Vaccination:

probably the
greatest Public
Health
achievement of
the 20th
Century
MMWR 1999; 48:241

A Photo Collection of
Vaccine-Preventable Diseases
Created by the
Immunization Action Coalition
Updated May 2013

Diseases for which vaccination is

routinely recommended
Diphtheria

Haemophilus influenzae type b

(Hib)

Hepatitis A

Hepatitis B

Herpes zoster (shingles)

Human papillomavirus (HPV)

Influenza

Measles
Meningococcal disease

Mumps
Pertussis
Pneumococcal disease
Polio
Rotavirus
Rubella
Tetanus
Varicella (chickenpox)

Diphtheria: This is a
picture of the throat of
a child who has
diphtheria. Notice the
thick gray coating
over the back of the
throat. If not treated,
this child could die
from suffocation.

Photo courtesy of the Centers for Disease Control and Prevention

(CDC)

Diphtheria: This child has bullneck

diphtheria.
Photo courtesy of the Centers for Disease Control and
Prevention (CDC)

Haemophilus influenzae type b: This girl is

hospitalized with Haemophilus influenzae type b
(Hib) infection shown here involving deep tissue of
this girls face. Hib disease can
also lead to brain damage, seizures, paralysis,
Photo courtesy of the Childrens Immunization Project,
hearing
Saint
Paul, Minn.

Hepatitis A: Hepatitis A infection has caused this

mans skin and the whites of his eyes to turn
yellow. Other symptoms of hepatitis A can include
loss of appetite, abdominal pain,
nausea
orCenters
vomiting,
fever,
headaches, and dark
Photo
courtesy of the
for Disease Control
and
Prevention (CDC)

Hepatitis B: This
woman died from liver
cancer four months
after she arrived in a
refugee resettlement
camp in Thailand. The
liver cancer was caused
by chronic infection with
hepatitis B virus.

Photo courtesy of Patricia Walker, M.D., Saint Paul, Minn.

Herpes Zoster (shingles): A dangerous

complication of shingles infecting the eye which can
lead to loss of vision. Without vaccination,
approximately 30% of all people who have
been infected with chickenpox Photo
willcourtesy
later
develop
of www.webmd.com
shingles.

Human Papillomavirus
(HPV):
HPV is the most common
sexually transmitted
infection in the United
States. Approximately 20
million people are
currently infected with
HPV. At least 50% of
sexually active men and
women acquire genital
HPV infection at some
point in their lives.
Persistent infection with
Photo courtesy of the Centers for Disease Control and Prevention (CDC)
high-risk types of HPV
is

Influenza: This photo shows how the influenza

virus
can spread through the air when someone
Photo courtesy of the Centers for Disease Control and
coughs.
Prevention (CDC)

Influenza: Photo of emergency hospital during the

1918 influenza pandemic, Camp Funston, Kansas.
This pandemic killed at least 50 million people
worldwide.

Photo courtesy of the National Museum of Health and Medicine, Armed Forces Institute of Pathology

Measles: This child

has a severe measles
rash. He has red eyes,
a runny nose, and a
fever.

Photo courtesy of the Centers for Disease Control and

Prevention (CDC)

Meningococcal disease: This four-month-old infant

has
gangrene of her hands and lower extremities as a result
Photo courtesy of the Centers for Disease Control and
of meningococcemia.
Prevention
(CDC)

Mumps: This childs jaw and cheek are

swollen from mumps. Mumps can lead to
painful swelling of the testicles in males
(sometimes causing sterility),
deafness, and brain damage.
Photo courtesy of the Centers for Disease Control and
Prevention (CDC)

Pertussis: This child

has pertussis
(whooping cough). He
has severe coughing
spasms, which are
often followed by a
whooping sound. It is
difficult for him to stop
coughing and catch his
breath.

Photo courtesy of the Centers for Disease Control and

Prevention (CDC)

Pertussis: This child has broken blood vessels in

his eyes
and bruising on his face because of coughing from
Photo courtesy of Thomas Schlenker, MD, MPH, Chief Medical Officer, Children's Hospital of Wisconsin

Pneumococcal disease: This is a photo of

the brain of a person who died from
pneumococcal meningitis. Note the
purulence (pus) that covers the brain
Photo courtesy of the Centers for Disease Control and
Prevention (CDC)
surface.

Polio: This 1952 photo of a Los Angeles hospital

respiratory ward shows polio victims in iron lungs
machines
which
were
necessary
to help victims breathe.
Photo courtesy
of the Centers
for Disease
Control and
Prevention (CDC)

Polio: This child has a

severely deformed leg
caused by polio.

Photo courtesy of the World Health Organization (WHO)

Rotavirus: Doctor examining a child dehydrated from

rotavirus infection. In developing countries, rotavirus
causes
approximately 600,000 deaths each year in children
Photo courtesy of World Health Organization, photo credit Dr. D. Mahalanabis
younger than
age 5 years.

Photo courtesy of the Centers for Disease Control and

Prevention (CDC)

Rubella: This teenager

has a rash from rubella.
The rash is not as
prominent as the
measles rash and is
often missed in
diagnosis. Rubella in
pregnant women can
lead to miscarriage,
severe heart defects,
and blindness or
deafness in their
newborns.

Rubella: This infant was born with rubella.

Babies whose mothers were infected with rubella
during pregnancy
can be born with deafness, blindness, heart
Photo courtesy of the Centers for Disease Control and
damage,
Prevention
(CDC)

Tetanus: This baby has neonatal tetanus. His

body is rigid. Infection can occur when the newly
cut umbilical cord is exposed to dirt. Most
newborns who get tetanus die.
Photo courtesy of the Centers for Disease Control and
Prevention (CDC)

Tetanus: This person has tetanus. The

muscles in his body are in spasm,
making it nearly impossible for him to
Photo courtesy of the Centers for Disease Control and
move.
Prevention (CDC)

Varicella: This newborn

has a secondary
bacterial infection,
which is a complication
following infection with
varicella (chickenpox).
He contracted
chickenpox from his
infected mother.

Source: Unknown

Varicella: This photo

shows the typical itchy
chickenpox rash. There
can be 500 sores or
more.

Photo courtesy of the Centers for Disease Control and

Prevention (CDC)

Other diseases for which vaccines are

used in special situations
Anthrax
Japanese encephalitis
Rabies
Smallpox
Typhoid fever
Yellow fever

Anthrax: Anthrax is a serious

disease caused by Bacillus
anthracis, a bacterium that
forms spores. Three types of
anthrax exist:
Skin (cutaneous)
Lungs (inhalation)
Digestive (gastrointestinal)
Humans can become infected
anthrax
by
This anwith
example
of cutaneous
handling products from anthrax.
infected animals or by
breathing in anthrax spores from infected animal
products. It can also be used as a weapon.
Photo courtesy of the Centers for Disease Control and
Prevention (CDC)

Japanese Encephalitis: The virus is

transmitted by the bites of infected
mosquitoes. This is an image of a
Culex mosquito laying eggs. Japanese
encephalitis is the most common
vaccine-preventable cause of
encephalitis in Asia.

Most infections are mild (e.g., fever and

headache) or without apparent symptoms.
However, about 1 in 200 infections results in
severe disease characterized by rapid onset of
high fever, headache, neck stiffness,
disorientation, coma, seizures, spastic paralysis,
Photo
courtesy
of the Centers for
Disease Control andare
Prevention
and
death.
Vaccines
available to
(CDC)

Rabies: Bites
from wild animals
such as raccoons,
bats, and skunks
account for the
majority of rabies
cases in
the U.S.
Rabies is caused by a virus that invades the central nervous
system and disrupts its functioning. The virus is transmitted
in the saliva of infected animals. Prompt postexposure
treatment is generally effective. Once symptoms appear,
the disease is almost always fatal.
Photo courtesy of the Centers for Disease Control and Prevention
(CDC)

Smallpox (Variola): This mans body is covered

with lesions from smallpox. A worldwide smallpox
vaccination program led to the eradication of the
disease in the late 1970s. The global eradication of
smallpox ranks as one of the greatest
Photo
courtesy of the Centers for Disease
Controlhistory
and
achievements
in the
of medicine.
Prevention (CDC)

Yellow Fever: This image of an autopsy specimen shows charac-teristic changes in

liver tissue from yellow fever infection. Yellow fever is transmitted by the bites of
infected mosquitoes.

The word "yellow" in the name refers to

the jaundice that affects some patients.
The virus is endemic in tropical areas of
Africa and Latin America. There is no
cure for yellow fever. Fortunately, the
majority of infected patients improve and
their symptoms disappear after 3 to 4
days. However, 15% of patients enter a
second, more toxic, phase of the disease.
About half of the patients who enter the
second phase die within 10 to 14 days,
the rest recover. Vaccination is the most
important preventive measure against
yellow fever.
Photo courtesy of the Centers for Disease Control and Prevention (CDC)

For more information on any of these diseases

and the vaccines that can prevent them, go to

www.immunize.org
www.vaccineinformation.org

Vaccines

How did we
get here?

History of Vaccination: Smallpox

Smallpox killed or maimed 10% of humankind.

Killed > 300,000,000 people in the 20th century alone
Ancient Chinese history: a once in a lifetime disease.
11th century China and India: Variolation
Scratch a healthy person with pus from infected person
If they dont die, they are immune for life

Vaccination
1796, Edward Jenner

Noted that milkmaids got cowpox, but not smallpox.

Injected pus from a cowpox lesion under the skin of a child
Waited 2 weeks
Deliberately infected the child with smallpox.
The boy survived

Question: could this be done today? If not, why not? What is the
alternative for testing a new vaccine?

An anti-vaccination movement emerged in England

in the early 1800s after news of Jenner's discovery
spread, drawing public criticism due to religious and
scientific reasons.
Some found that it was "unchristian" to vaccinate
because of the vaccine's animalistic origins, while
others were simply not comfortable with the practice
of medicine.
Furthermore, these people held the popular belief
that smallpox was spread not by infection but by
filth.
Similar views were held during that period of time in
the United States as well.

History of Vaccination
Despite Jenners success, it
took 100 years til the next
vaccine.
1881, Louis Pasteur: coined
the word vaccine.
Used dried spinal cord from rabid
rabbit to create a rabies vaccine.
Also developed vaccines to fowl
cholera and anthrax

July 6, 1885: 9 year old Joseph

Meister who was badly bitten by a
rabid dog.
Although Pasteur was not a
licensed physician, the boy would
most certainly have died without
treatment like many before him.
Pasteur decided to treat the boy
and inoculated Joseph with
rabies vaccine that had been
tested only on dogs previously.
The risk paid off and the boy
recovered dramatically.

1813
U.S. Vaccine Agency
Established
The U.S. Congress
authorized and James
Madison signed "An Act to
Encourage Vaccination,"
establishing a National
Vaccine Agency. James
Smith, a physician from
Baltimore, was appointed the
National Vaccine Agent. The
U.S. Post Office was
required to carry mail
weighing up to 0.5 oz. for
free if it contained smallpox
vaccine materialan effort
to advance Congresss ruling
to preserve the genuine
vaccine matter, and to
furnish the same to any
citizen of the United States.

1855: Vaccination Law Passes

Massachusetts passed the first U.S.
law mandating vaccination for
schoolchildren.

2/20/1905:
U.S. Supreme Court Addresses Vaccination
The U.S. Supreme Court in the case of Jacobson v. Massachusetts upheld
the constitutionality of mandatory smallpox vaccination programs to
preserve the public health.

Anti-vaccination debates continued throughout the 20th century. In the 1970s,

the DTP (Diphtheria, Tetanus, and Pertussis) controversy exploded
internationally, concerning patients who developed neurological conditions
after receiving the vaccine. In response, lawmakers passed the National
Childhood Vaccine Injury Act (NCVIA) to relieve the public distress by
promising compensation to victims of the DTP vaccine.

Impact of Vaccines in the US

Disease

Baseline 20th
Century Annual
Cases

2006 Cases

Percent Decrease

Measles
Diphtheria
Mumps
Pertussis
Smallpox
Rubella

503,282
175,885
152,209
147,271
48,164
47,745

55
0
6,584
15,632
0
11

99.9%
100%
95.7%
89.4%
100%
99.9%

Haemophilus
influenzae type b,
invasive

20,000

29

99.9%

Polio
Tetanus

16,316
1,314

0
41

100%
96.9%

Credit: Morbidity and Mortality Weekly Report, Centers for Disease Control and Prevention,
4/2/99, 3/21/08

International Mortality Vaccinepreventable disease

In 2002, WHO
estimated that 1.4
million of the deaths
among children < 5
years old were due to
diseases that could
have been prevented
by routine vaccination
14% of total global
mortality in children
< 5 years of age

Impact of Vaccine-preventable
disease
Heather Whitestone,
named Miss America
in 1994
Became deaf at 18
months of age after
contracting Hib
meningitis

2010: Practicing Pediatricians: Top Vaccine Safety Concerns of

Patients/Families
Autism
Thimerosal
Aluminum
Pain of so many shots
Why so many shots at once/so early? Concern about
overwhelming
the immune system.
Have not seen these diseases so do not see the value that
outweighs any risk

Vaccine-educated parents
May be pro-vaccine for themselves, but object to it for
infants/children
May no longer believe in a vaccine-autism connection
(or at least will not say so)
Want green vaccinespure, natural (no additives)
Overwhelming the young immune system = #1 concern,
many want alternative schedule

More Parent Concerns

General mistrust of scientific research/systems
of carefunding, motives (per shot payment)
My unvaccinated baby is healthier than
vaccinated children (rosy cheeks)
I am fine not caring about public healthmy
responsibility is MY child only
Highly influenced by non-MD providers
chiropractors, nurses, midwives/doulas

Why Parents Who Planned To Delay/Refuse

Vaccine Changed Their Minds

Gust et al Pediatr 2009;122:718

From: Measles Outbreak as a Catalyst for Stricter Vaccine Exemption Legislation

JAMA. 2015;314(12):1229-1230. doi:10.1001/jama.2015.9579

Table Title:
Proposed State Legislation Related to Childhood Vaccine Exemptions From January 1 to July 15, 2015

Date of download: 9/22/2015

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