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Vaccination Age Changing from Infancy and Childhood to Adolescence and
Adulthood: An In-Dispensable Approach in Immunization Programs
Sey-yed Hessameddin Tafreshi*
R&D Department, Vaccine Research Unit, Pasteur Institute of Iran, Iran
*Corresponding author: Sey-yed Hessameddin Tafreshi, R&D Department, Vaccine Research Unit, Pasteur Institute of Iran, Iran, Tel: +026-36100965; Fax:
026-36102900; E-mail: tafreshi@pasteur.ac.ir
Received date: October 05, 2016; Accepted date: November 04, 2016; Published date: November 07, 2016
Copyright: © 2016 Tafreshi SH. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use,
distribution, and reproduction in any medium, provided the original author and source are credited.
Abstract
Objectives: Despite the positive effects of vaccines on control of many infectious diseases, they are not
completely safe. The purpose of this article is to draw attention to the problems associated with newborns and
infants immunization.
Data Collection Method: For each subject, a review of electronic sources was carried out in the PubMed and
Google Scholar using appropriate key words.
Results: For different reasons including: the differences between the immune systems of newborns/children and
adults, sever adverse events and inefficacy of vaccines, deceptive advertising and inadequate parental awareness
about vaccines and vaccination; newborns and children are at risk and accordingly a decline in public confidence is
observed.
Conclusion: The revision of vaccination age changing (at least for some vaccines) in order to maintain
newborns/children's health and to prevent the return of infectious diseases is required. To achieve this goal, new
retrospective and prospective studies to reassess the safety, efficacy, quality and protection duration of vaccines,
proper implementation of good clinical practice, establishment of a network vaccine safety database by collaboration
of international organizations, vaccine manufacturers and academic centers for sharing of information and
enhancement of awareness of healthcare professionals and people about immunization at global level are needed.
Keywords: Vaccination age; Immunization; Public condence; AEFI;
HBV
Introduction
e aim of vaccination is protection of population against
preventable infectious disease. Despite vaccines have contributed in
reducing the impact of many infectious diseases, they are not
completely safe and can cause adverse eects. While common side
eects of vaccines are mild, some vaccines have been associated with
serious or even deadly side eects [1]. On the other hand, public
condence in vaccines is waning [2-4]. For these reasons, vaccine
pharmacovigilance is the centre of attention and is of particular
importance to promote both public condence in vaccines and
acceptance of immunization programs.
Pharmacovigilance is the science and data gathering activities
relating to the detection, assessment and understanding of adverse
events and its ultimate goals are: prevention of adverse drug reactions,
rational use of pharmaceutical products, enhancement of patient care
and patient safety and risk minimization by education of healthcare
professionals or patients [5-7]. e importance of vaccines
pharmacovigilance is related to the vaccines characteristics including:
1) they are biological products (variation in manufacturing process); 2)
mandated by governments through national immunization programs;
3) Heat, light and freezing sensitive (need cold chain); 4) administered
to healthy individuals and given for prevention; 5) highly expensive
with limited shelf life; 6) given once or only a few times; and 7)
inducing body immune system for protection [8-11]. e purpose of
this article is to draw attention to the problems associated with
newborns and infants immunization and based on recent researches in
the eld of vaccines and vaccination, hypothesizes the necessity of
revision of the vaccination age changing.
Data Collection Method
For each subject, a review of electronic sources was carried out in
the PubMed and Google Scholar using appropriate key words.
Results and Discussion
e dierences between the immune systems of newborns/
children and adults
Infants and children are not just small adults. During the rst few
months of life, neonates exhibit a physiological immunodeciency, are
dependent on maternal antibodies and do not respond to vaccines
which need antibody production for protection. Production of
antibodies occurs at 3-6 months of age and adult levels of
immunoglobulin M (IgM) and immunoglobulin G (IgG) are reached
by 4-5 years and 7-8 years, respectively [12]. Newborns are unable to
induce a thymus independent response and make adequate antibodies;
and accordingly do not respond to bacteria with polysaccharide
antigens (for example,
Streptococcus pneumoniae, Neisseria
Journal of Infectious Diseases and
Therapy Tafreshi, J Infect Dis Ther 2016, 4:6
DOI: 10.4172/2332-0877.1000304
Research Article OMICS International
J Infect Dis er, an open access journal
ISSN:2332-0877
Volume 4 • Issue 6 • 1000304
meningitidis, Haemophilus inuenza
). e ability to respond to
polysaccharide antigens is developed by 18-24 months of age [13,14].
In neonates, the immune response appears to shi from the 1 to
the 2 prole [12,15]. Also, a decrease in interferon (IFN) production
by lymphocytes (and correspondingly hyporesponsiveness of
macrophages) and a reduction of 1 cytokines production such as
interleukin 1 (IL-1) and IL-12 by mononuclear phagocytes are
observed. Progesterone and IL-10 which are produced by the placenta,
down-regulate 1 response in order to prevent fetus rejection. In
addition, signaling of Toll-like receptors (TLR) maybe impaired in
children. For example, an insucient amount of MyD88 (an adaptor
protein involved in TLR signaling) was found in children [16,17].
Increase in infant mortality rate
ere is a high statistically signicant correlation between
increasing number of vaccine doses and growing infant mortality rates
and the percentage of hospitalizations. Based on a study published in
2009, in spite of the United States (US) spending more per capita on
health care, the country (with 6.22 infant deaths per 1000 live birth)
ranked 34th in order of infant mortality rate and 33 countries such as
Singapore, Iceland, Malta, Czech Republic and Cuba ranked higher
than the US. In the rst ve countries such as Singapore (2.31), Sweden
(2.75), Japan (2.79), Iceland (3.23) and France (3.33) only 12 vaccine
doses and in the US, 26 vaccine doses are given to infants during the
rst year of life. High rate of infant mortality have been reported
between the ages of 2 to 4 months (the highest rate of vaccination)
especially when the rst doses of DPT vaccine were given to infants
[18,19]. Evaluation of a mathematical model of the 2009 H1N1
inuenza pandemic in Mexico in six age groups (0-5 yr, 6-12 yr, 13-19
yr, 20-39 yr, 40-59 yr, ≥ 60 yr) has revealed that the optimal age groups
for vaccination against the disease were young adults (20-39 yr)
followed by school age children (6-12 yr) [20].
Adverse events following immunization (AEFI)
Excipients: 1) A few months aer Pandemrix® (the inuenza A
vaccine containing the AS03 adjuvant) administration following the
inuenza A (H1N1) epidemic in Europe, more than 800 children
across Europe (especially in Sweden and Finland) have been diagnosed
with narcolepsy-cataplexy [21]. At present, assessments of the causal
mechanisms about the adjuvant remains to be investigated and long
term epidemiological studies about AS03-adjuvanted inuenza A
(H1N1) pandemic vaccine prepared with the European inactivation/
purication protocol are recommended [22].
2) Aluminum adjuvants are neurotoxin and associated with a set of
autoimmune/inammatory disorders [23] and autism [24]. ese
adjutants should not be used as placebos in clinical trial studies [25].
3) Autistic spectrum disorder [26] and psychomotor development
decit [27] have been reported with thimerosal containing vaccines. It
was indicated that the instantaneous relative excess mercury that the
US children received from vaccines ranged from 11 to 150-fold in
comparison to the US Environmental Protection Agency (EPA) safety
guidelines and 2.7 to 37-fold in comparison to the US Food and Drug
Administration (FDA) safety guidelines for the oral ingestion of
methylmercury at a given age [28]. Nevertheless, the World Health
Organization (WHO) and the US Centers for Disease Control and
Prevention (CDC) emphasize the safety of thimerosal and continued
use of thiomersal-containing vaccines [29,30].
Vaccines: 1) Vaccine-associated paralytic poliomyelitis (VAPP) and
vaccine-derived polioviruses (VDPV) are the serious outcomes of the
administration of live oral poliovirus vaccine (OPV), because all live
attenuated strains of OPV can mutate or revert to neurotropic form
[31]. e risks of these disorders was considerably increased aer the
OPV administration and OPV cessation and transition from OPV to
inactivated poliovirus vaccine (IPV) is necessary in order to reduce the
risk of VAPP and the dangers of outbreaks associated with VDPV [32].
OPV has not been used in the US since 2000 and it was discontinued
in New Zealand in 2002. Aerwards, no VAPP has been reported in
the US [33].
2) During the swine u pandemic in 1976, the inuenza A
(H1N1)/New Jersey/1976 vaccine was administered to 45 million
people in the US, but the vaccination campaign was suspended aer 10
weeks because of increased cases of Guillain-Barré syndrome [34]. In
2003, 27 years later, the Institute of Medicine concluded that: "people
who received the 1976 swine inuenza vaccine had an increased risk
for developing Guillain-Barré syndrome but the exact reason for this
association remains unknown" [35]. New investigations revealed that
inuenza A (H1N1) vaccine was associated with the risk of Guillain-
Barré syndrome [36].
Deep distrust to vaccination campaigns
In 2011, the Central Intelligence Agency (CIA) organized a fake
vaccination program against hepatitis B virus (HBV) in a poorer part
of Abbottabad (Pakistan) to obtain Osama bin Laden's children DNA
to provide evidence that the family was present. Genetic material
retrieved from his infant relatives during vaccination would have been
compared to a DNA sample from the brain of Bin Laden’s sister who
died of cancer in Boston in 2010. In order to organize the vaccination
campaign, the CIA enlisted a Pakistani doctor, Shakil Afridi, who has
since been arrested by the Inter-Services Intelligence agency of
Pakistan for cooperating with American intelligence agents. e
project evidently failed, but the violation of trust threatens to set back
global public health eorts by decades. Aer three years, Lisa Monaco,
a counterterrorism and homeland security adviser to President
Obama, in response to a January 2013 letter signed by the deans of 12
public health schools that sharply criticized the CIA's use of a
vaccination campaign (such programs have prompted attacks on
medical workers in Pakistan), wrote in a letter that: "the CIA would no
longer use immunization programs - or workers - as a means to collect
intelligence, no DNA or genetic material would be used and the CIA
policy applied worldwide and to U.S. and non-U.S. persons alike"
[37-39].
Inecacy of vaccines
Vaccines do not provide complete or permanent protection against
infectious diseases.
On the basis of the German Health Interview and Examination
Survey for Children and Adolescents (KiGGS) data published in 2011,
unvaccinated children in two of the three age groups under
investigation (1-5 and 11-17 yr versus 5-10 yr) showed fewer infections
and atopic disorders than those who were vaccinated. e study
compared the health outcomes of unvaccinated children versus
vaccinated children which were conducted from May 2003 to May
2006 by the Robert Koch Institute [40].
Despite a high coverage rate with two doses of mumps-containing
vaccine, the largest mumps outbreak in two decades occurred in the
Citation: Tafreshi SH (2016) Vaccination Age Changing from Infancy and Childhood to Adolescence and Adulthood: An In-Dispensable Approach
in Immunization Programs. J Infect Dis Ther 4: 304. doi:10.4172/2332-0877.1000304
Page 2 of 8
J Infect Dis er, an open access journal
ISSN:2332-0877
Volume 4 • Issue 6 • 1000304
US. Of the 133 patients with investigated vaccine history in Iowa, 87
(65%) had documentation of receiving two doses and 19 (14%) one
dose of mumps-containing vaccine [41].
Vaccines contamination
e FDA recommended suspension in the use of Rotarix® due to
contamination with porcine circovirus 1 (PCV1) DNA [42]. Victoria et
al. examined the purity of a number of human attenuated viral
vaccines. e sequence analysis revealed the unexpected viral
sequences of retrovirus avian leukosis in the measles vaccine
(Attenuvax®), low level of a virus similar to simian retrovirus in
RotaTeq® and signicant levels of PCV1 in Rotarix® [43].
Polyvalent vaccines risks
A rise to the possible association between administration of
hexavalent vaccines and sudden unexplained infant death (SUID) has
been reported [44] and according to the CDC report, increased or
unexpected deleterious health eects are the results of mixed exposures
to chemical substances and other stressors [28].
Role of national health care systems
Repevax® is recommended by the United Kingdom National Health
Service for pregnant women immunization against pertussis and
consists of nine various antigens including: diphtheria, tetanus,
pertussis and poliomyelitis (produced in Vero cells), aluminum
phosphate, phenoxyethanol and polysorbate 80. It is stated in the
factsheet: "is says that the vaccine is not recommended for use in
pregnancy because of the routine exclusion of pregnant women from
clinical trials and not because of any specic safety concerns or
evidence of harm in pregnancy. Use in pregnancy is not
contraindicated" [45].
But the manufacturer of the vaccine, Sanou Pasteur, has explicitly
specied in the package leaet: "Tell your doctor or nurse if you or
your child is pregnant or breast-feeding, think you or your child might
be pregnant or planning to have a baby. Your doctor or nurse can
advise you whether or not vaccination should be delayed. e use of
REPEVAX® is not recommended during pregnancy" [46].
e manufacturer statement about side eects and adverse events of
the vaccine: " Some additional adverse events have been reported in the
various recommended age groups during the commercial use of
REPEVAX®. e frequency of these adverse events cannot be precisely
calculated, as it would be based on voluntary reporting in relation to
the estimated number of vaccinated persons [46].
ere is one main conclusion to be drawn from the above
statements: No well-controlled studies (for example, post marketing
surveillance studies) have assessed the adverse events following
immunization with this vaccine in pregnant women and the safety of
the vaccine (as cited in the factsheets) in pregnancy is in disagreement.
Deceptive advertising
More than 120 types of human papillomavirus (HPV) have been
identied and they are classied as: low-risk viruses (Lr-HPV),
probable high-risk viruses (pHr-HPV) and high-risk viruses (Hr-
HPV) that the latter cause precancerous lesions and cancer, including
types 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68, 73 and 82 [47].
Cervical cancer takes years to develop and HPV infection does not
necessarily mean cervical cancer. Most HPV infections are transient
and will clear completely from the body within 2 years [48].
ere are two HPV vaccines, Gardasil® and Cervarix®. Both vaccines
protect against infection with the types of high-risk HPV (types 16 and
18); Gardasil® also protects against infection with the two types of low-
risk HPVs (types 6 and 11) that cause genital warts.
It seemed that some of advertising campaign slogans of Gardasil®
manufacturer, Merck, such as: "Your daughter could become one less
life aected by cervical cancer" and "Boys can be aected by HPV
disease too" designed to exaggerate the danger of HPV infections and
cervical cancer to promote vaccination with Gardasil®.
HPV vaccination facts
1) Gardasil® and Cervarix® do not prevent infection with all HPV
types that may cause cervical cancer and the vaccines are not used to
treat HPV infection, abnormal cervical cells, or cervical cancer. ese
vaccines protect against infection with HPV types 16 and 18 (2 types
from 15 types of Hr-HPV).
2) Gardasil® enhances cervical disease (a greater number of cervical
intraepithelial neoplasia grade 2/3, CIN 2/3) in individuals who had
HPV infection with vaccine-relevant HPV types (16 and 18) prior to
vaccination. CIN 2/3 is considered to be precursors to cervical cancer
[49].
3) Current HPV vaccines do not protect against all HPV types that
cause cervical cancer and women who have received the HPV
vaccines, still need regular cervical screening. In other words,
vaccination is not a substitute for routine cervical cancer screening and
it is important for vaccinated women to continue to undergo routine
cervical cancer screening [50].
4) Type replacement is dened as: elimination of some viral types
causing an increase in incidence of other types and can occur naturally
during infection or by vaccination. Mass vaccination with HPV types
targeted by vaccines, can change the distribution of infection with
other types of HPVs. For example, Choi et al. reported an increase of
3-10% in long-term cervical cancer incidence due to non-vaccine HPV
types following vaccination [51].
5) Studies have shown that infections with multiple types
(coinfections) of HPV can occur (samples with three, four, or ve
genotypes were also seen and these dierent genotypes are not
necessarily high-risk HPV types 16 and 18) and seem to act
synergistically in cervical carcinogenesis [52]. On the other hand, HPV
infections are type and age-specic. For instance, a research in the US
showed that both cytological abnormalities and Hr-HPV infections
with types 16 and 18 decreased with increasing age [53] and in other
investigations, HPV type 45 was present chiey in Colombian women
under 50. Type and Age-specic HPV prevalence and multiple types
infections can inuence vaccine impact and highlight the role of HPVs
other than types 16 and 18 [54].
6) HPV is a necessary but not sucient cause of all cervical cancers,
and other cofactors are necessary for progression from cervical HPV
infection to cervical cancer. ese cofactors include: younger age at
rst full-term pregnancy and number of full-term pregnancies,
number of sexual partners, body mass index, younger age at rst
intercourse, long-term hormonal contraceptive use [55], tobacco
smoking [56], other sexually transmitted coinfections such as herpes
simplex virus-2 (HSV-2) [57],
Chlamydia trachomatis
[58], human
immunodeciency virus (HIV) [59], male circumcision [60], diet and
Citation: Tafreshi SH (2016) Vaccination Age Changing from Infancy and Childhood to Adolescence and Adulthood: An In-Dispensable Approach
in Immunization Programs. J Infect Dis Ther 4: 304. doi:10.4172/2332-0877.1000304
Page 3 of 8
J Infect Dis er, an open access journal
ISSN:2332-0877
Volume 4 • Issue 6 • 1000304
nutrition [61] and occupation [62]. As can be seen, various cofactors
are involved in development and progression of cervical cancer aer
primary HPV infection.
Evaluation of hepatitis B vaccination as an example
Transmission/exposure of hepatitis B virus:
• From infected mother to her newborn at birth
• Unprotected sex and through of body uids, such as semen and
vaginal uids
• Sharing IV drug needles, syringes, or other drug-injection
equipment
• Living in a household with an infected person
• Sharing earrings, razors and toothbrushes with an infected person
• Unsterilized needles, including tattoo or piercing needles
• Direct contact with an infected person blood [63-64]
Glancing at the routes of transmission, except from mother to
newborn and living with an infected person, HBV cannot transmit to
infants by other routes of exposure. In the US, the CDC recommends
routine screening of all pregnant women for hepatitis B virus surface
Antigen (HBsAg) and in case of infected pregnant women; hepatitis B
vaccine and hepatitis B immune globulin (HBIG) are administered
aer birth [65]. e incidence rates of acute hepatitis B are highest
among adults; especially males aged 25-44 years [66].
Duration of protection and booster vaccination: In the 1980s,
duration of protection of hepatitis B vaccine was optimistically
predicted for ten years but the results of various researches showed
shorter duration of protection and dierent immune responses among
vaccinated individuals. For example, protection periods from 5 yr
(one-third failed to response to a booster dose) [67] to 15 yr [68] have
been reported. In spite of the dierences in immune responses between
newborns and adults and considering maximum reported duration of
protection (15 yr), booster vaccination is necessary when vaccinated
individuals reach puberty. Accordingly, booster vaccination is
recommended [69].
Serious and chronic side eects of hepatitis B vaccine: Just like other
vaccines, this vaccine also has side eects but some of them are chronic
which cannot be cured or rather do not have denite treatments. For
example, autism [70], systemic lupus erythematosus [71], Guillain-
Barré syndrome [72] and multiple sclerosis [73]. Guillain-Barré
syndrome and multiple sclerosis have been mentioned as the side
eects in the leaets of three hepatitis B vaccine manufacturers
(ENGERIX®-B, HBVAXPRO® and RECOMBIVAX HB®) whereas the
WHO considers that the complete data do not support a causal
relationship between hepatitis B vaccine and the mentioned side eects
[74].
Statistics for hepatitis B vaccine adverse events: Due to the main
database of vaccines adverse events in the US is the Vaccine Adverse
Events Reporting System (VAERS), in next part, some possible errors
of this system will be evaluated.
1) From 1991 to 1998, a total 1771 neonatal adverse reactions and
18 cases of death were reported to VAERS. For 18 cases of neonatal
death, the mean age of neonates at vaccination was 12 days (age range,
1-27 days), the median time from vaccination to onset of symptoms
was 2 days (range, 0-20 days) and median time from onset of
symptoms to death was 0 day. Aer autopsy, the causes of 12 cases
were reported sudden infant death syndrome (SIDS) [75].
It should be noted that the occurrence of SIDS is rare during the
rst month of life and its peak is 2-3 months aer birth [76] and in
order to diagnosis of SIDS or sudden unexplained death in childhood
(SUDC) a complete autopsy with trained specialist, a uniform federal
law, a suitable and standard questionnaire for the interview with
parents of SIDS victims and referral centers for performing autopsies
are required [77]. In the US, the rst autopsy protocol was published in
1976 but since March 1, 2006 taking the vaccination history is required
in new sudden unexplained infant death investigation (SUIDI)
reporting form and according to the Soldatenkova and Yazbak
research, a systematic review of neonatal SIDS and other unexpected
infant deaths following the rst dose of hepatitis B vaccination should
be done at the international level [78].
2) Principally, monitoring of vaccine safety for various reasons
including occurrence of rare but serious adverse reactions aer
widespread use, multivalent vaccination, errors in reporting of side
eects and simultaneous incidence of several side eects is
complicated. For these reasons, establishment of a vaccine safety
monitoring system (in the US, VAERS and Vaccine Safety Datalink
(VSD) have established) in order to study possible risks of vaccines and
performing an eective post marketing surveillance program is
essential, but the interpretation of data from such databases is complex
and is associated with substantial uncertainty [79]. For example, 2% of
adverse reactions are reported to VAERS [19]. is under-reporting
highlights the limitations of the passive systems in exact evaluation of
incidence of adverse events following immunization. Meranus et al. by
performing a survey study in the US, indicated that 17% of
respondents (composed of 60 commercial vaccinator employees and
school health nurses, 500 physicians and 300 pharmacists) would not
know how to report an adverse event, 61% of respondents citing
unclear denitions of a reportable adverse event and 18% of
respondents unaware of whose responsibility it is to report an adverse
event. e response rate was 36% [80].
3) If an adverse event appears immediately or a few days aer
vaccine administration, it is reported by parents or physicians but in
the case of long term adverse events (e.g., aer a few weeks or months),
there is diering view on the subject and these events are never
reported for lack of parental awareness about delayed types of adverse
reactions of vaccines.
In 2011, a survey study was performed with 1745 Canadian parents
in order to investigate parents’ knowledge, awareness, attitudes and
behaviors related to immunization by telephone. e study showed
4.24% (74 from 1745) of parents sought medical attention for their
child as a result of a reaction to medication and only 0.23% (4 from
1745) of them said that their child became ill (including seizures,
vomiting, diarrhea, u, shortness of breath and eye irritation) in the
days following the vaccination [81].
4) Randomized clinical trials (because of limited volunteers and
relative short durations) [82] cannot detect long term adverse events
and risk of an adverse event in population that not exposed to the
vaccine. Accordingly, spontaneous reports and results of randomized
clinical trials do not provide sucient data for vaccine safety databases
[83]. On the other hand, vaccines are biological products and adverse
events for a particular vaccine may vary from one manufacturer to
another [84] and batch to batch variation in vaccine manufacturing is
still remained a problem [85]. For these reasons, post marketing
Citation: Tafreshi SH (2016) Vaccination Age Changing from Infancy and Childhood to Adolescence and Adulthood: An In-Dispensable Approach
in Immunization Programs. J Infect Dis Ther 4: 304. doi:10.4172/2332-0877.1000304
Page 4 of 8
J Infect Dis er, an open access journal
ISSN:2332-0877
Volume 4 • Issue 6 • 1000304
surveillance, follow up of medical reports and computerized claims
databases for detection of possible new, unusual and rare vaccines
adverse events, change in the frequency of known ones and in order to
determine patient risk factors for special types of adverse events are
essential [82-83].
Hepatitis B Vaccination and Hepatocellular Carcinoma
e most important reason for immediately aer birth hepatitis B
vaccination is the WHO recommendation that states: "If infection is
observed combined with Hepatitis B virus at very low age, the
probability of chronic disease and as a result appearances of long term
complications such as Cirrhosis or Hepatocellular Carcinoma (HCC)
increases during adulthood" [86].
Risk factors of HCC: HCC is the sixth most common cancer in the
world and the third common cause of death from cancer. Annually,
HCC is the cause of the 600000 deaths worldwide that almost half of
them are in China [87]. HCC risk factors include: cirrhosis [88],
Aatoxins [89], hemochromatosis [90], alcohol consumption [91],
diabetes [92], tobacco smoking [93], overweight and obesity [94], sever
α1-antitrypsin deciency [95], anabolic steroids [96], oral
contraceptives [97] and chronic hepatitis B or C [87-90, 92, 96].
Global increase of HCC: It was proved that HCC is increasing
worldwide, For example, in the United States [98] and southern Europe
[99]. Hepatitis C virus, tobacco smoking, heavy alcohol consumption
and obesity are responsible for the increasing trend of HCC in these
regions [100,101].
In Asia and Africa, HBV infection is the main risk factor of HCC
[102] but the role of other HCC risk factors cannot be ignored. For
instance, Hepatitis C virus, alcohol consumption and overweight in
Japan [103], hepatitis C virus, alcohol consumption and aatoxins in
India [104] and aatoxins in sub-Saharan Africa and Asia [105] have
been reported as other important risk factors of HCC.
Hepatitis B vaccination and HCC protection: e results of a 20-yr
follow up study in Taiwan (1983-2004 and ages 10-29 yr) showed that
the 50% of the vaccinated children were developed HCC despite the
complete immunoprophylaxis with the vaccine (vaccine failure); in
other words, even administration of complete hepatitis B vaccination
could not protect a half of children from HCC. Also, HCC incidence
rate was highly statistically signicant in 20 years or older full
vaccinated individuals. According to the research, current vaccination
program could not prevent mother-to-child transmission of HBV and
improvement of the HBIG administration during the rst 24 hours
aer newborn birth should be performed [106]. Because of the current
hepatitis B immunization program failures to prevent hepatitis B
maternal transmission (which can lead to HCC development) [107]
and vaccine failure, HBIG administration or antiviral therapy have
been the focus of attention [108]. Also, a globally special attention on
behavior modifying, improving individual education, exact testing of
all blood donations and assuring asepsis in clinical practice is needed
to reduce the infection rate of HBV in the world [109].
Briey, considering the HBV routes of exposure, need to booster
vaccination and short duration of protection, insucient data obtained
from clinical trials about chronic and serious side eects of the vaccine,
the importance and the role of other HCC risk factors, vaccine failure
to prevent HCC and the fact that humans are the known reservoirs of
HBV, except mother-to-child exposure and living with someone who
has a HBV infection, screening of pregnant women in order to identify
at risk newborns is completely safer than routine newborns
vaccination immediately aer birth and postpone of HBV vaccination
until puberty is quite rational.
Conclusion
In an overview of the all above mentioned issues, because of: (i) the
dierences between the immune systems of newborns/children and
adults, (ii) death, serious and chronic side eects due to excipients or
active ingredients of vaccines, (iii) vaccine failure and inadequate
quality control of vaccines, (iv) risks of polyvalent vaccines, and (v) a
prot-seeking approach to vaccination, changing the age of
vaccination from infancy/childhood to adolescence/adulthood is
necessary. In order to achieve public condence in immunization and
success of vaccination programs, the following activities should be
performed: (i) retrospective and prospective studies to reassess safety,
ecacy, quality and protection duration of vaccines in infants and
children worldwide, (ii) proper implementation of good clinical
practice and prospective studies to investigate chronic side eects of
vaccines in the world, (iii) establishment of a globally network and
vaccine safety database by collaboration of international organizations
and institutions, vaccine manufacturers, national regulatory authorities
and vaccine research academic centers of all countries for sharing and
exchange of information and experiences about vaccines quality
control, safety and ecacy, (iv) new researches and investigations to
choose safer excipients and more ecient formulation of vaccines, and
(v) enhancement of awareness and knowledge of healthcare
professionals and people about immunization and its related issues by
governments.
Disclaimer
e opinions, interpretations and conclusions expressed in the
paper are the private views of the author and do not necessarily
represent the views of the Pasteur Institute of Iran as a vaccine
manufacturer. e information was obtained from publicly available
sources, including published literatures and regulatory documents.
Conict of Interest
e author declares that there is no conict of interest.
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Citation: Tafreshi SH (2016) Vaccination Age Changing from Infancy and Childhood to Adolescence and Adulthood: An In-Dispensable Approach
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ISSN:2332-0877
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