General Information on Vaccines

THE CHILDHOOD IMMUNIZATION SCHEDULE: WHY IS IT LIKE THAT?

Q:  Who decides what immunizations children need ?

A:  Each year, top disease experts and doctors who care for children work together to decide

what to recommend that will best protect U.S. children from diseases. The schedule is

evaluated each year based on the most recent scientific data available. Changes are

announced in January, if needed. The schedule is approved by the American Academy of

Pediatrics, the Centers for Disease Control and Prevention, and the American Academy of

Family Physicians.

Q:  How are the timing and spacing of the shots determined?

A:  Each vaccine dose is scheduled using 2 factors. First, it is scheduled for the age when the

body's immune system will work the best. Second, it is balanced with the need to provide

protection to infants and children at the earliest possible age.

Q:  Why are there so many doses?

A: Researchers are always studying how well vaccines work. For many vaccines three or four

doses are needed to fully protect your child. The doses need to be spaced out a certain

amount to work the best.

Q:  Why is the schedule  "one size fits all"? Aren't there some children who

shouldn't receive some vaccines?

A:  Your child's health and safety are very important to your child's doctor. The schedule is

considered the ideal schedule for healthy children but there may be exceptions. For example,

your child might not receive certain vaccines if she has allergies to an ingredient in the

vaccine, or if she has a weakened immune system due to illness, a chronic condition, or

another medical treatment. Sometimes a shot needs to be delayed for a short time, and

sometimes not given at all.

Your pediatrician stays updated about new exceptions to the immunization schedule. This is

one reason your child's complete medical history is taken at the pediatrician's office, and why

it is important for your child's health care providers to be familiar with your child's medical

history.

Q:  Why can't the shots be spread out over a longer period of time? There are 25

shots recommended in the first 15 months of life; why not spread these out over 2 or 3

years?

A:  First, you would not want your child to go unprotected that long. Babies are hospitalized

and die more often from some diseases, so it is important to vaccinate them as soon as it is

safe. Second, the recommended schedule is designed to work best with a child's immune

system at certain ages and at specific times. There is no research to show that a child would

be equally protected against diseases with a very different schedule. Also, there is no

scientific reason why spreading out the shots would be safer. But we do know that any

length of time without immunizations is a time without protection.

Q:  I've seen another schedule in a magazine that allows the shots to be spread out.

It was developed by a pediatrician. Why can't I follow that schedule? My child would

still get his immunizations in time for school.

A:  There is no scientific basis for such a schedule. No one knows how well it would work to

protect your child from diseases. And if many parents in any community decided to follow

such a schedule, diseases will be able to spread much more quickly. Also, people who are too

sick or too young to receive vaccines are placed at risk when they are around unvaccinated

children.

For example, following one alternative schedule would leave children without full polio

protection until age 4. Yet it would take only one case of polio to be brought into the U.S.

for the disease to take hold again in this country. This schedule also delays the measles

vaccine until age 3. We have already seen outbreaks of measles in some parts of the country

because children were not immunized. This is a highly infectious disease that can cause

serious harm--even death. The reason we recommend vaccines when we do is because young

children are more vulnerable to these diseases.

Pediatricians want parents to have reliable, complete, and science-based information, so that

they can make the best decision for their child about vaccination.

Q:  Isn't it possible that my child has natural immunity to one or more diseases? If

he does, can't he skip the shot?

A:  Tests that check for immunity to certain diseases do not work well in young children.

Q:  Isn't it overwhelming to a child's immune system to give so many shots in one

visit?

A:  Infants and children are exposed to many germs every day just by playing, eating, and

breathing. Their immune systems fight those germs, also called antigens, to keep the body

healthy. The amount of antigens that children fight every day (2,000-6,000) is much more

than the antigens in any combination of vaccines on the current schedule (150 for the whole

schedule). So children's immune systems are not overwhelmed by vaccines.

Q:  There are no shots given at 9 months, other than maybe flu vaccine or catch-up

vaccines. Why not give some at that visit instead of at 6 months or 12 months?

A:  Waiting until 9 months would leave the child unprotected from some diseases, but 9

months is too early for some of the 12-18 month vaccines. For example, it is too early for

the live measles, mumps, rubella and varicella vaccines, since some infants might have a bit

of protection left from their mother during the pregnancy, and that protection could make

the vaccine less effective.

VACCINE SAFETY: THE FACTS

Why vaccinate? Vaccines save lives and protect against the spread of disease. If you decide not to immunize your child, you put your child at risk. Your child could catch a disease that is dangerous or deadly. Getting vaccinated is much better than getting the disease.

Your pediatrician knows that you care about your child's health and safety. That's why you need to get all the scientific facts from a medical professional you can trust before making any decisions based on stories you may have seen or heard on TV, the Internet, or from other parents. Your pediatrician cares about your child too and wants you to know that €¦

Vaccines work. They have kept children healthy and have saved millions of lives for more than 50 years. Most childhood vaccines are 90% to 99% effective in preventing disease. And if a vaccinated child does get the disease, the symptoms are usually less serious than in a child who hasn't been vaccinated. There may be mild side effects, like swelling where the shot was given, but they do not last long. And it is rare for side effects to be serious.

Vaccines are safe. All vaccines must be tested by the Food and Drug Administration (FDA). The FDA will not let a vaccine be given unless it has been proven to be safe and to work well in children. The data get reviewed again by the Centers for Disease Control and Prevention (CDC), the American Academy of Pediatrics, and the American Academy of Family Physicians before a vaccine is officially recommended to be given to children. Also, the FDA monitors where and how vaccines are made. The places where vaccines are made must be licensed. They are regularly inspected and each vaccine lot is safety-tested.

Vaccines are necessary. Your pediatrician believes that your children should receive all recommended childhood vaccines. In the United States vaccines have protected children and continue to protect children from many diseases. However, in many parts of the world many vaccine-preventable diseases are still common. Since diseases may be brought into the United States by Americans who travel abroad or from people visiting areas with current disease outbreaks it's important that your children are vaccinated.

Also, children with certain health problems may not be able to get some vaccines or may need to get them later. Since each child is different, your child's doctor will know what is best for your child. You should get information about each vaccine at the doctor's office. Ask your child's doctor if you don't understand what you've read.

Vaccines are studied. To make sure the vaccine continues to be safe, the FDA and the CDC created the Vaccine Adverse Event Reporting System (VAERS). All doctors must report serious side effects of vaccines to VAERS so they can be studied. Parents can also file reports with VAERS. For more information about VAERS, visit www.vaers.hhs.gov or call the toll-free VAERS information line at 800/822-7967.

Based on VAERS reports, vaccine safety professionals continuously look for any problem with a vaccine, study the problem, and decide what to do. And if there is a problem, changes are made as soon as possible. For example,

• If a vaccine is no longer safe, it is no longer given.
• If there are new side effects, safety alerts are sent out to your health care providers.

Another way the CDC checks vaccine safety is by studying information about side effects collected from 8 large insurance companies. The Vaccine Safety Datalink (VSD) helps identify if there are any serious problems or safety issues from the records of thousands of children.

In the rare case that a child has serious side effects to a vaccine, parents can contact the National Vaccine Injury Compensation Program (VICP) at 800/338-2382 or www.hrsa.gov/vaccinecompensation. This federal program was created to help pay for the care of people who have been harmed.

QUESTIONS AND ANSWERES ABOUT VACCINE INGREDIENTS

Q: What ingredients are in vaccines?

A: All vaccines contain antigens. Antigens make vaccines work. They prompt the body to

create the immune response needed to protect against infection. Antigens come in several

forms. The form used in a vaccine is chosen because studies show it is the best way to

protect against a particular infection.

Antigen forms include:

-  Weakened live viruses. They are too weak to cause disease but can still prompt an

immune response. Measles, mumps, rubella, rotavirus, chickenpox, and one type of

influenza vaccine contain weakened live viruses.

-  Inactivated (or killed) viruses. These viruses cannot cause even a mild form of the

disease, but the body still recognizes the virus and creates an immune response to

protect itself. The polio, hepatitis A, influenza and rabies vaccines contain inactivated

viruses.

-  Partial viruses. These are made up of the specific part of the dead virus that will

prompt a protective immune response. Some vaccines are made this way including

the hepatitis B and HPV vaccine.

-  Partial bacteria. These vaccines work in two ways. First, the Hib, pneumococcal

and meningococcal vaccines are made using part of the sugar coating (or

polysaccharide) of the bacteria. The vaccine creates immunity against this sugar

coating, providing protection against the bacteria. Second, vaccines against

diphtheria, tetanus and pertussis (whooping cough) are made by inactivating the

protein in the bacteria that causes harm.

Vaccines also contain other ingredients, which help make them safer and more

effective. They include:

-  Preservatives. They keep the vials from getting contaminated with germs.

-  Adjuvants. They help the body create a better immune response. These are

aluminum salts.

-  Additives. They help the vaccine stay effective while being stored. Additives include

gelatin, albumin, sucrose, lactose, MSG and glycine.

-  Residuals of the vaccine production process. Some ingredients are needed to

make the vaccine. Although these ingredients are removed, tiny (residual) amounts

are left in the final product. Depending on how the vaccine is made, it may include

tiny amounts of antibiotics (neomycin), egg protein or yeast protein.

Q: Why are these other ingredients in vaccines? Are they safe?

A: Each ingredient has a specific function in a vaccine. These ingredients have been studied

and are safe for humans in the amount used in vaccines. This amount is much less than

children encounter in their environment, food and water.

-  Aluminum salts. Aluminum salts help your body create a better immune response

to vaccines. Aluminum salts are necessary to make some of the vaccines we use more

effective. Without an adjuvant like aluminum, people could need more doses of

shots to be protected. Everyone is exposed to aluminum because there is much

aluminum in the earth's crust. It's present in our food, air and water, including breast

milk and formula. The amount of aluminum in vaccines is similar to that found in 33

ounces of infant formula. Aluminum has been used and studied in vaccines for 75

years and is safe.

-  Formaldehyde. Formaldehyde is used to detoxify diphtheria and tetanus toxins or

to inactivate a virus. The tiny amount which may be left in these vaccines is safe.

Vaccines are not the only source of formaldehyde your baby is exposed to.

Formaldehyde is also in products like paper towels, mascara and carpeting. Our

bodies normally have formaldehyde in the blood stream and at levels higher than in

vaccines.

-  Antibiotics. Antibiotics, such as neomycin, are present in some vaccines to prevent

bacterial contamination when the vaccine is made. Trace amounts of antibiotics in

vaccines rarely, if ever, cause allergic reactions.

-  Egg protein. Influenza and yellow fever vaccines are produced in eggs, so egg

proteins are present in the final product and can cause allergic reaction. Measles and

mumps vaccines are made in chick embryo cells in culture, not in eggs. The much

smaller amount of remaining egg proteins found in the MMR (measles, mumps,

rubella) vaccine does not usually cause a reaction in egg allergic children.

-  Gelatin. Some vaccines contain gelatin to protect them against freeze-drying or heat.

People with severe allergies to gelatin should avoid getting gelatin-containing

vaccines.

Q: Do vaccines contain antifreeze?

A: No. Antifreeze is typically made of ethylene glycol, which is unsafe. Polyethylene glycol (a

chemical used in antifreeze and personal care products like skin creams and toothpaste) is

used in vaccines and is safe. It is used to inactivate the influenza virus in some influenza

vaccines. It is also used to purify other vaccines.

Q: Do vaccines contain mercury?

A: Thimerosal, a mercury-based preservative, was removed from most childhood vaccines in

2001. It is still present in some influenza vaccines. Thimerosal is still used in the manufacture

of some vaccines to prevent contamination. The thimerosal is removed at the end of the

manufacturing process. In some cases, a tiny amount of thimerosal remains. The remaining

amount is so small, that it is not possible for it to have any effect. Valid scientific studies

have shown there is no link between thimerosal and autism. In fact, autism rates have

actually increased since thimerosal was removed from childhood vaccines. The American

Academy of Pediatrics (AAP), the American Medical Association (AMA), the CDC, and the

Institute of Medicine (IOM) agree that science does not support a link between thimerosal in

vaccines and autism. For the IOM report, go to

http://www.iom.edu/CMS/3793/4705/4717.aspx.

Q: Should vaccines be  "greener"?

A: The amount of each additive used in vaccines is very small. In fact, we are exposed to

much higher levels of these chemicals in our everyday lives. In vaccines, these ingredients are

used to make the vaccine safer and more effective. Each vaccine is tested many times to

make sure it is safe and works. Taking ingredients out might affect the ability of the vaccine

to protect a child.

The information contained in this publication should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.

Copyright  © American Academy of Pediatrics, October 2008

WHY DOES MY CHILD NEED TO BE IMMUNIZED?

Immunizations have helped children stay healthy for more than 50 years. They are safe and they work. In fact, serious side effects are no more common than those from other types of medication.

Vaccinations have reduced the number of infections from vaccine-preventable diseases by more than 90%! Yet many parents still question their safety because of misinformation they've received. That's why it's important to turn to a reliable and trusted source, including your pediatrician, for information.
The following are answers to common questions parents have about immunizations.

Q: Why are some of these vaccines still needed if the diseases are not as common anymore?

A:  Because of vaccines, many of these diseases
are not as common as they once were. However, the bacteria and viruses that cause them still exist.

For example, before the Hib vaccine was developed
in the 1980s, there were about 20,000 cases of Hib disease in the United States a year.

Today there are fewer than 100 cases a year. However, the bacteria that causes Hib disease still exists. That is why children
need the vaccine to be protected.

In the United States vaccines protect children from many diseases. However, in many parts of the world vaccine- preventable diseases are still common. Because diseases may be brought into the United States by Americans who travel abroad or from people visiting areas with current disease outbreaks, it's important that your child is vaccinated.

Q: Do vaccines even work? It seems like most of the people who get these diseases have been vaccinated.

A: Yes. Vaccines work very well. Millions of children have been protected against serious illnesses because they were immunized. Most childhood vaccines are 90% to 99% effective in preventing disease. When a large majority of children have been vaccinated, it is expected that most who get the disease will have been vaccinated. And if a vaccinated child does get the disease, the symptoms are usually milder with less serious side effects or complications than in a child who hasn't been vaccinated.

Q: "What side effects will my child have after getting a vaccine? Are they serious?"

A: There may be mild side effects, like swelling, redness, and tenderness where the shot was given, but they do not last long. Your child may also have a slight fever and be fussy for a short time afterward. It is rare for side effects to be serious. However, call your pediatrician right away if your child has

• A very high fever (>103 °F) and is younger than 3 months
• Hives or black-and-blue areas at places where the injection was not given
• A seizure

You should also call your pediatrician if you have any other concerns.

Q: "Should some children not be immunized?"

A: Children with certain health problems may need to avoid some vaccines or get them later. In most cases, children with cancer, those taking oral or injected steroids for lung or kidney conditions, or those who have problems with their immune systems should not get vaccines that are made with live viruses. To protect these children it is very important for others to be vaccinated. For children with a recent history of seizures, the pertussis part of the DTaP vaccine may need to be delayed. However, a child with a minor illness such as low-grade fever (<100.4 °F), an ear infection, cough, a runny nose, or mild diarrhea can safely be immunized.

Last Updated 6/9/2010 

Source Immunizations: What You Need to Know (Copyright  © 2003 American Academy of Pediatrics, Updated 1/10)