24.9: Vaccinations
Overview
Vaccination is the administration of antigenic material from pathogens to confer immunity against a specific microorganism. Vaccination primes the immune system to recognize and mount an immune response faster and more effectively if the real pathogen is encountered. Vaccinations are one of the most efficient ways to protect both individual humans and the general public from disease. A growing anti-vaccination skepticism risks the successes of vaccination programs that helped reduce and, in some instances, eradicate fatal diseases.
Forms and Administration of Vaccines
Vaccines can be administered via oral and intranasal routes, as well as by injection into the muscle (intramuscular), the fat layer under the skin (subcutaneous), or the skin (intradermal). Vaccines contain antigens derived from a specific pathogen. Those containing “dead” antigens, which are intact but unable to replicate, are referred to as inactive vaccines. By contrast, subunit vaccines contain only parts of the pathogen. Some vaccines contain the live pathogen in a weakened (attenuated) form. An attenuated pathogen stimulates the immune system without causing severe disease. Vaccines often contain adjuvants, chemicals that enhance the immune response against the pathogen.
The Mechanisms of Vaccine-Induced Immunity
When a vaccine is administered, antigen-presenting immune cells (APCs), such as dendritic cells or macrophages, engulf the antigen from the vaccine, degrade it, and display pieces of the antigen bound to major histocompatibility complex (MHC) molecules on their surfaces. The activated APCs then migrate to the lymph nodes, where they encounter and stimulate naive helper T cells and cytotoxic T cells. The activated helper T cells differentiate into different subtypes such as type 1 (Th1) and type 2 (Th2) helper T cells.
Th1 cells stimulate phagocytic activity and promote the activation of cytotoxic T lymphocytes (CTLs, also known as killer T cells), which can destroy virus-infected and cancer cells. Th2 cells increase antibody responses by activating B cells and initiating their differentiation into plasma cells and memory B cells. The plasma cells produce antibodies that are specific to the vaccine-introduced antigen. After a pathogen has been cleared, a small percentage of T cells remain that exhibit an enhanced immune response upon reexposure to the pathogen (memory T cells). In summation, vaccines induce mock infections that generate memory B and memory T cells as well as antibodies that are specific to the vaccine-introduced antigen. If the body encounters an identical antigen in the future, it can mount a much more efficient immune response.
Herd Immunity
In addition to conferring immunity in successfully vaccinated individuals, vaccination also helps to establish herd immunity. Herd immunity occurs when the entire community is protected from a given pathogen because a high percentage of the population is vaccinated against the pathogen. As a result, even the minority of people who could not be vaccinated (because they are too young or have an immune deficiency) have a much-reduced likelihood of becoming infected. However, if a larger percentage of individuals is not vaccinated, the pathogen can find sufficient susceptible hosts to continue propagating.
As a result of successful vaccination programs, the smallpox virus is no longer a threat to humanity. Health organizations have high hopes to also eradicate measles in the near future. However, there were approximately 136,000 fatal infections worldwide in 2018, nearly a 50% increase from 2017. This is caused by a lack of access to vaccines and poorly functioning health systems in the developing world as well as vaccine refusal in highly developed countries. In 2016, the World Health Organisation (WHO) declared that measles was eradicated in the Americas. Since then, measles has reemerged, with 372 reported cases in 2018 and 387 cases in the first three months of 2019.
The Flu Vaccination Can Reduce the Risk of Flu-Associated Hospitalization
The flu, or Influenza, is a virus-borne infection of the respiratory tract that causes 3 to 5 million cases of severe illness and about 290,000 to 650,000 deaths globally every year. The evolutionary rate of the Influenza virus is so fast that a new vaccine has to be developed every year.
