3Centers for Disease Control and Prevention, 404-639-3670 during weekday business hours; 770-488-7100 during nights, weekends, and holidays (emergency requests only); http://www.cdc.gov/laboratory/drugservice/formulary.html. Clinicians who suspect a diagnosis of botulism should immediately call their state health department’s 24-hour emergency number.
whenever possible. Materials available for passive immunization are summarized in Table A–3.
It is the physician’s responsibility to inform the patient of the risk of immunization and to use vaccines and antisera in an appropriate manner. This may require skin testing to assess the risk of an untoward reaction. Some of the risks previously described are, however, currently unavoidable; on balance, the patient and society are clearly better off accepting the risks for routinely administered immunogens (eg, influenza and tetanus vaccines).
Manufacturers should be held legally accountable for failure to adhere to existing standards for production of biologicals. However, in the present litigious atmosphere of the USA, the filing of large liability claims by the statistically inevitable victims of good public health practice has caused many manufacturers to abandon efforts to develop and produce low-profit but medically valuable therapeutic agents such as vaccines. Since the use and sale of these products are subject to careful review and approval by government bodies such as the Surgeon General’s Advisory Committee on Immunization Practices and the US Food and Drug Administration, “strict product liability” (liability without fault) may be an inappropriate legal standard to apply when rare reactions to biologicals, produced and administered according to government guidelines, are involved.
Every adult, whether traveling or not, should be immunized with tetanus toxoid and should also be fully immunized against poliomyelitis, measles (for those born after 1956), and diphtheria. In addition, every traveler must fulfill the immunization requirements of the health authorities of the countries to be visited. These are listed in Health Information for International Travel, available from the Superintendent of Documents, US Government Printing Office, Washington, DC 20402. A useful website is http://wwwnc.cdc.gov/travel/. The Medical Letter on Drugs and Therapeutics also offers periodically updated recommendations for international travelers (see Treatment Guidelines from The Medical Letter, 2012;10:45). Immunizations received in preparation for travel should be recorded on the International Certificate of Immunization. Note: Smallpox vaccination is not recommended or required for travel in any country.
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Dennehy PH: Active immunization in the United States: Developments over the past decade. Clin Micro Rev 2001;14:872.
Gardner P, Peter G: Vaccine recommendations: Challenges and controversies. Infect Dis Clin North Am 2001;15:1.
Gardner P et al: Guidelines for quality standards for immunization. Clin Infect Dis 2002;35:503.
General recommendations on immunization. Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Morb Mortal Wkly Rep 2011;60(2):1.
Hill DR et al: The practice of travel medicine: Guidelines by the Infectious Diseases Society of America. Clin Infect Dis 2006;43:1499.
Keller MA, Stiehm ER: Passive immunity in prevention and treatment of infectious diseases. Clin Microbiol Rev 2000;13:602.