4 Vaccines in use

4.1 GloballyMore than 40 vaccines have been developed for the preventionof human diseases. Several vaccines protect against multiple
serotypes of virus or bacteria (e.g. polio types 1, 2, and 3).
Several vaccines are delivered in combination to protect
against multiple diseases.
Most countries routinely use only a portion of vaccines
available to them. The selection of vaccines for use in a nationalschedule is based on the local epidemiology and the risks
associated with each specific vaccine-preventable disease.

In resource-poor countries, the WHO recommended theprioritization of childhood immunization and the protectionof women of child-bearing age. For more than 20 years,
the EPI targeted only six diseases: tuberculosis, polio,measles, diphtheria, pertussis and tetanus. Now WHO
recommendations are part of an overarching strategy andvision for immunization that promotes routine immunization of
all age groups and includes several additional target diseases(See Table 28).

In 1974, the World Health Assembly resolved to build on thesuccess of the smallpox eradication program and ensurethat all children benefited from the ability of vaccines to save
lives. In 1977, the WHO set a goal of providing universal
immunization for children by 1990, through the Expanded
Programme on Immunization (EPI)164.

Universal recommendations
AntigenChildren

BCG (tuberculosis)√Hepatitis B

√

Polio

√

Diphtheria, Tetanus, Pertussis√

Haemophilus influenzae
type b (Hib)√

Pneumococcal conjugate√

Rotavirus√

Measles√

Human Papillomavirus
TABLE 28. WORLD HEALTH ORGANIZATIONRECOMMENDATIONS FOR IMMUNIZATION165

Regional recommendations

AdolescentsJapanese
Encephalitis Virus√

Yellow Fever√

For high risk or notpreviously immunized

Td booster種Td booster

booster

Some High-Risk recommendations
Typhoid

Primary series and booster

CholeraPrimary series and booster

Meningococcal A√

Hepatitis A

Primary series

RabiesPrimary series

Recommendations for some immunization programs
Mumps

√

Rubella√Or adolescent girls and women ofchild-bearing age

Influenza√

Revaccinate annuallyGirls only

Mast EE, Ward JW. Hepatitis B vaccine. pp 205-241. In Vaccines 5th edition, S Plotkin, W Orenstein and P Offit, Eds, Saunders Elsevier, China, 2008.
World Health Organization. Immunization service delivery and accelerated disease control. Expanded programme on immunization.
http://www.who.int/immunization_delivery/en/165
World Health Organization.Table 1. Recommended Routine Immunization – Summary of WHO Position Papers. October 21, 2010.
http://www.who.int/immunization/policy/Immunization_routine_table1.pdf
163
164

96 | VACCINE FACT BOOK 2012

4.2 USIn the US, immunization has been classified as one of the top
10 public health achievements of the 20th century. Vaccinepreventable diseases are now at a record low. In addition,for every dollar the US spends on immunization against 10
vaccine-preventable diseases (diphtheria, tetanus, pertussis,polio, hepatitis B, Haemophilus influenzae type b, measles,
mumps, rubella, and varicella), it saves $5.30 and society
saves $16.50166. Every 26 days, the US saves the equivalentof its entire investment in the smallpox eradication programfrom savings on treatment of disease alone167.
In 1977, the US launched a national immunization initiative.
Its goals were to achieve national vaccination coverage of
90% by 1979 and establish a permanent system to provide
immunization services to the annual US birth cohort of3 million. At that time, an estimated 20 million children were
not fully immunized.
In 1991, a new objective was set: to ensure that 90% ofchildren had completed the full series of vaccinations by
their 2nd birthday. And in 1993, the Childhood Immunization
Initiative was launched to improve the quality and quantityof vaccine delivery services, expand access to vaccines,
enhance community involvement, improve the measurementof immunization coverage and surveillance of vaccinepreventable diseases, simplify the immunization schedule,
and improve vaccines.

“In 1991, a newobjective was set:to ensure that
90% of children
had completed
the full series ofvaccinations by their
2nd birthday.

The number of vaccine-preventable diseases covered by
the current childhood immunization schedule in the US has
doubled, from eight to 16 diseases, in the last 20 years (SeeTable 29).

Orenstein, WA, Rodewald LE, Hinman AR, et al. Immunization in the United States. pp 1479-1510. In Vaccines 5th edition, S Plotkin, W Orenstein and P Offit, Eds,Saunders Elsevier, China, 2008.
167
Brilliant LB. The management of smallpox eradication in India: a case study and analysis. Ann Arbor, University of Michigan Press, 1985.
166

VACCINE FACT BOOK 2012 | 97

Age of administration
AntigenBirth

2months

1 month4months

6months

12months

15months

18
months19-23
monthsInfluenza

4-6
years

7-10
years

11-12
years

13-18
years

AnnuallyInactivatedPolio√√

Pneumococcal
conjugate

√

√

√

√

Haemophilus
influenzae typeb√

√

√

√

√

Diphtheria,
Tetanus,acellular
Pertussis√√√

Rotavirus√√√

Hepatitis B

2-3
years

√

√
Pneumococcal polysaccharide high-risk√√

Tetanus,diphtheria,acellular
pertussis√√

TABLE 29. CHILDHOOD IMMUNIZATION SCHEDULE IN THE US (EXCLUDING CATCH-UP SCHEDULE)168

Age of administration
AntigenBirth

1 month

2months

4months

6months

12months

15months

18
months19-23
months

2-3
years

4-6
years

Measles,
Mumps, Rubella√√Varicella√√

Hepatitis A
Meningoccal
conjugate
HumanPapillomavirus

7-10
years

11-12
years

13-18
years

high-risk√
high-risk

√

girls

Centers for Disease Control and Prevention. Vaccines & Immunizations. Recommendations and guidelines: 2011 child and adolescent immunization schedules forpersons aged 0 – 6 years, 7 – 18 years, and “catch-up schedule”.http://www.cdc.gov/vaccines/recs/schedules/child-schedule.htm
168

98 | VACCINE FACT BOOK 2012

4 Vaccines in use

The Adult Immunization Schedule, in addition to providing
for boosters of childhood vaccines, also provides for
immunization against varicella zoster, an excruciatingly
painful and potentially neurologically damaging condition(See Table 30).

Antigen19-26 years

27-49 years

Influenza60-64 years≥ 65 years

1 dose annually

Tetanus, Diphtheria, Acellular Pertusis /Tetanus, Diphtheria

1dose of Tdap then Td every 10 years

Varicella
Human Papillomavirus

50-59 years

Td every 10 years

2 doses if no evidence of immunity
3 doses (females) if
not yet received

Herpes zoster
Measles, Mumps, Rubella
Pneumococcal polysaccharide

1 dose1 or 2 doses

1 dose high-risk
1or 2 doses high-risk

Meningococcal polysaccharide

1 or more doses high-risk

Hepatitis A

2 doses high-risk

Hepatitis B

3 doses high-risk

1 doseTABLE 30. ADULT IMMUNIZATION SCHEDULE IN THE US169

US Department of Health and Human Services and Centers for Disease Control and Prevention. Recommended adult immunization schedule United States 2011.
http://www.cdc.gov/vaccines/recs/schedules/downloads/adult/adult-schedule.pdf
169

VACCINE FACT BOOK 2012 | 994.3 European Union√√√√√√√√√√√√√√√√√√√√√√√√√√√√√√√√√√√√√√√√√√√√√√√√√√√√√√√√√√√√√√√√√√√√√√√√√√√√√√√√√√√√√√√√√√√√√√√√√√√√√√√√√√√√√√√√√√√√√√√√√√√√√√√√√√√√√√√√√√√√√√√√√√√√√√√√

Euvacnet. National childhood vaccination schedules. http://www.euvac.net/graphics/euvac/vaccination/vaccination.html

100 | VACCINE FACT BOOK 2012

√

√
√

√

√
√
√
√
√

TABLE 31. CHILDHOOD VACCINES USED IN EUROPEAN COUNTRIES (LAST UPDATE OF SCHEDULE RANGE FROM DEC 2006 – JULY 2011)170170

Meningococcal C

Varicella

Diphtheria, Tetanus,
Acellular Pertussis

Tetanus

Diphtheria, TetanusInactivated Polio√

Rotavirus√√√

HumanPapillomavirus√√√√√√√√

Diseases typically targeted by immunization in Europe areshown by country in Table 31 below.

Diphtheria, Tetanus√√√√√√√√√√√√√√√
√
√
√
√
√
√
√
√*
√
√
√
√
√
√√
√*
√

related to immunization. The EURO policy framework targets
a number of diseases for prevention by vaccination.

Measles, Mumps,Rubella√√√√√√√√√√√√√√√√√√√√√√√√√√√√√√√√

Pneumococcal
Conjugate√√√√√√√√√√√√√√√√√√√√√√√*√√√√√√√√√

Hepatitis B

Inactivated Polio√√√√

Haemophilus
iinfluenzae type b

Austria/08
Belgium/11
Bulgaria/10
Croatia/08
Cyprus/09
Czech/10
Denmark/09
Estonia/09
Finland/11
France/10
Germany/10
Greece/07
Hungary/10
Iceland/10
Ireland/10
Italy/08
Latvia/11
Lithuania/08
Luxemburg/08
Malta/10
Netherlands/06
Norway/10
Poland/07
Portugal/09
Romania/10
Slovakia/11
Slovenia/09
Spain/08
Sweden/10
Switzerland/08
Turkey/10
United Kingdom/11

Diphtheria, Tetanus,
Acellular Pertussis

Country / year last
updatedBCG (tuberculosis)

European countries do not have a unified vaccination policy.
The number and types of vaccines used in European countries
varies from one country to the other. However, the European
Union’s European Center for Disease Prevention and Control(ECDC) and the WHO’s European Regional Office (EURO)do provide common guidance to member states on matters√√√√4 Vaccines in use

4.4 Australia

The Australian childhood immunization schedule closely
resembles that of the US (See Table 32).

Age of administration
2months

4months

6months

12months

√

√

√*

√*

Rotavirus√√√

Diphtheria, Tetanus,
Acellular Pertussis

√

√

√

Haemophilus influenzae
type b√√√Pneumococcal conjugate

√

√

√

Antigen

Birth

Hepatitis B√

1
month

18
months4 years

10years

12years

13years

15-17 years√

Tetanusdiphtheria,acellularpertussis√√

Pneumococcal
polysaccharide
Inactivated Polio

24
monthshigh-risk√√√√
Aboriginalhigh-risk

Influenza
Measles, Mumps, Rubella√√Varicella√

Hepatitis Ahigh-risk

Meningococcal C conjugate√√

Human Papillomavirus

girls

TABLE 32. AUSTRALIAN CHILDHOOD IMMUNIZATION SCHEDULE

171

The adult Australian immunization schedule provides forpneumococcal and influenza vaccines. Influenza is not part of
the routine childhood immunization schedule (See Table 33).

Antigen15 - 49 years

50 years and over

65 years and over

Influenzahigh-risk Aboriginal

Aboriginal

√

PPV23

high-risk Aboriginal

Aboriginal√

TABLE 33. AUSTRALIAN ADULT IMMUNIZATION SCHEDULE172
Australian government. Department of Health and Ageing. National Immunisation Program Schedule (Valid from 1 July 2007).
http://www.immunise.health.gov.au/internet/immunise/publishing.nsf/Content/E875BA5436C6DF9BCA2575BD001C80BF/$File/nip-schedule-card-july07.pdf
172
Australian government. Department of Health and Ageing. National Immunisation Program Schedule (Valid from 1 July 2007).
http://www.immunise.health.gov.au/internet/immunise/publishing.nsf/Content/E875BA5436C6DF9BCA2575BD001C80BF/$File/nip-schedule-card-july07.pdf
171

VACCINE FACT BOOK 2012 | 101

4.5 Japan

Like in many industrialized countries, vaccines in thechildhood immunization schedule in Japan are provided at nocost in public health centers. But Japan has been slow toadopt many of the newest vaccines from the last 10 – 15 years
and its immunization schedule resembles the schedule of aGross National Income / capita (US$)
BCG (tuberculosis)

country of much lower economic status. A table of Japan’schildhood immunization schedule relative to countries in theregion with comparable or much lower levels of wealth isshown in Table 34 below.

Japan

Australia

Korea, South

Singapore

Indonesia

ThailandUSA

37,78043,77018,83037,2202,230

37,76047,240√√√√√√√√√Diphtheria, Tetanus, Pertussis
Diphtheris, Tetanus, Acellular Pertussis√

Oral Polio√

Inactivated Polio
Haemophilus influenzae type b√

√√
√

√

Hepatitis B√

√√√

√

√

√

√

√

√

√

√

√

√

√

√

√

√

√

Tetanus
Diphtheria, Tetanus√√

Measles. Mumps, Rubella
Japanese Encephalitis Virus√√

Measles
Measles, Rubella or combination

√√
√

√

Tetanus, Diphtheria√

Tetanus, Diphtheria, Acellular Pertussis
Pneumococcal conjugate√

Varicella√Meningococcal C conjugate

√√√

√√√√

√

Meningococcal A,C,W,Y conjugate

high risk√

Human Papillomavirus√√√

Rotavirus√√√

high risk√

Hepatitis ATyphoidInfluenza

high risk√

high risk

high risk√√

TABLE 34. JAPAN’S CHILDHOOD IMMUNIZATION SCHEDULE COMPARED TO OTHER COUNTRIES IN THE REGION AND THE US

173

World Health Organization. WHO Vaccine Preventable Diseases Monitoring System.
http://apps.who.int/immunization_monitoring/en/globalsummary/countryprofileselect.cfm
173

102 | VACCINE FACT BOOK 2012

4 Vaccines in use

4.5.1 Current situation in Japan

Japan was one of only a few pioneering countries in vaccinedevelopment. Several vaccines were developed first in Japanand later produced or further adapted in other countries.
Ironically, Japan has lagged behind most countries ofsimilar economic development in both vaccine policy andimplementation. Over the last several decades, the US andcountries in the European Union have outpaced Japan indeveloping policies and practices for the introduction of newvaccines.
Initiatives, such as the Childhood Immunization Initiative of theearly 1990s, helped the US to develop systems to efficientlyachieve public health objectives for disease prevention.
These systems include the provision of vaccines for children
who are uninsured or otherwise would not have access toimmunization.
Likewise, the WHO’s Vision and Immunization Strategy,
launched at the start of the 2000s, was developed toassist developing countries to further develop policies andimmunization objectives. At the start of the 2000s, many
developing countries had not updated their immunization
programs and policies from the 1970s when they were firstlaunched. The WHO’s overarching strategy for immunization
has evolved to include several new vaccines that have become
available since the 1970s. It also includes new target groups,
such as adolescents and adults, for specific immunizations.
The relatively high incidence of deafness from mumps in Japan,
when the US and countries in Europe have virtually eliminatedthe disease, highlights the divergence in immunization policy
and implementation between Japan and countries of similar
economic status. In the absence of a renewed or reinvigoratedemphasis on immunization in Japan, the contrast in publichealth outcomes may become increasingly apparent. With
clear objectives, solid policies, and robust implementation
systems, Europe and the US have been very quick to adopt
recently licensed vaccines. These investments in prevention
are expected to have net advantages over curative care thatwould otherwise be required, particularly at a time of budgetary
constraint and austerity.
Therefore, Japan has recently undertaken to reform vaccine
policy and practice, as evidenced by the activities of the Vaccine
Committee of the Ministry of Health, Labor and Welfare.

VACCINE FACT BOOK 2012 | 103