Hinman A R, Orenstein W A, Mortimer E A
Center for Prevention Services, Centers for Disease Control, Atlanta, GA 30333.
Ann Epidemiol. 1992 Nov;2(6):805-12. doi: 10.1016/1047-2797(92)90074-z.
There are two main reasons for failure of immunizations: (1) failure of the vaccine delivery system to provide potent vaccines properly to persons in need; and (2) failure of the immune response, whether due to inadequacies of the vaccine or factors inherent in the host. The first category is by far the most important worldwide. The major factor contributing to failure of the delivery system is failure to vaccinate; in the developing world this is commonly a result of inadequacy of the vaccine supply. Other important factors include barriers to immunizations, improper use of vaccines, vaccine ineffectiveness at the time of use, and factors relating to client attitudes and knowledge. Failure of the immune response may be either primary or secondary (loss of protection after initial effectiveness). The shortcomings of existing vaccines must not deter us from taking maximal advantage of their benefits.
（1）疫苗接种系统未能将有效的疫苗正确地提供给有需要的人群；（2）免疫反应失败，这可能是由于疫苗本身的不足或宿主内在的因素所致。到目前为止，在全球范围内，第一类原因是最重要的。导致接种系统失败的主要因素是未能进行疫苗接种；在发展中世界，这通常是疫苗供应不足的结果。其他重要因素包括免疫接种的障碍、疫苗的不当使用、使用时疫苗无效以及与受种者态度和知识相关的因素。免疫反应失败可能是原发性的，也可能是继发性的（初始有效后失去保护作用）。现有疫苗的缺点不应阻碍我们最大限度地利用其益处。
