Frenkel Lawrence Dean, Nielsen Kimberly
Department of Pediatrics University of Illinois, College of Medicine at Rockford, Rockford, Illinois 61107, USA.
Ann Allergy Asthma Immunol. 2003 Jun;90(6 Suppl 3):45-52. doi: 10.1016/s1081-1206(10)61660-2.
Review and discuss major issues of vaccination and immunization. The development and application of vaccination and immunization is one of the most remarkable successes of the 20th century. This is true both in the United States and worldwide. In the United States, a number of vaccine-preventable diseases have been all but eliminated through the development of a recommended childhood immunization schedule by governmental and nongovernmental organizations, education of providers about these recommendations, and enforcement of these recommendations by school and day care entry mandates. Despite these successes, vaccine-preventable diseases continue to occur, in part because of missed opportunities by health care providers, antivaccine forces empowered by misguided mass media, and parental ignorance. Important aspects of the 2002 recommended childhood immunization schedule are reviewed, including: birth dose hepatitis B, diphtheria underimmunization and tetanus overimmunization, increasing pertussis disease, the success of conjugate vaccines, the change in poliovirus vaccines, measles vaccine and autism, the safety of varicella vaccine, and adult vaccination recommendations. Finally, future prospects for vaccination and immunization are discussed, including: combination vaccines, vaccines against new diseases such as rotavirus, new routes of delivery of immunizing agents, the use of computerized vaccine registries to prevent missed opportunities, and vaccines against bioterrorism agents.
A careful analysis of risk and benefit suggests that the benefit of vaccination far outweighs the risks from the utilization of immunizing agents. Vaccination delayed may be protection denied. The bottom line is that vaccines are good and disease is bad.
回顾并讨论疫苗接种与免疫的主要问题。疫苗接种与免疫的发展及应用是20世纪最显著的成就之一。在美国及全球皆是如此。在美国，通过政府和非政府组织制定推荐的儿童免疫接种计划、向医疗服务提供者宣传这些建议以及通过学校和日托机构入学强制要求来执行这些建议，许多疫苗可预防疾病几乎已被消除。尽管取得了这些成功，但疫苗可预防疾病仍有发生，部分原因是医疗服务提供者错失机会、被误导的大众媒体助长的反疫苗势力以及家长的无知。本文回顾了2002年推荐的儿童免疫接种计划的重要方面，包括：出生剂量乙肝疫苗、白喉免疫不足和破伤风免疫过度、百日咳疾病增加、结合疫苗的成功、脊髓灰质炎疫苗的变化、麻疹疫苗与自闭症、水痘疫苗的安全性以及成人疫苗接种建议。最后，讨论了疫苗接种与免疫的未来前景，包括：联合疫苗、针对轮状病毒等新疾病的疫苗、免疫制剂的新给药途径、使用计算机化疫苗登记系统以防止错失机会以及针对生物恐怖主义制剂的疫苗。
对风险和益处的仔细分析表明，疫苗接种的益处远远超过使用免疫制剂带来的风险。延迟接种疫苗可能导致无法获得保护。关键在于疫苗有益，疾病有害。
