Plotkin’s Vaccines (Vaccines (Plotkin)) 7th Edition

Book Preface

Since the last edition of this book six new vaccines have been licensed in the United States: a live attenuated oral vaccine to protect against cholera; a human papillomavirus (HPV) vaccine containing antigens against an additional five serotypes to enhance protection against HPV-associated cancers; two protein-based meningococcal Group B vaccines, one of which is the product of reverse genetics technology; an adjuvanted influenza vaccine for use in the elderly; and a combination vaccine for use in 4- to 6-year-olds to protect against diphtheria, tetanus, pertussis, and polio. This time interval has also been marked by important global advances in the delivery of previously licensed vaccines against rotavirus diarrhea, cancer caused by HPV, hepatitis A, cholera, and pneumococcal infections. Of particular note has been the progress on global polio eradication. Type 2 polio has been officially declared eradicated, marking in a sense the second human virus ever to have been eradicated through the use of vaccines (the other being smallpox). There is promise that type 3 polio may have been eradicated with the last case detected in 2012, and type 1 polio is at record low levels. In addition, steady progress is being made in exploiting genetic engineering to make new vaccines, and there have been notable, though partial, successes against HIV, dengue, and malaria.

However, challenges remain as new pathogens emerge or reemerge such as the Ebola outbreak in West Africa and more recently the Zika virus in the Western Hemisphere, neither of which have available licensed vaccines. The need to anticipate and rapidly develop vaccines for these and other emerging pathogens is taking on greater importance.

Vaccines remain one of the most effective and economical prevention measures available and the only medical procedure recommended repeatedly for all children and some adults. But vaccines do not save lives; vaccinations save lives. It is critical to ensure that safe and effective vaccines are delivered to all persons for whom they are recommended.

Since the last edition there has been much progress on maternal vaccination. By vaccinating pregnant women, protection is afforded to both the mother and the infant. In fact, universal vaccination of all pregnant women against influenza and pertussis has been implemented in several countries. The potential for administering respiratory syncytial virus and group B streptococcal vaccines to pregnant women to prevent these common diseases in their infants is also being studied. Much progress has been made.

Vaccine availability is also paramount. The advent of new manufacturers in Asia and Latin America has enhanced the availability of vaccines for developing countries, and their growing economic strength has enabled more people than ever to be immunized. Critical to the successful introduction of new vaccines into developing countries has been Gavi, the Vaccine Alliance, with strong advocacy and financial support from the Bill & Melinda Gates Foundation. Nevertheless, the problem of financing for both old and new vaccines remains.

Moreover, with the increase in vaccination throughout the world, resistance to vaccines has also grown as misinformation retailed by the Internet is rife. It is helpful to have the perspective that vaccine hesitancy is as old as Jenner’s smallpox vaccine despite the fact that it succeeded in eradicating a terrible disease. Perhaps it is not surprising that prevention by vaccination in healthy people is more difficult for the public to accept than treatment of established disease, but the proverb “better prevention than cure” is still as sound as it ever was.

Finally, a word to our authors and to our readers. We are grateful to our authors for all their work and for their expertise, which allows us to be sure that the information in the book is correct, and we apologize for harassing them to be on time! We are also grateful to our readers, who by their laudatory comments have given us the enthusiasm to manage the editorial tasks. We regret that the references had to move online (available at ExpertConsult.com), but it was necessary to maintain the affordability of the book. In any case, we hope this edition will be considered the best yet, and that it will be read by all those, young and old, who recognize the value of vaccines.
Walter A. Orenstein Paul A. Offit Kathryn M. Edwards Stanley A. Plotkin