Immunization Information, Resources, History

PH 172: Immunizations and Public Health

• Course is labeled PH 172, section A00
• Aims to introduce the history and perspectives on immunizations
• The first class occurred on January 7th, 2025
• Instructor: Margaret Ryan, MD, MPH, is an Occupational and Preventive Medicine physician
• Ryan is also a Clinical Professor (part-time) at Herbert Wertheim School of Public Health
• She retired as UC San Diego Captain, Medical Corps, US Navy
• Currently serves as Medical Director of Defense Health Agency Pacific Region Immunization Program at Naval Medical Center San Diego

Course Objectives

• Upon completion of this course, students should be able to understand how public health principles apply to historic events, and future vaccination efforts
• Students can identify the principles of immunology that apply to vaccine preventable diseases
• The course will explore the fundamental science relating to vaccination topics
• Immunization recommendations and policies will also be covered
• Also including the roles of FDA, VRBAC, CDC, and ACIP in the United States
• Equivalent advisory organizations are internationally considered in the course
• Lectures will discuss immunization practices, including challenges addressing clinical adverse events following immunization (AEFIs)
• Risk communication and clinical management of vaccinations will be taught
• Students can effectively communicate public health information about specific vaccine preventable diseases
• Understanding of public health sources, the scientific literature, and other resources will be demonstrated as well

Public Health Values

• Classes will review concepts such as justice, equity, diversity, and inclusion
• Public health people are committed to service, compassion, and kindness
• Interactions will start by assuming the best in each other
• The class strives to maintain learning enviroments, safe spaces, both physically and emotionally
• Immunization topics may incite passionate views, so the health values will apply to keep these scenarios at bay

Course Materials

• All information is on Canvas such as syllabus, slides, and assignments
• Slides and other course-specific material should not be publicly posted without permission from Dr. Ryan
• Immunization information can become outdated quickly
• Course information may be viewed out of context
• Slides and other course-specific material may be protected as UCSD intellectual property
• Academic materials that students will use include:
• CDC Pink Book
• CDC Yellow Book
• Immunize.org

Course Engagements

• Class engagement is important
• Attendance is considered important to engagement in the course, as well as support of the class community
• 16 class material submissions, up to 5 points each
• Brief assignments on Canvas (4 assignments, up to 20 points each)
• There will be two exams, 80 points each
• One in class, the other take-home
• There will be a group presentation on one vaccine-preventable disease for 80 points

Academic Integrity

• Academic integrity is critical to the learning and practice of public health
• Public health professionals and students may use GenAI tools to enhance learning, but these tools should not replace mastery of the material
• Students should view GenAI responses cautiously, since some GenAI responses may be incorrect and/or perpetuate bias
• If GenAI tools are used for a written assignment, the student must cite the tool (e.g., ChatGPT) and describe how it was used. Copy-pasting a response that was GenAI-generated is not permitted.

Course Philosophy

• Upper division courses are more like graduate school courses focused on learning rather than points, and collaboration and enjoyment are encouraged
• The course aims to provide students with the tools to succeed in a graduate setting

Class Schedule

• Week 1: Introduction to course, History and perspectives on immunizations - January 7, 2025
• Week 1: Overview of vaccine-preventable infections - January 9, 2025
• Week 2: Immunology basics and vaccination - January 14, 2025
• Week 2: Adverse events following immunization - January 16, 2025
• Week 3: Vaccine production and the role of FDA - January 21, 2025
• Week 3: Vaccine recommendations and role of CDC - January 23, 2025
• Week 4: Ethical and equity challenges in immunization policy - January 28, 2025
• Week 4: Vaccine hesitancy and risk communication - January 30, 2025
• Week 5: Vaccinations in clinical practice - February 4, 2025
• Week 5: Review of topics - February 6, 2025
• Week 6: Exam #1 - February 11, 2025
• Week 6: Important vaccine stories: Smallpox - February 13, 2025
• Week 7: Important vaccine stories: Polio - February 18, 2025
• Week 7: Important vaccine stories: Influenza - February 20, 2025
• Week 8: Important vaccine stories: COVID-19 - February 25, 2025
• Week 8: Student vaccine presentations: Groups 1, 2, 3 - February 27, 2025
• Week 9: Student vaccine presentations: Groups 4, 5, 6 - March 4, 2025
• Week 9: Student vaccine presentations: Groups 7, 8, 9 - March 6, 2025
• Week 10: Student vaccine presentations: Groups 10, 11, 12 - March 11, 2025
• Week 10: Perspectives on the future of immunizations and course wrap-up, Exam #2 due - March 13 & 21, 2025

Class #1 Objectives

The goal is to understand the following:

• Definitions related to the study of immunizations
• Appreciate some historically important contributions to the field
• Identify important legislation and the basic roles of FDA and CDC/ACIP in immunization care in the US
• Explain factors that make immunization a special topic

Definitions

• Immunity is the ability of the human body to recognize and eliminate microbial threats.
• Immunization is an action taken to induce immunity.
• Passive immunization is the provision of short-term protection from another source.
• Examples of passive immunization: maternal antibodies to pertussis, human rabies immune globulin, monoclonal antibodies to respiratory syncytial virus (RSV)
• Active immunization induces long-term protection by challenging the body with infection or infection-related antigens to prompt the creation of antibodies.
• Vaccines are active immunization products.
• Immunizations reduce morbidity (illness) and mortality (death) from infectious pathogens on an individual level.
• Immunizations reduce the incidence of infections, to eliminate, control, or eradicate an infectious threat on a population level.
• Control is the reduction in incidence to a locally acceptable level, where continued intervention measures are required.
• Hepatitis A in the US is an example
• Elimination is the reduction to zero incidence, or no sustained transmission when a pathogen is reintroduced, in a defined geographic area; it requires continued intervention measures.
• Polio in the US is an example.
• Eradication is the permanent reduction to zero of the worldwide incidence of infection, and intervention measures are no longer needed.
• Smallpox is an example.
• Extinction means the specific infectious agent no longer exists in nature or in the laboratory.
• There are currently no examples.

Important Milestones in Immunization History

• 400 BCE: Hippocrates described human-to-human transmission of mumps and subsequent resistance.
• 1100s CE: Cultures in Asia and Africa began the practice of variolation.
• Variolation: Deliberate inoculation with fluid from smallpox lesions to induce mild illness and protection.
• 1796: Edward Jenner demonstrated that deliberate infection with cowpox (vaccinia) resulted in protection from smallpox (variola) in England.
• The practice was later called vaccination extending use beyond smallpox prevention
• 1885: Louis Pasteur demonstrated that weakened or killed rabies virus could be used as a vaccine to prevent rabies in dogs and humans after rabies exposure in Paris, France
• 1894: Dr. Anna Wessels Williams helped develop diphtheria antitoxin (antibody serum drawn from horses) in New York.
• Diphtheria antitoxin provides passive immunity to treat diphtheria.
• 1902-1906: The US enacted the Biologics Control Act and the Pure Food and Drug Act.
• This followed incidents of contaminated smallpox vaccine (9 children's deaths) and contaminated diphtheria antitoxin (13 children's deaths).
• The FDA licenses the safe manufacture of immunization products due to the origin of these laws
• World War I era: Vaccines were developed to prevent tetanus, pertussis, typhoid, yellow fever, and influenza.
• 1946: The US Communicable Disease Center (CDC) was created, later being called the Centers for Disease Control and Prevention.
• The CDC was charged with the prevention of malaria and other infections in the US
• 1952: The worst polio epidemic occurred in US history with over 21,000 paralytic cases
• 1955: Jonas Salk developed the first polio vaccine (IPV) using formalin-inactivated poliovirus and FDA licensed it immediately.
• The IPV vaccine was responsible for dramatic decrease in polio cases
• 1955: Cutter Laboratories failed to inactivate poliovirus appropriately.
• After vaccine administration, 200 children developed paralytic polio and 10 died.
• The "Cutter incident” highlighted failures of FDA and strengthened subsequent regulations on vaccine manufacturing.
• 1960s: Measles, mumps, and rubella vaccines were developed.
• 1967: The World Health Organization launched the coordinated global smallpox eradication program and administered a live vaccinia vaccine (similar to Jenner's original cowpox vaccine).
• 1980: Smallpox was declared globally eradicated
• 1980s: Public concerns about rare vaccine-related adverse events increased as the childhood vaccine schedule expanded
• 1986: The National Childhood Vaccine Injury Act was passed, which established VAERS, Vaccination Adverse Event Reporting System
• Directed use of Vaccine Information Statements (VISs), and documentation on how vaccinations must be done
• 1988: The NVICP (National Vaccine Injury Compensation Program) was established
• Compensation was setup after adverse events post immunization, (AEFIs)
• The program is a federal insurance system, a civil litigation alternative to civil litigation, and protected vaccine availability
• 1990s: Vaccines preventing Haemophilus influenzae type b (Hib) and pneumococcal infections were added to the routine infant vaccine schedule, leading to a >99% reduction in infant meningitis
• 1993 Vaccines for Children (VFC) was available
• This program was established to improve vaccine equity and access. All CDC/ACIP vaccines are covered under this
• 1998 CDC/ACIP recommended live oral rotavirus vaccine for infants
• 1999 CDC/ACIP withdrew their recommendations for rotavirus after VAERS reports that 112 infants developed intussusception
• 2004 vaccines in pregnancy were first used
• CDC/ACIP stated influenza vaccines should be used to protect the fetus, pregnant mother and newborn, maternal antibodies were passed passively to the baby after birth via breast milk
• 2012 CDC/ACIP pushed pertussis-containing vaccine (Tdap) in every pregnancy to protect newborns
• Vaccine in preganacy is at 50% and still needs to be improved
• COVID-19 and pandemic were vaccine related events in immunizatioons, CDC and WHO are tracking effects now

Immunization being a Special Topic in Public Health

• Three different ways these events shape public helath
• Vaccines having saved more lives than many other intervention throughout history
• The human immune system's understanding has evolved quite a lot of late
• Immunizatons products are numerous and complex with over 75 US FD approved vaccines
• US standards are updated every single year regarding these new medicines and vaccines
• Vaccinne is not new and should not be viewed as such
• Healthy people have little to learn about the adverse affect and consequences of vaccinations and how they may be affected
• The key is education in these unique scenarios

Class #2 Objectives

• Know correct terminology related to vaccine preventable infections
• Describe infection-specific goals of immunization
• Appreciate some priorities for current and future infection-specific immunizations
• Apply an understanding of infections to frame the value of immunization in reducing impacts on human health

Infection-Related Terminology

• Pathogens are microbial agents, including microbes, germs, and bugs
• Bacteria are microscopic organisms with DNA within cellular machinery that live, feed, and replicate in a host or other environment.
• Viruses are tiny spheres of DNA or RNA in a protein or lipoprotein coat and rely on host cells for replication.
• Parasites are organisms with defined nuclei that may be single-celled or multicellular.
• Fungi are diverse group of eukaryocytes with complex internal structures that live, feed, and replicate in warm, moist environments.
• A host is a person or animal infected by a pathogen
• A vector is an organism that carries a pathogen without being, transmitting the pathogen to others
• Zoonotic infections are pathogens that can cause illness in humans and other animal species
• Antimicrobial Agents are like antibiotics, antivirals, and antifungals
• Immunizations include active & passive immunity
• Vaccines induce Active immunity
• Immunoglobulins provide passive immunity

Naming Pathogens

• Names may describe microscopic appearance, clinical presentation, or year discovered
• WHO and CDC use these methods
• New and previous versions of labels can relate to a geographic setting and occupational role
• It should not involve animals as well which may contribute to cultural stereotyping
• It is based on microscope structure

Vaccine Preventable Infections

• Among thousands of pathogens that cause human infections, only 32 are vaccine-preventable in various degrees
• Pathogens described here have current US FDA-approved vaccines. Non-US vaccines are available for a small number of other pathogens vaccines are available for about 32 pathogens
• Bacterial Vaccine-Preventable Infections include:
  • Bacillus anthracis
  • Vibrio cholerae
  • Corynbacterium diptheriae
  • Haemophilus influenzae type b
  • Neisseria meningitidis
  • Bordetella pertussis
  • Streptococcus pneumoniae
  • Clostridium tetani
  • Mycobaceria tuberculosis
  • Salmonella typhi
• Viral Vaccine-Preventable Infections include:
  • Adenovirus (types 4 and 7)
  • Ebola Virus
  • Chikungunya Virus
  • Dengue (types 1, 2, 3, and 4)
  • Hepatitis A and B
  • Flu (specific seasonal types of A/H1N1, A/H3N2, and B virus)
  • Japanese Encephalitis virus
  • Measles, Mumps and Rubella
  • Mpox
  • Polio (types 1, 2, 3)
  • Rabies
  • Rotavirus
  • RSV (Respiratory Syncytial Virus)
  • SARS-CoV-2
  • Smallpox
  • Varicella Zoster
  • Yellow Fever
• Passive Immunizations are used to assist in the treatment of patients or prevention of infection
• May be helpful to immunocompromised
• May be helpful before high risk exposures
• May be helpful against infections where no other vaccine is available

Goals of Immunizations

• Provide lifelong protection from infection
• Examples: Hepatitis A & B, Measles, Mumps, Polio, Rubella, Smallpox, Varicella and Yellow Fever
• Provide Short-term protection from diseases when more vulnerable
• Provide short term protection against infections during vulnerable times
• Also reduce the severity of those that still occur
• Those that ideally prevent all infections are more for those with medical problems
• Prevent infection in other people - community immunity
• Prevent late conequences of infection. Many infections can leado to disabling of the body

Future of vaccines

• Tuberculosis is one such example where infection comes form contact.
• BCG provides good immunity for young infants
• Malaria is spread via mosquitos via parasites via vector that require liver treatment

Two Different Vaccine Preventable Infections with Military Significance

• Anthrax is a bioweapon as it can cause toxin issues once infection occurs
• Accidental contamination in 1979 killing about 68
• In 2001 bioterrorists poisoned 22 and killed 5 via the USPS
• An Inactivated vaccine exists licenced FDA, requires lots of dosages yearly and needs annual bosters
• 90+ for Vax strength and success, however, are not 100% safe

Explore immunization information, its limitations, and trusted resources like the CDC. Discover the history of vaccine development with pioneers like Edward Jenner and Louis Pasteur. Learn about resources for academic research.