Immunity can be achieved activated by the application of antigens (eg. As vaccines, toxoids) Passive by use of antibodies (eg. B. immunoglobulins, antitoxins) A toxoid is a bacterial toxin that has been modified to no longer be toxic, but still can stimulate antibody formation. A vaccine is a suspension of whole (live or inactivated) or fractionated no longer pathogenic bacteria or viruses. For vaccines that are available in the US, see table: vaccines available in the US. The current recommendations for vaccinations are available at the Centers for Disease Control and Prevention (CDC) website and as “free mobile app.” Also see Table: Recommended vaccination schedule for the age of 0-6 years, recommended vaccination schedule for the age of 7-18 years (see also the Childhood Immunization Schedule to the CDC.) And guidelines for vaccine administration in adults. For the content of the individual vaccines (including additives), s. the package insert of the vaccine. Vaccination is extremely effective worldwide for the prevention of serious diseases and improving health conditions. Because vaccines are infections that were once very common and / or life-threatening were (z. B. smallpox, polio, measles, diphtheria), now rare or entirely eliminated. However, these infections are still on in parts of the developing world. Effective vaccines are not yet available for many important infections, including Most sexually transmitted diseases (eg., HIV, herpes, syphilis, gonorrhea, chlamydia infection) transferable through ticks infections (eg. As Lyme disease, ehrlichiosis and anaplasmosis , babesiosis) Many tropical diseases (eg. as malaria, chikungunya disease, dengue) New diseases (eg. as Ebola hemorrhagic fever, West Nile virus infection) Some vaccines are routinely to all adults of a certain age who have not been vaccinated previously or have no evidence of prior infection, recommended. Other vaccines (eg. As rabies, BCG, typhoid, yellow fever) are not given routinely, but are only recommended for certain people and circumstances (s. Recommended Adult Immunization Schedule to the Centers for Disease Control and Prevention [CDC] and under the specific disturbance elsewhere in the Merck Manual). Some adults do not get the recommended vaccines for them. For example, only 55.1% of the subjects were> 65 years the tetanus vaccine in a period of 10 years. In addition, the immunization rates tend to be niederiger in blacks, Asians and Latin Americans than in whites. Vaccines that are available in the US Vaccines type way Anthrax Inactivated bacteria s.c. BCG (tuberculosis) weakened (attenuated) vaccine – Mycobacteria bovis Intradermal or s.c. Diphtheria-tetanus-acellular pertussis (DTaP or Tdap) toxoids and inactivated bacterial components i.m. DTaP plus Haemophilus influenzae type b conjugate vaccine (DTaP-Hib) toxoids, which have inactivated all bacteria and bacterial polysaccharides are conjugated to protein. in the. DTaP-Hepatitis-B-polio (DTaP-IPV-HepB) toxoids, recombinant viral antigen and inactivated poliovirus i.m. DTaP-IPV toxoids, inactivated bacteria and inactivated poliovirus i.m. DTaP-IPV-Hib toxoids, inactivated bacteria, inactivated polio virus and bacterial polysaccharides conjugated to protein i.m. Haemophilus influenzae type b conjugate vaccine (Hib) bacterial polysaccharide conjugated to protein i.m. Hepatitis A (HepA) Inactivated virus i.m. Hepatitis B (HepB) Recombinant viral antigen (HBsAg) i.m. Hepatitis A and hepatitis B virus and inactivated recombinant viral antigen i.m. Hep B bacterial polysaccharide conjugate plus. Inactivated viral antigen plus HbCV. I.m. Human papillomavirus (HPV) Non-infectious virus-like particles i.m. Influenza live influenza A and B virus intranasal influenza, types A and B virus or inactivated viral components i.m. or intradermally Inactivated Japanese Encephalitis virus s.c. Measles-mumps-rubella (MMR) live viruses s.c. Measles-mumps-rubella-varicella (MMRV) live viruses s.c. Meningococcal, polysaccharide (MPSV4) Bacterial polysaccharides of serogroups A / C / Y / W-135 s.c. Meningococcal conjugate (MenACWY) Bacterial polysaccharides of Serotgruppen A, C, Y and W-135 conjugated to diphtheria toxoid protein i.m. Meningococcal group B (MenB) recombinant vaccine, composed of two LP2086 antigens (factor H binding proteins) i.m. Pneumococci, polysaccharide (PPSV23) Bacterial polysaccharides of 23 pneumococcal types i.m. or s.c. Pneumococcal conjugated (PCV13) polysaccharides from 13 types, conjugated to diphtheria toxin i.m. Poliovirus (IPV) Inactivated viruses of all three serotypes i.m. Rabies (Rabies) Inactivated virus Intradermal * or s.c. Rotavirus live virus oral smallpox vaccination with live viruses Intradermal several puncture systems tetanus-inactivated toxin (toxoid) i.m. Tetanusund diphtheria toxoids adsorbed or (Td) Diphtheria-Tetanus (DT) Inactivated toxins (toxoids) i.m. tuberculosis (see BCG) – – Typhoid capsular i.m. Typhoid live attenuated vaccine p.o. Varicella live virus s.c. Zoster (shingles) live virus s.c. Yellow fever live virus s.c. * Intradermal dose is lower and is only used for preexposure vaccination. vaccines with adjuvants should i.m. are given. Td contains the same amount of tetanus toxoid as DTP or DT, but a reduced dose of diphtheria toxoid. Modified according to the recommendations of the Advisory Committee on Immunization Practices (ACIP). Called on 12.11.2014. Vaccine administration more information on vaccine administration can be found in Vaccine administration to the CDC. Vaccinations should be given strictly according to the recommendations of the leaflet; Nevertheless, the distances between the individual doses for most vaccines can possibly be extended without loss of efficacy. Injectable vaccines are usually administered i.m. in the medio-lateral thigh given (in infants and young children) or into the deltoid muscle (in school children and adults). Some vaccines are administered subcutaneously. For details on vaccine administration, s. Vaccination Administration: Recommendations and Guidelines and Administering Vaccines to Adults. Clinicians should have a process to ensure that the vaccination status of their patients is checked at each visit, so that the vaccines are administered in accordance with their recommendations ensure. Patient (or caregiver) should be encouraged (written or electronic) keep a documentation of their vaccinations and to share this information with new clinicians, physicians and institutions to ensure that all vaccinations are up to date. Tips and risks If vaccination series is interrupted, the practitioner should next time, when the patient presents, administer the next recommended dose, if the recommended interval has elapsed between doses; they should not begin new series (d. e. with the first dose). If vaccination series (. Eg hepatitis B or human papillomavirus) is interrupted, the practitioner should next time, when the patient presents, administer the next recommended dose, if the recommended interval has elapsed between doses; they should start no new series. You should not start new series (d. E. With the first dose). Guidelines for vaccine administration in adults parameters Needles Remarks After Route s.c. 23-25 ??Width 1.5875 cm long (5/8 inches) The needle should be inserted into the fatty tissue over the triceps. in the. 23-25 ??width for injection into the deltoid muscle, the needle length is determined by the sex and the weight (p. U.) Was determined. By sex and weight for i.m. Injection can only be for a i.m. Male or female, <60 kg 1.5875 to 2.54 cm (5 / 8-1 inches) A ??1.5875 cm (5.8 inches) long needle Injection are used in the deltoid muscle, when the subcutaneous tissue is not concentrated, and the Einstechung is made at an angle of 90 °. Female, 60-90 kg 2.54-3.81 cm (1-1.5 inches) - male, 60-118 kg 2.54-3.81 cm (1-1.5 inches) - Female > 90 kg 3.81 cm (1.5 inches) – Male> 118 kg 3.81 cm (1.5 inches) – simultaneous administration of various vaccines concomitant with few exceptions safe, effective and convenient (anti-vaccination movement: the use of multiple, simultaneous vaccines); it is particularly recommended if children are not available for future vaccinations may, or when adults at the same time several vaccines need (eg. as before international travel). An exception is the concurrent administration of the pneumococcal conjugate vaccine (PCV13) and the meningococcal conjugate vaccine MenACWY-D (Menactra®) in children with functional or anatomical Asplenie; these vaccinations should not be administered during the same visit, but ? 4 weeks apart. In the co-administration may be combination preparations (see table: vaccines available in the US) or the use of ? 1 elnzelnen antigen vaccines. It can also be administered more than one vaccine product at the same time when different injection sites and syringes are used. If live vaccines (varicella and MMR) are not given at the same time, they should be administered at a distance of ? 4 weeks. Limitations, precautions and high-risk groups restrictions and precautions are conditions that increase the risk of adverse reaction to a vaccine or interfere with the ability of a vaccine to produce immunity. These conditions are usually temporary, which means that the vaccine can be administered at a later date. Sometimes a vaccination is indicated when a precaution because the protective effect of the vaccine against the risk of adverse reaction to the vaccine outweighs. Contraindications are conditions that increase the risk of a serious side effect. A vaccine should not be administered when a contraindication exists. For many allergy vaccines is the only contraindication a severe allergic reaction (z. B. anaphylactic) reactions to the vaccine or its components. Egg allergy is widely used in the United States. Some vaccines that are produced in cell culture systems, including most influenza vaccines (influenza vaccine), contain traces of egg antigens; so are concerns about the use of such vaccines in patients who are allergic to eggs before. The guidelines of the CDC for the influenza vaccine indicate that although mild reactions may occur, severe allergic reactions (eg., Anaphylaxis) are unlikely and that vaccination is contraindicated with deactivated influenza vaccine only in patients who had after a previous dose of any influenza vaccine or vaccine component, including egg protein, an anaphylaxis. A live influenza vaccine is not recommended for patients with a history of any egg allergy. Patients with a history less severe reactions to eggs (z. B. hives) a prepared with egg, disabled influenza vaccine can be administered if the clinician is experienced in dealing with allergic reactions and observed the patient for 30 minutes after vaccination. Asplenie Asplenische patients are predisposed to a massive bacteremic infection, primarily caused by encapsulated organisms such as Streptococcus pneumoniae, Neisseria meningitidis, or Haemophilus influenzae type b (Hib). Asplenischen adult should be given the following vaccines (if possible, before splenectomy): Hib conjugate vaccine (HbCV): a single dose and no refresh meningococcal conjugate vaccine (MenACY- meningococcal vaccine): 2 doses 8 to 12 weeks spaced and refreshes every 5 years pneumococcal conjugate (PCV13) and polysaccharide vaccine (PPSV23): PCV13 if patients have not previously received a full series as a routine vaccination, then PPSV23 eight weeks later (? 2 weeks before or after splenectomy) with a single PPSV23-booster after five years and a routine booster dose at the age of 65 years (pneumococcal vaccine). additional doses can based on clinical decisions administered werden.Einsatz of blood products vaccinations with live microorganisms should not be taken with blood – verab or plasma transfusions, or immune globulin be enough; these products can interfere with the development of the desired antibodies. Ideally, these vaccinations should be 2 weeks or 6 to 12 weeks of immunoglobulins given werden.Fieber or other acute illnesses A severe fever (body temperature> 39 ° C) or serious illness without fever requires a postponement of vaccination, but not harmless infections such. As a flu infection (even at leichtgradigem fever). This precaution prevents confusion between the manifestations of the underlying disease and possible side effects of the vaccine to prevent the overlapping of side effects of the vaccine on the underlying disease. Vaccination is, if possible, be deferred until the illness passed ist.Guillain-Barre Syndrome patients who develop Guillain-Barre syndrome (GBS) within 6 weeks after a previous influenza vaccination or DTaP vaccine, can the vaccine be given if it is assumed that the benefits of vaccination makes the risks betting. For example, clinicians can draw a dose of the vaccine into consideration in patients who develop the syndrome after a dose of DTaP, when a pertussis erupts; However, such decisions should be made in consultation with a specialist in infectious diseases. The Advisory Committee on Immunization Practices (ACIP) does not see a history of GBS as a precaution for the use of meningococcal conjugate vaccine, although it still listed as a precaution in the package insert wird.Immunschwäche immune Compromised Patients generally should not receive live virus vaccines that could cause serious or fatal infections. If the immunodeficiency ([20 mg prednisone or equivalent for ? 2 weeks ?], antimetabolites, immunomodulators, alkylating agents, radiation therapy z. B. High-dose corticosteroids) is caused by an immunosuppressive therapy, live virus vaccines should be exposed to the immune system from the treatment of recovered (the time interval is dependent on the therapy). In patients receiving long-term immunosuppressive therapy, clinicians should discuss the risks and benefits of vaccination and / or revaccination with an infectious disease specialist. Patients with HIV infection should generally receive inactivated vaccines (eg. As diphtheria-tetanus-pertussis [Tdap], polio [IPA], Hib) according to the routine recommendations. Despite the general caution in the administration of live virus vaccines, patients receiving a number of CD4 ? 200 / ul (i. E. Not severely immune compromised) certain live virus vaccines are administered, including measles-mumps-rubella (MMR). Can Patients with HIV infection should both the pneumococcal conjugate vaccine and the polysaccharide vaccine received (and be revaccinated after 5 years) .Lebendvirusimpfstoffe Ideally, should be given this vaccination or 2 weeks before 6-12 weeks of immunoglobulins. Vaccinations with live microorganisms should not be administered simultaneously with blood, plasma or immunoglobulin, as this interfere with the development of the desired antibodies kann.Schwangerschaft pregnancy is a contraindication to vaccination with MMR, intranasal (live) influenza vaccine, varicella and other live virus vaccines. The vaccination with the HPV vaccine is not recommended (Overview of Immunization: restrictions, precautions, and high-risk groups) .Transplantationen before proceeding to transplantation of a solid organ, patients should receive all the appropriate vaccinations. Patients who had an allogeneic or autologous blood stem cell transplantation should be considered not immune and should receive all appropriate vaccinations repeated doses. The care of these patients is complex and vaccination decisions for these patients should be taken in consultation with the hematologist-oncologist of the patient and a specialist in infectious diseases. Vaccine safety in the United States is guaranteed the safety of vaccines by numerous surveillance systems; selected events that occur after routine immunization must, the Vaccine Adverse Event Reporting System [VAERS] the CDC Vaccine Safety Datalink [VSD] – efficacy and safety of childhood immunizations are via forwarded electronically to mail, fax or. For more information on the safety of the individual vaccines, s. Vaccine Safety on the CDC website. Still, many parents remain concerned about the safety and potential side effects (especially autism) vaccines for their children. These concerns, which are maintained on the Internet, have led some parents to not allow their children all the recommended vaccines are administered some or (anti-vaccination movement). The result is that outbreaks of diseases that were rarely made by vaccination (eg. as measles, pertussis), and more often occur among unvaccinated children in North America and Europe. One of the main concerns of parents that vaccines may increase the risk of autism. Reasons cited for this include use of the measles-mumps-rubella combination vaccine (anti-vaccination movement: MMR vaccine and autism) thimerosal, which is used in some vaccines, a mercury-containing preservative (anti-vaccination movement: thimerosal and autism ) use of multiple, simultaneous vaccines as recommended (anti-vaccination movement: use of multiple, simultaneous vaccines) in 1998 published Andrew Wakefield and colleagues a brief report in the Lancet (anti-vaccination movement: MMR vaccine and autism). In Wakefield postulated a connection between the measles virus in the MMR vaccine and autism. This report has been given much attention in the media worldwide and many parents began to doubt the safety of the MMR vaccine. In the meantime, The Lancet has, however, withdrawn the report because it contains serious scientific deficiencies; many subsequent large studies were able to show no link between the vaccine and autism. Gerbner and Offit1 reviewed epidemiological and biological studies on this issue and found no evidence of a link between the use of vaccines and the risk for autism (1). The US Institute of Medicine Immunization Safety Review Committee2 reviewed epidemiological studies (published and unpublished) to determine whether the measles-mumps-rubella vaccine and vaccines containing thimerosal cause autism, and the possible biological mechanisms of such a link to identify; due to the findings, this group had a causal relationship between these vaccines and autism back (2). Currently, virtually every vaccine, which is given to children free of thimerosal. Smaller amounts of thimerosal are still in multidose vials of influenza vaccine and in several other vaccines that are intended for use in adults (for information on vaccines that contain small amounts of mercury or thimerosal, s. The FDA website [FDA’s web site] and thimerosal content in Some US Licensed Vaccines) was used. Thimerosal is also used in many vaccines produced in developing countries. As with any treatment, clinicians should talk to their patients about the relative risks and benefits of the recommended vaccines. In particular, clinicians need to make sure is that the parents of their patients to the potentially serious consequences (including death) of preventable by vaccination childhood diseases such as measles, Hib infection and pertussis aware; clinicians discuss any concerns that parents may have about the vaccination of their children; Resources for these discussions are available on the CDC web site: (. See also Talking with Parents about Vaccines for Infants and Some Common Misconceptions About Vaccination and How to Respond to Them) Provider Resources for Vaccine Conversations with Parents available. Notes on vaccine safety first Gerber JS, Offit PA: Vaccines and autism: A tale of shifting hypotheses. Clin Infect Dis 48 (4): 456-61, 2009. 2. Institute of Medicine: Immunization safety review: Vaccines and autism. Washington DC, National Academies Press, 2004. Available on http://www.ncbi.nlm.nih.gov/books/NBK25349/. Travel vaccinations for travel to areas with endemic infectious diseases possibly vaccinations may be required (see table: Vaccines for international travel *, , ). Information include. a. Available: United States: CDC can provide this information; A telephone helpdesk (1-800-232-4636 [CDC-INFO]) and website (wwwnc.cdc.gov/travel/) available 24 hours / day available; Germany: travel medical advice centers, tropical medicine institutes and on the Internet (Robert Koch Institute, www.rki.de; German Society for Tropical Medicine eV, www.dtg.org.).