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Vaccine Information

Effective 10/01/2015 our practice will no longer accept new patients/families that do not adhere to the standard immuniztion schedule.  All of our providers follow the recommendations of  the CDC (Centers for Disease Control) and AAP (American Academy of Pediatrics) for childhood vaccines to ensure the health and safety of your child. 

For more detailed information regarding vaccines please visit the Center for Disease Control at or click here to see our Vaccine Schedule.


6 Mos-35 Mos     Infant Influenza Vaccine Dosage - Intramuscular
3 Yrs +               Regular Influenza Vaccine Dosage - Intramuscular
2 Yrs +               Intranasal Influenza Vaccine Dosage (Flu Mist)

The Parent’s Guide to Childhood Immunizations
In 1796, Edward Jenner inoculated an 8-year-old boy against smallpox and coined the term “vaccination” to describe what he had done.
Today, thanks to vaccination, there is no more smallpox, and routine vaccination against childhood diseases is an important part of our children’s health care.
As parents, we want to do everything we can to keep our children from getting sick. In this booklet you will learn more about the role vaccines play in keeping them healthy. You will learn about:
Diseases that are prevented by vaccines, and the vaccines that prevent them.
How to prepare for a doctor’s visit that includes vaccinations, and what to expect during and after the visit.
How vaccines help your child’s immune system do its job.
How well vaccines work, and how safe they are.
Where to find more information.
Cover design by Kyle Brooks
Your child’s vaccinations might be given by a doctor. They might also be given by a nurse, a nurse practitioner, a medical assistant, a physician’s assistant, or a pharmacist. The terms ‘health care provider’ or ‘provider’ also appear in this booklet. They can apply to anyone who gives a vaccination.
Revised 08/2015
Part One Vaccine-Preventable Diseases and Childhood Vaccines
Part One Vaccine-Preventable Diseases and Childhood Vaccines
Part 1: Vaccine-Preventable Diseases
and Childhood Vaccines
Most medicines are given to cure an illness or to relieve its symptoms.
Vaccines are different. They are given to prevent illness.
Vaccine-Preventable Diseases
Fourteen diseases can be prevented by routine childhood vaccines:
• Caused by bacteria.
• Causes sore throat, fever, and chills.
• If not properly diagnosed and treated, it can produce a toxin that can
cause heart failure or paralysis.
• About 1 person in 10 infected with diphtheria dies.
• Through the 1920s, about 150,000 people got diphtheria each year,
and about 15,000 died.
Hepatitis A
• Caused by hepatitis A virus.
• Found mostly in bowel movements and spread by personal contact
or through contaminated food or water.
• Causes liver disease – muscle and stomach pain, diarrhea or vomiting,
loss of appetite, fatigue, yellow skin or eyes (jaundice).
• Children younger than about 6 years old might not have any symptoms.
• About 100 people die each year from liver failure caused by hepatitis A.
Hepatitis B
• Caused by hepatitis B virus.
• Spread through contact with blood or other body fluids.
• Causes liver disease – muscle and stomach pain, diarrhea or vomiting,
loss of appetite, fatigue, yellow skin or eyes (jaundice).
• Some people recover and others become “chronically infected,”
which can lead to cirrhosis of the liver or liver cancer.
• Chronically infected people can infect others through, for example,
unprotected sex or sharing needles.
• Babies of chronically infected mothers are usually infected at birth.
• About 3,000 to 5,000 people die each year.
Haemophilus influenzae type b (Hib)
• Caused by bacteria.
• If Hib bacteria enter the bloodstream they can cause meningitis,
pneumonia, arthritis, and other problems.
• Before vaccine, Hib was the leading cause of bacterial meningitis in
children younger than 5 (about 1 out of every 200 children in that age
• One child in 4 suffered permanent brain damage, and 1 in 20 died.
Influenza (flu)
• Caused by influenza virus.
• Occurs mostly during the winter.
• Causes fever, sore throat, cough, headache, chills, muscle aches.
• Can lead to sinus infections, pneumonia, and inflammation of
the heart.
Part One Vaccine-Preventable Diseases and Childhood Vaccines
• Hospitalization rates are high among children, especially babies
under 1 year old.
• Flu causes more deaths each year than any other vaccine-preventable
disease – mostly among the elderly, but it can also kill children.
Measles Trivia:
The word “measles” probably comes
from a Latin word meaning “miserable.”
In 1970, astronaut Ken Mattingly
could not participate in the Apollo
XIII moon mission because he
had been exposed to measles.
• Caused by measles virus.
• Extremely contagious.
• Causes a rash all over the body, runny nose, fever, and cough.
• About 1 child in 10 also gets an ear infection, up to 1 in 20 gets pneumonia,
1 in 1,000 gets encephalitis.
• Before vaccine, almost all children got measles – about 48,000 were
hospitalized each year, 7,000 had seizures, about 1,000 suffered permanent
brain damage, and about 450 died.
• Measles still kills about a half million people a year around the world.
• About 1 person in 1,000 who gets measles will die.
• Caused by mumps virus.
• Used to be a very common childhood disease.
• Usually a relatively mild disease – causes fever, headache, and inflammation
of salivary glands.
• Mumps can lead to meningitis (about 1 child in 10), encephalitis or
deafness (about 1 in 20,000) or death (about 1 in 10,000).
Pertussis (whooping cough)
• Caused by bacteria.
• Can look like a common cold at first.
• After one or two weeks, it can cause violent coughing spells that can
interfere with eating, drinking, or even breathing.
• Can lead to pneumonia, seizures, encephalopathy (brain infection),
and death.
Pneumococcal Disease
• Caused by bacteria.
• Most common in winter and early spring.
• After Hib disease began to decline, pneumococcal disease became
the most common cause of bacterial meningitis in children under 5.
• Can lead to ear infections, blood infections, and death.
• African Americans, some Native American tribes, children with
sickle cell disease or with HIV infection and children without a working
spleen are at higher risk.
Part One Vaccine-Preventable Diseases and Childhood Vaccines
• Caused by polio virus.
• Can cause paralysis, leaving a person unable to walk or even breathe.
• About 1,200 polio victims in the United States were forced to live in
700-pound “iron lungs,” which enabled them to breathe. Several of
these people, first confined to an iron lung in the 1950s, still live in
them today.
• Polio caused panic in the 1950s before vaccine – about 20,000 people
were paralyzed each year.
Polio Trivia:
In 1948, a retired schoolteacher was
a patient in a San Diego polio ward,
surrounded by young children also
suffering from polio. To help cheer
them up she created a simple board
game for them to play together. A
year later, the toy manufacturer Milton
Bradley bought the game from
her. Today polio has been nearly eliminated, but Candy Land is
still being played in millions of homes around the world.
• Caused by a virus.
• Causes diarrhea and vomiting in young children – sometimes so
severe it can lead to dehydration.
• Before vaccine, rotavirus caused more than 400,000 doctor visits,
200,000 emergency room visits, up to 70,000 hospitalizations, and
20 to 60 deaths each year.
Rubella (German measles)
• Caused by a virus.
• Usually a mild disease, causing swollen glands in the neck, fever, rash
on the face and neck, and sometimes arthritis-like symptoms.
• The greatest danger from rubella is to unborn babies. If a pregnant
woman gets rubella, her unborn baby has about an 80% chance of
“congenital rubella syndrome” (CRS), which can lead to deafness,
blindness, mental impairment, or heart or brain damage. Miscarriages
are also common.
• In 1964-65, before vaccine, a major rubella epidemic in the United
States infected 12.5 million people and led to 20,000 cases of CRS.
Tetanus (lockjaw)
• Caused by bacteria.
• Enters the body through cuts, burns, or other breaks in the skin – not
spread from person to person.
• About 3 weeks after exposure, a child could become cranky, get a
headache, or have spasms in the jaw muscles.
• Tetanus can then produce a toxin that causes painful muscle cramps
in the neck, arms, legs, and stomach – strong enough to break a
child’s bones.
• A child might have to spend several weeks in intensive care. One or
two out of every 10 die.
Varicella (chickenpox)
• Caused by varicella virus.
• Causes an itchy rash all over the body, fever, and drowsiness.
Part One Vaccine-Preventable Diseases and Childhood Vaccines
• Usually mild, but can cause skin infections and encephalitis. For
every 100,000 infants younger than 1 year old who get chickenpox,
about 4 die.
• If a pregnant women gets chickenpox around the time of delivery, the
baby can be infected, and 1 out of 3 will die if not treated quickly.
• Before vaccine, almost every child (about 4 million each year) got
Many of these diseases are spread from person to person through the air
by coughing, sneezing, or just breathing. Exceptions are polio, hepatitis
A, and rotavirus, which enter the body through the mouth; hepatitis B,
which is transmitted through blood or body fluids; and tetanus, which
enters the body through breaks in the skin.
All of these diseases were much more common before vaccines.
Annual Reported
Cases 20th
Reported Cases 2013
Diphtheria 21,053 0
Measles 530,217 187
Tetanus 580 26
Mumps 162,344 584
Rubella 47,745 9
However, after declining for years, some of them – notably measles and
pertussis – are again causing outbreaks in the United States, partly because
some parents are not getting their children vaccinated.
MMR (Measles, Mumps, and Rubella) vaccine
Childhood Vaccines
Ten vaccines, which children receive between birth and 6 years of age can
prevent these 14 diseases.
1. Hepatitis A (HepA) vaccine
2. Hepatitis B (HepB) vaccine
3. Hib (Haemophilus influenzae type b) vaccine
4. Influenza (flu) vaccine
5. PCV13 (pneumococcal disease) vaccine
6. Polio vaccine
7. Rotavirus (RV) vaccine
8. Varicella (chickenpox) vaccine
9. DTaP (Diphtheria, Tetanus, and Pertussis) vaccine
These vaccines are given by injection (shot), except for rotavirus, which
is a liquid that is swallowed, and one type of flu vaccine, which is sprayed
into the nose.
Part One Vaccine-Preventable Diseases and Childhood Vaccines
The Vaccine Schedule
All of these childhood vaccines are given in a series of 2 or more doses, at
specific ages.
Age Vaccine
at birth HepB
2 months HepB (1-2 mos) + DTaP + PCV13 + Hib
+ Polio + RV
4 months DTaP + PCV13 + Hib + Polio + RV
6 months HepB (6-18 mos) + DTaP + PCV13 +
Hib + Polio (6-18 mos) + RV
12 months
MMR (12-15 mos) + PCV13 (12-15 mos)
+ Hib (12-15 mos) + Varicella (12-15
mos) + HepA (12-23 mos)
15 months DTaP (15-18 mos)
For more detailed versions of this schedule, visit CDC’s website at
For some of these vaccines, a booster dose is also recommended at 4-6
years of age.
A dose of flu vaccine is recommended every winter for children 6 months
old or older.
Several “combination” vaccines are available for children. These are vaccines
that contain more than one vaccine in a single shot, which means
fewer shots at one visit:
Vaccine Name Contains
Pediarix® DTaP, Polio, and HepB
Pentacel® DTaP, Polio, and Hib
Kinrix® DTaP and Polio
Quadracel® DTaP and Polio
ProQuad® MMR and Varicella
Other Vaccines
There are other vaccines that might be recommended for older children
or adolescents, or for young children in certain circumstances.
Rabies vaccine might be recommended for a child who was bitten by an
animal, or is traveling to a country where rabies is common.
Children traveling abroad may need other vaccines, too. These could
include Japanese encephalitis, typhoid, meningococcal, or yellow
fever vaccines.
Meningococcal vaccine is also recommended for adolescents between 11
and 18 years of age, and for younger children with certain medical conditions,
to protect them from infections that could cause bacterial meningitis.
Tdap is a tetanus, diphtheria, pertussis vaccine that is similar to
DTaP, but is formulated for adolescents and adults. It is recommended
at the 11-12 year doctor’s visit. Human papillomavirus (HPV) vaccine is
also recommended at the 11-12 year visit. HPV is a virus that causes cervical
cancer and other types of cancer.
Your healthcare provider can tell you more about these vaccines.
Part One Vaccine-Preventable Diseases and Childhood Vaccines
Vaccine Trivia:
The world’s first vaccine, Dr. Edward Jenner’s smallpox vaccine,
was actually made from cowpox virus. Jenner called the process
“vaccination” from vacca, a Latin word for cow.
Part Two The Vaccine Office Visit
Part Two The Immunization Office Visit
Part 2: The Vaccination Office Visit
Before the Vaccination Visit
If you have a vaccination
record card for your child,
take it along so the provid
er can enter the shots giv
en today. If she is getting
her first vaccination(s),
ask for a card. This record
could come in handy later
to show that your child
has had the vaccinations
necessary to get into
school, or if you move or
switch doctors. The pro
vider should enter the vaccinations into an electronic
medical record or vaccine registry.
doctor or nurse will ask you some questions about your child. Be
prepared to tell them:
If your child ever had a severe reaction to a dose of any vaccine.
Babies often get a sore leg or a mild fever after vaccinations. But let
your provider know if your baby has ever had a more serious reaction.
There are a few uncommon reactions that could be a reason to
not get another dose of certain vaccines.
If your child has any severe allergies.
A severe allergy is one that could be life-threatening. A baby who has
a severe allergy to a substance that is in a vaccine shouldn’t get that
vaccine. Milder allergies aren’t a problem.
You can’t be expected to know whether or not your baby is allergic
to every substance in every vaccine, but report any allergies you do
know about, including eggs, gelatin, any antibiotics, yeast, or latex.
Your doctor or nurse will be able to check them against lists of vaccine
Don’t be too worried that your child might have allergies you don’t
know about. Severe allergic reactions to vaccines are rare (around 1
in a million), and your provider is prepared to deal with them if they
do occur.
If your child has an immune system problem.
A child with a damaged or suppressed immune system should not
get vaccines containing live virus, such as MMR, varicella, or rotavirus.
Immune system problems can be caused by diseases such as
AIDS, leukemia, sickle cell disease, or cancer, or by medical treatments
such as steroids, chemotherapy, or radiation.
Your doctor, nurse, or other provider will be able to help you answer
any questions.
During the Vaccination Visit
Your provider should give you a Vaccine Information Statement (VIS)
for each vaccine your child receives. The VIS contains useful information
about the vaccine, including its risks and benefits. If you would like to
review these statements before the office visit, you can find them online
Your provider will ask questions to help them determine if there are reasons
your baby should not get certain vaccines.
Always ask your provider if you have any questions or would
like more information.
Your provider might ask you to hold your baby in a certain way to steady
the arm or leg where the shot will be given. These techniques are designed
to keep children still without actually holding them down or
frightening them.
Part Two The Immunization Office Visit
Many providers like to keep a child in the office for observation for about
15 or 20 minutes after getting vaccines, in the unlikely event of an allergic
reaction or in case the child becomes dizzy or faints.
If your child has a moderate or severe cold or other illness, you might be
asked to postpone vaccinations until he gets better.
Be sure that all vaccinations that are given get recorded in your baby’s
shot record.
After the Vaccination Visit
Sometimes a child will have a fever or a sore leg or arm where a shot was
given. You can give your child a non-aspirin pain reliever to reduce any
pain or fever that might follow vaccinations. Giving the child plenty of
fluids to drink can also help reduce a fever. A cool, wet washcloth over the
sore area can help relieve pain.
If your baby cries for 3 or more hours without stopping, if he seems limp
or unresponsive, if he starts having seizures (convulsions), or if you are
worried at all about how your baby looks or feels, call your provider right
away. Serious reactions are not common, but your provider will know how
to deal with them if they occur.
Again, severe allergic reactions after a vaccination
are very rare, but if one were to happen,
be ready to respond to it:
• If an allergic reaction occurs, it will usually
happen within a few minutes to a few
hours after the vaccination.
• Signs of a severe allergic reaction can
include difficulty breathing, dizziness,
swelling of the throat, hives, fast heart
beat, hoarseness or wheezing.
• If your child shows these signs, call 9-1-1 or get him to the nearest
hospital right away.
• Be ready to tell the doctor when the reaction occurred, what vaccinations
were given, and when.
In the unlikely event that your child does have any serious reaction to a
vaccination, there are two programs you should know about afterward:
VAERS. The Vaccine Adverse Event Reporting System is a sys
tem for reporting possible vaccine side effects. If your child has an
unusual medical condition after getting a vaccine, even if you don’t
know whether it was caused by the vaccine, you should report it to
VAERS. One of the jobs of VAERS is to collect these reports and use
the data to help determine whether specific medical problems might
be caused by vaccines.
provider will usually file a VAERS report for you. However, you
can also file it yourself. For more information, visit the VAERS website
Vaccine Injury Compensation Program. If you believe your child
was seriously injured by a vaccine, there is a no-fault federal program
that can help compensate you for his care. To learn more about the
Vaccine Injury Compensation Program, visit their website at www.
Most parents will never need these programs, but they are there if
you do.
Part Two The Immunization Office Visit 19
Part One VaccPinaer-tP rTehvernetea bMleo rDei sAebaosuets Vaancdc iCnheisl
d hood Vaccines
Part Three More About Vaccines
Part 3: More About Vaccines
How Vaccines Work
Immunity from Disease
When disease germs enter your body, your immune system goes to work.
It does three important things:
1. It recognizes the disease germs as not belonging in your body – as
being “foreign invaders.”
2. It responds by producing proteins called antibodies, which help
destroy these germs. Unfortunately, these antibodies can’t act
quickly enough to stop you from getting sick. But by eliminating
the germs, they help you get well.
3. It remembers the germs that made you sick, and if they ever try
to infect you again – even after many years – your immune system
will come to your defense again. But now they are able to stop the
invading germs before they can make you sick. This is immunity.
It is what keeps you from getting sick from diseases like measles or
chickenpox a second time, no matter how often you are exposed to
In other words, the first time you are exposed to a disease, your immune
system won’t stop you from getting sick, but it will help you recover and
make you immune to that disease if you are ever exposed to it again.
Immunity from Vaccines
With vaccination, killed or weakened disease germs are intentionally
introduced into the body, usually by injection. Then your immune system
goes to work, just as if you were exposed to a disease:
1. It recognizes the vaccine germs as not belonging in your body – as
being “foreign invaders.”
2. It responds by producing antibodies, the same as if you had been
exposed to the disease. But there is a difference. The germs in
the vaccine are weakened or killed, so they won’t make you
3. However, you will still develop immunity, just as if you had gotten
sick from the actual disease. So if germs from that disease ever do
try to infect you, your immune system will come to your defense and
stop them from making you sick.
In other words, getting a disease or getting a vaccine can both give you
future protection from that disease. The difference is that with the disease
you have to get sick to get that protection. With the vaccine you don’t.
How Safe Are Vaccines?
This is a question that naturally worries any new parent. No matter how
good vaccines are at preventing disease, no matter how much they have
reduced diseases over the years, no matter how many lives they have
saved, what if they can actually harm your baby?
Vaccine safety is a complex issue, and some specific questions will be
addressed in Part 4 (Frequently Asked Questions) of this booklet. In the
meantime, here are some basics:
Can vaccines harm my child? Any medicine can cause a reaction, even
aspirin. Vaccines are no exception.
Will vaccines harm my child? Probably not. Many children never have
a reaction to a vaccine. For those who do, most reactions will be minor . . .
a sore leg, a slight rash, or a mild fever that goes away in a day or two.
Some children have more serious reactions like a high fever, chills, fussiness,
or muscle aches. One of the scariest of these reactions is called a
febrile seizure. This is a seizure, or convulsion, caused by a high fever.
During a febrile seizure a child might shake uncontrollably, become
unresponsive, or even lose consciousness. About one child in 25 will
Part Three More About Vaccines
have at least one febrile seizure, usually between 6 months and 3 years of
age. Any high fever, regardless of the cause, can trigger a febrile seizure,
including a fever associated with a vaccination. Febrile seizures look seri
ous, but fortunately they almost never are. Children recover with no last
ing effects. You can learn more about febrile seizures at
Rarely, a child will have a truly serious reaction, like encephalopathy
(brain infection) or a severe allergic reaction. These are the scary possibilities
that make some parents think that it might actually be better not
to vaccinate their children.
Would it?
First, serious reactions are extremely rare. One of the most serious
– a life-threatening allergic reaction to a substance in a vaccine – occurs
only about once in every million vaccine doses.
There are about a million words in the 7-volume series of Harry
Potter books. If we let each of those words represent a dose of
vaccine, then one word, somewhere within the 7 books’ 4,224
pages, would represent the risk of a severe allergic reaction.
Second, sometimes it is hard to tell if a reaction was even caused by
a vaccine. Any serious reaction that could be caused by a vaccine could
also be caused by something else. There is no such thing as a serious
health problem that is caused only by vaccines. For something that affects
only one child in a hundred thousand or a million, it can be very hard to
isolate the cause.
Example: Sudden Infant Death Syndrome (SIDS) is the unexplained,
sudden death of an infant, usually while sleeping. The
causes of SIDS have always been uncertain, and for a time, some
people blamed DTP* vaccine. As evidence, they pointed to the
fact that SIDS deaths often seemed to occur within several days
after a child received a dose of DTP vaccine.
But SIDS, by definition, occurs at the same ages when millions
of babies were getting multiple doses of DTP – so it would have
been remarkable if SIDS didn’t occasionally strike right after
the shot. Studies were conducted to test this theory, and it was
found that babies who had been vaccinated with DTP were no
more likely to get SIDS than babies who weren’t vaccinated –
in other words, there was no association. Since then, we have
learned that precautions such as putting babies to sleep on
their backs and not smoking around them can dramatically
reduce the risk of SIDS. (For more information about SIDS, see
the American SIDS Institute webpage at
*DTP is an older version of DTaP.
Third, it isn’t just risks – it’s also benefits. True, there is a risk that a
dose of vaccine could cause discomfort and other side effects, and a very
small risk that it could cause a serious problem.
What do you get for taking that small risk?
Most importantly, your baby will be protected from more than a dozen
potentially serious diseases. (At this point you might be asking how
likely your child is to actually be exposed to one of these diseases if she
isn’t vaccinated? For a discussion of this question, see Part 4 [Frequently
Asked Questions].)
Meet Riley
In most ways, Riley is a typical 8-year-old girl. She takes piano and gymnastics lessons, plays soccer, likes to swim, and gets into fights with her brothers.
But Riley has something most 8-year olds don’t – another child’s heart. She was born with a serious heart defect and had to get a transplant within days of her birth.
Because Riley’s new heart doesn’t really belong to her, her body would reject it if she didn’t take special drugs. These drugs suppress her immune system, and because of this she can’t get live-virus vaccines like measles, mumps, rubella, or chickenpox.
Consequently, Riley is not immune to these diseases. She has to depend on the immunity of people around herfor protection. If one of her schoolmates or playmates were to come down with a case of measles or chickenpox, Riley could easily catch it from them. And because her immune system can’t fight off the infection, it could become very serious if not treated promptly.
Riley enjoys a normal life today, partly thanks to her friends who are protecting her from infections by getting all their shots.
Part Three More About Vaccines 27
Riley’s self-portrait
However, the benefits of vaccinating your child also extend to other children.
As mentioned earlier, a small percentage of children fail to develop
immunity from vaccines. There are also children who can’t get certain
vaccines for medical or other reasons, and babies who are too young to be
vaccinated. These children rely on the immunity of people around them
to protect them from infectious diseases. The more children in a community
who are vaccinated, the harder it is for a disease to spread.
And finally, getting vaccinated today will help protect future generations
of children.
Smallpox was one of the deadliest diseases the world has ever known,
killing 300 million people in the 20th century alone. But as millions of
children and adults got vaccinated over the years, the disease began to
disappear until finally, in October 1977, only one person on Earth had
smallpox. When he recovered, smallpox was gone, and it will never kill
another baby.
In the United States where disease rates are very low, your child’s risk of
getting one of these diseases may also be very low. Does that mean vaccination
isn’t important? What would happen if everyone stopped getting
vaccinated? We know what would happen because it has happened in
other countries.
Example: In the mid-1970s, about 80% of Japanese children
were vaccinated against pertussis. In 1974, there were only 393
cases of whooping cough in the entire country, and no one died
from it. But then, because of fear about the vaccine’s safety, the
immunization rate dropped to only about 10%. Within 5 years,
the country was in the grip of a whooping cough epidemic that
infected more than 13,000 people and left 41 dead in 1979 alone.
When routine vaccination was resumed, the disease numbers
dropped again.
Part Three More About Vaccines
Even a few cases of a contagious disease in a vulnerable population could
touch off a major outbreak. This is why we still vaccinate against polio,
even though we haven’t seen it in this country for more than 10 years. One
infected traveler from another country could set us back 50 years if our
own population wasn’t protected.
When you get your child vaccinated, you are not just protecting her. You
are also protecting her friends and schoolmates and their families, and
her children, grandchildren, and future generations.
Part One VPaaccritn eF-oPurerv eFnretaqbuleen Dtliys eAasskeesd a nQdu eCshtilodnhso
od Vaccines
Part Four Frequently Asked Questions
Part 4: Frequently Asked Questions
How do we know vaccines aren’t causing long-term
health problems?
Observing vaccinated children for many years to look for long-term
health conditions would not be practical, and withholding an effective
vaccine from children while long-term studies are being done wouldn’t be
ethical. A more practical approach is to look at health conditions themselves
and at the factors that cause them. Scientists are already working to
identify risk factors that can lead to conditions like cancer, stroke, heart
disease, and autoimmune diseases such as lupus or rheumatoid arthri
tis. Thousands of studies have already been done looking at hundreds of
potential risk factors. If immunizations were identified as a risk factor in
any of these studies, we would know about it. So far, they have not.
learn about a vaccine’s safety during clinical trials before it is licensed,
and monitor it continually as millions of doses are administered after it is
licensed. We also know there is not a plausible biologic reason to believe
vaccines would cause any serious long-term effects. Based on more than
50 years of experience with vaccines, we can say that the likelihood that a
vaccine will cause unanticipated long-term problems is extremely low.
Why do children need so many doses
of certain vaccines?
The reason depends on whether the vaccine is inactivated (killed) or live.
With an inactivated vaccine, each dose contains a fixed amount of disease
antigen (virus or bacteria). Immunity is built in phases, with each dose
boosting immunity to a protective level. Live vaccines are different in that
they contain a small amount of antigen which reproduces and spreads
throughout the body. One dose produces satisfactory immunity in most
children. But a second dose is recommended, because not all children
respond to the first one.
Aren’t some of the ingredients in vaccines toxic?
Some vaccine ingredients could be toxic, but at much higher doses. Any
substance – even water – can be toxic given a large enough dose. But at
a very low dose, even a highly toxic substance can be safe. For example,
many adults have one of the most toxic substances known to humanity,
Botox, injected into their face to reduce wrinkles.
We aren’t always aware of it, but we are exposed to small amounts of these
same “toxic” substances every day:
Mercury: Babies are exposed to mercury in milk, including breast milk.
Seafood also contains mercury.
Formaldehyde: Formaldehyde is in automobile exhaust; in household
products and furnishings such as carpets, upholstery, cosmetics, paint,
Part Four Frequently Asked Questions
and felt-tip markers; and in health products such as antihistamines,
cough drops, and mouthwash.
Aluminum: The average person takes in an estimated 30 to 50 mg of aluminum
every day, mainly from foods, drinking water, and medicines. Not
all vaccines contain aluminum, but those that do typically contain about
.125 mg to .625 mg per dose, or roughly 1% of that daily average.
Components of vaccines are all there for a reason. Some (like aluminum)
help the vaccine work better. Others (like formaldehyde) were used during
manufacturing and have been removed except for a tiny trace.
One final word – you can’t believe everything you read about harmful
ingredients in vaccines. For example, no vaccine contains, or has ever
contained, even a molecule of antifreeze, although you would never know
that after reading any of a dozen websites claiming that they do.
Can a child get a disease even after being vaccinated?
It isn’t very common, but it can happen. Depending on the vaccine, about
1% to 5% of children who are vaccinated fail to develop immunity. If these
children are exposed to that disease, they could get sick. Sometimes giv
ing an additional vaccine dose will stimulate an immune response in a
child who didn’t respond to 1 dose. For example, a single dose of measles
vaccine protects about 95% of children, but after 2 doses, almost 100% are
a child is exposed to a disease just prior to being vaccinated,
and gets sick before the vaccine has had time to work. Sometimes a child
gets sick with something that is similar to a disease they have been vacci
nated against. This often happens with flu. Many viruses cause symptoms
that look like flu, and people even call some of them flu, even though
they are really something else. Flu vaccine doesn’t create immunity to
these viruses.
Can a child actually get the disease from a vaccine?
Almost never. With an inactivated (killed) vaccine, it isn’t possible. Dead
viruses or bacteria can’t cause disease. With live vaccines, some children
get what appears to be a mild case of disease (for example, what looks like
a measles or chickenpox rash, but with only a few spots). This isn’t harm
ful, and can actually show that the vaccine is working. A vaccine causing
full-blown disease would be extremely unlikely. One exception was the
live oral polio vaccine, which could very rarely mutate and actually cause
a case of polio. This was a rare, but tragic, side effect of this otherwise ef
fective vaccine. Oral polio vaccine is no longer used in the U.S.
that rates of vaccine-preventable diseases
are very low, my child is unlikely to get one of these
diseases. Therefore, isn’t the benefit of vaccination
also very low?
That’s a reasonable question. Statistically, the chances of any particular
child getting measles, pertussis, or another vaccine-preventable disease
might be low.
But you don’t wear a seatbelt because you expect to be in a serious acci
dent; you wear it because you want to be protected in the unlikely event
that you are. If you’re never in an accident, the benefit of wearing a seat
belt might be zero. But if you are, the consequences of not wearing it can
be very high.
the same with vaccines. Your child might never need the protection
they offer, but you don’t want him to be lacking that protection if he ever
does need it.
Why does the government require children to be
vaccinated to attend school?
School immunization laws are not imposed by the federal government,
but by the individual states. But that doesn’t answer the question, which
is often asked by people who see this as a violation of their individual
Part Four Frequently Asked Questions
Public health programs, such as immunization, are designed to protect
the health of the public – that is, everybody. Remember that vaccines pro
tect not only the person being vaccinated, but also people around them.
Immunization laws exist not only to protect individual children, but to
protect all children.
vaccines were not mandatory, fewer people would get their children
vaccinated – they would forget; they would put it off; they would feel
they couldn’t afford it; they wouldn’t have time. This would lead to levels
of immunity dropping below what are needed for herd immunity (see
Glossary), which would, in turn, lead to outbreaks of disease.
So mandatory vaccination might not be a perfect solution, but it is a
practical solution to a difficult problem. School immunization laws are
like traffic laws. Laws forbidding us to drive as fast as we want on crowded
streets or ignore traffic signals could also be seen as an infringement on
individual rights. However, these laws are not so much to prevent driv
ers from harming themselves, which you could argue is their right, but to
prevent them from harming other people, which is not.
children be exempted from school
immunization laws?
Under certain circumstances, yes. All states allow medical exemptions,
so children who cannot safely receive certain vaccines (like Riley – see
page 27) are not required to get them. Most states also allow religious
exemptions for children whose religion prohibits vaccination. Finally,
some states allow philosophic exemptions for people who oppose vac
cination on non-religious grounds. To protect themselves and others,
unvaccinated students may be prohibited from attending classes if there
is an outbreak of a vaccine-preventable disease at their school or in their
Vaccines are expensive. Is there a way to reduce
the cost?
You can go to a public clinic or health department rather than to a private
physician. Vaccinations are generally cheaper there, and may be free
except for an administration charge.
There is also a national program called Vaccines for Children (or VFC),
which allows qualified families to get free vaccinations for their children
at participating doctors’ offices. You can learn more about the VFC pro
gram at
Can’t so many vaccines overwhelm a child’s
immune system?
We may not know exactly how many germs a baby’s immune system can
handle at one time, but it is considerably more than they will ever get
from vaccines. After all, this is the immune system’s job. From the day a
baby is born, her immune system has to deal with the thousands of germs
she is exposed to as part of daily life. As one doctor put it, “Worrying
about too many vaccines is like worrying about a thimble of water getting
you wet when you are swimming in an ocean.”
Isn’t vaccination “unnatural?”
No. Your child’s immune system produces immunity following vaccina
tion the same as it would following “natural” infection with a disease.
The difference is that the child doesn’t have to get sick first. (See “How
Vaccines Work” on page 23.)
Part Four Frequently Asked Questions 39
PaPrat rFti vOen Seu Vmamccianrey- Porfe Cvehniltdabhloeo Ddi sVeaacsceisn aen-dP Crehvilednhtoaobdl eV aDcicsineaess es
Disease Caused by Spread by
Chickenpox Varicella Zoster virus Air, direct contact
Diphtheria Corynebacterium
diphtheriae bacteria
Air, direct contact
Hib Disease Haemophilus influenzae
type b bacteria
Air, direct contact
Hepatitis A Hepatitis A virus Personal contact.
Contaminated food
or water.
Hepatitis B Hepatitis B virus Contact with blood or
body fluids
Influenza (Flu) Influenza virus Air, direct contact
Measles Measles virus Air, direct contact
Mumps Mumps virus Air, direct contact
Pertussis (whooping
Bordetella pertussis
Air, direct contact
Polio Poliomyelitis virus Through the mouth
Pneumococcal Disease Streptococcus
pneumoniae bacteria
Air, direct contact
Rotavirus Rotavirus virus Through the mouth
Rubella (German
Rubella virus Air, direct contact
Tetanus (lockjaw) Clostridium tetani
Exposure through
cuts in skin
Part Five Summary of Childhood Vaccine-Preventable Diseases
Signs & Symptoms Complications
Rash, fever Bacterial infections, meningitis,
encephalitis, pneumonia, death.
Sore throat, mild fever, membrane
in throat, swollen neck
Heart failure, paralysis,
pneumonia, death.
May be no symptoms unless
bacteria enter blood.
Meningitis, epiglotittis, pneumonia,
arthritis, death.
Fever, stomach pain, loss of
appetite, fatigue, vomiting,
jaundice, dark urine.
Liver failure, death.
Fever, headache, malaise, vomiting,
Chronic infection, cirrhosis, liver
failure, liver cancer, death.
Fever, muscle pain, sore throat,
Pneumonia, Reye syndrome,
myocarditis, death.
Rash, fever, cough, runny nose,
Pneumonia, ear infections,
encephalitis, seizures, death.
Swollen salivary glands, fever,
headache, malaise, muscle pain.
Meningitis, encephalitis,
inflammation of testicles or
ovaries, deafness.
Severe cough, runny nose, fever. Pneumonia, seizures, brain
disorders, ear infection, death.
May be no symptoms, sore throat,
fever, nausea.
Paralysis, death.
Pneumonia (fever, chills, cough,
chest pain).
Bacteremia (blood infection),
meningitis, death.
Diarrhea, fever, vomiting Severe diarrhea, dehydration,
electrolyte imbalance, kidney and
liver disease, death
Rash, fever, lymphadenopathy,
Encephalitis, arthritis/arthralgia,
hemorrhage, orchitis.
Stiffness in neck, difficulty
swallowing, rigid abdominal
muscles, muscle spasms, fever,
sweating, elevated blood pressure.
Broken bones, breathing
difficulty, death.
Adverse Event — A medical problem that occurs after a vaccination, which may or may not have been caused by the vaccine.
Adverse Reaction — A medical problem that occurs after a vaccination when it is assumed that the vaccine is the cause.
Antibody — A protein produced by the immune system that helps identify and destroy foreign substances that enter the body.
Antigen — A substance that causes your immune system to produce antibodies against it. A disease germ, generally a bacterium or virus.
Bacteremia — Presence of bacteria in the blood.
Clinical Trials — Testing the safety and effectiveness of vaccines before they are licensed, during which they are given to increasingly larger groups of volunteer subjects.
Communicable Disease — A disease that can spread from one person to another.
Convulsion — See Seizure.
Encephalitis — Inflammation of the brain.
Encephalopathy — An illness affecting the brain.
Epidemic — A large outbreak of disease (see Outbreak). A worldwide
epidemic is called a pandemic.
Exposure — Contact with germs that cause disease. A person must be both exposed and susceptible to a disease to get sick from it.
Febrile Seizure — A seizure caused by a high fever.
Herd Immunity — Protection from disease in a community, due to a large enough proportion of the population having immunity to prevent the disease from spreading from person to person.
Immunity — Protection from disease. Having antibodies to a disease organism usually gives a person immunity.
Iron Lung — A cylindrical steel chamber that “breathes” for a person
whose muscles that control breathing have been paralyzed. Some
polio patients have been confined to an iron lung for life.
Local Reaction — A reaction that is confined to a small area of the
body. With vaccines, a local reaction usually refers to redness, sore
ness, or swelling where an injection was given. (A reaction that affects
the body as a whole, such as a fever or bacteremia, is called a “system
ic” reaction.)
— Inflammation of the covering of the brain or spinal
Outbreak — An unusually large number of cases of a disease occurring
at the same time and place, involving people who got the disease
from the same source or from each other.
Paralysis — Inability to move the muscles. Paralysis usually occurs
in the arms or legs, but any muscle can become paralyzed, including
those that control breathing.
Schedule (or Vaccination Schedule) — The ages and/or intervals at
which vaccines are recommended.
Seizure — A spell during which muscles may jerk uncontrollably,
or a person stares at nothing. Usually a seizure lasts only a brief time
and doesn’t cause permanent harm. A seizure can have many causes,
including epilepsy or other brain disorders, or a high fever (see Febrile
Seizure). Also called convulsion or fit.
Susceptible — Vulnerable to disease. Someone who has never had a
disease or has never been vaccinated against it is susceptible to that
disease. Opposite of immune.
Toxin — Poison.
Vaccine-Preventable Disease — Any disease for which there is a
Your state health department’s immunization program can answer many questions about immunization in your state. Find your state’s immunization website at
There are man y bo oks and internet sites devoted to vaccination issues. Keep in mind that these reflect a wide range of interpretation of facts, not to mention personal opinions, making it hardfor a parent to know what to believe. Here are a few questions to ask yourself when evaluating a vaccination-related book or website:
CDC Websites:
General vaccine information:
Information about hepatitis:
Information about flu:
International travel information:
Information about vaccine safety:
CDC-INFO. Live professionals are available 8:00 a.m. to 8:00 p.m., Monday through Friday to answer your questions. Call800-232-4636 (800-CDC-INFO).
are the author’s credentials? How well does he or she know the subject?
Does the author cite his or her sources? Are the sources reputable?
Does information from other sources appear to be edited or taken out of context? Are you directed to the original source?
Is personal opinion presented as fact?
What are the author’s apparent motives?
Is the author’s tone reasonable? Does the language seem objective, or overly biased o r manipulative?
Learn More
The following are thanked for submitting their drawings for use
in this publication:
Adriana Toungette, Alejandro Macias, Alex Cordon, Amber Blakely,
Andwon Tyson, Brandon Rosillo, Cynthia Reys, Daniel Orta, Dioner
Gala, Estefany, Evn Marilyn Benson, Gihasel Kahn, Henock, Iyana
Williams, Jocelyn Kopfman, Jonathan Moore, Kyle Smith, Maggie
Desantos, Manuela Rahimic, Marisol Baughman, Melissa Lopez,
Moises, Nataly Leal, Nataneal Nistor, Ramon Perez, Riley Wright,
Sam Toungette, Trent L., Vincent, Gabrielle Kroger, Rylie Jacobs,
Rachel Kroger, Gaby Grossman, and Phoebe Wolfe-Carlin.
Department of Health and Human Services
Centers for Disease Control and Prevention
National Center for Immunization and Respiratory Disease
Live professionals are available to answer your
questions about vaccines and vaccine-preventable diseases.
Call 800-232-4636 (800-CDC-INFO).

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