疫苗

维基百科，自由的百科全书

疫苗是一種抗原性製劑，用以建立個體針對某種傳染病的免疫力。(詳見疫苗注射)

The term derives from Edward Jenner's use of cowpox ("vacca" means cow in Latin), which, when administered to humans, provided them protection against smallpox, which Pasteur and others perpetuated. The process of distributing and administrating vaccines is referred to as vaccination.

Vaccines can be prophylactic (e.g. to prevent or ameliorate the effects of a future infection by any natural or "wild" pathogen), or therapeutic (e.g. vaccines against cancer are also being investigated; see cancer vaccine).

目录 1 歷史 1.1 重要預防性疫苗發展表 2 種類 3 免疫力的建構 4 疫苗接種時間表 5 爭議 5.1 潛在的副作用 5.2 效力的質疑 5.3 MMR混合疫苗的爭議 5.4 科學研究 5.5 The case for widespread vaccines 5.6 Criticism of widespread vaccine policy 6 Economics of vaccine development 7 保存方式 8 List of Vaccines 9 List of Vaccines Approved for Use in the United States 10 參見 11 參考文獻 12 外部連結 13 External links 13.1 Vaccine promotion sites, little or no anti-vaccination viewpoint 13.2 Sites or articles supportive of vaccines 13.3 Sites or articles critical of vaccines 13.4 Sites decidedly or apparently totally against vaccination 13.5 Links related to controversy and specific to MMR 13.6 General 13.7 Vaccine proponent views 13.8 Vaccine safety critical views

[编辑] 歷史

[编辑] 重要預防性疫苗發展表

此份列表專注於預防性疫苗的研發里程，較早期的疫苗以其發展或試驗年份為主，近代則以上市或最新試驗為據。儘管這些疫苗的目的在防範人類疾病，卻只有天花成功地從世界上滅絕。

• 1796年，史上第一劑疫苗，本質為牛痘疫苗，用以對抗天花
• 1879年，首支抗霍亂疫苗
• 1881年，首支抗炭疽疫苗
• 1882年，首支抗狂犬病疫苗
• 1890年，首支抗破傷風、白喉疫苗
• 1896年，首支抗傷寒熱疫苗（typhoid fever）
• 1897年，首支抗鼠疫疫苗
• 1926年，首支抗百日咳疫苗
• 1927年，首支抗結核疫苗
• 1932年，首支抗黃熱病疫苗
• 1937年，首支抗傷寒（typhus）疫苗
• 1945年，首支抗流行性感冒疫苗
• 1952年，首支抗小兒麻痺疫苗
• 1954年，首支抗日本腦炎疫苗
• 1957年，首支抗腺病毒疫苗
• 1962年，首支抗小兒麻痺口服疫苗
• 1964年，首支抗德國麻疹疫苗（Rubella）
• 1967年，首支抗腮腺炎疫苗（Mumps）
• 1970年，首支抗玫瑰疹疫苗（roséole）
• 1974年，首支抗水痘疫苗
• 1977年，首支抗肺炎疫苗（肺炎雙球菌）
• 1978年，首支抗腦膜炎疫苗（腦膜炎雙球菌）
• 1981年，首支抗B型肝炎疫苗
• 1985年，首支抗B型流感嗜血桿菌疫苗
• 1992年，首支抗A型肝炎疫苗
• 1998年，首支抗萊姆病、輪狀病毒疫苗
• 2006年，首支抗乳突病毒疫苗

[编辑] 種類

Vaccines may be living, weakened strains of viruses or bacteria that intentionally give rise to unapparent-to-trivial infections. Vaccines may also be killed or inactivated organisms or purified products derived from them.

There are four types of traditional vaccines[2]:

• Inactivated - these are previously virulent micro-organisms that have been killed with chemicals or heat. Examples are vaccines against flu, cholera, bubonic plague, and hepatitis A. Most such vaccines may have incomplete or short-lived immune responses and are likely to require booster shots.
• Live, attenuated - these are live micro-organisms that have been cultivated under conditions that disable their virulent properties. They typically provoke more durable immunological responses and are the preferred type for healthy adults. Examples include yellow fever, measles, rubella, and mumps.
• Toxoids - these are inactivated toxic compounds from micro-organisms in cases where these (rather than the micro-organism itself) cause illness. Examples of toxoid-based vaccines include tetanus and diphtheria.
• Subunit - rather than introducing a whole inactivated or attenuated micro-organism to an immune system, a fragment of it can create an immune response. Characteristic example is the subunit vaccine against HBV that is composed of only the surface proteins of the virus (produced in yeast)

The live tuberculosis vaccine is not the contagious TB strain, but a related strain called "BCG"; it is used in the United States very infrequently.

A number of innovative vaccines are also in development and in use:

• Conjugate - certain bacteria have polysaccharide outer coats that are poorly immunogenic. By linking these outer coats to proteins (e.g. toxins), the immune system can be led to recognize the polysaccharide as if it were a protein antigen. This approach is used in the Haemophilus influenzae type B vaccine.
• Recombinant Vector - by combining the physiology of one micro-organism and the DNA of the other, immunity can be created against diseases that have complex infection processes
• DNA vaccination - in recent years a new type of vaccine, created from an infectious agent's DNA called DNA vaccination, has been developed. It works by insertion (and expression, triggering immune system recognition) into human or animal cells, of viral or bacterial DNA. Some cells of the immune system that recognize the proteins expressed will mount an attack against these proteins and cells expressing them. Because these cells live for a very long time, if the pathogen that normally expresses these proteins is encountered at a later time, they will be attacked instantly by the immune system. One advantage of DNA vaccines is that they are very easy to produce and store. As of 2006, DNA vaccination is still experimental, but shows some promising results.

Note that while most vaccines are created using inactivated or attenuated compounds from micro-organisms, synthetic vaccines are composed mainly or wholly of synthetic peptides, carbohydrates or antigens.

[编辑] 免疫力的建構

The immune system recognizes vaccine agents as foreign, destroys them, and 'remembers' them. When the virulent version of an agent comes along, the immune system is thus prepared to respond, by (1) neutralizing the target agent before it can enter cells, and (2) by recognizing and destroying infected cells before that agent can multiply to vast numbers.

Vaccines have contributed to the eradication of smallpox, one of the most contagious and deadly diseases known to man. Other diseases such as rubella, polio, measles, mumps, chickenpox, and typhoid are nowhere near as common as they were just a hundred years ago. As long as the vast majority of people are vaccinated, it is much more difficult for an outbreak of disease to occur, let alone spread. This effect is called herd immunity. Polio, which is transmitted only between humans, is targeted by an extensive eradication campaign that has seen endemic polio restricted to only parts of four countries. The difficulty of reaching all children, however, has caused the eradication date to be missed twice by 2006.

[编辑] 疫苗接種時間表

主条目：接種時間表

Vaccination schedule In order to provide best protection, children are recommended to receive vaccinations as soon as their immune systems are sufficiently developed to respond to particular vaccines, with additional 'booster' shots often required to achieve 'full immunity'. This has led to the development of complex vaccination schedules. In the United States, the Advisory Committee on Immunization Practices, which recommends schedule additions for the Center for Disease Control, recommends routine vaccination of children against: hepatitis A, hepatitis B, polio, mumps, measles, rubella, diphtheria, pertussis, tetanus, HiB, chicken pox, rotavirus, influenza, meningococcal disease and pneumonia. The large number of vaccines and boosters recommended (up to 24 injections by age two) has led to problems with achieving full compliance. In order to combat declining compliance rates, various notification systems have been instituted and a number of combination injections are now marketed (e.g., Prevnar and ProQuad vaccines), which provide protection against multiple diseases.

A significant number of vaccinations may be a requirement for school admission at various grades. This requirement exists primarily to reduce the number of diseases which are transmissable in the classroom, not as comprehensive list of the vaccinations which may be appropriate for any given child. As a result, a school may require a vaccination for highly contagious diseases like HIB and chicken pox, which can cause significant school disruption during outbreaks, but is less likely to require vaccination against Hepatitis B, which is strictly a bloodborne pathogen and which can not be caught through the kind of casual contact one encounters in a classroom. In the US, individual states may set varying exemptions to compulsory vaccination that parents may claim for religious, ethical, or medical reasons.

Besides recommendations for infant vaccination boosters, many specific vaccines are recommended for repeated injections throughout life -- most commonly for measles, tetanus, influenza, and pneumonia. Pregnant women are often screened for continued resistance to rubella. In 2006, a vaccine was introduced against shingles, a disease caused by the chicken pox virus, which usually affects the elderly. Vaccine recommendations for the elderly concentrate on pneumonia and influenza, which are more deadly to that group.

[编辑] 爭議

The vaccine controversy encompasses many issues over the benefits and risks of vaccines.

Vaccines are widely credited with reducing the prevalence and consequences of many diseases. National and international public health organizations have made vaccination a central part of their strategies. The consensus of health organizations and medical doctors is that mass vaccination campaigns have been an essential and effective component of eradication or control of several deadly diseases via individual and herd immunity.

While the medical community overwhelmingly support vaccination as an effective and safe means of preventing the spread and reducing the impact of infectious illnesses, and the majority of public health advocates hold the opinion that the benefit to the public justifies mandatory programs, anti-vaccinationists question the claimed efficacy and safety of such programs, often citing lack of research on the adverse effects.

Research continues into both the development of new vaccines for a broadening array of diseases and the efficacy and safety of vaccines already in common use.

Opposition to vaccination, from a wide array of vaccine critics, has existed since the earliest vaccination campaigns^[1]：

A number of vaccines, including those given to very young children, have contained thimerosal, a preservative that metabolizes into ethylmercury. It has been used in some influenza, DTP (diphtheria, tetanus and pertussis) vaccine formulations. Since 1997, use of thimerosal has been gradually diminishing in western industrialized countries after recommendations by medical authorities, but trace amounts of thimerosal remain in many vaccines and in some vaccines, thimerosal has not yet been phased out despite recommendations. Some states in USA have enacted laws banning the use of thimerosal in childhood vaccines.

In the late 1990s, controversy over vaccines escalated in both the US and the United Kingdom when a study, published in the respected journal Lancet, by Dr. Andrew Wakefield suggested a possible link between bowel disorders, autism and MMR vaccine, and urged further research ^[2]. His report, which focused upon a novel syndrome he described as autistic enterocolitis, garnered significant media attention, leading to a drop in the uptake of the MMR vaccine in the United Kingdom and some other countries. The study garnered criticism for its small sample size, and for failing to use healthy controls. In response to the controversies, a number of studies with larger sample sizes were conducted, and failed to confirm the findings^{[3] [4]}。 In 2004, 10 of the 13 authors of the original Wakefield study retracted the paper's interpretation, without disputing the central finding of a consistent set of bowel disorders among the autistic study subjects, stating the data were insufficient to establish a causal link between MMR vaccine and autism.^[5] Wakefield was also later found to have received a substantial sum from trial lawyers^[6] to fund this research further calling into question the validity of its findings. Also in 2004, the United States' Institute of Medicine reported that evidence "favors rejection" of any link between vaccines containing thimerosal, or MMR, and the development of autism ^[7]。

2004年和2005年，英國的英格蘭和威爾斯地區合作實驗發現成人和青少年族群中腮腺炎發生率（incidence）的提高。The age group affected were too old to have received the routine MMR immunisations around the time Wakefield et al's paper was published, and too young to have contracted natural mumps as a child, and thus to achieve a herd immunity effect. With the decline in mumps that followed the introduction of the MMR vaccine, these individuals had not been exposed to the disease, but still had no immunity, either natural or vaccine induced. Therefore, when the disease re-emerged as immunization rates declined following the controversy, they were susceptible to infection. ^{[8] [9]} . This and similar examples indicate the importance of:

1. careful modelling to anticipate the impact that an immunisation campaign will have on the epidemiology of the disease in the medium to long term
2. ongoing surveillance for the relevant disease following introduction of a new vaccine and
3. maintaining high immunisation rates, even when a disease has become rare.

There is opposition to vaccination (of any type) from some sectors of the community, particularly those who favour 'alternative' health care. Often this opposition is not based on specific data or details but rather a general leaning against conventional medicine and science. Naturopaths and other alternative health care practitioners sometimes offer their own, alternative treatments to conventional vaccination.

In 澳洲, a massive increase in vaccination rates was observed when the federal government made certain benefits (such as the universal 'Family Allowance' welfare payments for parents of children) dependent on vaccination. As well, children were not allowed into school unless they were either vaccinated or their parents completed a statutory declaration refusing to immunize them, after discussion with a doctor, and other bureaucracy. (Similar school-entry vaccination regulations have been in place in some parts of Canada for several years.) It became easier and cheaper to vaccinate one's children than not to. When faced with the annoyance, many more casual objectors simply gave in.

[编辑] 潛在的副作用

Some refuse to immunize themselves or their children, because they believe certain vaccines' adverse side effects outweigh their benefits. A variation of this reasoning is that not enough is known of the adverse effects to determine whether the potential benefits make the risks worthwhile. Since most people are vaccinated against contagious and potentially fatal diseases, the chances of someone who is not vaccinated becoming ill is a good deal smaller than it might be if their opinion was held by more people. Therefore, they acquire some of the benefits of vaccines through herd immunity without assuming the risks those who choose to vaccinate do.

Advocates of recommended routine vaccination argue that side effects of most approved vaccines are either far less serious than actually catching the disease, or are very rare, and argue that the calculus of risk/benefit ratio should be based on benefit to humanity rather than simply on the benefit to the immunized individual. The main risk of rubella, for example, is serious birth defects, including autism (it is one of the very few known causes), in about one-quarter of fetuses of pregnant women who become infected. This risk can be effectively reduced by immunization during childhood to prevent transmission to pregnant women during later life. However, some parents specifically refuse to vaccinate their boys on the grounds that boys, after birth, do not suffer seriously if they catch this disease. Other people point out that these parents risk the health and well-being of their future grandchildren, since the unvaccinated male might, years later, catch this highly contagious disease and pass it along to his own pregnant wife, or any other pregnant woman.

[编辑] 效力的質疑

Vaccines do not guarantee complete protection from a disease. Even after a vaccination, there is still a possibility that a vaccinated person may get the disease. Sometimes this is because the host's immune system simply doesn't respond adequately or at all. This is known in medical jargon as a 'low titre of antibodies'. This may be due to a lowered immunity in general (diabetes, steroid use, HIV infection) or just bad luck (the host's immune system does not have a B-cell capable of generating antibodies to that antigen).

Even if the host develops antibodies, the human immune system is not perfect. Some germs can mutate (the common cold and influenza viruses are highly efficient at this), and in any case the immune system might still not be able to defeat the infection.

Adjuvants are typically used to boost immune response. The efficacy or performance of the vaccine is dependent on a number of factors:

• the disease itself (for some diseases vaccination performs better than for other diseases)
• the strain of vaccine (some vaccinations are for different strains of the disease) ^[10]
• whether one kept to the timetable for the vaccinations (see Vaccination schedule)
• some individuals are 'non-responders' to certain vaccines, meaning that they do not generate antibodies even after being vaccinated correctly
• other factors such as ethnicity or genetic predisposition

In cases where a vaccinated individual does develop the disease vaccinated against, the disease is likely to be milder than without vaccination.

[编辑] MMR混合疫苗的爭議

Controversy has arisen regarding the safety of the MMR vaccine, because a handful of scientists and parents argue that the vaccine is the cause of the increased incidence of autism noted in western countries and Japan, and bowel disorders such as Crohn's disease. A theory advanced by proponents of the link is that the MMR vaccine overwhelms an immune system they assert is already struggling from the effect of the mercury-compound thimerosal contained in previous vaccines. They assert that live measles virus in the formulation of the MMR is detrimental to susceptible individuals in a fashion in which wild measles never was.

During the 1980s and 1990s, a number of lawsuits were brought in the United States against manufacturers of vaccines, alleging the vaccines had caused a variety of physical and mental disorders in children. While these were inconclusive, they did lead to a massive jump in the costs of the MMR vaccine, as pharmaceutical companies sought to cover potential liabilities by lobbying for legislative protection. By 1993, Merck KGaA had become the only company willing to sell MMR vaccines in the United States and the United Kingdom. Two other MMR vaccines were withdrawn in the UK in 1992 on safety grounds arising from the strain of mumps component.

In September 1995, the Legal Aid Board in the UK granted a number of families financial assistance to pursue legal claims against the state health authorities and the vaccine's manufacturers, claiming that their children were killed^{[來源請求]} or seriously injured by the MMR vaccine. A pressure group called JABS (Justice, Awareness, Basic Support) was established to represent families with children who, their parents said, were "vaccine-damaged."

In 1996, in New Zealand claims by an academic from Melbourne University that MMR contained a human blood product, serum albumin, and could therefore spread Creutzfeldt-Jakob disease caused anxiety.^{[來源請求]} This did not last, since serum albumin was not an ingredient of the MMR vaccine.

[编辑] 科學研究

Epidemiological research continues to show a dramatic increase in the incidence of autism, but whether the increase is real, rather than an artifact of changes in diagnosis and reporting, is unknown, and no causal connection has been demonstrated to the MMR vaccine. Since Wakefield's paper, there has been substantial clinical research investigating his claim to have found measles virus located in the gut of proportion of children, much of which has been financed by litigation, with the results not reported on legal grounds.

• In October 2004, the Journal of American Physicians and Surgeons, formerly the Medical Sentinel, magazine of the conservative Association of American Physicians and Surgeons, published a paper by Wakefield supporters and concluded that "Developing safer vaccination strategies and supporting further investigation of the hypothesized link between the MMR vaccine and autism should have a high priority." It also noted that in Denmark Thimerosal is eliminated as a factor in any relationship between MMR and autism. [3]
• Also in October 2004, a review, financed by the European Union, was published in the October 2004 edition of Vaccine^[11] that assessed the evidence given in 120 other studies and considered unintended effects of the MMR vaccine. The authors concluded that
  • the vaccine is associated with some positive and negative side effects,
  • it was "unlikely" that there was a connection between MMR and autism, and
  • "The design and reporting of safety outcomes in MMR vaccine studies ... are largely inadequate".
• In January 2005, intensive research in a single county in Minnesota reported an eightfold increase in the incidence of autism over a period beginning in the early eighties and ending in the late nineties but found no evidence of a link with MMR. The authors of the research suggested that the increase in autism was due to an increased awareness of the disorder, a growth in services, and changing definitions. [4]

• Japan provided a natural experiment on the subject: combined MMR vaccine was introduced in 1989, but the programme was terminated in 1993 and only single vaccines used thereafter.[5] In March 2005 a study of over 30,000 children (278 cases) born in one district of Yokohama concluded "The incidence of all autistic spectrum disorders (ASD), and of autism, continued to rise after MMR vaccine was discontinued. The incidence of autism was higher in children born after 1992 who were not vaccinated with MMR than in children born before 1992 who were vaccinated. The incidence of autism associated with regression was the same during the use of MMR and after it was discontinued." Autism rose (from 46-86 cases per 10,000 children, to 97-161/10,000). The authors concluded: "The significance of this finding is that MMR vaccination is most unlikely to be a main cause of ASD, that it cannot explain the rise over time in the incidence of ASD, and that withdrawal of MMR in countries where it is still being used cannot be expected to lead to a reduction in the incidence of ASD."^[12] This study did not question whether or not both MMR and separate vaccines were capable of contributing to ASD, Crohns and other disorders; with separate vaccines, rather than MMR, being responsible for a more severe effect.

• Dr. Wakefield contends the pattern of autism rates revealed by the data support his hypothesis[6] . His views, however, have found little support.^[13]

• In October 2005, the Cochrane Library published a review of 31 scientific studies, and concluded that "there was no credible evidence behind claims of harm from the MMR vaccination" and "MMR is an important vaccine that has prevented diseases that still carry a heavy burden of death ....."[7] However the authors of the report also stated that "the design and reporting of safety outcomes in MMR vaccine studies, both pre- and post-marketing, are largely inadequate."^[14] Cochrane, based in Oxford, England, is widely regarded by scientists as the most authoritative independent reviewer of medical literature, and the custodian of evidence-based medicine.

• A Journalist for UPI, Dan Olmsted, has conducted a journalistic investigation reported in his "Age of Autism" column [8] and did not find many never-vaccinated children with autism. Olmsted looked for autistic children among unvaccinated Amish; in a subset of homeschooled children who are not vaccinated for religious reasons; and in a pediatric practice in Chicago with several thousand never-vaccinated children. Partly as a result of this, a U.S. Congresswoman has produced a draft Autism Bill [9]

• In 2006 a study is underway, led by Arthur Krigsman of New York University School of Medicine, involving 275 children. Serious intestinal inflammations have been found in some of the autistic children and biopsies of gut tissue have been performed on 82 of them. Of these, 70 are said to have shown evidence of the measles virus. The study is yet to be completed or peer reviewed.^[15]

[编辑] The case for widespread vaccines

Public health officials, the medical community and public opinion overwhelmingly agree that children should routinely be vaccinated against a range of diseases, such as measles, polio, diphtheria, rubella, tetanus, pertussis, hepatitis B, and others. Some vulnerable groups are also advised to be vaccinated against influenza. Supporters of widespread vaccination policies contend that:

• Vaccines have saved more lives than any other form of medical intervention.^{[來源請求]} Among the most striking successes are the worldwide destruction of smallpox and the near eradication of polio.

• Vaccines are a cost-effective way of ensuring health, compared to treatment of a manifest disease. Routine childhood immunization saves about $40 billion in overall healthcare and social costs per birth year cohort vaccinated. [10]

• Vaccines prevent epidemics in vulnerable areas. When vaccination against polio was recently halted in Nigeria, for instance, the number of cases significantly rose [11]. A recent measles outbreak in 2005 in Indiana was attributed to lack of vaccination among children whose parents refused vaccination [12].

• Other critics of vaccination, such as Robert F. Kennedy, Jr. and Andrew Wakefield, are part of a plaintiffs' lawyers' campaign to generate contingent fees from litigation against vaccine manufacturers using junk science.[13]

• Physicians almost uniformly support polyvalent (more than one antigen) vaccines, such as DPT and MMR, as being in the best interests of the child.^{[來源請求]} The reasons given are that it reduces the unprotected exposure to all but one of the components over that of spaced immunization with single components, one injection is less uncomfortable than several, and it is more cost-effective for parents.

• If individual or multiple vaccinations were to "weaken the immune system", then they would be expected to increase hospitalization for other infections following immunization. Epidemiological surveys give a probability below one in a thousand that this happens. The statistical power of the study —given the Cohort size— is too small to reduce uncertainty further.[14].

[编辑] Criticism of widespread vaccine policy

The practice of vaccination has been opposed by some since its inception in the late 18th century [15], but criticism has become more visible in the US and some other developed countries in recent years, roughly paralleling the widespread availability of online information. While positions vary from outright rejection of the practice to calls for more selective and cautious use of vaccination, one or several of the following arguments are typically invoked:

• Secondary and long-term effects on the immune system from introducing immunogens and adjuvants directly into the body are not fully understood. Some autoimmune diseases like Acute disseminated encephalomyelitis, Guillain-Barré syndrome, Transverse myelitis and multiple sclerosis are known to be connected to vaccines, which suggests other autoimmune disorders might also be vaccine-related ^{[16] [17]}

• At least some vaccine studies did not include such young children (e.g., 5 week old infants, 2 month old infants)^{[來源請求]}, yet vaccination schedules start with newborns[16]. There can be a vast difference between the weight and all around development of a newborn baby versus a toddler, yet this is not accounted for.

• Opponents of current vaccination policy question whether vaccinations actually create immunity against the targeted diseases, since some people who have been vaccinated still contracted the illness.

• By not exposing children to common childhood illnesses, they may be more susceptible to diseases at a point when their immune system is weakened^{[來源請求]}, e.g., at an old age or when sick for other reasons.

• As is true with any medication, adverse events to the vaccine (even when rare) may be worse than the disease itself^{[來源請求]}, and there are isolated reports of serious health damage and even death, within hours or a few days of vaccination^{[來源請求]}. Although there are now various national databases where reported reactions can be recorded, anti-vaccinationists claim that serious adverse events are grossly under-reported.

• There are a number of possible conflicts of interest that may affect the research design, findings, and opinions about vaccines, including financial interests of companies, the self-regulatory mechanism of medical doctors, and fear of the consequences should vaccines be found to be dangerous (see 2000 Simpsonwood CDC conference for example of such fears). But there are also concerns that opponents of vaccines may be seeking to enrich themselves through litigation or the sale of alternatives, by spreading fear and misjudgment among the public.

• Religious objections, by certain churches and by Christian Scientists to all forms of medical intervention.

[编辑] Economics of vaccine development

One challenge in vaccine development is economic: many of the diseases most demanding a vaccine, including HIV, malaria and tuberculosis, exist principally in poor countries. Although some contend pharmaceutical firms and biotech companies have little incentive to develop vaccines for these diseases, because there is little revenue potential, the number of vaccines actually administered has risen dramatically in recent decades. This increase, particularly in the number of different vaccines administered to children before entry into schools may be due to government mandates, rather than economic incentive. Most vaccine development to date has relied on 'push' funding by government and non-profit organizations, of government agencies, universities and non-profit organizations.

Many researchers and policymakers are calling for a different approach, using 'pull' mechanisms to motivate industry. Mechanisms such as prizes, tax credits, or advance market commitments could ensure a financial return to firms that successfully developed an HIV vaccine. If the policy were well-designed, it might also ensure people have access to a vaccine if and when it is developed.

[编辑] 保存方式

為延長疫苗有效期限，並減少製作和儲存成本，過去一度大量使用乙基汞（ethylmercury）做為局部抗菌劑（thimerosal）^[18]。但由於許多兒童因使用相關疫苗，導致神經發育異常及心臟疾病^[19]，因此除了少數的流行性感冒疫苗，局部抗菌劑在美國^[20] 、丹麥^[21]等多個國家中逐步淘汰，但可能用於製造過程。許多父母希望疫苗的製作可以避免使用此類化學藥劑，而有越來越多的疫苗儲存，已被要求完全避免或微量使用該抗菌劑^[22]，但美國布希政權已於21世紀初推動取消部分相關限制，並將藥廠可用水銀量提高以利疫苗的保存^[23]。

[编辑] List of Vaccines

GIDEON's vaccine list and vaccine trade name list

[编辑] List of Vaccines Approved for Use in the United States

http://www.fda.gov/cber/vaccine/licvacc.htm

[编辑] 參見

• 疫苗注射
• 免疫學
• 免疫系統

[编辑] 參考文獻

• "Anti-vaccinationists Past and Present" BMJ 2002;325:430-432
  • Supplementary boxes - arguments from 1850 etc
• "MMR: Science and Fiction. Exploring the Vaccine Crisis; MMR and Autism: What Parents Need to Know", Rapid Responses to book review, British Medical Journal 2004

• "Content and Design Attributes of Antivaccination Web Sites" Robert M. Wolfe, MD; Lisa K. Sharp, PhD; Martin S. Lipsky, MD Journal of the American Medical Association JAMA. 2002;287:3245-3248  : Systematically examined antivaccination Web site attributes and delineated specific claims and concerns of antivaccination groups. 22 sites.
• Miller, C.L. Deaths from Measles in England and Wales. 1970-83.], Epidemiological Research Laboratory, Public Health Laboratory Service, London; measles mortality statistics published in the British Medical Journal, Vol 290, February 9, 1985

[编辑] 外部連結

[编辑] External links

[编辑] Vaccine promotion sites, little or no anti-vaccination viewpoint

• Immunize.org - Immunization Action Coalition' (nonprofit working to increase immunization rates)
• MMRtheFacts.nhs.uk - 'MMR the Facts', UK National Health Service
• WHO.int - 'Immunizations, Vaccines and Biologicals: Towards a World Free of Vaccine Preventable Diseases', World Health Organization (WHO's global vaccination campaign website)

[编辑] Sites or articles supportive of vaccines

• CDC.gov - "National Immunization Program: Leading the Way to Healthy Lives", US Centers for Disease Control (CDC information on vaccinations)

• CDC.gov - "Mercury and Vaccines (Thimerosal)", US Centers for Disease Control

• NYTimes.com - "On Autism's Cause, It's Parents vs. Research", Gardiner Harris, Anahad O'Connor, New York Times (front page; June 25, 2005)
• OpinionJournal.com - "Autism and Vaccines: Activists Wage a Nasty Campaign to Silence Scientists" (editorial), Wall Street Journal (February 16, 2004)
• SNHS.com - "Anti-vaccine Activists get Jabbed", Michael Fumento (March 11, 2004)
• ZyNet.co.uk - "Polio Virus, Vaccine and Eradication", Lincolnshire Post-Polio Network (UK)
• iVillage ParentsPlace Vaccine Support Message Board

[编辑] Sites or articles critical of vaccines

• About.com - 'Killing the Messenger: Dr. Andrew Wakefield Fired', Floyd Tilton (December 5, 2001)
• Doctors' Group Votes to Oppose Vaccine Mandates. Association of American Physicians and Surgeons, Inc. - 於2000-11-02從本原始頁面封存。 - 於2006-07-01zh-tw:造;zh-cn:采訪。
• GenerationRescue.org - 'Thousands of Parents, Hundreds of Doctors and Scientists and Several Congressmen Agree. The Cause of Autism - and its Cure- has been Found.', Generation Rescue
• InformedParent.co.uk - 'MMR Manufacturers Keep Up Legal Pressure on MMR Children', Informed Parent
• NewMediaExplorer.org - 'S 1873: Pandemic Vaccine Bill to Put Drug Firms Beyond Reach of Law', Sepp Hasslberger, Health Supreme (October 26, 2005)
• NVIC.org - National Vaccine Information Center
• RollingStone.com - 'Kennedy Report Sparks Controversy: Intense Reaction from Medical Establishment and Leading News Organizations' (editorial), Rolling Stone (July 14, 2005)
• ThinkTwice.com - Think Twice Global Vaccine Institute

[编辑] Sites decidedly or apparently totally against vaccination

• AVN.org.au - The Australian Vaccination Network (AVN)
• Educate-Yourself.org - 'The Vaccine Industry vs Robert F. Kennedy, Jr.', Mark Sircus Ac, OMD (June 22, 2005)
• VaccinationDebate.com - 'Vaccination Debate', Ian Sinclair
• VacLib.org - 'Free Your Mind...From the Vaccination Paradigm', Vaccination Liberation
• VRAN.org - 'Vaccine Risk Awareness Network: Your Source for Vaccination Information' (Canada)

[编辑] Links related to controversy and specific to MMR

• BBC.co.uk - 'Does the MMR Jab Cause Autism?' (TV programme transcript), BBC (May 29, 2005)
• Susan Mayor (March 13, 2004). "Authors Reject Interpretation Linking Autism and MMR Vaccine". British Medical Journal 328: 602. DOI:10.1136/bmj.328.7440.602-c.

• Abi Berger (13 September 2003). "The Third Degree. MMR: Can You Decide?". British Medical Journal 327: 628. DOI:10.1136/bmj.327.7415.628.

• BrianDeer.com - "The Lancet Scandal (Investigation of MMR Affair), Brian Deer
• At Last - the End of the MMR Myth: Dr Simon Atkins on Why it's Safe to Give Jabs，The Guardian，October 20, 2005。
• Jabs.org.uk - 'The Support Group for Vaccine-Damaged Children' (UK advocacy group)
• MedicalNewsToday.com - "Cochrane Library Publishes the Most Thorough Survey of MMR Vaccination Data", Medical News Today
• Medinfo.co.uk - "Medical Information for Patients: MMR Vaccination"
• MMRTheFacts.NHS.uk - "MMR the Facts", United Kingdom National Health Service (government website)
• MMRTheQuestions.com - "MMR: The Questions" (includes response from Andrew Wakefield to Brian Deer's investigation)
• RedFlagsDaily.com - "Alive and Well: The MMR-Autism Connection", F. Edward Yazbak, MD, FAAP, Red Flags (October 29, 2005)
• SpikedOnline.com - "How Did the Doctor Get Away With it? Brian Deer's Investigative Documentary on MMR went Some Way Towards Redeeming the Reputation of the Media", Dr. Michael Fitzpatrick (November 19, 2004)

[编辑] General

• Vaccines: Types and development - University of Arizona

[编辑] Vaccine proponent views

• CGDev.org -'Vaccines for Development' (updated regularly), Center for Global Development
• ClearlyExplained.com - 'Vaccines', Richard Conan-Davies, BSc Dip Ed (October 22, 2001)
• NIH.gov - 'Immunization' ('conventional' opinion on vaccines), National Institute of Health
• TownHall.com - 'Don't believe the childhood vaccine fearmongers', Michael Fumento (June 30, 2005)

[编辑] Vaccine safety critical views

• TruthCampaign.ukf.net - 'Vaccination Assault on the Human Species', Pat Rattigan, ND
• Maxanim.com Constructing Vaccines (Animation)
• MacroBiotic.net - 'A Short History of Vaccines'
• IOM.edu (pdf) - 'Before the Institute of Medicine' (statement on link between thimerosol and autism), US Congressman Dave Weldon, MD, (February 9, 2004)
• Liberty-Page.com - 'Bad Medicine: Or...How government interference in the vaccine market causes shortages, intellectual stagnation and death.'
• NoVaccine.com - 'The American Vaccine Information Directory' (AVID), Dr. Dan Schultz
• Painkillers may threaten power of vaccines

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