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| | __NOTOC__ |
| | {{Meningitis}} |
| | {{CMG}}; {{AE}}{{MehdiP}} |
| ==Overview== | | ==Overview== |
| Vaccination is the administration of agent-specific, but relatively harmless, [[antigenic]] components that in vaccinated individuals can induce protective [[immunity]] against the corresponding [[infectious agent]]. In practice, the terms '''vaccination''' and '''immunization''' are often used interchangeably. Vaccination is highly effective to prevent some particular infections. Vaccines are safe with minimal adverse reactions. vaccination can prevents illness, disability and death from vaccine-preventable diseases including [[cervical cancer]], [[diphtheria]], [[hepatitis B]], [[measles]], [[mumps]], [[pertussis]], [[pneumonia]], [[polio]], [[rotavirus]] diarrhea, [[rubella]] and [[tetanus]]. Vaccines help develop [[immunity]] by imitating an infection. This type of infection, however, does not cause illness, but it does cause the [[immune system]] to produce [[T-lymphocytes]] and [[antibodies]]. Immunization currently averts an estimated 2 to 3 million deaths every year. An additional 1.5 million deaths could be avoided, however, if global vaccination coverage improves. An estimated 19.4 million infants worldwide are still missing out on basic vaccines. The material administrated as vaccine, can either be live, but weakened forms of [[pathogens]] such as [[bacteria]] or [[viruses]], killed or inactivated forms of these pathogens, or purified material such as [[proteins]].<br>
| | |
| [[Benjamin Jesty]] is notable as perhaps the first person recorded to have [[vaccinated]] with [[cowpox]] in order to artificially induce immunity to [[smallpox]] in the [[epidemic]] of 1774. The term [[vaccination]] was first used by [[Edward Jenner]] an English physician 22 years later in 1796. [[Pasteur|Louis Pasteur]] further adapted in his pioneering work in microbiology. Vaccination (''vacca'' in [[latin]] means ''cow'') is so named because the first [[vaccine]] was derived from a [[virus (biology)|virus]] affecting cow, the relatively benign [[cowpox]] virus, which provides a degree of immunity to [[smallpox]], a contagious and deadly disease which, the World Health Organization coordinated the global effort to eradicate this disease. The last naturally occurring case of smallpox occurred in Somalia in 1977.
| | ==Causes== |
| ==Vaccine preventable diseases==
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| <br>
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| |+ align="center" style="background:#4479BA; color: #FFFFFF;" |'''Characteristics of diseases vaccinated against in most vaccine schedules<ref name= "WHO">[http://www.who.int/immunization/topics/en/ '''Estimated''' Incidence/deaths] World Health Organization ''Immunization, Vaccines and Biologicals'' Year 2000 data </ref><ref name= "CDC1">[http://www.cdc.gov/nip/publications/pink/Appendices/appdx-full-g.pdf '''Reported''' cases/deaths (pdf)] CDC "Pink Pages", Year 2002 data </ref><ref name=UK1>[http://www.immunisation.nhs.uk/article.php?id=91 '''Reported''' cases/deaths] NHS Immunisation Information, Year 2000 data (unless noted)</ref><ref>[http://www.who.int/mediacentre/factsheets/fs286/en/ See also: Estimated regional measles deaths (with uncertainty bounds)] Fact sheet N°286 (2004). The World Health Organization (WHO) and UNICEF. Revised March 2006.</ref><ref name= "WHO2005">(2005 data) Polio is endemic in only four countries; Nigeria, India, Afghanistan and Pakistan</ref><ref>(year 2000: due to [[neonatal tetanus]] from non-sterile delivery and/or umbilical severing tools)</ref><ref>[http://www.cdc.gov/nchstp/tb/surv/surv2005/PDF/table1.pdf ''Reported Tuberculosis in the United States''] The National Center for HIV, STD, and TB Prevention Statistics: 2002</ref>'''
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| |rowspan="2" align="center" style="background:#DCDCDC;"| Disease
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| !colspan="2" align="center" style="background:#DCDCDC;"| Characteristics
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| !colspan="2" align="center" style="background:#DCDCDC;"| Worldwide
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| !colspan="2" align="center" style="background:#DCDCDC;"| U.S.
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| !colspan="2" align="center" style="background:#DCDCDC;"| U.K.
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| |-
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| !align="center" style="background:#DCDCDC;"|Transmission
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| !align="center" style="background:#DCDCDC;"|Incubation
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| !align="center" style="background:#DCDCDC;"|Incidence
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| !align="center" style="background:#DCDCDC;"|Deaths
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| !align="center" style="background:#DCDCDC;"|Incidence
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| !align="center" style="background:#DCDCDC;"|Deaths
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| !align="center" style="background:#DCDCDC;"|Incidence
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| !align="center" style="background:#DCDCDC;"|Deaths
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| |-
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| |align="left" style="background:#DCDCDC;"|[[Diphtheria]]
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| |style="padding: 5px 5px; background: #F5F5F5;" align="center" | Saliva
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| |style="padding: 5px 5px; background: #F5F5F5;" align="center" | 1-4 days
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| |style="padding: 5px 5px; background: #F5F5F5;" align="center" | 30,000
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| |style="padding: 5px 5px; background: #F5F5F5;" align="center" | 3,000
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| |style="padding: 5px 5px; background: #F5F5F5;" align="center" | 1
| |
| |style="padding: 5px 5px; background: #F5F5F5;" align="center" | 0
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| |style="padding: 5px 5px; background: #F5F5F5;" align="center" | 0
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| |style="padding: 5px 5px; background: #F5F5F5;" align="center" | 0
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| |-
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| |align="left" style="background:#DCDCDC;"|[[Haemophilus influenzae|Haemophilus <br>influenzae]]
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| |style="padding: 5px 5px; background: #F5F5F5;" align="center" |Airborne droplet
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| |style="padding: 5px 5px; background: #F5F5F5;" align="center" |1-4 days
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| |style="padding: 5px 5px; background: #F5F5F5;" align="center" |2-3,000,000
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| |style="padding: 5px 5px; background: #F5F5F5;" align="center" |450,000<br/><small>(mostly children)</small>
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| |style="padding: 5px 5px; background: #F5F5F5;" align="center" | 1,743
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| |style="padding: 5px 5px; background: #F5F5F5;" align="center" | 7
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| |style="padding: 5px 5px; background: #F5F5F5;" align="center" | 30
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| |style="padding: 5px 5px; background: #F5F5F5;" align="center" | 0
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| |-
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| |align="left" style="background:#DCDCDC;"|[[Hepatitis B]]
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| |style="padding: 5px 5px; background: #F5F5F5;" align="center" | Contact with body fluids
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| |style="padding: 5px 5px; background: #F5F5F5;" align="center" | 6 weeks - 6 months
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| |style="padding: 5px 5px; background: #F5F5F5;" align="center" | 5,700,00 <small>(acute)</small>
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| |style="padding: 5px 5px; background: #F5F5F5;" align="center" | 521,000
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| |style="padding: 5px 5px; background: #F5F5F5;" align="center" | 7,996
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| |style="padding: 5px 5px; background: #F5F5F5;" align="center" | 7
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| |style="padding: 5px 5px; background: #F5F5F5;" align="center" | 600
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| |style="padding: 5px 5px; background: #F5F5F5;" align="center" | <small>Not reported</small>
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| |-
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| |align="left" style="background:#DCDCDC;"|[[Measles]]
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| |style="padding: 5px 5px; background: #F5F5F5;" align="center" |Airborne
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| |style="padding: 5px 5px; background: #F5F5F5;" align="center" |10-12 days
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| |style="padding: 5px 5px; background: #F5F5F5;" align="center" |30-40,000,000
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| |style="padding: 5px 5px; background: #F5F5F5;" align="center" |610,000
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| |style="padding: 5px 5px; background: #F5F5F5;" align="center" | 44
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| |style="padding: 5px 5px; background: #F5F5F5;" align="center" | 0
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| |style="padding: 5px 5px; background: #F5F5F5;" align="center" | 77
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| |style="padding: 5px 5px; background: #F5F5F5;" align="center" | 1
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| |-
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| |align="left" style="background:#DCDCDC;"|[[Mumps]]
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| |style="padding: 5px 5px; background: #F5F5F5;" align="center" |Airborne droplets
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| |style="padding: 5px 5px; background: #F5F5F5;" align="center" |14-21 days
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| |style="padding: 5px 5px; background: #F5F5F5;" align="center" |477,079 <small>(reported)</small>
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| |style="padding: 5px 5px; background: #F5F5F5;" align="center" | N/A
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| |style="padding: 5px 5px; background: #F5F5F5;" align="center" | 270
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| |style="padding: 5px 5px; background: #F5F5F5;" align="center" | 1
| |
| |style="padding: 5px 5px; background: #F5F5F5;" align="center" | 16,436
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| |style="padding: 5px 5px; background: #F5F5F5;" align="center" | 0
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| |-
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| |align="left" style="background:#DCDCDC;"|[[Pertussis]]
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| |style="padding: 5px 5px; background: #F5F5F5;" align="center" |Airborne droplets
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| |style="padding: 5px 5px; background: #F5F5F5;" align="center" |5-10 days
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| |style="padding: 5px 5px; background: #F5F5F5;" align="center" |39,000,000
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| |style="padding: 5px 5px; background: #F5F5F5;" align="center" |297,000
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| |style="padding: 5px 5px; background: #F5F5F5;" align="center" | 9,771
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| |style="padding: 5px 5px; background: #F5F5F5;" align="center" | 18
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| |style="padding: 5px 5px; background: #F5F5F5;" align="center" | 2
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| |style="padding: 5px 5px; background: #F5F5F5;" align="center" | 2
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| |-
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| |align="left" style="background:#DCDCDC;"|[[Polio]]
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| |style="padding: 5px 5px; background: #F5F5F5;" align="center" |Fecal contamination
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| |style="padding: 5px 5px; background: #F5F5F5;" align="center" |Hours
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| |style="padding: 5px 5px; background: #F5F5F5;" align="center" | 1,951
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| |style="padding: 5px 5px; background: #F5F5F5;" align="center" |<1,000
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| |style="padding: 5px 5px; background: #F5F5F5;" align="center" | 0
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| |style="padding: 5px 5px; background: #F5F5F5;" align="center" | 0
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| |style="padding: 5px 5px; background: #F5F5F5;" align="center" | 0
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| |style="padding: 5px 5px; background: #F5F5F5;" align="center" | 0
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| |-
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| |align="left" style="background:#DCDCDC;"|[[Rubella]]
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| |style="padding: 5px 5px; background: #F5F5F5;" align="center" |Airborne droplets
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| |style="padding: 5px 5px; background: #F5F5F5;" align="center" |5-7 days
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| |style="padding: 5px 5px; background: #F5F5F5;" align="center" |<small>Not reported</small>
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| |style="padding: 5px 5px; background: #F5F5F5;" align="center" |631,571 <br>[[Congenital rubella syndrome]] (CRS)
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| |style="padding: 5px 5px; background: #F5F5F5;" align="center" | 18
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| |style="padding: 5px 5px; background: #F5F5F5;" align="center" | (1 CRS)
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| |style="padding: 5px 5px; background: #F5F5F5;" align="center" | 0
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| |style="padding: 5px 5px; background: #F5F5F5;" align="center" | 0
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| |-
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| |align="left" style="background:#DCDCDC;"|[[Tetanus]]
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| |style="padding: 5px 5px; background: #F5F5F5;" align="center" |Penetrating injury, <br>blood contamination, <br>
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| |style="padding: 5px 5px; background: #F5F5F5;" align="center" |3-10 days
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| |style="padding: 5px 5px; background: #F5F5F5;" align="center" |18,781
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| |style="padding: 5px 5px; background: #F5F5F5;" align="center" |200,000
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| |style="padding: 5px 5px; background: #F5F5F5;" align="center" | 25
| |
| |style="padding: 5px 5px; background: #F5F5F5;" align="center" | 5
| |
| |style="padding: 5px 5px; background: #F5F5F5;" align="center" | 6
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| |style="padding: 5px 5px; background: #F5F5F5;" align="center" | 0
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| |-
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| |align="left" style="background:#DCDCDC;"|[[Tuberculosis]]
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| |style="padding: 5px 5px; background: #F5F5F5;" align="center" |Airborne
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| |style="padding: 5px 5px; background: #F5F5F5;" align="center" |3 day - 15 weeks
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| |style="padding: 5px 5px; background: #F5F5F5;" align="center" |8,000,000
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| |style="padding: 5px 5px; background: #F5F5F5;" align="center" |1,600,000
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| |style="padding: 5px 5px; background: #F5F5F5;" align="center" | 15,056
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| |style="padding: 5px 5px; background: #F5F5F5;" align="center" | 784
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| |style="padding: 5px 5px; background: #F5F5F5;" align="center" | 6,572
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| |style="padding: 5px 5px; background: #F5F5F5;" align="center" | 373
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| |-
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| |align="left" style="background:#DCDCDC;"|[[Varicella]]
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| |style="padding: 5px 5px; background: #F5F5F5;" align="center" |Airborne
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| |style="padding: 5px 5px; background: #F5F5F5;" align="center" |2 weeks
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| |style="padding: 5px 5px; background: #F5F5F5;" align="center" |<small>Not reported</small>
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| |style="padding: 5px 5px; background: #F5F5F5;" align="center" |<small>Not reported</small>
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| |style="padding: 5px 5px; background: #F5F5F5;" align="center" | 22,841
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| |style="padding: 5px 5px; background: #F5F5F5;" align="center" | 32
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| |style="padding: 5px 5px; background: #F5F5F5;" align="center" |<small>Not reported</small>
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| |style="padding: 5px 5px; background: #F5F5F5;" align="center" |<small>Not reported</small>
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| |-
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| |}
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| |}
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| ==Classification== | | ==Classification== |
| <br><br>
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| {{familytree/start}}
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| {{familytree | | | | | | | | | | | | | | | | | | | | | A01 | | | | | |A01=Immunization}}
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| {{familytree | | | | | | | | | | | |,|-|-|-|-|-|-|-|-|-|^|-|-|-|-|-|-|-|-|-|-|-|-|.| }}
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| {{familytree | | | | | | | | | | | B01 | | | | | | | | | | | | | | | | | | | | | B02 |B01='''Passive'''|B02='''Active (vaccination)'''}}
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| {{familytree | | | | | |,|-|-|-|-|-|+|-|-|-|-|-|.| | | | | | |,|-|-|-|-|v|-|-|-|-|+|-|-|-|-|v|-|-|-|-|.|}}
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| {{familytree | | | | | C01 | | | | C02 | | | | C03 | | | | | C04 | | | C05 | | | C06 | | | C07 | | | C08 |C01=Human immune globulin (IG)|C02=Hyperimmune globulin|C03=Monoclonal antibodies|C04=Live, attenuated vaccines|C05=Inactivated vaccines|C06=Toxoid vaccines|C07=Subunit vaccines|C08=Conjugate vaccines|}}
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| {{familytree | | |,|-|-|^|-|-|.| | | | | | }}
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| {{familytree | | D01 | | | | D02 |D01=IV immune globulin (IVIG)|D02=Subcutaneous immune globulin (SCIG)|}}
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| {{familytree/end}}
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| ===Passive immunization===
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| Passive immunization is a method of disease prevention by transferring pre-made [[antibodies]] to a person at risk of acquiring a certain disease. Although, this type of immunity could be acquired naturally , during [[pregnancy]] by trans-placental maternal antibodies' transfer to the fetus. Artificial passive immunization is normally given by pre-made [[immunoglobulins]] to a person at risk of acquiring a certain disease.
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| ====Human immune globulin (IG)====
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| Human immune globulin is obtained from normal persons and is a concentrated solution of [[antibodies]] mainly, [[IgG]] antibodies. Human immune globulin is given [[Intramuscular|intra-muscular]] (IM). Up to 48 hours is required for IGs to reach the maximum serum concentration and their half-life is about 3 weeks. The sooner administration the more effective prevention. IGs only provide temporary protection. Diseases with available human immune globulins include:
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| *[[Hepatitis A]]
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| *[[Measles]]
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| *[[Primary immunodeficiency|Immunoglobulin deficiency]]
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| *[[Varicella]] (in [[immunocompromised]] patients when [[varicella-zoster]] IG is unavailable)
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| *[[Rubella]] exposure during the 1st trimester of [[pregnancy]]
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| =====IV immune globulin (IVIG)=====
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| IV immune globulin contains larger amounts of human immune globulin and it administers via [[IV]] route. Diseases that may be prevented or ameliorated by using IVIGs include:
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| *[[Kawasaki disease]]
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| *[[HIV]] infection in children
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| *[[Chronic lymphocytic leukemia|Chronic B-cell lymphocytic leukemia]]
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| *[[Primary immunodeficiency|Primary immunodeficiencies]]
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| *[[Idiopathic thrombocytopenic purpura|Immune thrombocytopenia]]
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| *Prevention of [[Graft-versus-host disease|graft-vs-host disease]]
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| =====Subcutaneous immune globulin (SCIG)=====
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| Subcutaneous immune globulin (SCIG) is prepared for home based use especially for persons affected by [[primary immunodeficiency]].
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| ====Hyperimmune globulin====
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| Hyperimmune globulin is derived of a person's [[plasma]] containing large amounts of [[antibodies]]. These persons are whom convalescing from natural infections or donors artificially immunized. Hyperimmune globulins are available for [[cytomegalovirus]], [[varicella-zoster]], [[hepatitis B]], infant [[botulism]], [[rabies]], and [[tetanus]].
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| ====Monoclonal antibodies====
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| Specific monoclonal antibodies can be used against infections. The only current available is, [[palivizumab]] which is active against [[RSV]].
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| ===Active immunization===
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| ===Live attenuated vaccines===
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| Live attenuated vaccines are produced by modifying a disease-producing (wild) virus or bacterium in a laboratory. The resulting vaccine organism retains the ability to replicate and produce immunity, but usually does not cause illness. These vaccines are produced by growing the [[virus]] in tissue cultures that will select for less virulent strains, or by [[mutagenesis]] or targeted deletions in [[genes]] required for [[virulence]]. Attenuated vaccines can not be used by [[immunocompromised]] individuals. Examples of live attenuated vaccines include [[MMR|measles, mumps, and rubella vaccine]] (MMR) and [[Varicella vaccine|varicella]] (chickenpox) vaccine.
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| ===Inactivated vaccines===
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| These vaccines are made by inactivating or killing the [[pathogen]] (mostly, viruses). The inactivated [[polio]] vaccine is an example of this type of vaccine.
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| ===Toxoid vaccines===
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| Toxoid vaccines are effective against bacteria that produces [[toxins]] and they are weakened toxins, produced by particular bacteria. The DTaP vaccine contains [[diphtheria]] and [[tetanus]] toxoids.
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| ===Subunit vaccines===
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| Subunit vaccines contain only some parts of bacteria or virus not the entire germ. Because these vaccines contain only the essential [[antigens]] and not all the other molecules that make up the germ, side effects are less common. The [[pertussis]] component of the DTaP vaccine is an example of a subunit vaccine.
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| ===Conjugate vaccines===
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| Conjugate vaccines are effective against bacteria that have [[polysaccharides]] in their [[cell wall]] components. [[Polysaccharides]] may cause less stimulation of [[immune system]] and result in defective immune response. Conjugate vaccines are effective for these types of bacteria because they connect (or conjugate) the [[polysaccharides]] to [[antigens]] that the [[immune system]] responds to very well. This linkage helps the immature [[immune system]] react to the coating and develop an immune response. An example of this type of vaccine is the [[Haemophilus influenzae type b|Haemophilus influenzae type B]] (Hib) vaccine.
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| ==Adverse reactions==
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| Adverse reactions to vaccines could be divided to 2 major groups.<ref name="pmid15131563">{{cite journal |vauthors=Johansson SG, Bieber T, Dahl R, Friedmann PS, Lanier BQ, Lockey RF, Motala C, Ortega Martell JA, Platts-Mills TA, Ring J, Thien F, Van Cauwenberge P, Williams HC |title=Revised nomenclature for allergy for global use: Report of the Nomenclature Review Committee of the World Allergy Organization, October 2003 |journal=J. Allergy Clin. Immunol. |volume=113 |issue=5 |pages=832–6 |year=2004 |pmid=15131563 |doi=10.1016/j.jaci.2003.12.591 |url=}}</ref>
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| *Allergic reactions
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| *Severe reportable reactions
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| ===Allergic reactions===
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| *Immediate reactions: Immediate reactions are IgE related reactions that begins within minutes.
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| *Delayed reactions: Delayed reactions appear several hours or even days after administration and they are mostly non-IgE related reactions.
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| ====Immediate reactions====
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| [[Anaphylaxis]], is rare but important among immediate reactions. Health care providers should be aware of it's symptoms and signs and be prepared for prompt treatment.<ref name="pmid16461139">{{cite journal |vauthors=Sampson HA, Muñoz-Furlong A, Campbell RL, Adkinson NF, Bock SA, Branum A, Brown SG, Camargo CA, Cydulka R, Galli SJ, Gidudu J, Gruchalla RS, Harlor AD, Hepner DL, Lewis LM, Lieberman PL, Metcalfe DD, O'Connor R, Muraro A, Rudman A, Schmitt C, Scherrer D, Simons FE, Thomas S, Wood JP, Decker WW |title=Second symposium on the definition and management of anaphylaxis: summary report--Second National Institute of Allergy and Infectious Disease/Food Allergy and Anaphylaxis Network symposium |journal=J. Allergy Clin. Immunol. |volume=117 |issue=2 |pages=391–7 |year=2006 |pmid=16461139 |doi=10.1016/j.jaci.2005.12.1303 |url=}}</ref><ref name="pmid26452420">{{cite journal |vauthors=McNeil MM, Weintraub ES, Duffy J, Sukumaran L, Jacobsen SJ, Klein NP, Hambidge SJ, Lee GM, Jackson LA, Irving SA, King JP, Kharbanda EO, Bednarczyk RA, DeStefano F |title=Risk of anaphylaxis after vaccination in children and adults |journal=J. Allergy Clin. Immunol. |volume=137 |issue=3 |pages=868–78 |year=2016 |pmid=26452420 |pmc=4783279 |doi=10.1016/j.jaci.2015.07.048 |url=}}</ref><br>
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| Other common but less serious immediate reactions include:
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| *Cutaneous symptoms: Flushing, itching, urticaria, and angioedema
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| *Respiratory symptoms: Nasal discharge, nasal congestion, change in voice quality, sensation of throat closure or choking, stridor, cough, wheeze, and dyspnea
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| *Cardiovascular symptoms: Faintness, syncope, altered mental status, palpitations, and hypotension
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| ====Delayed reactions====
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| Common delayed reactions to vaccines include:
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| *Fever: Fever is common after vaccination and should not preclude vaccine in the future.<ref name="pmid21293327">{{cite journal |vauthors= |title=General recommendations on immunization --- recommendations of the Advisory Committee on Immunization Practices (ACIP) |journal=MMWR Recomm Rep |volume=60 |issue=2 |pages=1–64 |year=2011 |pmid=21293327 |doi= |url=}}</ref>
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| *Local reactions: Local reactions such as, swelling and erythema are common and can be treated with cold compress.<ref name="pmid21293327">{{cite journal |vauthors= |title=General recommendations on immunization --- recommendations of the Advisory Committee on Immunization Practices (ACIP) |journal=MMWR Recomm Rep |volume=60 |issue=2 |pages=1–64 |year=2011 |pmid=21293327 |doi= |url=}}</ref>
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| *Serum sickness and serum sickness-like reactions
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| ====Vasovagal reactions====
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| Vasovagal reactions such as, faint, hypotension, pallor, diaphoresis, weakness, nausea, vomiting, bradycardia, and if severe, loss of consciousness may be seen after vaccination.<ref name="pmid19050332">{{cite journal |vauthors=Kang LW, Crawford N, Tang ML, Buttery J, Royle J, Gold M, Ziegler C, Quinn P, Elia S, Choo S |title=Hypersensitivity reactions to human papillomavirus vaccine in Australian schoolgirls: retrospective cohort study |journal=BMJ |volume=337 |issue= |pages=a2642 |year=2008 |pmid=19050332 |pmc=2769055 |doi= |url=}}</ref>
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| ====Reaction to vaccine components====
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| Vaccine constitute such as, gelatin, egg proteins, cow's milk, thimerosal, aluminum, and phenoxyethanol that are used as vaccine preservatives, may cause adverse reactions ranging from fever or skin reactions to severe reactions that may need skin test before future administration.<ref name="pmid11080728">{{cite journal |vauthors=Kelso JM |title=Raw egg allergy-a potential issue in vaccine allergy |journal=J. Allergy Clin. Immunol. |volume=106 |issue=5 |pages=990 |year=2000 |pmid=11080728 |doi= |url=}}</ref><ref name="pmid21624648">{{cite journal |vauthors=Kattan JD, Konstantinou GN, Cox AL, Nowak-Węgrzyn A, Gimenez G, Sampson HA, Sicherer SH |title=Anaphylaxis to diphtheria, tetanus, and pertussis vaccines among children with cow's milk allergy |journal=J. Allergy Clin. Immunol. |volume=128 |issue=1 |pages=215–8 |year=2011 |pmid=21624648 |doi=10.1016/j.jaci.2011.04.046 |url=}}</ref><ref name="pmid21293327">{{cite journal |vauthors= |title=General recommendations on immunization --- recommendations of the Advisory Committee on Immunization Practices (ACIP) |journal=MMWR Recomm Rep |volume=60 |issue=2 |pages=1–64 |year=2011 |pmid=21293327 |doi= |url=}}</ref><ref name="pmid16242081">{{cite journal |vauthors=Heidary N, Cohen DE |title=Hypersensitivity reactions to vaccine components |journal=Dermatitis |volume=16 |issue=3 |pages=115–20 |year=2005 |pmid=16242081 |doi= |url=}}</ref><ref name="pmid8473675">{{cite journal |vauthors=Kelso JM, Jones RT, Yunginger JW |title=Anaphylaxis to measles, mumps, and rubella vaccine mediated by IgE to gelatin |journal=J. Allergy Clin. Immunol. |volume=91 |issue=4 |pages=867–72 |year=1993 |pmid=8473675 |doi= |url=}}</ref>
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| ===Severe reportable reactions===
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| Anaphylaxis or anaphylactic shock within seven days of any vaccine should be reported. Other vaccine specific reactions that must be reported include:<ref name="pmid21293327">{{cite journal |vauthors= |title=General recommendations on immunization --- recommendations of the Advisory Committee on Immunization Practices (ACIP) |journal=MMWR Recomm Rep |volume=60 |issue=2 |pages=1–64 |year=2011 |pmid=21293327 |doi= |url=}}</ref>
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| *Tetanus: Brachial neuritis within 28 days
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| *Pertussis: Encephalopathy or encephalitis within seven days
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| *Measles, mumps, and/or rubella (MMR): Encephalopathy or encephalitis within 15 days
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| *Rubella: Chronic arthritis within six weeks
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| *Measles: Thrombocytopenic purpura within 7 to 30 days; vaccine-strain measles infection in an immunodeficient recipient within six months of measles vaccination
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| *Oral polio: Paralytic polio or vaccine-strain polio within 30 days to 6 months (this vaccine is no longer used for routine childhood immunization)
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| *Rotavirus: Intussusception within 30 days of rotavirus immunization
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| ==References== | | ==Diagnosis== |
| {{reflist|2}}
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