Vaccine success

The last case of smallpox that was reported in the United States was in 1949, wild-type polio virus was eliminated from the Western Hemisphere by 1991, and cases of Haemophilus influenzae type b invasive disease have declined dramatically since the vaccine's introduction in the United States in 1987 (CDC, 1999b). Since 1998, measles outbreaks in the United States have all resulted from introduction by susceptible international travelers who entered the US incubating the infection. As noted above, the world was declared free of smallpox in 1980, polio eradication was achieved in the Americas, Western Pacific, and European regions of the WHO by 2002, and measles has recently been eliminated in the Americas (CDC, 1999b; Plotkin and Orenstein, 2004). In the US, the incidence of most diseases for which vaccines are available has been reduced by more than 85 percent (Orenstein et al., 2005), demonstrating that immunization is cost-effective and enormously beneficial to both individual and public health (Lieu et al., 2005; Orenstein et al., 2005). Immunization is widely regarded as a public health triumph, with vaccine coverage often serving as a metric for judging public health programs.

Immunization results in direct cost savings within the health-care sector by reducing both the acute morbidity and disability due to vaccine-preventable disease, such as lameness following paralytic polio, or hearing loss following Haemophilus b meningitis. The benefits of widespread immunization extend beyond the direct effects of reducing effects on all sectors of society (Table 10.1).

Gains in life-years and health status result in healthier, more productive individuals, able to contribute to their nation's economy. Curtailing outbreaks of vaccine-preventable diseases avoids costly losses in both tourism and trade (Ehreth, 2003). Increases in child survival by preventing deaths from vaccine-preventable disease can lead to greater utilization of family planning, and concomitant reductions in family sizes (Shearley, 1999). When a disease such as smallpox can be eradicated the long-term economic benefits are enormous, because costly programs can be eliminated and scarce public health resources redirected.

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