ABSTRACT
The ultimate goal in medicine is not treatment but prevention of disease and vaccine administration represents the most efficacious and cost effective measure for accomplishing this goal. Success is best supported by the worldwide eradication of smallpox, elimination of polio in the western hemisphere and control of previously common severe infections such as measles (Fig. 1), diphtheria, tetanus (Fig. 2), and pertussis (Fig. 3). Fourteen diseases can be preventedwith vaccines that should be routinely administered to all children prior to beginning school. Thediseases includehepatitis B,H. influenzae, pneumococcus, diphtheria, tetanus toxoid, pertussis, trivalent polio, rotavirus, influenza, hepatitis A, measles, mumps, rubella and Varicella-Zoster. In addition, 3 immunizations are recommended for administration in preadolescents, aged 11 to 12 years. They are the conjugatemeningococcal (Menactra), booster pertussis-TdaP (Adacel or Boostrix), and for girls, human papilloma virus (Gardasil) vaccines. The current recommendations from the Committee on Infectious Diseases, American
FIGURE 1 (See color insert.) The Koplik spots with measles allow an early definitive diagnosis. They appear on the buccal mucosa opposite the upper and lower premolar teeth 24 to 48hours before onset of the rash and may persist for 48 to 72hours after the rash begins. If the spots are not present 24hoursbeforeandafteronsetof the rash, thediagnosisofmeasles isunlikely.
