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The terms inoculation, vaccination and immunization are often used synonymously to refer to artificial induction of immunity against various infectious diseases. This is supported by some dictionaries. However, there are some important historical and current differences. In English medicine, inoculation referred only to the practice of variolation until the very early 1800s. When Edward Jenner introduced smallpox vaccine in 1798, this was initially called cowpox inoculation or vaccine inoculation. Soon, to avoid confusion, smallpox inoculation continued to be referred to as variolation and cowpox inoculation was referred to as vaccination . Then, in 1891 Louis Pasteur proposed that the terms vaccine and vaccination should be extended to include the new protective procedures being developed. Immunization refers to the use of all vaccines but also extends to the use of antitoxin, which contains preformed antibody to e.g. diphtheria or tetanus exotoxins. Inoculation is now more or less synonymous in nontechnical usage with injection etc., and the question e.g. "Have you had your flu injectionvaccinationinoculationimmunization" should not cause confusion. The focus is on what is being given and why, not the literal meaning of the technique used.