VACCINES have played a vital role in improving health care in the United States. One need only remember that from 1951 to 1955 the United States averaged more than 35 000 cases of paralytic poliomyelitis annually, whereas in 1984 there were only eight reported cases.
Nonetheless, there continue to be difficulties with immunization programs. Complacency is a major one; there are times when the glamour of modern curative medicine has overshadowed the steady, undramatic activities involved in immunization programs. This is particularly true when adult immunizations are considered. The emphasis on disease prevention, so dominant in the training of pediatricians, has not been as strong in the training received by US internists or general practitioners. The low 20% figure of yearly influenza immunizations given to high-risk patients is eloquent but sad testimony to this problem.
Table 1 summarizes commonly used vaccines and immunoprophylactic agents. This review briefly describes the efficacy