#ALSO IS RABIE BABY A KID BC OF THE NAME

[ghostfixedsysknight]

Question I've been thinking about ever since Icky Licky was revealed: How old are the Smiling Critters and Nightmare Critters? Cause I assumed they were kids, with them being the protagonists of a kid show and all.

But- Icky Licky is a frog. There's not a hint of tadpole in him. Therefore, he's not technically a kid, right?

All the names of the Critters (with the exception of Rabie Baby) don't outright say that they are kids. Baba Chops can refer to both lamb (baby sheep) and mutton (adult sheep) chops. Dogday and Catnap aren't Puppyday or Kittennap.

But then- Kickin is yellow. Like a baby chick. And doesn't have the adult chicken traits like a wattle. Is this hairdo a yellow comb? Is his tail meant to be the curved tail feathers of a rooster? Cause the animals can be in different colours (no rabbit is naturally green) so is he just a yellow fully grown chicken? Or is Icky just a kid frog?

[mapofyourstars]

@uniquecellest replied to your post:

They're switches but Charles tops more Despite coming from wealth he and Raven have shopped from like Dollar Tree/ .99 cent and similar stores for food, it's a trait they've carried over with their romantic interests as well Charles's love languages is gift giving and words of affirmation Erik's love languages are baking/cooking (i think that counts as gift giving idk) and acts of service (jm so bad with describing love languages lol)

In mafia aus Charles should be the head boss not bc of wealth but bc he does things differently and he and his crew are so discreet no one knows what they really look like. Most people confuse Erik for being the head when really hes Charles's right hand and/or civilian partner that knows about the mafia In pregnancy aus (at least the ones that follow the 2010 movies) I don't think either would a) know they're pregnant if jt happens right before cuba (we can talk if it's like months before) but even then they wouldn't use the pregnancy to get the other on their side. They'd let bygones be bygones (Hank runs the school, Raven the brotherhood, these two fucked off to the countryside somewhere to raise their kids) Hank and Darwin are more Charles's kids, Angel and Alex more Erik's, Sean was the kid that would've kept them together I think Shaw should've caused more angst for them by meeting Charles earlier. Maybe bringing stuff about Erik where Charles would've punched him (Erik: I'd hate to be on the side of Charles's right hook. *Erik 11 yrs later) Alpha Charles Omega Erik Moira knew about them. She did. And she kept it secret bc 60s. They would've been at the frontlines at Stonewall Nina and Peter love Charles to a point Erik thinks they favor Charles over him (it's okay. Jean does the same thing makes Charles think she prefers Erik over Charles) They're audhd4audhd Bad guys need to learn if you want to take over the world you kidnap them both but keep them separate. Real good torture. (Also you're dead in like 5min if you kidnap one and leave the other roaming around) Charles reintroduced Erik to some of his Jewish heritage by doing small things with him (i forget the name but I know there's one thing where Jewish people don't eat or drink from sundown Friday until sundown Saturday) eventually Erik reached out to a rabi (idk how it's spelt) and they start celebrating every Jewish holiday together Bc of his upbringing Charles has a complicated relationship with religion via his parents. He'll celebrate Christmas and Easter but not much else. (He mainly just celebrates Christmas the more he gets older) Theyd run the US for 16 yrs (2 terms Charles 2 terms Erik while the other is vp/first gentleman) Erik thinks Charles has fine china, and tries to make any metal plates form back together if broken (Charles doesn't care.) Living together outside the Xavier estate they have a small cottage that looks like it's at most two bed on the outside but it's super spacious inside and hosts all of their kids and friends in their own rooms Scalp massages help Charles with any headaches (regular or chronic) Erik is more than happy to give

I have things to say because you fed me with these head canons. in order are my responses:

agreed. both switch, but yeah, charles tops more.

raven, in my mind, would be more prone to shop at places like that, and over time, charles just gets used to it because his sister drags him there enough for random snacks and drinks. and honestly, who wants to pay loads of money for basic essentials.

charles dotes on erik, it's disgusting.

erik helps charles out whenever he knows he needs it most without having to be told, and charles fawns over it.

love that. it's because erik is scary to most upon meeting them, but charles running things is great.

so what you're saying is that once charles/erik tells the other of their pregnancy, both would cave and just give up their goals to raise their babies together? I'm soft, I love that.

ooooh, spicy thought. always thought of alex as charles' kid, very interesting. though sean definitely would have kept them together - he's like the baby.

in what way do you think charles would have met shaw? just sometime before cuba? or entirely different circumstances? (I imagine you're keeping to the movie-verse, so I assume before cuba.) charles would have taken one look in that man's mind and severely debilitated him.

praise alpha!charles and omega!erik. (I'm going to get around to writing a fic with that, I swear.)

agreed, and love the concept of it. moira really is a great friend.

YES. with raven alongside as well, I feel.

ooooh, you think jean has a very strong relationship with erik, nice. I feel like that's not common, but maybe I'm just a jean-hater from time to time. I'm learning to love her and her relationship with her dads though.

yeah, I think erik definitely has some neurodivergency there, but charles is definitely autistic in my mind. his telepathy alleviates his autistic tendencies, but when he's without it, he's fully unmasked and unable to gather the social cues he gained by his telepathy. though, it does make me wonder if he has relied on his telepathy for so long that he naturally is unable to do x, y, and z without it, and his mannerisms, actions, and thoughts appear to align with autism. kind of like what came first, y'know?

oh, yeah - erik can hear charles' getting tortured in the other room and vice versa. definitely affects them psychologically and emotionally.

sabbath and rabbi, right? and yeah, I love the idea of reclamation of erik's ethnicity and religion. however, I also feel that erik might have difficulty doing so and tends to abstain from jewish tradition because he feels slighted by whatever higher power might be out that there chose to do those atrocities to his people. I've seen both sides from older jewish people who survived the holocaust, and I think both ideas could apply to erik. the first one is beautiful though.

agreed. I just tend to look at charles as an agnostic atheist. I see him too involved with science to believe in anything else other than the absence of a god.

could you imagine charles and erik as presidents? the things they'd get done? the stark differences between how they run the country? oof, incredible.

lol, kind of love erik just not knowing but thinking it's important to charles.

yeah, them having an alternate house is definitely a big head canon of mine. the house will be a little cottage or cabin with tons of books and two chess tables and barely any metal around, and they go there whenever they just need to get away or spend time away from technologically advanced world. after all, they are old men.

erik giving charles a scalp massage is the cutest thought ever. he'd do anything for his man.

[deadmegumi]

Crawls out of notesapp carrying nell lore. If you guys even care

Was difficult for me to reconcile durge canonically being raised by a normal family before joining the bhaalists bc nell has such an obvious lack of socialization but I've figured it out

- she was adopted and raised by a zariel tiefling couple in the lower city. because she was born directly of bhaal's flesh w no non-godly parents she didn't really have like… a firm physical form or appearance? As a small child she was very malleable and was kind of like a changeling that wasn't in control of her transformations. Constantly shifting form and appearance etc. as she grew up she began to solely model herself off of her adoptive family and by age ~4 she looked solidly like a zariel tiefling except slightly wrong. She still kind of has an uncanny valley type deal but for the most part she passes as a normal tiefling even though she definitely is not.

- family! Mother and father were kind ordinary folk. Owned an apothecary in the lower city and loved her very much even though they could tell she was hmmmm absolutely fucking deranged. She would bite another kid's arm off at the playground and they'd go oh isn't our baby so spirited :). Like ok first of all that is a dog and she has rabies. Her adoptive parents also already had a son called laurence, who was about four years older than nell and an apprentice wizard. He and nell were extremely close even though he could tell something was wrong with her.

- when nell was ten the temple of bhaal decided it was time to collect her; they offered her the choice of letting them kill her family, or doing it herself. She burned down their home and returned to the temple as bhaal's chosen. Worst preteen ever. Laurence was at his apprenticeship when the fire happened and survived, but though nell had died with his parents for several years after.

- nell had a different name when she with her adoptive parents but after years back with the cult + her general lack of attachment to the name she's forgotten it. “Nell” is actually a name gortash gave her (cringe). They took the name from one of the flaming fists nell murdered during their first meeting; her name was donella and when gortash decided he wanted to call nell something that was not "dearest bhaalspawn" was what he chose. When nell woke up on the nautiloid she had nooooo clue gortash chose it for her and thought it was her birth name :)

- back to her brother. about six months before the game starts he's now a fully-fledged wizard with a family of his own. Orin, by then already plotting durge’s downfall, discovers laurence survived the fire, and disguises herself as a flaming fist to tell him that nell also survived, but has been held captive the last ~25 years. He obviously rushes to rescue her. Bad idea. Instead of finding his baby sister a prisoner to the people who killed their parents he finds a deranged bhaalspawn who kills first and asks questions later. Oops. Nell recognizes him only after he's dead. He's the only person in the world she'd ever felt guilt over killing! Oops!!!!!

- still debating over whether it's meaner to have nell then find his family and kill them OR gave her return to baldur's gate post lobotomy, find them grieving, have some inexplicable recognition/connection with his children, and then have orin reveal exactly what happened to laurence after they've already formed these bonds. Also nell's dream guardian is laurence and that's the primary reason she decides the emperor has to die bc how dare he dress up as the sole physical manifestation of my guilt…

[someonewhos-world]

TWIN HEADCANONS

Slow ass tumblr isn't gonna stop me

>Jett and Jack are Puerto Rican and Italian

>Jett babysits for a family that lives a floor under their apartment and Jack tags along bc he loves to tire out the kids while Jett takes care of the baby.

>Three cats,one dog, two boys and one very overworked mom? Giant nap pile in the living room.

>Jack works nightshifts which works bc hes a night owl but also really bad bc he has school the very next day but also good bc less people yk

>Jett sticks to the babysitting, it feeds into his napping habits because by the time the parents show up, it's just this scary looking teenager on their couch, baby against his side with its head supported on his elbow and two kids watching old cartoons like looney tunes or Tom and Jerry.

>They did eventually move back to New York after a few years, they loved Canada but New York will always be their home.

>BROOKLYN BABIES they live by old Fulton by the waters.

>Internshipping with Chris?? Yk how he forgot to feed the interns that one episode? Yeah, Jett was running on a caffeine high and Jack was foaming at the mouth like an animal with rabies bc he had too much candy.

>those crashes were the worst bc they looked dead and it took a while to recover

>Genderswapped tho???

>Jess' cats are the dumbest motherfuckers known to man. They somehow end up in Canada at Jody's place for food.

>Jace's cat is the only normal one. Mostly. If it isnt the middle of the night.

>Back to normal, them cats are crazy but they also have a dog. His name is Wally :3

>The boys love their pets, although Jack wont stop feeding the pigeons outside so ig they have birds too.

>Jack came out those sewers dressed like a ninja turtle and Jett pulled up with a hotdog.

>The twins didnt use the steel wool rope Cheis had. They're new Yorkers. New Yorkers find ways to graffiti on trains that are in the air and on buildings they probably dont live in.

>wait

>sorry I remembered how a lady climbed onto the statue of Liberty in protest. Bc the twins scamper up the statue like squirrels.

>Jett definitely has blackmail on people. Because he talked to Sierra.

>Jack is still afraid of Sierra. Very afraid. Jett is mostly indifferent now but. He can feel the glare sometimes on his back when he talks to Cody.

>genderswapped twins are the same. No matter the gender, the twins fear Sierra and her strength. Never her height, they think shes cool for being tall but they fear her strength and mindset. She's unpredictable and they grew up with unpredictable. They dont like her.

>when Jett naps, Jack sits with him and the cats join. Wally joins too but he wakes Jett up by accidentally smothering him bc hes a very big dog.

>Jack never naps, hes running on sugar and a will to live.

>Jett runs on one iced vanilla frappuccino.

>Jack can be very mean, when push comes to shove. Hes gonna shove and hes gonna shove hard. He will defend people and wont hesitate to get nasty

>Jett has a soft side, he's open to those who need a shoulder to vent to. He'd have his headphones on but when he tilts his head towards you, you know hes listening.

>they dont know how weather works. Not all the time.

That's all I have for today!! I'll reblog this and add more when I come up with more!! You're also open to make headcanons of your own about the twins or ask about them!!

[emilycollins00]

I WROTE TOO MUCH FOR THIS TO POST AS A COMMENT BUT I WILL NOT BE SILENCED BY WORD LIMITS, SO I HAD TO SEND AN ASK

I KNEW IT!!! I CALLED IT!! teared up by the time i got to citron's and it devolved from there. how is it that i can absolutely see all of these happening, you're genuinely SO SPOT ON. i can 100% see tsuzuru doing the Dad LeanTM on the counter in his kitchen while chit chatting with his toddler. tenma gagging on baby food YES. kazu crying in a full suit while holding his newborn WHILE STILL MAKING JOKES. Kumon having tickle fights with his kid im gonna sob!!! And you KNOW kumon and juza’s kids have playdates all the time and each kid loves their uncles bc they think they’re so funny and weird compared to their own dad. Omi,.,..,catch me lying on the ground for a full minute to recover from just the idea of him having a kid. GUY PLEASE I-[passes out bc i have developed rabies]. homare sitting crisscross applesauce on the floor reading a poem to his literal infant child has me melting. the baby is wearing a cravat with his onesie. Azuma fostering kids!!!!! dear god i cant anymore

my heart is warm and my soul is fed!!! thank you a million times over for this emi

OMG OMG OMG THIS GAVE ME LIFE BESTIE

Yes yes yes!! I bet at least one of Tsuzuru's kids will probably want to learn how to become a writer and Tsuzuru -while please don't misunderstand he is elated- will be like uuuuh let's choose one that's not as stressing?? ALSO YES YES KAZU WOULD TOTALLY BE A DADDY'S GIRL I bet they have drawing dates in their house and this girl is so artistic!!

Also i take your hyodo's playdates (which which is asdfghj adorable?? imagine kumon's kid being like "Imma bake uncle Ju a cake!!" while juza's is like "I think uncle Kumon and /daughter name/ arrived dad!! I can hear them already!!") and add the idea of TROUPES PLAYDATES IMAGINE THE CHAOS???

Like spring troupe has Citron's daughter and Tsuzuru's oldest being the most energetic and begging Chikage's son to teach them karate because it looks SO cool?? poor boy looks at the rest for help but except for Sakuya's son (because of course he would help others he takes after his daddy) the others think is a lost cause and go to the sofas to play with the videogames itaru's son brought and i'm getting off track here but aaaaaah

OH Omimi and Guy are just so so in love with their sons?? the softness in their eyes i cry?? like asdfghjk and I bet they are also incredibly attached to their daddies and probably have to hold back their tears when they are left at school!! (unlike Banri's or Tasuku's who probably dash out the door as soon as they can)

Azuma's was pure chance!! because I didn't know what to give them and then talking to Viv at one point the word adoption came up and then they said hold on what about foster AND adoption??? and then our brain went boom.

I COULD TALK ABOUT THIS ALL DAY

[midoriyaizukustan-inactive]

OH UH FOR THE ASK THING HAVE YOU DONE SHINSOU HITOSHI AND UH.. KENDO ITSUKA?? (Orange haired girl that beats her 'son' monoma neito he has rabies)

I HAVE NOT DONE EITHER OF THEM THANK YOU FOR ASKING ECHO AHH I SHALL TRY TO MAKE YOU PROUD

shinsou:

favorite thing about them

he’s just a funky lil dude. just like midoriya he hasnt given up even tho some setbacks have happened on his road to achieve his goal. he knows what he wants and on god he is going to get it. rlly makes u root for him

least favorite thing about them

hes so like,,,he thinks he has a moral high ground almost?? compared to the hero course kids. like when i first watched his fight w midoriya i actually rlly disliked him bc he’s going off like “ohh you dont know how hard it is” like??? even discounting the fact that midoriya was quirkless until less than a year ago, he doesnt know him at all?? he doesnt know what he’s been through?? jesus dude chill out

favorite line

“im not giving up. ill show them i can be in the hero course and become a greater hero than all of u” when he’s talking to mido after their match. idk man like i mentioned earlier, he’s so determined it rlly makes u root for him. also this was like a promise that we were gonna see him again so HOoo,,,yeah

brOTP

shinken (shinsou nd kendou), monoshin, shinkami, shinkure (shinsou and hagakure)

OTP

SHINIIDA shindeku SHINKIRI please,,,and a lil bit of shinoji,,,

nOTP

ehh romantic shin-kami just isnt my cup of tea but i understand why ppl like it!! its rlly cute its just not my favored ship dynamic i suppose. also dont be gross abt him and the adults i havent seen anything but i dont trust this fandom dkfjk

random headcanon

bro’s a lil colorblind. cant see diff between red and green. only reason he guessed mido’s hair and eye color right is bc the word green (”midori”) is literally in mido’s name

unpopular opinion

I DIDNT LIKE HIM AT FIRST,,,HE FREAKED ME OUT,,,i mean i love him now and he’s listed as one of my favs but i RLLY DIDNT LIKE HIM AT FIRST,,,i thought he was kinda a brat and i didnt like how he brainwashed others to be on his cavalry even tho like objectively it was a smart move

song i associate with them

welcome to my life by simple plan

DJNKSJKSJNKD IM KIDDING 

but hmmm,, sleep is for the weak by the dreadnoughts

favorite picture of them

HHHH SMILE EXCITED BOY,,,,

kendou:

favorite thing about them

SHES SO CUTE,,she cares so much for class 1-b and i just appreciate her personality a lot i think she cooperative, earnest, nd focused i love that for her

least favorite thing about them

hmm this is hard

perhaps that she doesnt seem to try to talk to monoma abt his obvious inferiority issues?? she just hits him and drags him away. and like it makes for a good bit and i know it’s not that deep but u know,,

favorite line

“us at ua have grown beyond ever thinking there’s no hope!” PLEASE THAT’S SO GOOD,,,she says this when she’s fighting mustard w tetsutetsu. it’s so good just,,love positive characters u know

brOTP

kendeku (kendou nd midoriya), kenmono (her nd monoma), shinken (shinsou nd her)

OTP

literally her and all of the class 1-a girls JKDJKFJK, kendotetsu (can i say power couple)

nOTP

mmm romantic ken-mono just kinda rubs me the wrong way i prefer them as sibling-esque friends

random headcanon

she’s rlly into american media nd stuff bc when her quirk first manifested, her dad was like “oh that’s a lot like khamala khan’s power in the marvel comics” so she got rlly into those and it evolved over time to her become a full-on westaboo djkfjk. she’s rlly lowkey abt it tho bc she’s a lil embarrassed abt it

unpopular opinion

i get the mom jokes r fun but kendou is actually more like class 1-b’s collective sister, not ma

song i associate with them

hmmmm feeling ok by best coast has a similar vibe that she does

favorite picture of them

SHES BABY,,

[buykamagragoldonline-blog]

Vaccines

Overview

The discovery and wide application of vaccines that protect against once-fatal childhood diseases like measles, mumps, rubella and diphtheria is one of the most significant medical contributions of the past two centuries. Today, newborns get their first vaccine soon after birth (hepatitis B), then, between one and two months begin a series of shots that will eventually protect them against 14 diseases. Worldwide, childhood vaccines prevent up to 3 million deaths each year. In recent years, however, parents are increasingly likely to under-vaccinate their children. A January 2013 study published in JAMA Pediatrics reported that nearly half of children ages 2 months to 24 months in the United States either aren’t getting all the necessary vaccines or have not been vaccinated at all. Vaccines are not just for kids. Adolescents and adults need them, too, whether to “boost” earlier immunizations that provided immunity against diphtheria, pertussis and tetanus or to protect against other diseases, such asinfluenza, pneumonia, shingles, bacterial meningitis or, for those traveling abroad,yellow fever and typhoid. Preteen girls and boys can now be vaccinated against several strains of the human papillomavirus (HPV), which cause most cervical cancers, as well as cancer of the anus, vagina and vulva. Vaccines are also being developed to prevent malaria and HIV, the virus that causes AIDS, as well as to harness the power of the immune system to fight cancer and other diseases. The History of Vaccines The roots of modern vaccines stretch halfway across the world to ancient China and India where, as early as the 10th century BC, people inhaled pus from smallpox blisters to inoculate themselves against the deadly disease. But it wasn’t until 1796 that a country doctor from England named Edward Jenner formally vaccinated a child against the disease. Rather than using pus or scabs from individuals infected with smallpox, he used pus from a similar, but less virulent pox disease called cowpox. He hypothesized this would protect against smallpox because milkmaids infected with cowpox never caught smallpox, even during epidemics. Two weeks after inoculating an 8-year-old boy, Jenner tried to infect him with smallpox. Nothing happened. Voila! The first successful vaccination. (Indeed, the word vaccine comes from the Latin word “vacca” for cow). It, however, would be nearly two centuries later before smallpox was eradicated worldwide (the last known case occurred in Somalia in 1977). Its banishment (except for samples held in Russian and American laboratories) has been heralded as one of the most significant medical achievements in history. We’ve come a long way from Jenner’s days, when “vaccines” were given by using a quill or ivory point to transfer the infected pus into a healthy person’s skin. Today, safe, hair-thin needles deliver nearly painless injections, while some vaccines can be given orally with drops or nasally through a spray. Today we have vaccines against childhood illnesses like diphtheria, mumps, rubella and measles, which used to kill millions of children each year; against tetanus and rabies; and even against cancer. Some are designed to protect against infection in the first place; others to prevent the pathogen’s replication and halt its ability to infect normal cells. In all, more than 300 approved vaccines protect against 30 diseases. Not only have vaccines saved lives, they have changed the very world in which we live. Vaccine Basics To understand how vaccines work, you first need to understand how your immune system works. There are two types of immunity: innate and adaptive. The innate immune system is a nonspecific response to any threat. Invaders such as bacteria, viruses and other pathogens display “signs” on their surface called antigens that signal immune system cells to action. The innate immune system includes visible protection, like skin and the mucus membranes in your nose and mouth that strain out pathogens, and invisible protection in the form of white blood cells like macrophages, which release inflammatory chemicals such as histamine and leukotrienes to destroy invaders. Sometimes this process runs amok, as when the innate immune system launches an all-out attack against harmless proteins like those from pollen or peanuts, resulting in an allergic reaction. A more targeted approach to threats comes from your adaptive immune system, which responds to specific antigens. The foundation of this system exists in T and Blymphocytes. These immune cells learn to recognize certain antigens. Once they identify a non–self invader, they generate specific responses to destroy that invader. B cells mature into specialized cells with antigen-specific antibodies on their surfaces that lock onto the antigen to annihilate it. T cells release toxins to destroy the invader or call other immune system cells into action. Once T and B cells are activated, they leave behind copies of themselves that are ready to spring into action again if the specific antigen appears. This is known as immunologic memory. These mature T and B cells enable your immune system to launch an attack against, say, a measles virus so quickly that the virus never has time to infect healthy cells and make you sick. Thus, the adaptive immune system, unlike the innate immune system, protects against reinfection. The problem with the adaptive immune system is that the first time it can take several days to get up to speed once it encounters a new antigen. That’s more than enough time for most pathogens to replicate and make you sick. Enter vaccines. A vaccine is designed to stimulate the adaptive immune system before you’re exposed to the virus and bacteria so when you do encounter it, specialized T and B cells already exist, ready to spring into action before the pathogen can make you sick. Types of Vaccines Vaccines may be produced in several ways:

Live, attenuated vaccines Inactivated vaccines Subunit vaccines Toxoid vaccines Conjugate vaccines DNA vaccines Recombinant vector vaccines

Live, attenuated vaccines. These vaccines contain a live, although significantly weakened, version of the pathogen. Measles, mumps and chicken pox vaccines are made with live viruses. The only bacterial vaccine made with live pathogens in the United States is the typhoid vaccine. The benefit of a live vaccine is that a single dose often provides lifelong immunity. The downside is that because viruses and other pathogens naturally mutate, or change, the virus within the vaccine could also change, possibly creating a more virulent version of itself that the immune system would have difficulty combatting. This was an issue with the early oral polio vaccines but is generally not a problem with current live vaccines, which are much safer than the virus they protect against. Only people with a suppressed immune system (such as those who have HIV/AIDS, are taking immunosuppressant drugs or are being treated for cancer) should be concerned about receiving live vaccines because they could, conceivably, become infected with the virus. Live vaccines also usually require refrigeration. Inactivated vaccines. These vaccines contain a killed version of the pathogen. They are more stable (meaning they don’t need refrigeration) and safer than attenuated viruses, but they don’t elicit as strong an immune response. Thus, the immunity they provide may not last as long and you might need a “booster” vaccine down the road. Subunit vaccines. These vaccines are made with bits and pieces of the inactivated antigen called epitopes. The advantage is that by using fewer molecules of the virus or bacteria, there is less risk of side effects. The disadvantage is that it is challenging and time consuming to identify the exact epitopes needed to stimulate the immune system. Toxoid vaccines. These vaccines are designed to protect against bacteria that secrete toxins. Treating the bacteria with formalin renders the toxins harmless but still retains enough of their structure to “teach” immune cells to recognize the bacteria and train them to lock onto the toxin antigen before the bacteria can release the chemical. Toxoid vaccines are used for diphtheria and tetanus. Conjugate vaccines. Conjugate vaccines are typically used to provide protection against certain types of bacterial infection, particularly in very young children. These bacteria, including those that cause bacterial meningitis, are surrounded by a thick capsule called a polysaccharide coating. This coating helps the bacteria hide from the immune system. Thus, antigen-presenting T cells can’t “show” the antigen to B cells. B cells can still produce antibodies against the bacterial antigens and provide some protection, albeit short-lived, but this type of protection doesn’t develop until children are about 2 years old. So many polysaccharide vaccines for adults and older children don’t work in younger children, leaving children highly susceptible to the illnesses those bacteria cause. Enter the conjugate vaccine. Antigens or toxoids that the baby’s immune system does recognize are attached to the polysaccharide coating. The infant’s immune system learns to recognize polysaccharide coatings as dangerous and to defend against such pathogens. DNA vaccines. DNA vaccines are not yet in use, though they are being tested for influenza and herpes. These vaccines are made of the organism’s genetic material, which carries the code, or recipe, for antigens. Once in the body, normal cells take up the DNA and begin making the microbe’s antigens, displaying them on their surface and stimulating the immune system to respond. Recombinant vector vaccines. These vaccines also are not yet approved for widespread use but are being evaluated for HIV, rabies and measles and are thought to be even safer than existing vaccines. With recombinant vector vaccines, the microbe’s DNA is inserted into another virus or bacteria that transports the DNA, enters cells and releases the DNA into the healthy cell, which then can provoke the immune response.

When to Vaccinate

These charts contain recommendations from the U.S. Centers for Disease Control and Prevention (CDC) for preventive vaccines. Don’t panic if you or your child has not received all vaccinations on time; the CDC has guidelines for “catch-up” vaccinations that your health care professional should be aware of. If you are traveling out of the country, make an appointment with your health care professional at least four to six weeks before your trip to see if you need any travel-related vaccines. Travel is also a good time to make sure you’re up-to-date on your other vaccines, as well. The only vaccines required by law are: Yellow fever: Required for travel to countries in sub-Saharan Africa and tropical South America Meningococcal vaccine: Required for travel to Saudi Arabia during the Hajj, an annual pilgrimage Other travel-related vaccines include typhoid, hepatitis A (for adults not vaccinated as children), Japanese encephalitis vaccine and rabies.

The Truth About Vaccines

Untruths and myths about vaccines have been circulated for hundreds of years. Complaints and concerns range from invasion of privacy and “bodily integrity” to concerns about safety, the use of animals to prepare and test vaccines and religious issues. But if only a few people vaccinate their children, vaccines would not be very effective in reducing or eliminating disease. Between 85 percent and 95 percent of a population must be vaccinated to provide protection for all (herd immunity). That’s why most states in the United States require vaccination before children enter school. The Supreme Court has upheld such laws since the early part of the 20th century. Even today, however, some parents refuse to vaccinate their children. The most recent controversy around vaccines stems from suspicion of a possible link to the rising rates of autism of either the preservative thimerosal, which contains mercury, or the measles component of the MMR (measles/mumps/rubella) vaccine. Parental concern led to numerous scientific investigations regarding such links, with study after study finding no connections. Nonetheless, thimerosal was phased out of most vaccines in 2001. Autism rates, however, have continued to rise. Vaccines are extremely safe. The Centers for Disease Control and Prevention operates an Immunization Safety Office, which continuously monitors vaccine safety, including side effects. Part of its mission is managing the vaccine adverse event reporting system, which serves as an “early warning” system to detect vaccine-related problems. About 30,000 adverse event reports are filed annually, but just 10 percent to 15 percent are classified as serious (causing disability, hospitalization, life-threatening illness or death), and most of the incidents are ultimately not linked to vaccination. Anyone can file a report, including health care providers, manufacturers, personal injury lawyers and vaccine recipients or their parents or guardians. Children or adults who are harmed by a vaccine may apply for compensation from theNational Childhood Vaccine Injury Compensation Fund. Other vaccine myths and truths: Myth: The flu vaccine can cause the flu. Fact: The vaccine cannot cause the flu if you’re vaccinated with the inactivated trivalent vaccine, made with killed virus. However, fever and achiness can occur after a flu vaccine. This is not the flu, however, but the result of an activated immune system. The nasal flu vaccine, which contains a weakened live virus, could, conceivably, cause the flu in someone with a suppressed immune system. Thus, it is only approved for use in healthy people between 2 and 49 years of age (younger and older people tend to have weaker immune systems). Studies involving hundreds of healthy children and adults showed no evidence that the nasal flu vaccine resulted in the flu. However, you can get the flu after being vaccinated if the viral types used to make the vaccine do not match the circulating flu viruses. These viruses change every year, which is why the vaccine changes every year and why you need an annual vaccine. Nonetheless, in any given year the flu vaccine typically protects about 60 percent of healthy adults under 65. The older you are the less effective it is, likely because of a weaker immune system. Even when the vaccine and viruses aren’t well matched, the vaccine still protects a considerable number of people. Plus, if you get the flu, having had a vaccine means a quicker recovery with fewer complications. And don’t forget it takes about two weeks after you’re vaccinated before the vaccine fully engages your immune system. During those two weeks, you’re still susceptible to an influenza virus, even one the vaccine should protect against. Myth: Adolescents don’t need vaccines. Truth: Adolescents (and adults) definitely need vaccines and regular boosters. Children 11 or 12 need the tetanus-diphtheria-acellular pertussis (Tdap) vaccine; the meningococcal conjugate vaccine; the influenza vaccine; and the human papillomavirus (HPV) vaccine, which helps protect against cancers of the cervix, anus, vagina and vulva. Plus, teens (and adults) who haven’t had chicken pox or been immunized against the disease should get a varicella vaccine. Unfortunately, while vaccination rates for young children are very good, those for adolescents are far below what they should be, though some of these rates are improving. According to the CDC, vaccination rates have been rising for tetanus-diphtheria (Tdap) and meningococcal-conjugate vaccine (MCV4). The increase in vaccine coverage rates for human papillomavirus (HPV) vaccine, however, is only about half the rate of the increases seen for Tdap and MCV4. Myth: Vaccines provide 100 percent protection forever. Truth: It depends on the vaccine. Most vaccines that children get in their early years provide lifetime immunity. Some, like the influenza vaccine, are required annually because the viruses causing influenza change every year. Others, like the diphtheria-tetanus-acellular pertussis (DTaP) vaccine, require “booster” shots to maintain immunity. For instance, immunity from pertussis (whooping cough) vaccination wears off, making adults and adolescents particularly susceptible to the disease. The bacterial disease can lead to significant time lost from work and school. More worrisome is the fact that it can be transmitted to children who have not been vaccinated, particularly newborns, in whom the disease can be fatal. Because booster shots are needed in adolescents and adults—who are less likely to get vaccinated than children—pertussis is the only vaccine-preventable infectious disease increasing in prevalence in the United States. In 2010, nearly 28,000 cases were reported to the CDC. The number of actual cases is likely triple that. That’s why the CDC added a recommendation for the adolescent booster of Tdap in 2005. Myth: It’s OK not to vaccinate your child if other parents vaccinate theirs. Truth: In our global world, it’s important to vaccinate all children. Each year, an average of 60 people in the United States contract measles. But in 2011, the number of measles cases was higher than usual at 222. Most of these cases occurred in people who were not vaccinated, and 40 percent got measles in other countries and brought the disease back to the United States and spread it to others. High vaccine rates are necessary to provide “herd immunity” (protecting those who have not been immunized). For instance, children under 12 months cannot receive the measles vaccine, so they are particularly vulnerable. Plus, some people cannot be vaccinated for medical reasons; high rates of vaccination in the community help protect them. Measles should not be taken lightly: it is one of the most infectious diseases known to man, able to be transmitted for up to two hours after an infected person has left the room. Before the vaccine became available in the mid-1960s, up to 450 deaths and 4,000 cases of measles-related encephalitis occurred each year in the United States. Myth: Giving a child multiple vaccinations for different diseases at the same time increases the risk of harmful side effects and can overload the immune system. Truth: There is no problem vaccinating children for different diseases at the same time. Numerous studies evaluating the effects of combinations of vaccines and of giving children several vaccines at once show this approach is as effective as giving children individual vaccines with no greater risk for side effects. Giving a child two or more vaccines during one health care visit not only provides maximum protection but reduces required office visits, saves time and money and minimizes trauma (from the shots) to the child. There are also combination vaccines, in which multiple vaccines are delivered in one shot.

Therapeutic Vaccines

Cancer Vaccines When you think of a vaccine, you think of something designed to protect you from a disease. These are called prophylactic vaccines. But vaccines are also being investigated as a way to harness the power of the immune system to fight existing disease, particularly cancer. These vaccines are called therapeutic vaccines. Cancer cells proliferate for two main reasons: They develop from normal cells, so they don’t register as “foreign” to the immune system, and they have developed ways to prevent detection by the immune system. The goal of therapeutic cancer vaccines is to enhance the “foreignness” of the tumor and train the immune system to recognize similar antigens as foreign. There is currently one vaccine approved by the United States Food and Drug Administration to help treat cancer. The vaccine, called sipuleucel-t (Provenge), is a dendritic cell vaccine that treats advanced prostate cancer that no longer responds to hormone therapy. Researchers also have several cancer vaccines in late-stage clinical trials, including one to treat breast cancer. Click each type to learn more.

Antigen vaccines. These vaccines are created by mass producing a few antigens from the tumor cell, altering them so they are more easily recognized by the patient’s immune system and injecting them into the patient. Tumor cell vaccines. These vaccines are composed of cells from the patient’s tumor that have been modified so they cannot reproduce. By injecting them into the patient, it is hoped they will stimulate the immune system to attack the specific antigen for that cancer and destroy original cancer cells that are replicating. Dendritic cell vaccines. Dendritic cells are immune system cells that show antigens to T cells so they can produce antibodies. A dendritic cell vaccine trains the patient’s dendritic cells to recognize the tumor antigen as foreign, then injects the “trained” dendritic cells into the patient so they can “train” T cells. DNA vaccines. DNA vaccines use genetic material from the tumor that encodes for one or more antigens to stimulate the immune response. Vector-based vaccine. A vector-based cancer vaccine uses a virus, bacteria or yeast cell to “deliver” cancer antigens or DNA. The immune system responds to the vector as well as the cancer antigen, triggering a stronger immune response. Autoimmune Vaccines Therapeutic vaccines are also under investigation to treat autoimmune diseases like multiple sclerosis (MS) and lupus. These diseases result from an overactive immune system, one that fails to differentiate between “self” and “nonself” cells and attacks the body’s own tissue. Vaccines to treat such conditions are designed to “downregulate” the immune system by training certain immune cells to attack disease-causing immune cells. One such vaccine that has shown good results in early clinical trials is a DNA vaccine that targets the T cells that attack myelin, nerve cell sheathing, in people with MS. Vaccines in the Future Although we have made great strides in providing vaccines for many major illnesses, particularly childhood diseases, several other serious conditions remain. In addition tocancer vaccines researchers are working on vaccines to prevent malaria and HIV, the virus that causes AIDS. Vaccines are also being investigated to prevent hepatitis C, tuberculosis, Alzheimer’s disease, Parkinson’s disease and numerous other neurological and autoimmune diseases. Malaria vaccine. Malaria is one of the most devastating diseases in the world, affecting more than 300 million people a year and killing more than 1 million, primarily in sub-Saharan Africa. The actual figures, however, are likely up to three times higher, given the difficulty of diagnosing and tracking the disease in these countries. Scientists at the CDC have an ongoing malaria vaccine development and evaluation program that is testing potential malaria vaccines in small New World monkeys. HIV vaccine. Researchers throughout the world have been working on an HIV vaccine for more than 20 years without success. In the United States alone, the National Institute of Allergy and Infectious Diseases at the National Institutes of Health has conducted more than 117 HIV vaccine clinical trials to test more than 70 possible vaccines. The U.S. Military HIV Research Program and the CDC are also researching HIV vaccines. The challenge in developing a vaccine against HIV is that our immune system is weak when it comes to eradicating the virus. The virus also takes over the DNA of normal immune system cells, often lying dormant for months or even years. When it is activated, it’s too late for an immune response to be of use because the virus has co-opted cells to churn out millions of HIV copies. Another problem is that the virus mutates easily. A vaccine designed against today’s virus may be irrelevant in a couple of years. Even when the immune system recognizes antigens on the virus and produces antibodies against it, the virus mutates before those antibodies can do much good. This is why existing drugs against the infection eventually fail; the virus mutates and becomes resistant to them. However, scientists still believe a vaccine to prevent HIV is possible, and they are building on what they have learned and moving forward with the research process.

Facts to Know

1. Today, more than 300 approved vaccines provide protection against 30 diseases. 2. The immune system has two components: the innate immune system, in which inflammation destroys invading pathogens; and the adaptive immune system, which “learns” to recognize certain pathogens and retains an immunologic memory so it can quickly mount a defense the next time the pathogen appears. 3. A vaccine is designed to stimulate the adaptive immune system before you’re exposed to the virus or bacteria so you’re already protected when you encounter it. 4. There are two main types of vaccine: prophylactic, which prevents disease; and therapeutic, which treats disease. 5. There are several types of vaccines, including live, attenuated vaccines and inactivated vaccines. The former are made with live, although weakened pathogens, while the latter are made with killed pathogens, or parts of them. 6. Adolescents and adults also require vaccination, including vaccines designed to protect against human papillomaviruses (HPV), which cause cervical cancer; influenza; pneumonia; and shingles. Adolescents and adults also require regular “booster” vaccines against diphtheria, tetanus and pertussis (whooping cough). 7. Prophylactic vaccines are extremely safe, although some may have mild side effects. The most common side effects are redness, soreness and irritation at the injection site and fever. 8. People with compromised immune systems, moderate-to-severe illnesses and/or those who have had a previous reaction to a vaccine should consult with their health care professional before getting vaccinated. 9. Researchers are working on vaccines that treat malaria, cancer, autoimmune diseases and neurological conditions like Alzheimer’s disease and Parkinson’s disease. 10. While many vaccines provide lifelong immunity, some require regular boosters.

Key Q&A

1. What is the difference between the innate and adaptive immune system? The innate immune system is designed to provide a kind of “shock and awe” protection against bacteria, viruses and other pathogens. When cells in the innate immune system “see” an invader, they rush in to destroy it, often by releasing inflammatory chemicals like histamines and leukotrienes. These invaders display “signs” on their surface called antigens that signal immune system cells to action. The adaptive immune system provides a more targeted approach. As immature T and B lymphocytes encounter antigens, they develop specific antibodies against those antigens. These “mature” lymphocytes hang out in tissue, ready to quickly spring to action when they encounter the same antigens. This creates immunologic memory and prevents reinfection. 2. How do vaccines work? All vaccines are designed to affect the immune system in some way. Prophylactic vaccines are designed to stimulate a response of the adaptive immune system to a modified version of the pathogen so that when you are infected with the actual virus or bacteria, it can quickly mount a major offense against the invader before you become sick. Therapeutic vaccines are designed to strengthen the immune system’s response to a cancer or other abnormal cell. 3. What is the difference between live and “killed” vaccines? Live, attenuated vaccines contain a live, although significantly weakened, version of the virus or bacteria. Measles, mumps and chicken pox vaccines are made with live viruses. The benefit of a live vaccine is that a single dose often provides lifelong immunity. The downside is that because viruses and other pathogens naturally mutate, or change, the virus within the vaccine could also change, creating a more virulent version of itself that the immune system would have difficulty combatting. This was an issue with the early oral polio vaccines, but is generally not a problem with current live vaccines, which are much safer than the virus they protect against. Only people with a suppressed immune system (such as those who have HIV, are taking immunosuppressant drugs or are being treated for cancer) should be concerned about receiving live vaccines because they could, conceivably, become infected with the virus. These vaccines also usually require refrigeration. Inactivated vaccines contain a killed version of the pathogen. They are more stable (meaning they don’t need refrigeration) and safer than attenuated viruses, but they don’t elicit as strong an immune response. Thus, the immunity they provide may not last as long and you might need a “booster” vaccine down the road. 4. What types of vaccines protect against bacterial infections? Typically, inactivated vaccines. Many bacteria secrete toxins that damage healthy cells. Toxoid vaccines treat the bacteria with formalin, which renders the toxins harmless but still retains enough of their structure to “teach” immune cells to recognize the bacteria and train them to lock onto the toxin antigen before the bacteria can release it. Toxoid vaccines are used for diphtheria and tetanus. Conjugate vaccines are also used in young children to protect against infections caused by Haemophilus influenzae type b (such as meningitis and lung infections) and pneumococcal disease. 5. What should I do if my child misses a vaccine? Call your health care professional. Children can “catch up” on nearly all vaccines, regardless of their age, except for the rotavirus vaccine, which protects infants against the severe vomiting and diarrhea caused by rotavirus. 6. What vaccines do adolescents require? Preteens and adolescents should receive vaccines against the human papillomavirus, meningococcal disease and tetanus/diphtheria/acellular pertussis (Tdap). Depending on what vaccines your child received when younger, he or she may also need “catch-up” vaccines for hepatitis B, mumps/measles/rubella, polio or varicella (chicken pox). Additionally, everyone 6 months and older should receive an annual influenza vaccine. 7. I’m traveling out of the country. What vaccines do I need? Make an appointment with your health care professional at least four to six weeks before your trip to see if you need any travel-related vaccines. The only required vaccines are yellow fever for those traveling to countries in sub-Saharan Africa and tropical South America and the meningococcal vaccine for travel to Saudi Arabia during the Hajj. You can learn more about vaccines required for overseas travel at theCenters for Disease Control website. Your local health department can typically provide the vaccines. 8. I’m worried about the safety of vaccines. Vaccines are extremely safe. The Centers for Disease Control and Prevention operates an Immunization Safety Office that continuously monitors vaccine safety, including side effects. Part of its mission is managing the vaccine adverse event reporting system, which serves as an “early warning” system to detect vaccine-related problems. About 30,000 reports are filed annually, but just 10 percent to 15 percent are classified as serious (causing disability, hospitalization, life-threatening illness or death), and most of the incidents are ultimately not linked to vaccination. Anyone can file a report, including health care providers, manufacturers, personal injury lawyers and vaccine recipients or their parents or guardians. 9. I heard that vaccines can cause autism. Some parents insist that their children developed autism after having early childhood vaccines, such as the measles/mumps/rubella (MMR) vaccine. Some suspect that a preservative once used in childhood vaccines that contained mercury caused autism. But numerous scientific investigations regarding a possible link found no connection. Today’s childhood vaccines do not have mercury-based preservatives; nonetheless, autism rates have continued to rise. 10. I have breast cancer. I heard there is a vaccine that can treat the cancer. How can I find out more? There are several vaccines under investigation for cancer. These are called therapeutic vaccines because they are designed to treat, rather than prevent, disease. However, none have been approved yet. So talk to your doctor about joining a clinical trial.

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Know About Vaccines

Overview

The discovery and wide application of vaccines that protect against once-fatal childhood diseases like measles, mumps, rubella and diphtheria is one of the most significant medical contributions of the past two centuries. Today, newborns get their first vaccine soon after birth (hepatitis B), then, between one and two months begin a series of shots that will eventually protect them against 14 diseases. Worldwide, childhood vaccines prevent up to 3 million deaths each year. In recent years, however, parents are increasingly likely to under-vaccinate their children. A January 2013 study published in JAMA Pediatrics reported that nearly half of children ages 2 months to 24 months in the United States either aren't getting all the necessary vaccines or have not been vaccinated at all. Vaccines are not just for kids. Adolescents and adults need them, too, whether to "boost" earlier immunizations that provided immunity against diphtheria, pertussis and tetanus or to protect against other diseases, such asinfluenza, pneumonia, shingles, bacterial meningitis or, for those traveling abroad,yellow fever and typhoid. Preteen girls and boys can now be vaccinated against several strains of the human papillomavirus (HPV), which cause most cervical cancers, as well as cancer of the anus, vagina and vulva. Vaccines are also being developed to prevent malaria and HIV, the virus that causes AIDS, as well as to harness the power of the immune system to fight cancer and other diseases. The History of Vaccines The roots of modern vaccines stretch halfway across the world to ancient China and India where, as early as the 10th century BC, people inhaled pus from smallpox blisters to inoculate themselves against the deadly disease. But it wasn't until 1796 that a country doctor from England named Edward Jenner formally vaccinated a child against the disease. Rather than using pus or scabs from individuals infected with smallpox, he used pus from a similar, but less virulent pox disease called cowpox. He hypothesized this would protect against smallpox because milkmaids infected with cowpox never caught smallpox, even during epidemics. Two weeks after inoculating an 8-year-old boy, Jenner tried to infect him with smallpox. Nothing happened. Voila! The first successful vaccination. (Indeed, the word vaccine comes from the Latin word "vacca" for cow). It, however, would be nearly two centuries later before smallpox was eradicated worldwide (the last known case occurred in Somalia in 1977). Its banishment (except for samples held in Russian and American laboratories) has been heralded as one of the most significant medical achievements in history. We've come a long way from Jenner's days, when "vaccines" were given by using a quill or ivory point to transfer the infected pus into a healthy person's skin. Today, safe, hair-thin needles deliver nearly painless injections, while some vaccines can be given orally with drops or nasally through a spray. Today we have vaccines against childhood illnesses like diphtheria, mumps, rubella and measles, which used to kill millions of children each year; against tetanus and rabies; and even against cancer. Some are designed to protect against infection in the first place; others to prevent the pathogen's replication and halt its ability to infect normal cells. In all, more than 300 approved vaccines protect against 30 diseases. Not only have vaccines saved lives, they have changed the very world in which we live. Vaccine Basics To understand how vaccines work, you first need to understand how your immune system works. There are two types of immunity: innate and adaptive. The innate immune system is a nonspecific response to any threat. Invaders such as bacteria, viruses and other pathogens display "signs" on their surface called antigens that signal immune system cells to action. The innate immune system includes visible protection, like skin and the mucus membranes in your nose and mouth that strain out pathogens, and invisible protection in the form of white blood cells like macrophages, which release inflammatory chemicals such as histamine and leukotrienes to destroy invaders. Sometimes this process runs amok, as when the innate immune system launches an all-out attack against harmless proteins like those from pollen or peanuts, resulting in an allergic reaction. A more targeted approach to threats comes from your adaptive immune system, which responds to specific antigens. The foundation of this system exists in T and Blymphocytes. These immune cells learn to recognize certain antigens. Once they identify a non–self invader, they generate specific responses to destroy that invader. B cells mature into specialized cells with antigen-specific antibodies on their surfaces that lock onto the antigen to annihilate it. T cells release toxins to destroy the invader or call other immune system cells into action. Once T and B cells are activated, they leave behind copies of themselves that are ready to spring into action again if the specific antigen appears. This is known as immunologic memory. These mature T and B cells enable your immune system to launch an attack against, say, a measles virus so quickly that the virus never has time to infect healthy cells and make you sick. Thus, the adaptive immune system, unlike the innate immune system, protects against reinfection. The problem with the adaptive immune system is that the first time it can take several days to get up to speed once it encounters a new antigen. That's more than enough time for most pathogens to replicate and make you sick. Enter vaccines. A vaccine is designed to stimulate the adaptive immune system before you're exposed to the virus and bacteria so when you do encounter it, specialized T and B cells already exist, ready to spring into action before the pathogen can make you sick.

Types of Vaccines Vaccines may be produced in several ways:

Live, attenuated vaccines Inactivated vaccines Subunit vaccines Toxoid vaccines Conjugate vaccines DNA vaccines Recombinant vector vaccines Live, attenuated vaccines. These vaccines contain a live, although significantly weakened, version of the pathogen. Measles, mumps and chicken pox vaccines are made with live viruses. The only bacterial vaccine made with live pathogens in the United States is the typhoid vaccine. The benefit of a live vaccine is that a single dose often provides lifelong immunity. The downside is that because viruses and other pathogens naturally mutate, or change, the virus within the vaccine could also change, possibly creating a more virulent version of itself that the immune system would have difficulty combatting. This was an issue with the early oral polio vaccines but is generally not a problem with current live vaccines, which are much safer than the virus they protect against. Only people with a suppressed immune system (such as those who have HIV/AIDS, are taking immunosuppressant drugs or are being treated for cancer) should be concerned about receiving live vaccines because they could, conceivably, become infected with the virus. Live vaccines also usually require refrigeration. Inactivated vaccines. These vaccines contain a killed version of the pathogen. They are more stable (meaning they don't need refrigeration) and safer than attenuated viruses, but they don't elicit as strong an immune response. Thus, the immunity they provide may not last as long and you might need a "booster" vaccine down the road. Subunit vaccines. These vaccines are made with bits and pieces of the inactivated antigen called epitopes. The advantage is that by using fewer molecules of the virus or bacteria, there is less risk of side effects. The disadvantage is that it is challenging and time consuming to identify the exact epitopes needed to stimulate the immune system. Toxoid vaccines. These vaccines are designed to protect against bacteria that secrete toxins. Treating the bacteria with formalin renders the toxins harmless but still retains enough of their structure to "teach" immune cells to recognize the bacteria and train them to lock onto the toxin antigen before the bacteria can release the chemical. Toxoid vaccines are used for diphtheria and tetanus. Conjugate vaccines. Conjugate vaccines are typically used to provide protection against certain types of bacterial infection, particularly in very young children. These bacteria, including those that cause bacterial meningitis, are surrounded by a thick capsule called a polysaccharide coating. This coating helps the bacteria hide from the immune system. Thus, antigen-presenting T cells can't "show" the antigen to B cells. B cells can still produce antibodies against the bacterial antigens and provide some protection, albeit short-lived, but this type of protection doesn't develop until children are about 2 years old. So many polysaccharide vaccines for adults and older children don't work in younger children, leaving children highly susceptible to the illnesses those bacteria cause. Enter the conjugate vaccine. Antigens or toxoids that the baby's immune system does recognize are attached to the polysaccharide coating. The infant's immune system learns to recognize polysaccharide coatings as dangerous and to defend against such pathogens. DNA vaccines. DNA vaccines are not yet in use, though they are being tested for influenza and herpes. These vaccines are made of the organism's genetic material, which carries the code, or recipe, for antigens. Once in the body, normal cells take up the DNA and begin making the microbe's antigens, displaying them on their surface and stimulating the immune system to respond. Recombinant vector vaccines. These vaccines also are not yet approved for widespread use but are being evaluated for HIV, rabies and measles and are thought to be even safer than existing vaccines. With recombinant vector vaccines, the microbe's DNA is inserted into another virus or bacteria that transports the DNA, enters cells and releases the DNA into the healthy cell, which then can provoke the immune response.

When to Vaccinate

These charts contain recommendations from the U.S. Centers for Disease Control and Prevention (CDC) for preventive vaccines. Don't panic if you or your child has not received all vaccinations on time; the CDC has guidelines for "catch-up" vaccinations that your health care professional should be aware of. If you are traveling out of the country, make an appointment with your health care professional at least four to six weeks before your trip to see if you need any travel-related vaccines. Travel is also a good time to make sure you're up-to-date on your other vaccines, as well. The only vaccines required by law are: Yellow fever: Required for travel to countries in sub-Saharan Africa and tropical South America Meningococcal vaccine: Required for travel to Saudi Arabia during the Hajj, an annual pilgrimage Other travel-related vaccines include typhoid, hepatitis A (for adults not vaccinated as children), Japanese encephalitis vaccine and rabies.

The Truth About Vaccines

Untruths and myths about vaccines have been circulated for hundreds of years. Complaints and concerns range from invasion of privacy and "bodily integrity" to concerns about safety, the use of animals to prepare and test vaccines and religious issues. But if only a few people vaccinate their children, vaccines would not be very effective in reducing or eliminating disease. Between 85 percent and 95 percent of a population must be vaccinated to provide protection for all (herd immunity). That's why most states in the United States require vaccination before children enter school. The Supreme Court has upheld such laws since the early part of the 20th century. Even today, however, some parents refuse to vaccinate their children. The most recent controversy around vaccines stems from suspicion of a possible link to the rising rates of autism of either the preservative thimerosal, which contains mercury, or the measles component of the MMR (measles/mumps/rubella) vaccine. Parental concern led to numerous scientific investigations regarding such links, with study after study finding no connections. Nonetheless, thimerosal was phased out of most vaccines in 2001. Autism rates, however, have continued to rise. Vaccines are extremely safe. The Centers for Disease Control and Prevention operates an Immunization Safety Office, which continuously monitors vaccine safety, including side effects. Part of its mission is managing the vaccine adverse event reporting system, which serves as an "early warning" system to detect vaccine-related problems. About 30,000 adverse event reports are filed annually, but just 10 percent to 15 percent are classified as serious (causing disability, hospitalization, life-threatening illness or death), and most of the incidents are ultimately not linked to vaccination. Anyone can file a report, including health care providers, manufacturers, personal injury lawyers and vaccine recipients or their parents or guardians. Children or adults who are harmed by a vaccine may apply for compensation from theNational Childhood Vaccine Injury Compensation Fund. Other vaccine myths and truths: Myth: The flu vaccine can cause the flu. Fact: The vaccine cannot cause the flu if you're vaccinated with the inactivated trivalent vaccine, made with killed virus. However, fever and achiness can occur after a flu vaccine. This is not the flu, however, but the result of an activated immune system. The nasal flu vaccine, which contains a weakened live virus, could, conceivably, cause the flu in someone with a suppressed immune system. Thus, it is only approved for use in healthy people between 2 and 49 years of age (younger and older people tend to have weaker immune systems). Studies involving hundreds of healthy children and adults showed no evidence that the nasal flu vaccine resulted in the flu. However, you can get the flu after being vaccinated if the viral types used to make the vaccine do not match the circulating flu viruses. These viruses change every year, which is why the vaccine changes every year and why you need an annual vaccine. Nonetheless, in any given year the flu vaccine typically protects about 60 percent of healthy adults under 65. The older you are the less effective it is, likely because of a weaker immune system. Even when the vaccine and viruses aren't well matched, the vaccine still protects a considerable number of people. Plus, if you get the flu, having had a vaccine means a quicker recovery with fewer complications. And don't forget it takes about two weeks after you're vaccinated before the vaccine fully engages your immune system. During those two weeks, you're still susceptible to an influenza virus, even one the vaccine should protect against.

Myth: Adolescents don't need vaccines.

Truth: Adolescents (and adults) definitely need vaccines and regular boosters. Children 11 or 12 need the tetanus-diphtheria-acellular pertussis (Tdap) vaccine; the meningococcal conjugate vaccine; the influenza vaccine; and the human papillomavirus (HPV) vaccine, which helps protect against cancers of the cervix, anus, vagina and vulva. Plus, teens (and adults) who haven't had chicken pox or been immunized against the disease should get a varicella vaccine. Unfortunately, while vaccination rates for young children are very good, those for adolescents are far below what they should be, though some of these rates are improving. According to the CDC, vaccination rates have been rising for tetanus-diphtheria (Tdap) and meningococcal-conjugate vaccine (MCV4). The increase in vaccine coverage rates for human papillomavirus (HPV) vaccine, however, is only about half the rate of the increases seen for Tdap and MCV4.

Myth: Vaccines provide 100 percent protection forever.

Truth: It depends on the vaccine. Most vaccines that children get in their early years provide lifetime immunity. Some, like the influenza vaccine, are required annually because the viruses causing influenza change every year. Others, like the diphtheria-tetanus-acellular pertussis (DTaP) vaccine, require "booster" shots to maintain immunity. For instance, immunity from pertussis (whooping cough) vaccination wears off, making adults and adolescents particularly susceptible to the disease. The bacterial disease can lead to significant time lost from work and school. More worrisome is the fact that it can be transmitted to children who have not been vaccinated, particularly newborns, in whom the disease can be fatal. Because booster shots are needed in adolescents and adults—who are less likely to get vaccinated than children—pertussis is the only vaccine-preventable infectious disease increasing in prevalence in the United States. In 2010, nearly 28,000 cases were reported to the CDC. The number of actual cases is likely triple that. That’s why the CDC added a recommendation for the adolescent booster of Tdap in 2005.

Myth: It's OK not to vaccinate your child if other parents vaccinate theirs.

Truth: In our global world, it's important to vaccinate all children. Each year, an average of 60 people in the United States contract measles. But in 2011, the number of measles cases was higher than usual at 222. Most of these cases occurred in people who were not vaccinated, and 40 percent got measles in other countries and brought the disease back to the United States and spread it to others. High vaccine rates are necessary to provide "herd immunity" (protecting those who have not been immunized). For instance, children under 12 months cannot receive the measles vaccine, so they are particularly vulnerable. Plus, some people cannot be vaccinated for medical reasons; high rates of vaccination in the community help protect them. Measles should not be taken lightly: it is one of the most infectious diseases known to man, able to be transmitted for up to two hours after an infected person has left the room. Before the vaccine became available in the mid-1960s, up to 450 deaths and 4,000 cases of measles-related encephalitis occurred each year in the United States.

Myth: Giving a child multiple vaccinations for different diseases at the same time increases the risk of harmful side effects and can overload the immune system.

Truth: There is no problem vaccinating children for different diseases at the same time. Numerous studies evaluating the effects of combinations of vaccines and of giving children several vaccines at once show this approach is as effective as giving children individual vaccines with no greater risk for side effects. Giving a child two or more vaccines during one health care visit not only provides maximum protection but reduces required office visits, saves time and money and minimizes trauma (from the shots) to the child. There are also combination vaccines, in which multiple vaccines are delivered in one shot.

Therapeutic Vaccines

Cancer Vaccines When you think of a vaccine, you think of something designed to protect you from a disease. These are called prophylactic vaccines. But vaccines are also being investigated as a way to harness the power of the immune system to fight existing disease, particularly cancer. These vaccines are called therapeutic vaccines. Cancer cells proliferate for two main reasons: They develop from normal cells, so they don't register as "foreign" to the immune system, and they have developed ways to prevent detection by the immune system. The goal of therapeutic cancer vaccines is to enhance the "foreignness" of the tumor and train the immune system to recognize similar antigens as foreign. There is currently one vaccine approved by the United States Food and Drug Administration to help treat cancer. The vaccine, called sipuleucel-t (Provenge), is a dendritic cell vaccine that treats advanced prostate cancer that no longer responds to hormone therapy. Researchers also have several cancer vaccines in late-stage clinical trials, including one to treat breast cancer. Click each type to learn more. Antigen vaccines. These vaccines are created by mass producing a few antigens from the tumor cell, altering them so they are more easily recognized by the patient's immune system and injecting them into the patient. Tumor cell vaccines. These vaccines are composed of cells from the patient's tumor that have been modified so they cannot reproduce. By injecting them into the patient, it is hoped they will stimulate the immune system to attack the specific antigen for that cancer and destroy original cancer cells that are replicating. Dendritic cell vaccines. Dendritic cells are immune system cells that show antigens to T cells so they can produce antibodies. A dendritic cell vaccine trains the patient's dendritic cells to recognize the tumor antigen as foreign, then injects the "trained" dendritic cells into the patient so they can "train" T cells. DNA vaccines. DNA vaccines use genetic material from the tumor that encodes for one or more antigens to stimulate the immune response. Vector-based vaccine. A vector-based cancer vaccine uses a virus, bacteria or yeast cell to "deliver" cancer antigens or DNA. The immune system responds to the vector as well as the cancer antigen, triggering a stronger immune response. Autoimmune Vaccines Therapeutic vaccines are also under investigation to treat autoimmune diseases like multiple sclerosis (MS) and lupus. These diseases result from an overactive immune system, one that fails to differentiate between "self" and "nonself" cells and attacks the body's own tissue. Vaccines to treat such conditions are designed to "downregulate" the immune system by training certain immune cells to attack disease-causing immune cells. One such vaccine that has shown good results in early clinical trials is a DNA vaccine that targets the T cells that attack myelin, nerve cell sheathing, in people with MS. Vaccines in the Future Although we have made great strides in providing vaccines for many major illnesses, particularly childhood diseases, several other serious conditions remain. In addition tocancer vaccines researchers are working on vaccines to prevent malaria and HIV, the virus that causes AIDS. Vaccines are also being investigated to prevent hepatitis C, tuberculosis, Alzheimer's disease, Parkinson's disease and numerous other neurological and autoimmune diseases. Malaria vaccine. Malaria is one of the most devastating diseases in the world, affecting more than 300 million people a year and killing more than 1 million, primarily in sub-Saharan Africa. The actual figures, however, are likely up to three times higher, given the difficulty of diagnosing and tracking the disease in these countries. Scientists at the CDC have an ongoing malaria vaccine development and evaluation program that is testing potential malaria vaccines in small New World monkeys. HIV vaccine. Researchers throughout the world have been working on an HIV vaccine for more than 20 years without success. In the United States alone, the National Institute of Allergy and Infectious Diseases at the National Institutes of Health has conducted more than 117 HIV vaccine clinical trials to test more than 70 possible vaccines. The U.S. Military HIV Research Program and the CDC are also researching HIV vaccines. The challenge in developing a vaccine against HIV is that our immune system is weak when it comes to eradicating the virus. The virus also takes over the DNA of normal immune system cells, often lying dormant for months or even years. When it is activated, it's too late for an immune response to be of use because the virus has co-opted cells to churn out millions of HIV copies. Another problem is that the virus mutates easily. A vaccine designed against today's virus may be irrelevant in a couple of years. Even when the immune system recognizes antigens on the virus and produces antibodies against it, the virus mutates before those antibodies can do much good. This is why existing drugs against the infection eventually fail; the virus mutates and becomes resistant to them. However, scientists still believe a vaccine to prevent HIV is possible, and they are building on what they have learned and moving forward with the research process.

Facts to Know

1. Today, more than 300 approved vaccines provide protection against 30 diseases. 2. The immune system has two components: the innate immune system, in which inflammation destroys invading pathogens; and the adaptive immune system, which "learns" to recognize certain pathogens and retains an immunologic memory so it can quickly mount a defense the next time the pathogen appears. 3. A vaccine is designed to stimulate the adaptive immune system before you're exposed to the virus or bacteria so you're already protected when you encounter it. 4. There are two main types of vaccine: prophylactic, which prevents disease; and therapeutic, which treats disease. 5. There are several types of vaccines, including live, attenuated vaccines and inactivated vaccines. The former are made with live, although weakened pathogens, while the latter are made with killed pathogens, or parts of them. 6. Adolescents and adults also require vaccination, including vaccines designed to protect against human papillomaviruses (HPV), which cause cervical cancer; influenza; pneumonia; and shingles. Adolescents and adults also require regular "booster" vaccines against diphtheria, tetanus and pertussis (whooping cough). 7. Prophylactic vaccines are extremely safe, although some may have mild side effects. The most common side effects are redness, soreness and irritation at the injection site and fever. 8. People with compromised immune systems, moderate-to-severe illnesses and/or those who have had a previous reaction to a vaccine should consult with their health care professional before getting vaccinated. 9. Researchers are working on vaccines that treat malaria, cancer, autoimmune diseases and neurological conditions like Alzheimer's disease and Parkinson's disease. 10. While many vaccines provide lifelong immunity, some require regular boosters. Key Q&A 1. What is the difference between the innate and adaptive immune system? The innate immune system is designed to provide a kind of "shock and awe" protection against bacteria, viruses and other pathogens. When cells in the innate immune system "see" an invader, they rush in to destroy it, often by releasing inflammatory chemicals like histamines and leukotrienes. These invaders display "signs" on their surface called antigens that signal immune system cells to action. The adaptive immune system provides a more targeted approach. As immature T and B lymphocytes encounter antigens, they develop specific antibodies against those antigens. These "mature" lymphocytes hang out in tissue, ready to quickly spring to action when they encounter the same antigens. This creates immunologic memory and prevents reinfection. 2. How do vaccines work? All vaccines are designed to affect the immune system in some way. Prophylactic vaccines are designed to stimulate a response of the adaptive immune system to a modified version of the pathogen so that when you are infected with the actual virus or bacteria, it can quickly mount a major offense against the invader before you become sick. Therapeutic vaccines are designed to strengthen the immune system's response to a cancer or other abnormal cell. 3. What is the difference between live and "killed" vaccines? Live, attenuated vaccines contain a live, although significantly weakened, version of the virus or bacteria. Measles, mumps and chicken pox vaccines are made with live viruses. The benefit of a live vaccine is that a single dose often provides lifelong immunity. The downside is that because viruses and other pathogens naturally mutate, or change, the virus within the vaccine could also change, creating a more virulent version of itself that the immune system would have difficulty combatting. This was an issue with the early oral polio vaccines, but is generally not a problem with current live vaccines, which are much safer than the virus they protect against. Only people with a suppressed immune system (such as those who have HIV, are taking immunosuppressant drugs or are being treated for cancer) should be concerned about receiving live vaccines because they could, conceivably, become infected with the virus. These vaccines also usually require refrigeration. Inactivated vaccines contain a killed version of the pathogen. They are more stable (meaning they don't need refrigeration) and safer than attenuated viruses, but they don't elicit as strong an immune response. Thus, the immunity they provide may not last as long and you might need a "booster" vaccine down the road. 4. What types of vaccines protect against bacterial infections? Typically, inactivated vaccines. Many bacteria secrete toxins that damage healthy cells. Toxoid vaccines treat the bacteria with formalin, which renders the toxins harmless but still retains enough of their structure to "teach" immune cells to recognize the bacteria and train them to lock onto the toxin antigen before the bacteria can release it. Toxoid vaccines are used for diphtheria and tetanus. Conjugate vaccines are also used in young children to protect against infections caused by Haemophilus influenzae type b (such as meningitis and lung infections) and pneumococcal disease. 5. What should I do if my child misses a vaccine? Call your health care professional. Children can "catch up" on nearly all vaccines, regardless of their age, except for the rotavirus vaccine, which protects infants against the severe vomiting and diarrhea caused by rotavirus. 6. What vaccines do adolescents require? Preteens and adolescents should receive vaccines against the human papillomavirus, meningococcal disease and tetanus/diphtheria/acellular pertussis (Tdap). Depending on what vaccines your child received when younger, he or she may also need "catch-up" vaccines for hepatitis B, mumps/measles/rubella, polio or varicella (chicken pox). Additionally, everyone 6 months and older should receive an annual influenza vaccine. 7. I'm traveling out of the country. What vaccines do I need? Make an appointment with your health care professional at least four to six weeks before your trip to see if you need any travel-related vaccines. The only required vaccines are yellow fever for those traveling to countries in sub-Saharan Africa and tropical South America and the meningococcal vaccine for travel to Saudi Arabia during the Hajj. You can learn more about vaccines required for overseas travel at theCenters for Disease Control website. Your local health department can typically provide the vaccines. 8. I'm worried about the safety of vaccines. Vaccines are extremely safe. The Centers for Disease Control and Prevention operates an Immunization Safety Office that continuously monitors vaccine safety, including side effects. Part of its mission is managing the vaccine adverse event reporting system, which serves as an "early warning" system to detect vaccine-related problems. About 30,000 reports are filed annually, but just 10 percent to 15 percent are classified as serious (causing disability, hospitalization, life-threatening illness or death), and most of the incidents are ultimately not linked to vaccination. Anyone can file a report, including health care providers, manufacturers, personal injury lawyers and vaccine recipients or their parents or guardians. 9. I heard that vaccines can cause autism. Some parents insist that their children developed autism after having early childhood vaccines, such as the measles/mumps/rubella (MMR) vaccine. Some suspect that a preservative once used in childhood vaccines that contained mercury caused autism. But numerous scientific investigations regarding a possible link found no connection. Today's childhood vaccines do not have mercury-based preservatives; nonetheless, autism rates have continued to rise. 10. I have breast cancer. I heard there is a vaccine that can treat the cancer. How can I find out more? There are several vaccines under investigation for cancer. These are called therapeutic vaccines because they are designed to treat, rather than prevent, disease. However, none have been approved yet. So talk to your doctor about joining a clinical trial. Read the full article

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Know About Vaccines

Overview

The discovery and wide application of vaccines that protect against once-fatal childhood diseases like measles, mumps, rubella and diphtheria is one of the most significant medical contributions of the past two centuries. Today, newborns get their first vaccine soon after birth (hepatitis B), then, between one and two months begin a series of shots that will eventually protect them against 14 diseases. Worldwide, childhood vaccines prevent up to 3 million deaths each year. In recent years, however, parents are increasingly likely to under-vaccinate their children. A January 2013 study published in JAMA Pediatrics reported that nearly half of children ages 2 months to 24 months in the United States either aren't getting all the necessary vaccines or have not been vaccinated at all. Vaccines are not just for kids. Adolescents and adults need them, too, whether to "boost" earlier immunizations that provided immunity against diphtheria, pertussis and tetanus or to protect against other diseases, such asinfluenza, pneumonia, shingles, bacterial meningitis or, for those traveling abroad,yellow fever and typhoid. Preteen girls and boys can now be vaccinated against several strains of the human papillomavirus (HPV), which cause most cervical cancers, as well as cancer of the anus, vagina and vulva. Vaccines are also being developed to prevent malaria and HIV, the virus that causes AIDS, as well as to harness the power of the immune system to fight cancer and other diseases. The History of Vaccines The roots of modern vaccines stretch halfway across the world to ancient China and India where, as early as the 10th century BC, people inhaled pus from smallpox blisters to inoculate themselves against the deadly disease. But it wasn't until 1796 that a country doctor from England named Edward Jenner formally vaccinated a child against the disease. Rather than using pus or scabs from individuals infected with smallpox, he used pus from a similar, but less virulent pox disease called cowpox. He hypothesized this would protect against smallpox because milkmaids infected with cowpox never caught smallpox, even during epidemics. Two weeks after inoculating an 8-year-old boy, Jenner tried to infect him with smallpox. Nothing happened. Voila! The first successful vaccination. (Indeed, the word vaccine comes from the Latin word "vacca" for cow). It, however, would be nearly two centuries later before smallpox was eradicated worldwide (the last known case occurred in Somalia in 1977). Its banishment (except for samples held in Russian and American laboratories) has been heralded as one of the most significant medical achievements in history. We've come a long way from Jenner's days, when "vaccines" were given by using a quill or ivory point to transfer the infected pus into a healthy person's skin. Today, safe, hair-thin needles deliver nearly painless injections, while some vaccines can be given orally with drops or nasally through a spray. Today we have vaccines against childhood illnesses like diphtheria, mumps, rubella and measles, which used to kill millions of children each year; against tetanus and rabies; and even against cancer. Some are designed to protect against infection in the first place; others to prevent the pathogen's replication and halt its ability to infect normal cells. In all, more than 300 approved vaccines protect against 30 diseases. Not only have vaccines saved lives, they have changed the very world in which we live. Vaccine Basics To understand how vaccines work, you first need to understand how your immune system works. There are two types of immunity: innate and adaptive. The innate immune system is a nonspecific response to any threat. Invaders such as bacteria, viruses and other pathogens display "signs" on their surface called antigens that signal immune system cells to action. The innate immune system includes visible protection, like skin and the mucus membranes in your nose and mouth that strain out pathogens, and invisible protection in the form of white blood cells like macrophages, which release inflammatory chemicals such as histamine and leukotrienes to destroy invaders. Sometimes this process runs amok, as when the innate immune system launches an all-out attack against harmless proteins like those from pollen or peanuts, resulting in an allergic reaction. A more targeted approach to threats comes from your adaptive immune system, which responds to specific antigens. The foundation of this system exists in T and Blymphocytes. These immune cells learn to recognize certain antigens. Once they identify a non–self invader, they generate specific responses to destroy that invader. B cells mature into specialized cells with antigen-specific antibodies on their surfaces that lock onto the antigen to annihilate it. T cells release toxins to destroy the invader or call other immune system cells into action. Once T and B cells are activated, they leave behind copies of themselves that are ready to spring into action again if the specific antigen appears. This is known as immunologic memory. These mature T and B cells enable your immune system to launch an attack against, say, a measles virus so quickly that the virus never has time to infect healthy cells and make you sick. Thus, the adaptive immune system, unlike the innate immune system, protects against reinfection. The problem with the adaptive immune system is that the first time it can take several days to get up to speed once it encounters a new antigen. That's more than enough time for most pathogens to replicate and make you sick. Enter vaccines. A vaccine is designed to stimulate the adaptive immune system before you're exposed to the virus and bacteria so when you do encounter it, specialized T and B cells already exist, ready to spring into action before the pathogen can make you sick.

Types of Vaccines Vaccines may be produced in several ways:

Live, attenuated vaccines Inactivated vaccines Subunit vaccines Toxoid vaccines Conjugate vaccines DNA vaccines Recombinant vector vaccines Live, attenuated vaccines. These vaccines contain a live, although significantly weakened, version of the pathogen. Measles, mumps and chicken pox vaccines are made with live viruses. The only bacterial vaccine made with live pathogens in the United States is the typhoid vaccine. The benefit of a live vaccine is that a single dose often provides lifelong immunity. The downside is that because viruses and other pathogens naturally mutate, or change, the virus within the vaccine could also change, possibly creating a more virulent version of itself that the immune system would have difficulty combatting. This was an issue with the early oral polio vaccines but is generally not a problem with current live vaccines, which are much safer than the virus they protect against. Only people with a suppressed immune system (such as those who have HIV/AIDS, are taking immunosuppressant drugs or are being treated for cancer) should be concerned about receiving live vaccines because they could, conceivably, become infected with the virus. Live vaccines also usually require refrigeration. Inactivated vaccines. These vaccines contain a killed version of the pathogen. They are more stable (meaning they don't need refrigeration) and safer than attenuated viruses, but they don't elicit as strong an immune response. Thus, the immunity they provide may not last as long and you might need a "booster" vaccine down the road. Subunit vaccines. These vaccines are made with bits and pieces of the inactivated antigen called epitopes. The advantage is that by using fewer molecules of the virus or bacteria, there is less risk of side effects. The disadvantage is that it is challenging and time consuming to identify the exact epitopes needed to stimulate the immune system. Toxoid vaccines. These vaccines are designed to protect against bacteria that secrete toxins. Treating the bacteria with formalin renders the toxins harmless but still retains enough of their structure to "teach" immune cells to recognize the bacteria and train them to lock onto the toxin antigen before the bacteria can release the chemical. Toxoid vaccines are used for diphtheria and tetanus. Conjugate vaccines. Conjugate vaccines are typically used to provide protection against certain types of bacterial infection, particularly in very young children. These bacteria, including those that cause bacterial meningitis, are surrounded by a thick capsule called a polysaccharide coating. This coating helps the bacteria hide from the immune system. Thus, antigen-presenting T cells can't "show" the antigen to B cells. B cells can still produce antibodies against the bacterial antigens and provide some protection, albeit short-lived, but this type of protection doesn't develop until children are about 2 years old. So many polysaccharide vaccines for adults and older children don't work in younger children, leaving children highly susceptible to the illnesses those bacteria cause. Enter the conjugate vaccine. Antigens or toxoids that the baby's immune system does recognize are attached to the polysaccharide coating. The infant's immune system learns to recognize polysaccharide coatings as dangerous and to defend against such pathogens. DNA vaccines. DNA vaccines are not yet in use, though they are being tested for influenza and herpes. These vaccines are made of the organism's genetic material, which carries the code, or recipe, for antigens. Once in the body, normal cells take up the DNA and begin making the microbe's antigens, displaying them on their surface and stimulating the immune system to respond. Recombinant vector vaccines. These vaccines also are not yet approved for widespread use but are being evaluated for HIV, rabies and measles and are thought to be even safer than existing vaccines. With recombinant vector vaccines, the microbe's DNA is inserted into another virus or bacteria that transports the DNA, enters cells and releases the DNA into the healthy cell, which then can provoke the immune response.

When to Vaccinate

These charts contain recommendations from the U.S. Centers for Disease Control and Prevention (CDC) for preventive vaccines. Don't panic if you or your child has not received all vaccinations on time; the CDC has guidelines for "catch-up" vaccinations that your health care professional should be aware of. If you are traveling out of the country, make an appointment with your health care professional at least four to six weeks before your trip to see if you need any travel-related vaccines. Travel is also a good time to make sure you're up-to-date on your other vaccines, as well. The only vaccines required by law are: Yellow fever: Required for travel to countries in sub-Saharan Africa and tropical South America Meningococcal vaccine: Required for travel to Saudi Arabia during the Hajj, an annual pilgrimage Other travel-related vaccines include typhoid, hepatitis A (for adults not vaccinated as children), Japanese encephalitis vaccine and rabies.

The Truth About Vaccines

Untruths and myths about vaccines have been circulated for hundreds of years. Complaints and concerns range from invasion of privacy and "bodily integrity" to concerns about safety, the use of animals to prepare and test vaccines and religious issues. But if only a few people vaccinate their children, vaccines would not be very effective in reducing or eliminating disease. Between 85 percent and 95 percent of a population must be vaccinated to provide protection for all (herd immunity). That's why most states in the United States require vaccination before children enter school. The Supreme Court has upheld such laws since the early part of the 20th century. Even today, however, some parents refuse to vaccinate their children. The most recent controversy around vaccines stems from suspicion of a possible link to the rising rates of autism of either the preservative thimerosal, which contains mercury, or the measles component of the MMR (measles/mumps/rubella) vaccine. Parental concern led to numerous scientific investigations regarding such links, with study after study finding no connections. Nonetheless, thimerosal was phased out of most vaccines in 2001. Autism rates, however, have continued to rise. Vaccines are extremely safe. The Centers for Disease Control and Prevention operates an Immunization Safety Office, which continuously monitors vaccine safety, including side effects. Part of its mission is managing the vaccine adverse event reporting system, which serves as an "early warning" system to detect vaccine-related problems. About 30,000 adverse event reports are filed annually, but just 10 percent to 15 percent are classified as serious (causing disability, hospitalization, life-threatening illness or death), and most of the incidents are ultimately not linked to vaccination. Anyone can file a report, including health care providers, manufacturers, personal injury lawyers and vaccine recipients or their parents or guardians. Children or adults who are harmed by a vaccine may apply for compensation from theNational Childhood Vaccine Injury Compensation Fund. Other vaccine myths and truths: Myth: The flu vaccine can cause the flu. Fact: The vaccine cannot cause the flu if you're vaccinated with the inactivated trivalent vaccine, made with killed virus. However, fever and achiness can occur after a flu vaccine. This is not the flu, however, but the result of an activated immune system. The nasal flu vaccine, which contains a weakened live virus, could, conceivably, cause the flu in someone with a suppressed immune system. Thus, it is only approved for use in healthy people between 2 and 49 years of age (younger and older people tend to have weaker immune systems). Studies involving hundreds of healthy children and adults showed no evidence that the nasal flu vaccine resulted in the flu. However, you can get the flu after being vaccinated if the viral types used to make the vaccine do not match the circulating flu viruses. These viruses change every year, which is why the vaccine changes every year and why you need an annual vaccine. Nonetheless, in any given year the flu vaccine typically protects about 60 percent of healthy adults under 65. The older you are the less effective it is, likely because of a weaker immune system. Even when the vaccine and viruses aren't well matched, the vaccine still protects a considerable number of people. Plus, if you get the flu, having had a vaccine means a quicker recovery with fewer complications. And don't forget it takes about two weeks after you're vaccinated before the vaccine fully engages your immune system. During those two weeks, you're still susceptible to an influenza virus, even one the vaccine should protect against.

Myth: Adolescents don't need vaccines.

Truth: Adolescents (and adults) definitely need vaccines and regular boosters. Children 11 or 12 need the tetanus-diphtheria-acellular pertussis (Tdap) vaccine; the meningococcal conjugate vaccine; the influenza vaccine; and the human papillomavirus (HPV) vaccine, which helps protect against cancers of the cervix, anus, vagina and vulva. Plus, teens (and adults) who haven't had chicken pox or been immunized against the disease should get a varicella vaccine. Unfortunately, while vaccination rates for young children are very good, those for adolescents are far below what they should be, though some of these rates are improving. According to the CDC, vaccination rates have been rising for tetanus-diphtheria (Tdap) and meningococcal-conjugate vaccine (MCV4). The increase in vaccine coverage rates for human papillomavirus (HPV) vaccine, however, is only about half the rate of the increases seen for Tdap and MCV4.

Myth: Vaccines provide 100 percent protection forever.

Truth: It depends on the vaccine. Most vaccines that children get in their early years provide lifetime immunity. Some, like the influenza vaccine, are required annually because the viruses causing influenza change every year. Others, like the diphtheria-tetanus-acellular pertussis (DTaP) vaccine, require "booster" shots to maintain immunity. For instance, immunity from pertussis (whooping cough) vaccination wears off, making adults and adolescents particularly susceptible to the disease. The bacterial disease can lead to significant time lost from work and school. More worrisome is the fact that it can be transmitted to children who have not been vaccinated, particularly newborns, in whom the disease can be fatal. Because booster shots are needed in adolescents and adults—who are less likely to get vaccinated than children—pertussis is the only vaccine-preventable infectious disease increasing in prevalence in the United States. In 2010, nearly 28,000 cases were reported to the CDC. The number of actual cases is likely triple that. That’s why the CDC added a recommendation for the adolescent booster of Tdap in 2005.

Myth: It's OK not to vaccinate your child if other parents vaccinate theirs.

Truth: In our global world, it's important to vaccinate all children. Each year, an average of 60 people in the United States contract measles. But in 2011, the number of measles cases was higher than usual at 222. Most of these cases occurred in people who were not vaccinated, and 40 percent got measles in other countries and brought the disease back to the United States and spread it to others. High vaccine rates are necessary to provide "herd immunity" (protecting those who have not been immunized). For instance, children under 12 months cannot receive the measles vaccine, so they are particularly vulnerable. Plus, some people cannot be vaccinated for medical reasons; high rates of vaccination in the community help protect them. Measles should not be taken lightly: it is one of the most infectious diseases known to man, able to be transmitted for up to two hours after an infected person has left the room. Before the vaccine became available in the mid-1960s, up to 450 deaths and 4,000 cases of measles-related encephalitis occurred each year in the United States.

Myth: Giving a child multiple vaccinations for different diseases at the same time increases the risk of harmful side effects and can overload the immune system.

Truth: There is no problem vaccinating children for different diseases at the same time. Numerous studies evaluating the effects of combinations of vaccines and of giving children several vaccines at once show this approach is as effective as giving children individual vaccines with no greater risk for side effects. Giving a child two or more vaccines during one health care visit not only provides maximum protection but reduces required office visits, saves time and money and minimizes trauma (from the shots) to the child. There are also combination vaccines, in which multiple vaccines are delivered in one shot.

Therapeutic Vaccines

Cancer Vaccines When you think of a vaccine, you think of something designed to protect you from a disease. These are called prophylactic vaccines. But vaccines are also being investigated as a way to harness the power of the immune system to fight existing disease, particularly cancer. These vaccines are called therapeutic vaccines. Cancer cells proliferate for two main reasons: They develop from normal cells, so they don't register as "foreign" to the immune system, and they have developed ways to prevent detection by the immune system. The goal of therapeutic cancer vaccines is to enhance the "foreignness" of the tumor and train the immune system to recognize similar antigens as foreign. There is currently one vaccine approved by the United States Food and Drug Administration to help treat cancer. The vaccine, called sipuleucel-t (Provenge), is a dendritic cell vaccine that treats advanced prostate cancer that no longer responds to hormone therapy. Researchers also have several cancer vaccines in late-stage clinical trials, including one to treat breast cancer. Click each type to learn more. Antigen vaccines. These vaccines are created by mass producing a few antigens from the tumor cell, altering them so they are more easily recognized by the patient's immune system and injecting them into the patient. Tumor cell vaccines. These vaccines are composed of cells from the patient's tumor that have been modified so they cannot reproduce. By injecting them into the patient, it is hoped they will stimulate the immune system to attack the specific antigen for that cancer and destroy original cancer cells that are replicating. Dendritic cell vaccines. Dendritic cells are immune system cells that show antigens to T cells so they can produce antibodies. A dendritic cell vaccine trains the patient's dendritic cells to recognize the tumor antigen as foreign, then injects the "trained" dendritic cells into the patient so they can "train" T cells. DNA vaccines. DNA vaccines use genetic material from the tumor that encodes for one or more antigens to stimulate the immune response. Vector-based vaccine. A vector-based cancer vaccine uses a virus, bacteria or yeast cell to "deliver" cancer antigens or DNA. The immune system responds to the vector as well as the cancer antigen, triggering a stronger immune response. Autoimmune Vaccines Therapeutic vaccines are also under investigation to treat autoimmune diseases like multiple sclerosis (MS) and lupus. These diseases result from an overactive immune system, one that fails to differentiate between "self" and "nonself" cells and attacks the body's own tissue. Vaccines to treat such conditions are designed to "downregulate" the immune system by training certain immune cells to attack disease-causing immune cells. One such vaccine that has shown good results in early clinical trials is a DNA vaccine that targets the T cells that attack myelin, nerve cell sheathing, in people with MS. Vaccines in the Future Although we have made great strides in providing vaccines for many major illnesses, particularly childhood diseases, several other serious conditions remain. In addition tocancer vaccines researchers are working on vaccines to prevent malaria and HIV, the virus that causes AIDS. Vaccines are also being investigated to prevent hepatitis C, tuberculosis, Alzheimer's disease, Parkinson's disease and numerous other neurological and autoimmune diseases. Malaria vaccine. Malaria is one of the most devastating diseases in the world, affecting more than 300 million people a year and killing more than 1 million, primarily in sub-Saharan Africa. The actual figures, however, are likely up to three times higher, given the difficulty of diagnosing and tracking the disease in these countries. Scientists at the CDC have an ongoing malaria vaccine development and evaluation program that is testing potential malaria vaccines in small New World monkeys. HIV vaccine. Researchers throughout the world have been working on an HIV vaccine for more than 20 years without success. In the United States alone, the National Institute of Allergy and Infectious Diseases at the National Institutes of Health has conducted more than 117 HIV vaccine clinical trials to test more than 70 possible vaccines. The U.S. Military HIV Research Program and the CDC are also researching HIV vaccines. The challenge in developing a vaccine against HIV is that our immune system is weak when it comes to eradicating the virus. The virus also takes over the DNA of normal immune system cells, often lying dormant for months or even years. When it is activated, it's too late for an immune response to be of use because the virus has co-opted cells to churn out millions of HIV copies. Another problem is that the virus mutates easily. A vaccine designed against today's virus may be irrelevant in a couple of years. Even when the immune system recognizes antigens on the virus and produces antibodies against it, the virus mutates before those antibodies can do much good. This is why existing drugs against the infection eventually fail; the virus mutates and becomes resistant to them. However, scientists still believe a vaccine to prevent HIV is possible, and they are building on what they have learned and moving forward with the research process.

Facts to Know

1. Today, more than 300 approved vaccines provide protection against 30 diseases. 2. The immune system has two components: the innate immune system, in which inflammation destroys invading pathogens; and the adaptive immune system, which "learns" to recognize certain pathogens and retains an immunologic memory so it can quickly mount a defense the next time the pathogen appears. 3. A vaccine is designed to stimulate the adaptive immune system before you're exposed to the virus or bacteria so you're already protected when you encounter it. 4. There are two main types of vaccine: prophylactic, which prevents disease; and therapeutic, which treats disease. 5. There are several types of vaccines, including live, attenuated vaccines and inactivated vaccines. The former are made with live, although weakened pathogens, while the latter are made with killed pathogens, or parts of them. 6. Adolescents and adults also require vaccination, including vaccines designed to protect against human papillomaviruses (HPV), which cause cervical cancer; influenza; pneumonia; and shingles. Adolescents and adults also require regular "booster" vaccines against diphtheria, tetanus and pertussis (whooping cough). 7. Prophylactic vaccines are extremely safe, although some may have mild side effects. The most common side effects are redness, soreness and irritation at the injection site and fever. 8. People with compromised immune systems, moderate-to-severe illnesses and/or those who have had a previous reaction to a vaccine should consult with their health care professional before getting vaccinated. 9. Researchers are working on vaccines that treat malaria, cancer, autoimmune diseases and neurological conditions like Alzheimer's disease and Parkinson's disease. 10. While many vaccines provide lifelong immunity, some require regular boosters. Key Q&A 1. What is the difference between the innate and adaptive immune system? The innate immune system is designed to provide a kind of "shock and awe" protection against bacteria, viruses and other pathogens. When cells in the innate immune system "see" an invader, they rush in to destroy it, often by releasing inflammatory chemicals like histamines and leukotrienes. These invaders display "signs" on their surface called antigens that signal immune system cells to action. The adaptive immune system provides a more targeted approach. As immature T and B lymphocytes encounter antigens, they develop specific antibodies against those antigens. These "mature" lymphocytes hang out in tissue, ready to quickly spring to action when they encounter the same antigens. This creates immunologic memory and prevents reinfection. 2. How do vaccines work? All vaccines are designed to affect the immune system in some way. Prophylactic vaccines are designed to stimulate a response of the adaptive immune system to a modified version of the pathogen so that when you are infected with the actual virus or bacteria, it can quickly mount a major offense against the invader before you become sick. Therapeutic vaccines are designed to strengthen the immune system's response to a cancer or other abnormal cell. 3. What is the difference between live and "killed" vaccines? Live, attenuated vaccines contain a live, although significantly weakened, version of the virus or bacteria. Measles, mumps and chicken pox vaccines are made with live viruses. The benefit of a live vaccine is that a single dose often provides lifelong immunity. The downside is that because viruses and other pathogens naturally mutate, or change, the virus within the vaccine could also change, creating a more virulent version of itself that the immune system would have difficulty combatting. This was an issue with the early oral polio vaccines, but is generally not a problem with current live vaccines, which are much safer than the virus they protect against. Only people with a suppressed immune system (such as those who have HIV, are taking immunosuppressant drugs or are being treated for cancer) should be concerned about receiving live vaccines because they could, conceivably, become infected with the virus. These vaccines also usually require refrigeration. Inactivated vaccines contain a killed version of the pathogen. They are more stable (meaning they don't need refrigeration) and safer than attenuated viruses, but they don't elicit as strong an immune response. Thus, the immunity they provide may not last as long and you might need a "booster" vaccine down the road. 4. What types of vaccines protect against bacterial infections? Typically, inactivated vaccines. Many bacteria secrete toxins that damage healthy cells. Toxoid vaccines treat the bacteria with formalin, which renders the toxins harmless but still retains enough of their structure to "teach" immune cells to recognize the bacteria and train them to lock onto the toxin antigen before the bacteria can release it. Toxoid vaccines are used for diphtheria and tetanus. Conjugate vaccines are also used in young children to protect against infections caused by Haemophilus influenzae type b (such as meningitis and lung infections) and pneumococcal disease. 5. What should I do if my child misses a vaccine? Call your health care professional. Children can "catch up" on nearly all vaccines, regardless of their age, except for the rotavirus vaccine, which protects infants against the severe vomiting and diarrhea caused by rotavirus. 6. What vaccines do adolescents require? Preteens and adolescents should receive vaccines against the human papillomavirus, meningococcal disease and tetanus/diphtheria/acellular pertussis (Tdap). Depending on what vaccines your child received when younger, he or she may also need "catch-up" vaccines for hepatitis B, mumps/measles/rubella, polio or varicella (chicken pox). Additionally, everyone 6 months and older should receive an annual influenza vaccine. 7. I'm traveling out of the country. What vaccines do I need? Make an appointment with your health care professional at least four to six weeks before your trip to see if you need any travel-related vaccines. The only required vaccines are yellow fever for those traveling to countries in sub-Saharan Africa and tropical South America and the meningococcal vaccine for travel to Saudi Arabia during the Hajj. You can learn more about vaccines required for overseas travel at theCenters for Disease Control website. Your local health department can typically provide the vaccines. 8. I'm worried about the safety of vaccines. Vaccines are extremely safe. The Centers for Disease Control and Prevention operates an Immunization Safety Office that continuously monitors vaccine safety, including side effects. Part of its mission is managing the vaccine adverse event reporting system, which serves as an "early warning" system to detect vaccine-related problems. About 30,000 reports are filed annually, but just 10 percent to 15 percent are classified as serious (causing disability, hospitalization, life-threatening illness or death), and most of the incidents are ultimately not linked to vaccination. Anyone can file a report, including health care providers, manufacturers, personal injury lawyers and vaccine recipients or their parents or guardians. 9. I heard that vaccines can cause autism. Some parents insist that their children developed autism after having early childhood vaccines, such as the measles/mumps/rubella (MMR) vaccine. Some suspect that a preservative once used in childhood vaccines that contained mercury caused autism. But numerous scientific investigations regarding a possible link found no connection. Today's childhood vaccines do not have mercury-based preservatives; nonetheless, autism rates have continued to rise. 10. I have breast cancer. I heard there is a vaccine that can treat the cancer. How can I find out more? There are several vaccines under investigation for cancer. These are called therapeutic vaccines because they are designed to treat, rather than prevent, disease. However, none have been approved yet. So talk to your doctor about joining a clinical trial. Read the full article