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The Revised Authoritative Guide To Vaccine Legal Exemptions

Vaccines Have Serious Side Effects

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Nil, HBsAg

Intramuscular

" A wide variety of different viral strains and eel! substrates are used in different countries; the selection listed is not comprehensive

BPL, P-Propiolactone; CEF, chick embryo fibroblast cultures; HEF, diploid strain on human embryo fibroblasts, HBsAg, hepatitis B surface antigen purified after gene cloning in yeast; HANA, mixture of purified hemagglutinin and neuraminidase spikes.

" A wide variety of different viral strains and eel! substrates are used in different countries; the selection listed is not comprehensive

BPL, P-Propiolactone; CEF, chick embryo fibroblast cultures; HEF, diploid strain on human embryo fibroblasts, HBsAg, hepatitis B surface antigen purified after gene cloning in yeast; HANA, mixture of purified hemagglutinin and neuraminidase spikes.

preferred, because heterologous protein may provoke serum sickness or anaphylaxis. Pooled normal human immunoglobulin contains reasonably high titers of antibody against all the common viruses that cause systemic diseases in humans, but specific high-titer immunoglobulin can also be collected from individuals known to have recently recovered from a particular infection, for example, herpes zoster. Passive immunization should be regarded as an emergency procedure for the protection of unimmunized individuals exposed to special risk; it is an important prophylactic measure against hepatitis A (in travelers to developing countries), hepatitis B (in newborn babies of infected mothers or in unimmunized laboratory or health workers following a needle stick or comparable accident), rabies (following a bite from a potentially rabid animal), measles (in unimmunized close contacts of a patient), or varicella (to protect newborn babies of mothers with chickenpox at the time of delivery).

Specific antibody can also occasionally be used as therapy for an established viral disease; for example, immune plasma reduces the mortality from Lassa fever. A wider role for antibody in treatment and postexposure prophylaxis is being reexamined in the light of the availability of monoclonal antibodies of high specificity and high titer.

The Expanded Immunization Programme

In the industrialized countries immunization is carried out reasonably effectively by the public health authorities and private medical practitioners. However, in Third World countries immunization used to be available only to the small wealthy elite; there were neither the health services, the political will, nor the funds to provide for the poor majority. To capitalize on the health infrastructure that had been developed in Third World countries to support the Intensified Smallpox Eradication Programme, the World Health Organization tn 1977 established the Expanded Programme on Immunization (EPI), with the specific goal of immunizing the world's children against six diseases for which there were satisfactory vaccines at that time: diphtheria, measles, poliomyelitis, tetanus, tuberculosis, and whooping cough. In 1985 the WHO program was greatly strengthened by the participation of the United Nations Children's Fund (UNICEF) as the provider of vaccines and augmentation of the funding. In 1990 the United Nations organized a World Summit for Children which endorsed the goals of the EPI and established the Children's Vaccine Initiative. As well as improving coverage with the present EPI vaccines, which is now about 80% overall, it is envisaged that over the next decade several additional vaccines may be added to the Programme, in certain cases only in countries where there is a special risk. These are vaccines for yellow fever, hepatitis A, hepatitis B, and Japanese encephalitis (lor which satisfactory vaccines have already been licensed), and rotavirus, respiratory syncytial virus, and dengue (for which vaccines are under development), plus the bacterial vaccines for pneumococcus, meningococcus, and Haemophilus influenzae B.

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