanley Plotkin developsRA 27/3 strain of rubellavaccine virus1971MMR vaccine licensed
Table of Contents14 Meningococcal DiseaseNeisseria meningitidis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 231Pathogenesis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 232Clinical Features. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 232Laboratory Diagnosis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 233Medical Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 234Epidemiology. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 234Secular Trends in the United States. . . . . . . . . . . . . . . . . . . . . . . 234Meningococcal Vaccines . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 236Vaccination Schedule And Use. . . . . . . . . . . . . . . . . . . . . . . . . . . 239Contraindications and Precautions to Vaccination . . . . . . . . . . . 241Adverse Events Following Vaccination. . . . . . . . . . . . . . . . . . . . . 241Adverse Reactions Following Vaccination . . . . . . . . . . . . . . . . . . 242Vaccine Storage and Handling. . . . . . . . . . . . . . . . . . . . . . . . . . . 242Surveillance and Reporting of Meningococcal Disease . . . . . . . . 243Antimicrobial Chemoprophylaxis. . . . . . . . . . . . . . . . . . . . . . . . . 243Selected References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24415 MumpsMumps Virus. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 247Pathogenesis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 247Clinical Features. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 247Complications. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 248Laboratory Diagnosis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 249Epidemiology. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 251Secular Trends in the United States. . . . . . . . . . . . . . . . . . . . . . . 251Mumps Vaccine. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 253Vaccination Schedule and Use. . . . . . . . . . . . . . . . . . . . . . . . . . . 253Contraindications and Precautions to Vaccination . . . . . . . . . . . 255Adverse Events Following Vaccination. . . . . . . . . . . . . . . . . . . . . 256Adverse Reactions Following Vaccination . . . . . . . . . . . . . . . . . . 257Vaccine Storage and Handling. . . . . . . . . . . . . . . . . . . . . . . . . . . 257Select
It was printed and distributed by the Public Health Foundation. For additional copies, contact the . smallpox vaccine licensed 1966 World Health Assembly calls for global smallpox eradication . Smallpox vaccine withdrawn from civilian market 1986 First recombinant vaccine licensed (hepatitis B)
Introduction to Epidemiology Epidemiology yIs the process to study the distribution and determinants of disease frequency yIs a discipline which approaches problems systematically and quantitatively yIs the basic science of public health The Public Health Cycle Measure/Evaluate Epidemiology Analyze Epidemiology Communicate Intervene Epidemiology
Introduction to Epidemiology and Genetic Epidemiology. Major goals in Epidemiology To obtain an unbiased & precise estimate of the true effect of an exposure or intervention on outcome in the population at risk To use this knowledge to prevent and treat disease.
Key words Epidemiology: , Familial aggregation, Genetic dominance, Genetic epidemi ology, Heritability, Popperian philosophy, Sampling, Shared environment, Twins. INTRODUCTION What is genetic epidemiology? Epidemiology has been defined as the "study of the distribution and determinants of health-related states and events in populations" [32].
Introduction to Genetic Epidemiology Different faces of genetic epidemiology K Van Steen 2 DIFFERENT FACES OF GENETIC EPIDEMIOLOGY 1 Basic epidemiology . Clayton D. Introduction to genetics (course slides Bristol 2003) Bon
COVID-19 in Children and Teens. Angela Campbell, MD, MPH, FPIDS, FIDSA. Virtual ACIP Emergency Meeting. January 27, 2021. Outline Overview of U.S. COVID -19 Epidemiology Epidemiology of COVID-19 in Children and Teens Multisystem Inflammatory Syndrome in Children (MIS-C) 2. Overview of U.S. COVID-19 Epidemiology. 0. 50000. 100000. 150000. 200000. 250000 . 300000. 350000. Jan 22 2020. Mar 7 2020 .
Principles of EPIDEMIOLOGY Second Edition An Introduction to Applied Epidemiology and Biostatistics 12/92 U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Public Health Service Centers for Disease Control and Prevention (CDC) Epidemiology Program Office Pub
Injury Epidemiology Thomas Songer, PhD University of Pittsburgh Center for Injury Research & Control Moving Towards Competency in Injury Prevention History forms the basis for many of the decisions and actions in epidemiology. Much of the current research in injury epidemiology is heavily influenced by the events of the past.
Introduction 1 Part I Ancient Greek Criticism 7 Classical Literary Criticism: Intellectual and Political Backgrounds 9 1 Plato (428–ca. 347 bc)19 2 Aristotle (384–322 bc)41 Part II The Traditions of Rhetoric 63 3 Greek Rhetoric 65 Protagoras, Gorgias, Antiphon, Lysias, Isocrates, Plato, Aristotle 4 The Hellenistic Period and Roman Rhetoric 80 Rhetorica, Cicero, Quintilian Part III Greek .
