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- Herausgeber: John Wiley & Sons
- Kategorie: Fachliteratur
- Sprache: Englisch
Inoculate yourself against the confusion and misinformation surrounding vaccines Measles, mumps, and rubella--oh my! Why are we vaccinating our children--and ourselves--against these diseases, and what goes on in our bodies after the needle comes out? Vaccines For Dummies will inform and entertain you about all things vax, including how the first vaccines were discovered, what's in modern vaccines, how they are tested and approved for use, and why the CDC's vaccine schedule is what it is. Inside, you'll also find a complete guide to vaccine benefits, potential side effects, and contraindications, so you'll be ready when shot time comes. From the very first inoculations hundreds of years ago to the brand new COVID-19 shot, creating immunity to diseases has become a human specialty. If you're wondering how safe and how necessary it all is, you aren't alone. In Vaccines For Dummies, we'll explore the issue from every angle, empowering you to take charge of your wellbeing. With this book, you will: * Discover the ABCs of vaccines, including what they're made of and how they work * Learn about each recommended childhood and adult immunization, plus the seasonal flu shot, all with this evidence-based guide * Take a journey through vaccine history, meeting the major players of yesterday and today * Decide what's right for your family, with the help of the most recent vaccine science Parents, parents-to-be, adults of any age, and anyone who wants to delve into the microscopic world of pathogens and their arch nemeses (antigens and antibodies) will get a double dose of knowledge from Vaccines For Dummies.
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Seitenzahl: 425
Veröffentlichungsjahr: 2021
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Vaccines For Dummies®
Published by: John Wiley & Sons, Inc., 111 River Street, Hoboken, NJ 07030-5774, www.wiley.com
Copyright © 2021 by John Wiley & Sons, Inc., Hoboken, New Jersey
Published simultaneously in Canada
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Library of Congress Control Number: 2021941394
ISBN 978-1-119-78781-5 (pbk); ISBN 978-1-119-78782-2 (ebk); ISBN 978-1-119-78783-9 (ebk)
Vaccines For Dummies®
To view this book's Cheat Sheet, simply go to www.dummies.com and search for “Vaccines For Dummies Cheat Sheet” in the Search box.
Table of Contents
Cover
Title Page
Copyright
Introduction
About This Book
Foolish Assumptions
Icons Used in This Book
Beyond the Book
Where to Go from Here
Part 1: Getting Started with Vaccine Basics
Chapter 1: Focusing on Vaccine Fundamentals
Realizing the Crucial Role of Vaccines
Explaining How a Vaccine Works
Comparing Viruses, Bacteria, and Toxins
Studying COVID-19 Vaccine Development
Understanding the Importance of Vaccine Schedules
Preparing for Potential Vaccine Side Effects
Optimizing Your Immune Response
Chapter 2: The (Non) Life of a Virus
Looking Inside Your Average Virus
Investigating Influenza Viruses
Examining Enteroviruses (Including Rhinoviruses)
Knowing About Norovirus
Understanding HIV
Trying to Say Goodbye to Measles
Checking Out the Cause of Chicken Pox: Varicella
Fighting Ebola
Surveying Variola (Smallpox)
Chapter 3: The Crowned Virus: Coronavirus
Identifying the Coronavirus in Humans
Combatting the Common Cold Coronavirus
Surveying SARS and MERS
COVID-19: The Novel (and Specially Confounding) Coronavirus
Chapter 4: Bacterial Bad Guys
Understanding What Makes Bacteria Different from Viruses
Digging into Vaccines That Defuse Bacteria
Comparing Antibiotics and Vaccines
Seeing How Vaccines Help Prevent Antibiotic Resistance
Part 2: Verifying Valuable Vaccines
Chapter 5: Distinguishing and Testing Different Vaccines
Getting to Know the Different Types of Vaccines
Testing Vaccines for Safety and Effectiveness
Studying the Efficacy of Vaccines
Tracing the History of Various Vaccines
Chapter 6: Tracking the Current List of Effective Vaccines
Chicken Pox (Varicella)
Diphtheria, Tetanus, and Pertussis
Haemophilus Influenzae Type B (Hib)
Hepatitis A
Hepatitis B
Human Papillomavirus (HPV)
Influenza (Flu)
Measles, Mumps, and Rubella (MMR)
Measles, Mumps, Rubella, and Varicella (MMRV)
Meningococcal Vaccines
Pneumococcal Vaccines
Rotavirus
Shingles (Herpes Zoster)
Chapter 7: What to Expect When You’re Vaccinating
Understanding Side Effects: What May Cause Them and What Happens
Recognizing and Treating Serious Reactions
Looking at Multiple Vaccines and the Immune System
Part 3: Scheduling Safety
Chapter 8: Vaccines for Children
Understanding Mom-to-Baby Immunity
Getting a Reminder of the Effectiveness and Importance of Vaccinations
Focusing on Vaccinations in the First Year of Life
Knowing New Vaccinations for Toddlers
Surveying a Few Vaccines for Ages 4 to 6
Adding Some School-Age Vaccinations
Needing a Booster: Vaccines for Teens
Catching Up on Childhood Vaccines
Checking Out Vaccine Schedules Around the World
Chapter 9: Vaccines for Adults
Vaccines When You’re 19–26 Years Old
Vaccines When You’re 27–49 Years Old
Vaccines When You’re 50–64 Years Old
Vaccines When You’re 65-Plus Years Old
Vaccines Before and During Pregnancy
Vaccines for Travelers
Catching Up: If Your Parents/Guardians Didn’t Vaccinate You
Chapter 10: Spelling Out Who May Face Risks
Knowing When to Avoid or Limit Vaccines
Understanding Vaccines and Allergies
Assessing Reactions to the COVID-19 Vaccine
Chapter 11: Anti-Vaxxers and Debunking Myths About Vaccines
Studying the Rise of Vaccine Hesitancy
Debunking Common Vaccine Myths
Reviewing Vaccine Recalls
Part 4: The Part of Tens
Chapter 12: Five People Who Created Ten (Or More) Modern Vaccines
Edward Jenner: Snuffing Out Smallpox
Louis Pasteur: Ridding the World of Rabies
Jonas Salk and Albert Sabin: Putting Polio Behind Us
Maurice Hilleman: The Master of Modern Vaccines
Chapter 13: Ten Diseases Without Vaccines, from A to Z
Avian Influenzas (Bird Flu)
Cytomegalovirus (CMV)
Epstein-Barr Virus (EBV)
Hepatitis C
Herpes Simplex Virus (HSV) 1 and 2
HIV/AIDS
Lyme Disease
Respiratory Syncytial Virus (RSV)
West Nile Virus
Zika Virus
Chapter 14: The Ten Most Lethal Major Pandemics
Antonine Plague (165–180)
Plague of Justinian (541–750)
Bubonic Plague (Black Death) (1346–1353)
Cholera (1846–1860)
Third Plague Pandemic (1855–1960)
Influenza (Russian Flu) (1889–1890)
Influenza (Spanish Flu) (1918–1919)
Influenza (Asian Flu) (1957–1958)
Human Immunodeficiency Virus (HIV) (1981–Present)
COVID-19 (2020–Present)
Chapter 15: Ten Ways to Boost Your Immune System
Getting Your Vaccinations
Decreasing Stress
Eating Well
Maintaining a Healthy Weight
Getting Enough Sleep
Exercising for Immunity
Saying No to Smoking
Drinking Only in Moderation
Staying Connected
Considering Supplements
Index
About the Authors
Connect with Dummies
End User License Agreement
List of Tables
Chapter 8
TABLE 8-1 First-Year Vaccination Schedule at a Glance
TABLE 8-2 Toddler Vaccination Schedule at a Glance
TABLE 8-3 Vaccines Given Between Ages Four and Six
TABLE 8-4 Vaccines at a Glance from Age 7 to 12
TABLE 8-5 Vaccines for Teens at a Glance
Guide
Cover
Table of Contents
Title Page
Copyright
Begin Reading
Index
About the Authors
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Introduction
Vaccines are a hot topic today, but that’s really not anything new. They have been lauded, criticized, and discussed for hundreds of years, although the creation of new vaccines has certainly accelerated over the past 70 or so years. Yet dozens of misconceptions about vaccines still exist. For every person who embraces being fully vaccinated, there’s someone who questions certain vaccines or, worse, rejects them altogether, despite their proven benefits.
This book is for both groups — the people who vaccinate themselves and their families but who want to know more about them, and the people who have questions about vaccines. Our goal is to have everyone vaccinated and, even more important, happy knowing they’re doing the best thing for their health.
About This Book
Obviously, vaccines are the main topic of this book. But we intend to do more than just give you a vaccine schedule. We explain the history of vaccines (and it goes back much further than you might think), talk about the types of germs and diseases that led to vaccine development, and explain why the vaccine schedules are set up the way they are. We also discuss the myths about vaccines, especially with regard to children, and explain why the vaccine schedules have changed over the years.
A quick note: Sidebars (shaded boxes of text) dig into the details of a given topic, but they aren’t crucial to understanding it. Feel free to read them or skip them. You can pass over the text accompanied by the Technical Stuff icon, too. The text marked with this icon gives some interesting but nonessential information about vaccines.
One last thing: Within this book, you may note that some web addresses break across two lines of text. If you’re reading this book in print and want to visit one of these web pages, simply key in the web address exactly as it’s noted in the text, pretending as though the line break doesn’t exist. If you’re reading this as an e-book, you’ve got it easy — just click the web address to be taken directly to the web page.
Foolish Assumptions
Here are some assumptions about you, dear reader, and why you’re picking up this book:
You want to learn more about vaccines in general.
You’re willing to keep an open mind about vaccines and vaccinations.
You’re looking for more information about how vaccines are created.
You have questions about vaccine scheduling.
Icons Used in This Book
Like all For Dummies books, this book features icons to help you navigate the information. Here’s what they mean.
If you take away anything from this book, it should be the information marked with this icon.
This icon flags information that delves a little deeper than usual into a particular topic related to vaccines.
This icon highlights especially helpful advice about vaccines and vaccinations.
This icon points out situations and actions to avoid when you’re planning to be vaccinated.
Beyond the Book
In addition to the material in the print or e-book you’re reading right now, this product comes with some access-anywhere goodies on the web. Check out the free Cheat Sheet for questions to ask your pediatrician about vaccines, facts about adult vaccinations, and the scoop on different types of vaccines. To get this Cheat Sheet, simply go to www.dummies.com and search for “Vaccines For Dummies Cheat Sheet” in the Search box.
Where to Go from Here
You don’t have to read this book from cover to cover, but if you’re an especially thorough person, feel free to do so! If you just want to find specific information and then get back to work, take a look at the table of contents or the index, and then dive into the chapter or section that interests you.
For example, if you’re just looking for more information on childhood vaccination schedules, go to Chapter 8. Adult schedules are in Chapter 9. If side effects concern you, read Chapter 7. And if your main interest right now is coronaviruses, you’ll find a ton of info in Chapter 3.
Vaccines have changed the world for the better. We hope this book gives you confidence that vaccinating yourself and your family is the best way to keep you all healthy.
Part 1
Getting Started with Vaccine Basics
IN THIS PART …
Focus on the fundamentals of vaccines.
Investigate viruses — what they are and how they work.
Understand coronaviruses from colds to COVID-19.
Get a handle on defeating dangerous bacteria.
Chapter 1
Focusing on Vaccine Fundamentals
IN THIS CHAPTER
Looking at the importance of vaccines
Getting a handle on how vaccines work
Surveying the COVID-19 vaccine
Checking out schedules and side effects
Boosting your immune system’s response
Infections that once haunted childhood are now seen only in textbooks. These were the true bogeymen of childhood, the real monsters under the bed. They were common and potentially life-threatening. We now have vaccines for these infections that were so tricky to treat and easy to spread. Most children around the world are vaccinated against these bogeymen, including, among others, measles, polio, diphtheria, tetanus, and smallpox. Vaccines have helped send these diseases packing, even though we still don’t always have good treatments for the diseases themselves.
There’s a lot of information — and misinformation — out there about vaccines. When large groups lose trust in the benefits of vaccination, many people, not just those who don’t want to be vaccinated, can suffer. Diseases like COVID-19 can continue to spread. Those who have weakened immune systems that don’t respond well to vaccines can be infected by others. It’s important that we keep our eyes on the common enemy — infectious diseases.
Realizing the Crucial Role of Vaccines
Vaccinations provide a valuable tool. You can give your immune system a heads-up about infections before you ever see them. You can stop diseases before you ever get sick by giving your immune system a cheat sheet on what to look for. Unlike medications that reduce the symptoms once the illness has begun, vaccines can stop infections before they ever happen. Childhood — and adulthood — have become a lot safer in the process.
Vaccines give your immune system a superpower. Through vaccines, your immune system learns how to stop bad guys it’s never seen before. These bad guys cause infectious diseases. They’re the pathogens, also called germs, which are so tiny that we can see them only with a microscope. These pathogens include bacteria, viruses, fungi, and parasites. Chapter 2 describes different viruses and the vaccines that combat them, while bacteria and their vaccines are discussed in Chapter 4.
Vaccines provide you with personal protection against these pathogens and the diseases they cause, but what works even better is if everyone is vaccinated. The superpower of a vaccine increases as more people jump on the bandwagon. With infectious diseases, we’re all in this together. If everyone is vaccinated, a pathogen spreading person to person is stymied.
Vaccines may not provide 100 percent protection. Some people may not be able to take or benefit from a vaccine; they may be too young or have a weakened immune system. But if enough of us are vaccinated, odds are the pathogen just can’t spread. It can’t jump from person to person. It may infect one person and maybe another, but if most people are vaccinated, it won’t keep finding new people to spread to and will fade away.
This is what herd immunity is all about — when enough people are vaccinated, we can push back the spread of some terrible and deadly diseases. Chapter 11 details the benefits of herd immunity and debunks the myths often perpetuated about vaccines. Diseases can bounce back if fewer people are vaccinated.
We can save many lives if we had more vaccines. Scientific challenges and the lack of funding and motivation have kept some vaccines from being developed. (See Chapter 13 for more information.) New diseases yet to emerge will need vaccines, as we have seen as COVID-19 has spread around the world. (See Chapter 3 for info on COVID-19 and the vaccine.)
It may not seem so exciting now, but we have had reliable and effective vaccines only since the end of the 1700s. At that time, it was found that one mild virus, cowpox, can train our immune system to protect us from a terrible virus, smallpox. (If vaccine history interests you, check out Chapter 12, which discusses the people instrumental in creating a number of vaccines. Chapter 14 describes major pandemics throughout history.)
Many vaccines work on the same principle as this first vaccine did: Show the immune system something harmless but similar to what causes the disease, and the immune system will learn to protect us against the dangerous one too. However, scientists continue working on vaccines to develop new, possibly more effective approaches to train our immune system. Different pathogens require different sorts of vaccines, and for some diseases, vaccines still elude us.
We do have vaccines for a wide range of infections, though. Vaccines can prevent some types of liver disease (hepatitis A and B) and some types of cancer (human papillomavirus). We also have vaccines for adults, such as for pneumonias and shingles, diseases we’re more prone to as we get older. But we still don’t have vaccines for the infections that year after year take the most lives. We don’t have an HIV vaccine, and we need better vaccines for tuberculosis and malaria. We also don’t have a vaccine for the common cold, which would be hard to make. Chapter 6 provides information on all current vaccines, while Chapter 13 looks at diseases that still aren’t preventable.
As is often said about vaccines, it’s not vaccines that save lives; it’s vaccinations. For communities to be protected, vaccines need to be given. The tough part is often ensuring that vaccines are accessible for all and vaccination rates are high enough to protect the entire community.
Explaining How a Vaccine Works
Vaccines hold up a “Wanted” photo of the bad guy — the pathogen or germ. Each vaccine is a little different, but they all show our immune system something super recognizable about the pathogen. That way, if we are ever exposed to this pathogen, our immune systems will respond to it.
The “Wanted” photo can be some bit from the outside of the pathogen, like a specific protein or sugar. These bits act as a way to identify the pathogen, similar to the way a tattoo or birthmark helps you identify a person. The vaccine version may attach this “Wanted” photo to a warning, like a blinking red light, such as a protein that will create a stronger immune response.
Other vaccines may be the equivalent of a head-to-foot photo; some vaccines use the whole pathogen (in a killed vaccine, explained more in Chapter 5) or in a live, but safe, similar version. Chapter 7 discusses the ingredients that typically make up vaccines.
Vaccines let you bypass the delay it would take to develop natural immunity if you were first exposed to the pathogen without this head start. Normally, it can take a couple of weeks for your immune system to figure out how to fight a new disease; with a vaccine, your body is ready and able to fight from the first time you see the actual pathogen.
Find out more about the basics of how a vaccine works in the following sections.
Distinguishing between antigens and antibodies
Antigens are what is memorable in the “Wanted” photo. An antigen is something very specific — like that birthmark or tattoo — that can’t be missed. Your immune system uses that very specific marking to create an immune response and memory. This marking is usually a protein or sometimes a sugar on the outside of the pathogen.
Antibodies are what your body makes in response to antigens. After your body has been shown the antigen or “Wanted” photo, you keep a supply of memory immune cells that can make a whole lot more antibodies if the pathogen ever arrives. Specific antibodies go after just one specific antigen. Once that antigen is found again, your body floods it with copies of this antibody from those memory immune cells. The antibodies then attach themselves to their antigens, which are on the outside of the pathogen. The antibodies then stop this specific pathogen, like a virus particle or bacterium cell, from causing any more problems.
It typically takes a few weeks after exposure for the body to produce this response. Vaccination gives you a head start so you already have the ability to make all these antibodies if you need to. With a natural infection, you can get quite sick before you were able to scramble and create an effective immune response.
Breaking down other vaccine ingredients
Vaccines contain more than just the “Wanted” photos, called antigens, that help your immune system identify pathogens (see the preceding section). Other ingredients are needed to make sure the vaccine works as it should:
Some of these “Wanted” photos don’t create much of an immune response. The immune system needs to be alerted to the fact that this “Wanted” photo is important to remember. Vaccines may include an alert, which acts like a red blinking light, saying “pay attention here.” This ingredient may even be directly attached to the “Wanted” photo. Such alerts when added to the vaccine mix are called
adjuvants.
A common adjuvant includes aluminum, also found in drinking water, antacids, and antiperspirants. We discuss the ingredients that go into vaccines more in
Chapter 7
.
Vaccines also may contain stabilizers, much like some of our food does. These include sugars and gelatin (also found in Jell-O) that keep the vaccine ingredients well mixed, so they don’t separate or deteriorate.
Vaccines can sometimes include preservatives to keep mold or bacteria from growing in the vaccine, much like we would have in a bottle of jam at home. Just as many foods are advertised as preservative-free, many vaccines are too. Preservatives are particularly used in multi-use vaccine bottles, especially for the flu, as these are kept open longer to vaccinate multiple people. In some cases, this can include thimerosal, which contains mercury, but it’s a type of mercury that doesn’t have the same worrisome risk as the mercury found in fish. Children’s vaccines do not include mercury, except in rare cases with multi-use flu vaccine vials and some specific brands of tetanus shots for adolescents.
Vaccines may also include trace amounts of chemicals used in their production. These substances are removed, but sometimes a very small amount remains. In order to include a whole virus or bacteria but make sure it’s dead and won’t make copies of itself, formaldehyde is used. The amount used in a vaccine is much, much less than we naturally have in our bodies.
Sometimes antibiotics, usually not the sorts we are allergic to, are used to keep bacteria from growing during production. These antibiotics are removed at the end, so at most only a tiny amount remains. Eggs are used to grow some viruses used to make vaccines, and so egg proteins, in very tiny amounts, may be present in some specific vaccines.
Comparing Viruses, Bacteria, and Toxins
Scientists have studied and created different vaccines for a whole range of different pathogens. Pathogens are the germs, so small that you need a microscope to see them, that cause infectious diseases. The two main types of pathogens we vaccinate against are viruses and bacteria:
Viruses
are super tiny particles, made of genetic material surrounded by a protein shell. They can make copies of themselves only inside of other cells.
Bacteria
are more complicated; they are single-celled, living organisms that can usually make copies of themselves on their own.
Viruses, the smallest of the common pathogens, are protein shells with a bit of genetic instructions tucked away inside. Viruses use these instructions inside another cell, such as our own, to make copies of themselves; in the process our cells may be damaged by the virus or our immune system’s response. Because viruses can’t make copies of themselves on their own and need to be inside a cell, they aren’t considered fully alive. We go more in-depth about viruses in Chapter 2.
Pathogens also include bacteria, as we talk about in Chapter 4. These are made up of a single cell that can reproduce on its own. Some bacteria invade your cells; others remain outside; some may do either. You have lots of bacteria inside your body at any time. In fact, we have more bacterial cells than human cells in our bodies. Our skin and gut and immune systems keep these bacteria where they should be, but sometimes these bacteria or new invading bacteria can make you sick. Antibiotics can work against these worrisome bacteria, but antibiotics don’t work as quickly as vaccines. Vaccines prevent you from ever getting sick, while antibiotics only reduce the symptoms once you do get sick.
Other types of pathogens include the following:
Parasites:
These can be single-celled like malaria, which is a lot larger and more complicated than bacteria are. Parasites can also include worms that infect you or even tiny insects like bed bugs or scabies. We haven’t been successful at making vaccines for many of these but are now having some success with making vaccines for malaria.
Fungi:
These are effectively the mini cousins of mushrooms. They include molds and yeasts. Infections may be from the environment, say from a dust storm in Arizona that can spread Valley Fever, a fungal infection, from the sand and dust. There haven’t been any approved fungal vaccines.
Prions:
Like viruses, prions also aren’t really alive, and they’re even smaller. They’re just crumped proteins that can cause other proteins of the same type to crumple up in the same way. This type of infection causes Mad Cow Disease and a few other diseases, but they’re incredibly rare. We don’t yet have any vaccines for prion diseases in humans (but there is some promising work for animal diseases).
Vaccines for viruses and bacteria can include many different types (see Chapter 5 for details):
The oldest type is a similar but alive (or replicating) bacteria or virus that shows our immune system what the danger is without causing us any harm.
Another tried-and-true method is to take killed, whole bacteria or viruses. These won’t be able to infect us but will show our immune system what to watch for.
Other vaccines use small proteins or sugars, found on the outside of bacteria or viruses, that can be used to recognize pathogens.
IS THIS INGREDIENT SAFE?
Vaccines go through rigorous multi-stage testing to ensure they prevent disease and are safe without worrisome side effects. Once vaccines are approved, they continue to be watched for any signs of any problems. Chapter 5 looks more closely at the vaccine testing and manufacturing processes.
The ingredients in vaccines are carefully monitored to ensure they don’t have worrisome side effects. The ingredients are clearly listed in the insert that comes with the vaccine. If you ever have any questions about any ingredients and whether you might be allergic to one, you can discuss this with your doctor or healthcare provider.
After vaccines are approved by government agencies, including the Food and Drug Administration (FDA) in the United States, they are still monitored for any signs of problems. Anyone who is vaccinated in the United States can report any side effects to a national database that watches for and tracks patterns and serious events.
The manufacturing of vaccines is also watched closely. There are ongoing inspections and monitoring of vaccine production facilities by the FDA in the United States and by other independent government organizations in other countries. Around the world, the World Health Organization (WHO) also assesses factories before they begin production for quality, safety, and efficacy. Only factories that are continually inspected and approved for production can make the vaccines.
Once vaccines are produced, they undergo testing again. Vaccines are made in batches called lots. Samples from every single lot must be tested to ensure they have the pure, potent, and safe ingredients they are intended to have. No vaccine lot can be distributed until it is released by the FDA. Other countries have similar regulations. If a problem was found in a vaccine from one lot, the entire lot can be recalled.
Once vaccines are released, they have to be packaged and stored in certain conditions to keep the vaccine from deteriorating. Many vaccines require what is called cold chain, meaning they have to be kept within a very specific range of cold temperatures all the way from factory to delivery for vaccination. That way, you can feel assured that the vaccine you receive is still potent when you receive it.
Some vaccines are made against the toxins that bacteria release to make us sick. The vaccine includes something similar and benign, called
toxoids,
which don’t make us sick, in order to teach our bodies to recognize toxins.
Two new types of vaccines have been used so far for viruses — viral vector vaccines and vaccines made from genetic material, like mRNA. These vaccines carry the genetic instructions into our cells in order to build a protein that our immune systems can use to recognize a pathogen.
Studying COVID-19 Vaccine Development
Infectious diseases have not been completely tamed. COVID-19 reminds us there are many viruses and bacteria out there that we’ve never dealt with before. It goes without saying that COVID-19 changed the world abruptly for us all. In the first full year of the pandemic (2020), it led to at least 350,000 deaths in the United States and at least 1.8 million deaths reported worldwide. Vaccines have been an important part of the solution.
No vaccines have been watched as closely as the COVID-19 vaccines as they passed through phase I, then II, then III, and onto use in the general population. The world watched as controlled trials studied the use of the vaccines versus a placebo. These trials — as well as post-rollout monitoring — looked closely for any side effects.
As we discuss in more detail in Chapter 3, many different types of vaccine methods are used today. A lot of advances in vaccine science led to the COVID-19 vaccines. The first vaccines came from science that was only a couple of decades old. The COVID-19 vaccines currently in use are messenger RNA (mRNA) or viral vector vaccines.
Vaccines were also shown to provide better protection than natural infection, especially when facing new variants of COVID-19. As COVID-19 has spread around the globe, it has collected many new mutations creating new variants, so your immune system may not recognize new variants after getting sick with a prior one. It may become necessary to have booster COVID-19 vaccinations to remain immune, just like you need to remain protected against the flu.
WHY LAST YEAR’S FLU VACCINE WON’T WORK THIS YEAR
Most vaccines work well year after year. Some, particularly for influenza, need an update. That’s because some pathogens change their looks. It’s the pathogen equivalent of a wig or a fake moustache that fools our immune systems. What the pathogen looked like last year may not be what it looks like this year, at least to our immune systems.
Pathogens may change their looks by collecting mutations that each make small changes generation after generation. Over time, in a pathogen’s family tree, the great-grandparents may look just a bit different than future generations. There may be different proteins (or sugars) on their surfaces, making them unrecognizable.
The flu does even more to dodge your immune system’s attention. Mutations build up as the flu copies itself again and again. But it does something more. It also mixes and matches the proteins on the outside. It takes a fake moustache and a hat one year, a wig and a mask another year. This means a vaccine that works this year may not work next year. Some types may persist for a few years. Others need to be updated. As we discuss in Chapter 6, a lot of thought goes into the flu vaccine each year, trying to guess six months ahead which fake moustaches and wigs will be en vogue for the flu this year. The vaccine is updated every year in both the Northern and Southern hemispheres in time to vaccinate everyone who wants it in preparation for the wintertime flu season.
Understanding the Importance of Vaccine Schedules
Unfortunately, vaccines don’t always fall into the “one and done” category. In many cases, a series of vaccines, given on a specific schedule, are necessary to provide you or your children with protection against diseases. While no one wants to get an injection more than once, skipping doses or spreading them out can decrease the effectiveness of the vaccine and increase your chance of becoming ill.
Vaccine schedules are particularly important for infants and children because the diseases that the vaccines prevent are especially deadly for them. While the number of vaccines given to babies today has increased, worrying some parents, science has shown that the total number of vaccines given today isn’t harmful. Spreading out vaccines on a delayed schedule can be harmful rather than helpful to infants, increasing their risk of becoming sick. To help you make the best decisions about vaccinations, Chapter 11 discusses the myths that surround vaccination and vaccine schedules, especially for young children.
Trying to keep track of vaccination schedules can be complicated. We make it easier by describing which vaccines are required for infants and children at which ages in Chapter 8. We include the same information for adults in Chapter 9. Chapter 10 explains when you or your child should not get vaccinated, due to certain health conditions. Thankfully, these conditions are rare.
Preparing for Potential Vaccine Side Effects
Any substance you put inside the human body has the potential to cause side effects. In most cases, side effects don’t affect everyone, and most side effects aren’t serious or long lasting. But it’s always nice to be prepared for typical side effects, and it’s important to be aware of more serious side effects that necessitate a visit to your healthcare provider. We spell out side effects and what to watch for in Chapter 7.
Rarely, around one in a million or so cases, a vaccine can cause an anaphylactic reaction. This type of reaction can affect many body systems and be life-threatening. Anaphylactic reactions can occur if you have an allergy to one of the ingredients found in the vaccine. If you have known allergies to a vaccine or a possible vaccine component, always check the ingredients on a vaccine’s label before being vaccinated. Anaphylactic reactions can include difficulty breathing, facial swelling, a drop in blood pressure, or loss of consciousness. Most, but not all, anaphylactic reactions occur within a few minutes after receiving a vaccine.
Anaphylactic reactions are a medical emergency and require immediate medical attention. If you’ve had this type of reaction in the past, your healthcare provider may recommend carrying an epinephrine (epi) pen.
Optimizing Your Immune Response
While you can’t prevent all illnesses, you can do your part to keep your immune system as healthy and effective as possible. Getting vaccinated is the number one thing you can do to boost your immune system. Certain lifestyle changes can also help keep your immune system humming.
No, there are no magic bullets, pills, or other easy ways to do this. But Chapter 15 includes information that you may not have realized on ways to keep your immune system healthy, from the effects of smoking and alcohol on your immune system to the benefits of getting enough sleep. We also include info on supplements often taken for good health.
Chapter 2
The (Non) Life of a Virus
IN THIS CHAPTER
Studying the make-up and reproduction of a virus
Looking at common viruses around the world
You’ve probably said, “I caught a virus” dozens of times in your life. And no wonder — so far humans have identified close to 7,000 virus species. We know there are hundreds of thousands more and think there are millions, if not trillions, more. Some viruses infect people; others infect other animals; and still others infect plants, fungi, or even bacteria. (There are even virophages that infect viruses themselves.) Viruses — infective agents that can only reproduce inside another cell — are pretty simple, but what they cause is not so simple. They may cause no symptoms. They may wreak havoc on us. They may cause something in between or go back and forth.
Virus particles (virions) are very small — smaller than we can see with a regular microscope. Yet they still manage to perplex us. Sometimes it even seems like they outwit us. As with any enemy, getting to know what a virus is and how it works is instrumental to thwarting it, and this chapter can help. As you also find out here, some viruses can be prevented by vaccines, while others still evade science’s attempts to prevent them.
There are more viruses than we know out there. As people increase transportation, move into areas with few inhabitants, and have contact with different animals, the world becomes increasingly connected. What may have caused an unknown outbreak in an isolated location that is quickly extinguished can become a large epidemic.
Looking Inside Your Average Virus
A virus is put together like a burrito. The tortilla is the protein shell. The filling is the genetic instructions, or codes in the form of DNA (deoxyribonucleic acid) or RNA (ribonucleic acid). The DNA strands are often but not always double strands; the RNA is usually but not always single stranded. This genetic code is what lets the virus reprogram and take over a cell.
Viruses can’t do anything on their own. That’s why they aren’t considered to be alive. They can’t make copies of themselves on their own. A virion all by itself isn’t enough to make you sick if it can’t get inside your cells. Viruses require what living things have in their cells to do what they do best — make copies of themselves. Once a virus is in a living cell, it’s almost like it is alive; it will turn that cell into a virus assembly machine.
Successful viruses turn our cells into photocopiers, churning out virions — more and more infectious viral particles. When we get sick, say with the flu, the cells in our bodies may produce as many as 100 trillion virions. That’s more than all the stars in the Milky Way.
With all of these copies, there are bound to be mistakes. Viruses make lots of mistakes. They often don’t copy their genetic material exactly the same each time. These miscopies are called mutations. Not all mutations are bad; many are dead ends. Headlines may say that a virus is mutating, but that’s just what viruses do. Viruses mutate; birds fly. Mutations, especially collecting over time, can lead to different variants or strains, and sometimes these changes can evade our immune responses or change how sick they make us.
There are many different types — or species — of viruses. Some viruses have round shells; some have long shells. Different viruses use different hooks, or receptors, to hold onto and enter a cell. A specific virus usually only infects a certain species or related species. If your dog gets a cold, you’re usually not going to get it. Sometimes, though, a virus can infect different species and can jump from ducks or pigs or bats to us. This jump across species often is another dead end, but sometimes it can lead to a virus that causes us a lot of problems.
Investigating Influenza Viruses
When you say, “I caught the flu,” you’re often referring to an influenza virus. These are the viruses that cause the sniffles, coughs, achy muscles, fever, and sore throat that can make your life miserable for a week or so. But some influenza viruses — often simply called the flu — can also make you extremely — even deathly — ill. Up to 500 million people are infected by influenza viruses worldwide. In the United States, between 12,000 and 61,000 have died from influenza viruses each year from 2010 through 2020.
Influenza viruses fall into one of four different types — unimaginatively named A, B, C, and D. Influenza viruses can affect many animal species. Some flu viruses just remain in other animals, but some flu subtypes can spread to us from animals, especially farm animals like chickens and pigs. Science has created influenza vaccines against some but not all types. The yearly flu vaccine consists of antigens against type A and type B influenza viruses.
Type A
Type A viruses cause us the most problems. They’re the only influenza viruses that have caused a global pandemic, like the COVID-19 pandemic, and they, along with type B, are the types that usually cause seasonal flu outbreaks. (See Chapter 3 for more about COVID-19.)
There are a lot of subtypes of influenza A. There may be 200 main subtypes out there, but only 131 main subtypes have been found. We can’t make a vaccine with that many different antigens — all those bits of the virus are needed to create a “Wanted” photo for each subtype. Usually, just a few subtypes dominate any flu season.
So, every year scientists have to make a decision — which two A subtypes and one, or likely two, B subtypes should go into a vaccine. The problem is that it takes a long time to make enough flu vaccines for everyone. Some types of the flu vaccine are grown in chicken eggs, and this takes time. (But don’t worry if you’re severely allergic to eggs; others are made just in the lab). It takes six months to make a vaccine, so scientists have to pick which subtypes to include half a year ahead of time. They peek at the other side of the globe (Northern or Southern Hemisphere) and figure what’s starting to spread, say, in Australia for Northern Hemisphere folks, and what they bet will spread where they are in six months.
Type A influenza viruses are unusual in that they have tricks to change what they wear, making those immune system “Wanted” photos not always work. They have more tricks for changing the proteins that are on their outside shell, and so they fool our immune system into not knowing who they are. Unlike other types of influenza viruses, Type A has two different ways to change and evade our immune systems. These two ways are called drift and shift. Influenza A can also infect some animals, and sometimes influenza of animal origins can be a problem for us:
Drift,
also called
antigenic drift,
happens when mutations occur over time. It occurs in all influenza types. After a few mutations, copies of the virus become a bit different from the original viruses. Over time, these small changes build up, and the virus may not even be recognized by our immune system. We can get sick from a subtype that’s similar to, but not the same as, one we’ve seen before. Vaccines continue to work as the virus mutates until there are enough mutations and the antibodies made in response to the vaccine won’t recognize the subtype anymore. These slight changes can lead to resistance to drugs we use to treat the flu or even change how this flu subtype affects us.
Shift
occurs only in type A influenza. Influenza A viruses each have two proteins on their surfaces: H (hemagglutinin) and N (neuraminidase). There are 18 different known H’s and 11 known N’s. That’s why there are so many different types of possible influenza A subtypes. These can mix and match — or shift — resulting in big changes in the flu subtype: H1N1, H1N2, H3N2, H7N9. These big changes can result in shifts that leave us unprepared for new subtypes and hence, the risk of flu pandemics.
The following sections go into more detail on two specific Type A viruses: bird flu and swine flu.
Battling bird flu
Birds can get the flu, too. They can get really sick or just a little under the weather, just like us. Sometimes they can pass the flu to us. What makes birds really sick may not make us really sick, but a flu that’s nothing for a bird may be catastrophic for us.
Many viruses don’t last when they try to infect another species, and even if they infect us, we may not be able to spread the virus to others. But there are specific subtypes that are usually found in birds that, when they cross to humans, can be quite deadly. These subtypes are commonly called bird flu or avian influenza. Bird flu, though rare, can be fatal. It’s fatal for some common types in about half of cases (H5N1 [60 percent], H7N9 [40 percent]). Fortunately, these bird flu subtypes don’t have much person-to-person spread.
Bird flu usually affects chicken farmers or persons with close contact with these birds. Fortunately, these are rarely transmitted from person to person. If there are outbreaks, farms are closed, culled, and quarantined to prevent further spread. However, bird flu can travel — either between poultry farms or with migratory birds — and different types have been found in many different countries. Our worry is that someday bird flu may spread more easily from person to person.
Suffering from swine flu
H1N1, another type A flu, has been a big worry for us in the past. An H1N1 subtype was the cause of the 1918 influenza pandemic (also called the Spanish flu), which led to the loss of more than 50 million lives worldwide and 650,000 in the United States. This subtype had genes of avian origin, though we haven’t yet figured out where it originated.
H1N1 has made news again and more recently caused concern when it began to spread in 2009. The virus crossed over from pigs, which is how it got its name: swine flu. However, H1N1 isn’t the only subtype of influenza to originate in pigs; the 2009 version, ultimately dubbed A(H1N1)pdm09, was, however, a new and unique variant not specifically seen before in animals or people, although it was related to prior H1N1 outbreaks.
Swine flu influenza viruses are spread, like other influenza viruses, through droplets in the air or by touching something that, for a graphic example, your pig has sneezed on, and then touching your mouth, nose, or eyes. While the first few cases were found in people who had direct or close contact with pigs, later cases were found to be from person-to-person contact. A vaccine was developed by the end of the year, and the pandemic ended by August 2010, according to the World Health Organization (WHO). In the United States, the CDC estimated there were about 60 million cases and 12,469 deaths from swine flu within the year after it was discovered, with worldwide deaths estimated at around 150,000 to 575,000.
Pigs can have other subtypes of influenza. Subtypes can also mix between birds and pigs before reaching us.
Type B
Type B causes illness similar to Type A. Type B doesn’t have subtypes but has two main lineages. It isn’t as common a cause of illness as type A is. Generally, type B causes just 25 percent of influenza illnesses during the year. It doesn’t change by shift, only by drift, so it doesn’t have the same sudden changes that throw off our immune system. Type B also isn’t known to infect animals, except for seals, so we don’t have to deal with lineages from animals. Type B can still cause serious illness, including pneumonia, and can be fatal in some cases. Vaccines used to include just one B influenza virus, but now most include two.
