Immunizations

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Immunizations

SPECIAL REPORT - The Risks Of Vaccines
Currently Outweigh Any Benefits To Human Health

SPECIAL REPORT - Inoculations Are
The True Weapons Of Mass Destruction

* Please note that most treatment modalities listed below are based on conventional medicine. PreventDisease.com does not advocate the use of any pharmaceutical drug treatments or immunizations. Use of vaccines is now widely accepted as detrimental to human health. All information is for your hisorical reference only and readers are strongly encouraged to research the dangers of vaccinations.

WHAT IS IMMUNIZATION?

Immunizations against childhood diseases have saved millions of lives. American vaccination rates are now at an all-time high. Disease and death from diphtheria, pertussis, tetanus, measles, mumps, rubella, and Haemophilus influenzae type b are at or near record lows.

General Guidelines

Routine Childhood Vaccines. Experts recommend that all children be routinely vaccinated against the following diseases:

Measles.
Mumps.
Rubella (German measles).
Diphtheria.
Tetanus.
Pertussis (whooping cough).
Poliomyelitis.
Chicken pox.
Hepatitis B.
Hepatitis A (recommended in selected states and in certain high-risk populations).
Haemophilus influenza type B (a cause of meningitis).
Pneumococcal disease.

Many vaccinations are started in infancy. Even premature infants can, in most cases, be given vaccinations on a normal schedule. There is even some evidence that immunization may offer some slight protection against sudden infant death syndrome.

Common Adult Vaccines. Vaccinations against the following disorders are also recommended routinely for certain adults:

Influenza.
Pneumococcal pneumonia.
Hepatitis A and B.
Tetanus.

Vaccine Forms. Vaccines are currently administered either orally or by injection. Vaccines usually contain one of two agents that will cause the body to produce antibodies, special agents of the immune system designed to attack the target disease:

A live but weakened virus. Live-virus vaccines provide longer immunity than inactivated ones, but they can cause serious infection in people with weakened immune systems and have also been associated with severe medical disorders in rare instances.
Inactivated bacteria, viruses, or toxoids. Inactivated vaccines are safe even in people with impaired immune systems.

The weakened or inactivated agent in the vaccine acts as a sparring partner for the immune system. While fighting this imitator, the antibodies learn to recognize the real agent and attack it when the person becomes exposed to the infection. The antibodies remain in the body, preventing future illnesses of the disease; this is called immunity.

Combination Vaccines. The American Academy of Pediatrics and American Academy of Family Physicians recommend that health-care providers use, whenever possible, combination vaccines instead of individual components. Currently a child must have 20 injections in the first year of life for full recommended immunity. Combination shots containing vaccines for diphtheria, measles and pertussis (DTaP), and for measles, mumps, and rubella (MMR) have been available for years. Researchers are now studying the inclusion of even more vaccines within a single injection. (New combinations that cover up to five vaccinations are being developed.)

There is some concern that increasing use of combinations may reduce the potency of some of the vaccines within other combinations. Some parents are also worried about increased side effects. Studies, to date, however, are reporting that combinations are effective and safe.

Passive Immunity. Another form of protection against disease is called passive immunity. This approach uses immune globulin , which are blood products containing antibodies. Immune globulin is generally used for people who cannot be vaccinated, when immediate protection is required, or to prevent severe complications of the disease. In some circumstances, passive immunity can interfere with active vaccinations, particularly live-virus vaccines, so, if possible, they should not be administered within weeks or even months of each other.

General Information on Side Effects. There have been a number of reports in the popular press about alarming side effects in many vaccines. Anti-vaccine groups have arisen to oppose immunizations in children. No vaccine is 100% safe, but childhood infections have not been wiped out and without immunization, these diseases have in the past killed millions of small children. [ See Box, Adverse Effects and the Anti-Immunization Movement.]

Special Note on Thimerosal

Some people are concerned by reports that vaccines contain thimerosal, a preservative that contains small amounts of mercury. It has been used since the 1930s and is present in many vaccines. There is no evidence that thimerosal has caused any harm other than a delayed allergic response in some children. Nevertheless, people are concerned about possible neurologic injuries from cumulative doses in vaccines given to infants.

Manufacturers are now removing thimerosal from vaccines. The status in the US as of this report is as follows:

The hepatitis B vaccine is now free of thimerosal.
Three of the four Haemophilus influenzae type b have never had thimerosal. Beginning July 2000, the remaining vaccine has been thimerosal-free.
Vaccines are now available for diphtheria, tetanus, and pertussis (DTaP) that are thimerosal-free or contain only trace amounts.
Measles-mumps-rubella, varicella, inactivated polio, and pneumococcal conjugate vaccines have never contained thimerosal.

Vaccination Recommendations during Pregnancy

Inactivated-virus and toxoid vaccines are usually safe in pregnant women, although any vaccination should be delayed, if possible, until the second or third trimester. Because of a possible risk to the fetus, live-virus vaccines should not be given to pregnant women or those likely to become pregnant within three months unless such women need immediate protection against life-threatening diseases, such as yellow fever, that are only prevented using live-virus vaccines. The live-virus MMR combination, which vaccinates against measles, mumps, and rubella, is not given to pregnant women because of the theoretical risk of the live-rubella vaccine on the fetus. [ See also individual discussion of vaccines below.]

Vaccination Recommendations for People with Immune Systems Compromised by Disease or Medications

Live-virus vaccines are not usually given to people with compromised immune systems. They include the following:

Persons who have immune deficiency diseases (such as HIV or AIDS).
Patients with active leukemia or lymphoma.
Patients are taking treatments that suppress the immune system, such as corticosteroids, alkylating drugs, antimetabolites, or radiation. (There are important exceptions, however, which are noted in discussion of individual vaccinations below.) Short-term corticosteroids (given for less than two weeks) do not suppress the immune system and so should not affect any live-virus vaccination. It should be noted that some topical corticosteroids are suppressive, and patients who need vaccinations and who take long-term or high-dose topical steroids should check with their physicians.

In general, vaccines are not completely effective for patients whose immune systems are compromised by disease or medications. Often, such patients are given immune globulin if they are exposed to infection. Experts estimate that it takes three months to a year before a person who has stopped taking immunosuppressant drugs regains the full ability to be successfully immunized against disease.

Helping Small Children Before, During, and After a Shot

Parents might ask if it's all right to give the child a dose of acetaminophen (Tylenol) before or after a shot.

Parents might also ask the physician about EMLA cream, a topical anesthetic that can be applied about an hour before the injection. (Parents should, of course, ask the doctor where the injection is going to be administered.)

Very small infants often accept the first injection easily, since they are not expecting it. It gets more difficult, however, with every succeeding shot. No one should lie and tell an older child that a shot will be painless. Some health providers suggest telling them that it stings a little and to count to five while it is being administered.

Interestingly, a 2001 British study reported that using longer needles rather than smaller ones reduced redness at the injection site by two thirds. Parents may want to ask their physicians about this study.

One study reported very good results with a breathing technique. The child is told to inhale very deeply right before the shot and blow out very hard as the injection is given.

Simply providing love and warmth helps children of all ages accept immunizations.

Giving a little reward immediately after the shot is very helpful. The lollipop or teaspoon of sugar is a time tested and effective soother. (Sugar has actual mild pain relieving properties for infants.)

ADVERSE EFFECTS AND THE ANTI-IMMUNIZATION MOVEMENTS

Of great concern are movements and organizations directed against immunizations. Because vaccinations have been in existence for so long, parents have not had to suffer the consequences of these dreaded infections, which have killed or severely sickened millions of children in the past. Ironically, parental fears have now been directed toward unsubstantiated reports of associations between small numbers of serious problems and some vaccinations. Such cases now outnumber reports of the infections themselves.

Well-conducted studies are ongoing and none to date have confirmed reports any significant association between most vaccines and severe side effects that would outweigh the benefits of these important and life-saving agents. A 2001 study reported that when children are not vaccinated their risk for infection increases significantly. In fact, there is a rise in infections even among immunized children.

No vaccine is 100% safe, however. Allergic and serious reactions are possible. In two cases, the early polio vaccine and the rotavirus vaccine, problems did occur, some serious. It is important to note, however, that even in these cases, the vaccines were withdrawn and the severe events still were far fewer than the lives saved.

Very effective watchdog systems are now in effect to monitor adverse effects from vaccination. One is a government service called VAERS (Vaccine Adverse Event Reporting System) and the other, called VSD (Vaccine Safety Datalink), is analyzing the records of five million patients. VAERS has limitations. It registers all adverse events reported after vaccination, including those not related to the vaccine. It also may record the same case more than once. It is useful for surveillance, but its results can be misleading. VSD will provide more accurate results, but at this time they are not yet available.

WHAT ARE THE VACCINES FOR DIPHTHERIA, TETANUS, AND PERTUSSIS?

Descriptions of Diphtheria, Tetanus, and Pertussis

Diphtheria. Diphtheria is caused by a bacterium, Corynebacterium diphtheriae , which can occur as either a toxic or nontoxic strain. When only the skin is involved, it is known as cutaneous diphtheria, and is likely to be a nontoxic strain. When the toxic strain affects the mucus linings in the body, such as the throat, diphtheria becomes life threatening. In the first quarter of the twentieth century diphtheria infected 200,000 people every year and killed between 5% and 10% of them, mostly the very young and very old. Because of immunizations, only one case was reported in 1999.

Tetanus. Tetanus is a disease marked by severe muscular contractions and convulsions brought on by a powerful toxin secreted by the bacterium, Clostridium tetani. The bacterium is anaerobic; that is, it lives without oxygen. People become infected by this dangerous bacterium through wounds in the skin. Only 513 American cases were reported between 1982 and 1989, nearly all of them in adults. It is fatal in 20% to 40% of cases.

Pertussis. Pertussis (whooping cough) was a very common childhood illness throughout the first half of the century. The disease is very easily spread from one person to another. Although immunizations caused a decline in cases to only 1,700 in 1980, the incidence has risen recently. Nearly half of pertussis cases now occur in people 10 years of age or older, and such cases may be greatly underreported. One study suggested that as many as 25% of adults who see a doctor for persistent cough may actually have pertussis, but it may go undiagnosed because symptoms are usually mild and adults are unlikely to have the classic "whooping" cough. This is of some concern, because such adults may unknowingly infect unvaccinated children. The younger the patient, the higher the risk for severe complications, including pneumonia, seizures, and even death.

Vaccinations for Diphtheria, Tetanus, and Pertussis

The Initial Vaccination. Diphtheria, tetanus, and pertussis are very different disorders, but a combination injection has been routinely given to children since the 1940s. There are two variations of the three vaccines:

The older vaccine (DTP) combines all three vaccines. The pertussis portion contains multiple toxins against different variants of the disease.
The standard vaccine is DTaP. It differs from DTP because uses a form of the pertussis component known as acellular pertussis, which consists of only of a single weakened toxoid. DTaP has fewer and milder side effects than DTP and is now recommended for all children. This is not only beneficial for infants but also for older people, who are more prone to side effects. The milder vaccine will allow such adults to have a pertussis booster. Its long-term effectiveness is still unknown, although an analysis of a number of studies reported that it appears to be beneficial and safer than older vaccines.

Some experts are concerned that DTaP may not be as protective as DTP against a variant pertussis strain known as B. parapertussis , which also causes whooping cough. Nevertheless, a 1999 study indicated that DTaP may actually be more effective against B. parapertussis . More research is needed.

The Booster. Protection against diphtheria and tetanus from the vaccine lasts about 10 years. At that point a booster may be given against tetanus and diphtheria (Td). The Td vaccine contains the standard dose against tetanus and a less potent one against diphtheria and does not contain the pertussis component.

The pertussis component of the vaccination is usually not given to older children and adults because whooping cough is less severe as people get older while the side effects of the vaccine may be more severe. Some experts are considering recommending continuing immunization against whooping cough in all older people who might become reinfected and therefore threaten unvaccinated children. The new acellular pertussis vaccine may make such adult boosters feasible although its effectiveness must still be determined.

DTaP Schedule in Childhood. The DTaP vaccine should be given to all children less than seven years old. In general, the vaccinations are given as follows:

Infants receive a series of three vaccinations at two, four, and six months of age. (Physicians may delay a vaccination in infants with suspected neurologic problems until their neurologic situation is clarified, but no later than their first birthday). Children with neurologic problems that have been corrected can be vaccinated.
A fourth dose is given some time between ages 15 and 18 months. (Infants at higher risk, such as those exposed to an outbreak of pertussis, may be given these vaccinations earlier.)
A fifth dose is then given at four to six years. This fifth shot now usually includes a vaccine against Haemophilus influenzae as well. [ See What Are the Vaccines for Haemophilus Type B? , below.]
Children between the ages of eleven and fifteen years old should receive a tetanus and diphtheria (Td) booster shot.

Parents should not be unduly concerned if the interval between shots is longer than that recommended. The immunity from any previous vaccinations persists, and the physician does not have to start a new series from scratch. If a child has a moderate or severe current or recent fever-related illness, vaccinations should be postponed until after recovery. Colds or other mild respiratory infections are no cause for delay.

DTP Schedule in Adulthood. Recommendations for adults are as follows:

All vaccinated adults should have a Td booster at least every ten years throughout their lifetimes.

Adults who did not receive the primary childhood vaccinations should have a series of three Td vaccinations. The first two doses should be given at least a month apart and the third dose given six to 12 months after the second.
Unvaccinated pregnant women should receive two doses of Td, properly spaced, and previously vaccinated women should have a booster.

Preventing Tetanus in Individuals with Wounds. A patient who requires medical care for any wound is a candidate for tetanus immunity. Some considerations for tetanus vaccinations are as follows:

Wounds that put patients at highest risks are puncture wounds or wounds contaminated with dirt, feces, or saliva.
A booster is needed if the last shot was five or more years before the injury.
Children under seven are usually given DTP if they are not fully vaccinated.
Most individuals are given the Td vaccination if they have been vaccinated.
Older patients who had experienced an allergic response to a previous tetanus booster may be given the tetanus immune globulin (TIG).

Side Effects of Diphtheria-Tetanus-Pertussis Vaccines

Allergic Reactions. In rare cases, people may be allergic to the DTP vaccine. Parents should tell their doctor if their children have any allergies. The DTaP vaccine may pose a slightly higher risk for an allergic reaction than the DTP. Children who have severe responses should not be given further vaccinations. A rash that occurs after a dose of DTP is of little consequence. In fact, it does not usually indicate an allergic response but only a temporary immune reaction and does not usually recur with subsequent shots. It should be noted that no deaths have been reported from allergic reactions, even severe (anaphylactic) ones, to the DTP vaccine. [ See Box , Symptoms of Severe Reactions to Vaccinations.]

Pain and Swelling at the Injection Site. Children may feel pain at the injection site. In some cases, a small lump may persist at the site for several weeks. Placing a clean, cool washcloth over any swollen, hot, or red area can help. Children should not be covered or wrapped tightly in clothes or blankets.

The risk for swelling, including of the whole arm or leg, increases with subsequent injections, particularly the fourth and fifth doses. If possible, parents should request that their children receive the same vaccine brand each time to help reduce the risk of side effects.

Fever and Other Symptoms. A child may develop a mild fever, irritability, drowsiness, and loss of appetite after a DTP shot.

The following remedies may be helpful:

Acetaminophen (Children's Tylenol and other brands) and a sponge bath in lukewarm, not cold, water may help relieve fever and pain.
The physician may suggest that children who have had previous high fevers or other reactions to the DTP shot be given acetaminophen at the time of the vaccination and every four hours afterward for 24 hours. (The doctor will determine the dosage according to the weight of the child.)
Children should never be given aspirin.

Fevers that should cause notice are the following:

A very high fever in children (over 105 degrees may cause convulsions and should be reported immediately to the physician. Although frightening, such fever-related seizures rarely have any long-term effect, and a recurrence after a subsequent vaccination is very unlikely. [ See Box , Symptoms of Severe Reactions.]
A new fever that develops 24 hours after the vaccination or a fever that persists for longer than 24 hours is most likely due to other causes.

Hypotonic-Hyporesponsive Episode (HHE). HHE is an uncommon response to the pertussis component and occurs within 48 hours of the injection in children under two. The child usually starts out feverish and irritable and then becomes pale, limp, and unresponsive. Breathing is shallow and the child's skin may turn bluish. The reaction lasts an average of six hours and, although it is frightening, virtually all children return to normal.

Neurologic Effects in Pertussis Component. Children with known neurologic abnormalities may be at risk for an outbreak of symptoms two or three days after the vaccination. Such a temporary worsening of their disease rarely poses a danger to the child. Of concern have been a few reports of permanent neurologic abnormalities, including brain damage (encephalopathy) and even death, that occurred following DTP vaccinations in children without existing neurologic disorders.

It is well known that the diphtheria and tetanus components have no adverse neurologic effects, so some people suspect the pertussis component. Three major studies, however, have failed to confirm a causal relationship between neurologic problems and the pertussis vaccination. One study that did find an association in a few children suggested that high fevers may have been responsible in most of those cases. Some experts suggest that children who have neurologic events following their DTP shot may already have a preexisting impairment, such as epilepsy or abnormal brain development, which is revealed, but not caused, by the vaccine. In summary, there is no proof to date that the pertussis vaccine caused these neurologic events, which, in any case, are so infrequent as to be nearly unmeasurable.

Other claims that DTP may be responsible for spinal column abnormalities or long-term neurologic disorders, such as attention deficit disorder, learning disorders, or autism, have no scientific basis. In fact, one study indicated that children who received pertussis vaccine had fewer problems in school than those who were not vaccinated, regardless of family income levels.

Studies on the newer DTaP have reported no safety concerns to date. Unwarranted fears of side effects from vaccinations can be dangerous. In England such fears caused a drop of 30% in immunization rates during the 1970s. Two outbreaks of whooping cough occurred as a result, causing 30 deaths and brain damage in many of the infected children.

Other Serious Conditions Attributed to DTP. Several large studies have found no association between DTP and either SIDS or any other unexpected deaths in infants. There is also no proof that DTP causes anemia or other blood disorders.

Symptoms of Severe Reactions to Vaccinations

Call the doctor immediately if a child has any of the following symptoms .

Extremely High Fever. A rectal temperature of 105°F or higher. (Temperatures taken under the arm or by mouth often register lower than actual temperatures.)
Inconsolable Crying. The child has been crying for over 3 hours without stopping or has a cry that isn't normal, such as being high-pitched.
Convulsions. The child's body starts shaking, twitching, or jerking. This is usually in response to a high fever. Place the child face down with the head to one side, protecting the head from hitting anything hard. Be sure the child can breathe freely. Seizures caused by fevers usually last less than 15 minutes.
Shock. The child collapses, turns pale and unresponsive.
Severe Allergic (Anaphylactic) Reaction. Swelling in the mouth and throat, wheezing and breathing difficulties, dizziness. The child collapses or is pale and limp.

Call the doctor if the following symptoms persist for more than 24 hours:

The injection site is still red and tender.
Fever does not go down.
The child is still fussy.

WHAT ARE THE VACCINES FOR MEASLES, MUMPS, AND RUBELLA?

Description of Measles, Mumps, and Rubella

Measles. Measles used to be a very common childhood disease and is usually self-limited. In severe cases, however, measles can cause pneumonia and, in about 1 out of 1000 cases it can lead to encephalitis (inflammation in the brain) or death. The risk for these severe complications is highest in the very young and very old. In pregnant women, measles increases the rates for miscarriage and low birth weight and birth defects in their infants.

Aggressive vaccination programs have reduced the incidence of measles in the US to 100 cases in 1999. About one third were imported from other countries. Full-blown measles cases among unvaccinated children still remains a serious international problem, with 42 million cases and over one million deaths in small children each year.

Mumps. In about 15% of cases, mumps affects the lining of the brain and spinal cord, although this is usually not ultimately harmful. Swelling of the testicles occurs in between 20% and 30% of males who have reached puberty, although sterility is rare. Deafness in one ear occurs in one patient out of 20,000 with mumps.

Rubella (German Measles). When rubella, commonly known as German measles, infects children or adults, it causes a mild illness that includes a rash, enlarged lymph nodes, and sometimes a fever. If a pregnant woman is infected during her first trimester, however, her baby has a 80% chance for developing birth defects, including heart abnormalities, cataracts, mental retardation, and deafness. Before the vaccine became available, about 56,000 cases of rubella occurred annually. Vaccination programs have dramatically reduced the incidence, but between 6% and 11% of adults are still susceptible.

Vaccines for Measles, Mumps, and Rubella

Safe and effective live-virus vaccines for measles, mumps, and rubella have been developed over recent decades. They are usually combined in children as the MMR vaccine. Individual live-virus vaccines or the combined MMR may be given to adults, depending on their risk factors.

Measles-Mumps-Rubella (MMR) Vaccine in Early Childhood. The combined MMR vaccine should be given in two doses:

Between ages 12 and 15 months for the first dose. (Some experts believe that the vaccine may be effective and safe in children younger than 9 months who are in areas of measles outbreaks. It should be noted that there were only 86 reported cases of measles in the US in 1999.)

Between ages four to six years for the second dose. (Children who receive only one dose at 15 months or older have five times the risk of measles compared to those who had two doses.)

Measles-Mumps-Rubella (MMR) Vaccine in Adolescents and Adults. The general recommendations for adult MMR vaccinations are as follows:

Most people born before 1957 have experienced these once-common childhood diseases and don't require vaccination.
All unvaccinated people born after 1956 who did not already have measles and mumps should be given two doses of the live MMR vaccine administered at least one month apart.
Many people received an inactivated-measles-virus vaccine in the early 1960s or an inactivated-mumps-virus vaccine between 1950 and 1978; such people need revaccination with two doses of the live MMR vaccine. (This will cause no harm even if someone had a previous live-virus-mumps vaccination.)
The American Academy of Pediatrics now recommends the live-virus MMR vaccine for HIV-infected children, adolescents, and young adults, except for those who are severely immunocompromised. At this time, however, the vaccine appears to be safe in HIV-infected children, and it should be stressed that measles is very dangerous in this population.

Rubella Vaccinations during Pregnancy. It is particularly important for any unvaccinated nonpregnant woman who wants children to be vaccinated against rubella. Except under very special circumstances, however, no live-virus vaccine, especially MMR, is given to an already pregnant woman, since there is a theoretical risk for birth defects from the rubella vaccine. Fortunately, the risk is low. In fact, studies have reported no increase in birth defects in women who were inadvertently vaccinated for rubella early in their pregnancy.

Side Effects of Live Measles Mumps-Rubella (MMR) Vaccines

Common side effects from the MMR vaccination include fever, rash, and joint pain. Children are more likely to experience such side effects from the second dose (at 10 to 12 years) than from the first (at four to six years).

Fever. About 5% to 15% of people who are vaccinated with any live measles virus vaccine develop a fever of 103 degrees or greater, usually between five and 15 days after the vaccination. It usually lasts one or two days but can persist up to five days. In very young children, seizures can occur from high fever but they are rare and almost never have any long-term effects.

Swollen Glands. The live-mumps vaccine can cause mild swelling in the glands that are situated near the ears.

Joint Pain. Up to 25% of women have joint pain one to three weeks after a vaccination with a live-rubella virus; it lasts for one day to three weeks. Such pain does not usually interrupt daily activities. Rarely, it recurs or becomes persistent.

Allergic Reaction. People who have known anaphylactic allergies (very severe reactions) to eggs or neomycin are at high risk for a severe allergic response to the MMR vaccine. People with allergies that do not cause anaphylactic shock to these substances are not at higher risk for a serious allergic reaction to the vaccine. Mild allergic reactions may occur in some people, including rash and itching. A rash occurs in about 5% of people who are vaccinated with a live-measles vaccine. A live-mumps vaccination has caused rash and itching, but these symptoms are usually mild.

Interaction with Tuberculosis Test. The live-measles vaccine may interfere with a tuberculosis test, so the two should be administered at least four to six weeks apart. No evidence exists that the vaccine has an adverse effect on tuberculosis itself.

Mild Infection. One study suggests that a mild form of measles that has no symptoms may develop in previously immunized people who are exposed to the virus, although this mild infection may not be significant.

Severe Side Effects. Much controversy has arisen over severe side effects of the MMR. This is of great concern since the evidence of any serious problems is very weak and studies refuting them tend to be stronger. It should be noted that in 2000, measles caused about a million deaths in children in countries where the vaccine is not used.

Researchers have confirmed that MMR can cause a rare bleeding disorder called idiopathic thrombocytopenic purpura (ITP). This can cause a purple bruise-like discolorations that can spread across the body, nose bleeds, or tiny red spots. It is nearly always mild and temporary. The risk for this is about one in 22,300 doses. (The risk is much higher with the actual infections, particularly rubella.)
There have been a few reports of encephalitis (inflammation in the brain) associated with the live-measles vaccine, although over incidence of these events are no higher in immunized children than in nonimmunized children (the events being rare in either case).
A small group of European researchers at the Royal Free Inflammatory Bowel Disease Study Group (RFIBDSG) originally suggested that there might be a link between the MMR vaccine and inflammatory bowel disease (IBD) or autism. Such links have been rigorously reviewed and refuted in a number of well-conducted studies. Two studies in 2000 and 2001 reported that although there indeed has been a dramatic upswing in autism, it has no relationship to measles vaccinations. (Autism continued to dramatically increase during the study period, but vaccinations had leveled off.) A 2001 study also found no higher risk for inflammatory bowel disease with the measles component.

WHAT ARE THE VACCINES FOR VARICELLA-ZOSTER VIRUS (CHICKEN POX)?

Description of Varicella-Zoster Virus (Chicken Pox)

Chicken pox (caused by the varicella-zoster virus) is a very common disease and nearly every unvaccinated child becomes infected with it. Most adults are immune to it. The infection rarely causes complications in healthy children, but it is not always harmless. Five out of every 1000 children are hospitalized and in rare cases, it can be fatal. For example, during 1998 alone, four unvaccinated adults and two unvaccinated children died from varicella in Florida. Since all six were good candidates for the vaccine, these deaths could have been prevented.

Chicken pox can be severe in adults and very serious in anyone with a compromised immune system. In addition, in about 20% of adults who have had chicken pox, the varicella virus (which persists after the childhood disease) erupts as a painful and distressing condition called herpes zoster (shingles).

Vaccines for Varicellavirus (Chicken Pox)

A live-virus vaccine (Varivax) produces persistent immunity against chicken pox. Data show that the vaccine can prevent chicken pox or reduce the severity of the illness even if it is used within three days, and possibly up to five days, after exposure to the infection. The vaccine is protects about 85% of children from getting chicken pox, and even if a vaccinated person becomes infected, nearly all cases are mild.

Recommendations for the Vaccine in Children. The vaccine is now recommended for all children between the ages of 18 months and adolescence who have not yet had chicken pox. Immunizations rates are now between 50% and 70%. Some physicians are reluctant to vaccinate children because it is not yet known how long the effects last and if they contract the infection as adults, the consequences are much more severe. In one 2001 study on day care centers, about 60% of the children had been vaccinated. Interestingly, the incidence of chickenpox was much lower than normal in the unvaccinated group. Although good news in the short term, these children then are neither immunized by the vaccination or by chickenpox itself, suggesting that they may be at risk for a more severe case as they age.

Recommendations for the Vaccine in Adults. Some experts suggest that every healthy adult without a known history of chicken pox be vaccinated. In general, however, the following adults should consider vaccinations:

Older people without a history of chicken pox and who are at high risk of exposure or transmission.
People who live or work in environments in which viral transmission is likely.
Nonpregnant women of childbearing age.
Adolescents and adults living in households with children.
International travelers.

As with other live-virus vaccines, the chicken pox vaccine is not recommended for the following:

Pregnant women.
People whose immune systems are compromised by disease or drugs. The vaccine is being studied, however, for its safety in some of these patients, particularly children with cancer or other high-risk conditions. Experts report that it is safe in children with acute lymphoblastic leukemia (ALL), who should receive two doses. Certain children who are HIV positive may be candidates for the vaccine.

At present, most patients who cannot be vaccinated but are exposed to chicken pox are given immune globulin antibodies against varicella virus. This helps prevent complications of the disease if they become infected.

Side Effects of the Varicella (Chicken Pox) Vaccine

Discomfort at the Injection Site. About 20% of vaccine recipients have pain, swelling, or redness at the injection site.
Mild Rash and Risk of Transmission. The vaccine may produce a mild rash within about a month of the vaccination, which has been known to transmit chicken pox to others. Individuals who have recently been vaccinated should avoid close contact with anyone who might be susceptible to severe complications from chicken pox until the risk for a rash has passed.
Severe Side Effects. Between 1995 and 1998 there were about 6,580 adverse effects out of 9.7 million doses. Of those, 263 cases (1 in 33,000 doses) were serious. Such events included seizures, pneumonia, anaphylactic reaction, encephalitis, Stevens-Johnsons syndrome, neuropathy, herpes zoster, and blood abnormalities. There were 14 deaths reported, although many of these were clearly not related to the vaccination. Anecdotal reports have found a higher association of side effects when varicella vaccine is given at the same time as the MMR vaccination (for measles, mumps, and rubella). Because combined vaccinations are being developed, such effects should be closely studied.

Late Vaccine Failure

Months or even years after the vaccination, some people develop a mild infection termed modified varicella-like syndrome (MVLS). In such people, the infection appears to be caused by a wild virus, not a reactivation of the vaccine. It is usually less contagious and has fewer complications than chicken pox in unvaccinated people.

In spite of some concerns, long-term studies are now finding that protection endures. (The apparent long-term protection, however, may be due to a renewed boost in antibodies that might occur if a vaccinated person is exposed to someone with chicken pox. As more and more children get vaccinated and there are fewer cases of chicken pox, the actual protection of the vaccine will become clearer.

WHAT IS THE VACCINE FOR HEPATITIS A?

Description of Hepatitis A

The hepatitis A virus infects up to 200,000 Americans every year and causes symptoms in about 134,000 of them. Almost 30% are children under age 15. Hepatitis A, formerly called infectious hepatitis, is always acute and never becomes chronic. The virus is excreted in feces and transmitted by contaminated food and water. Eating shellfish taken from sewage-contaminated water is a common means of contracting hepatitis A. It can also be acquired by close contact with individuals infected with the virus. It is estimated that 11% to 16% of reported cases occur among children or employees in daycare centers or among their contacts. The hepatitis A virus does not directly kill liver cells, and experts do not yet know how the virus actually injures the liver.

Vaccines for Hepatitis A

Experts now recommend vaccinations for children and adolescents in high-risk states and communities. Others who should be vaccinated include travelers to developing countries, people living in communities where outbreaks occur, people with blood-clotting disorders, sexually active homosexual men, people with chronic liver disease, and health care workers exposed to the virus. The vaccine is very safe and effective, although allergies can occur. It can be given along with immune globulin and other vaccines. Individuals should also receive immune globulin if they are exposed within four weeks of the vaccination.

WHAT ARE THE VACCINES FOR HEPATITIS B?

Description of Hepatitis B

About 350 million people carry hepatitis B worldwide and 65 million people are expected to die from its complications. The average lifetime risk for acquiring the infection in the US is about 5%, although some groups have a much higher risk. In the US, there are about 1 to 1.35 million people with chronic hepatitis B, which poses a risk for cirrhosis and liver cancer. Pregnant women with hepatitis B can transmit the virus to their babies. Even if they are not infected at birth, unvaccinated children of infected mothers run a 60% risk of developing hepatitis B before age five. Each year in the United States, approximately 4,000 people die of HBV-related cirrhosis and 800 of HBV-related liver cancer.

Vaccine for Hepatitis B

Several inactivated virus vaccines, including Recombivax HB, GenHevac B, Hepagene, and Engerix-B, can prevent hepatitis B and are safe, even for infants and children. Vaccination programs are also proving to reduce the risk for liver cancer.

Hepatitis B Vaccine for Early Childhood. Experts now recommend that all infants and children not previously vaccinated be immunized by the time they reach seventh grade. Typical schedules for hepatitis B vaccinations in childhood are as follows:

Infants of mothers infected with HBV should be treated with immune globulin plus the hepatitis vaccine within 12 hours of birth. The second dose should be given at one to two months and the third at six months.
Infants of mothers without evidence of HBV infection are usually scheduled to receive the first dose at one to two months, the second at four months and the third between six and 18 months later. One study reported that such children are still protected if the booster shots are given a year apart after the first dose. (Children in high-risk communities, however, should receive their vaccinations on the shorter schedule.)
When it is not known if a mother is infected or not, the infant should receive the vaccine within 12 hours of birth. The mother's blood should then be tested right away. If she is infected, the infant should receive immune globulin as soon as possible (no later than a week).
Children who are between 11 and 12 and who have not been immunized should receive two or three doses of the vaccine (depending on the brand) given over a few months.

Hepatitis B vaccine protection lasts at least eight to ten years. Booster shots after that may be recommended depending on continuing risk. Because of past thimerosal content, professional organizations had recommended suspending vaccinations in infants with noninfected mothers. [ See Box, Note on Thimerosal.] In September 1999, the thimerosal-free vaccine became available. Unfortunately many hospitals had begun reducing vaccinations and many even failed to vaccinate infants with mothers who carried the infection. Even after the thimerosal-free vaccine became available, a number of hospitals failed to restore universal vaccination of all infants. This is a safe vaccine and parents should be sure their children are immunized.

Hepatitis B Vaccine for Adults. The following adults are at very high risk and should be vaccinated:

Healthcare and public safety workers who may be exposed to blood products. Such individuals have a risk for hepatitis B virus that ranges from 15% to 30%.
People in the same household as HBV infected individuals. (Unvaccinated people who have had intimate exposure to people with HBV may be protected with immune globulin, which is sometimes administered with the vaccine.)
Travelers to developing countries.
Patients who require transfusions and have not been infected with HBV. (Those with blood clotting disorders should have the vaccination administered under the skin not injected in the muscle.)

Other people at risk who would benefit from vaccinations are the following:

Sexually active people with multiple partners.
Patients and workers in mental institutions and morticians.
Patients on hemodialysis. (People on hemodialysis may need larger doses or boosters; they also may need to be revaccinated if blood tests indicate they are losing immunity.)
People who use injected drugs.
Pregnant women at risk for the virus should be vaccinated; there is no evidence that the vaccine is dangerous to the fetus.
People receiving treatments or who have conditions that suppress the immune system may need the vaccination, although its benefits for this group are unclear except for those at high risk, such as people with HIV or spleen abnormalities.

The regimen in adults is typically three doses given over six months. One study reported that older adults would benefit from a fourth dose without incurring serious side effects. People with alcoholism may need high doses.

A small percentage of people do not develop immunity even after a vaccine has been given repeatedly. A more potent vaccine is proving to be effective in of these people; it loses its effect after five years in about a third of those who receive it.

Side Effects of Hepatitis B Vaccine

Soreness. Soreness at the injection site is the most common side effect.

Nerve Inflammation. There have been some reports of nerve inflammation after vaccinations for hepatitis B, and there has been some concern about three small studies associating the vaccine with a nonsignificant increase in multiple sclerosis. A 2001 study of 121,700 nurses reported no association between the vaccine and a risk for multiple sclerosis, and an earlier report on 260,000 Canadian adolescents also found no higher incidence. Because of even a small theoretical risk of nerve damage in infants, some groups oppose the vaccination in children who are not in high-risk groups. It should be strongly stressed that worldwide, 65 million people with chronic hepatitis are expected to die from liver disease and vaccinations are saving lives. For example, in Taiwan, where infection rates are high and infants are at risk for hepatitis B from infected mothers, vaccination programs have significantly reduced the risk for liver cancer. [For more information, see Report #59, Hepatitis.]

WHAT ARE THE VACCINES FOR POLIOMYELITIS?

Description of Poliomyelitis

Poliomyelitis is a disorder caused by a virus and marked by potentially paralyzing nerve-related damage, which can be fatal. Fifty years ago it was a major killer of children. In 1999 there was not one reported case of wild-poliovirus.

Vaccines for Poliovirus

Two poliovirus vaccines have been available in the US: oral poliovirus vaccine (OPV), which is a live-virus vaccine, and inactivated poliovirus vaccine (IPV), which is a killed vaccine that is administered by injection. Both produce immunity in over 95% of people. The live-virus vaccine, however, has been associated with a vaccine-associated paralysis. [See side effects below.] The Centers for Disease Control and Prevention now recommends only the inactivated vaccine for children. The schedule is four doses of IPV at ages 2 months, 4 months, 6 to 18 months, and 4 to 6 years.

Poliovirus Vaccine in Older Children and Adults. The poliovirus vaccine is not usually recommended for people over 18. Exceptions are unvaccinated healthcare workers, laboratory technicians, or others exposed to polioviruses. Travelers to developing countries where outbreaks of poliovirus have been reported should be vaccinated. Adults should also be given the inactivated poliovirus vaccine (IPV).

Side Effects of the Poliomyelitis Vaccines

Allergic Reactions. The inactivated poliovirus vaccine (IPV) contains small amounts of streptomycin and neomycin, so people allergic to these antibiotics can also have an allergic response to this vaccine. Patients should report any allergies to their physician.

Paralysis. Rare cases of paralysis have occurred in people taking the oral live poliovirus vaccine or in those exposed to recipients of this vaccine. It should be stressed the risk is very small, with 8 to 10 cases reported each year out of millions of doses. The newly recommended series that uses only inactivated poliovirus (IPV) vaccine should eliminate even this small risk. A 2001 review of adverse effects on IPV found no pattern of adverse effects that raised any concern.

Contamination by Simian Virus 40. The public has been alarmed by reports of contamination of polio vaccines given between 1955 and 1963 by a virus known as SV40. The virus has been detected in certain rare cancers, including mesotheliomas (a lung cancer normally associated with asbestos exposure), osteosarcomas, and brain tumors. About 98 million people may have been exposed and such cancers are very rare. At least 40 years of observation have raised no red flags that indicate any serious problem. And, on the other hand, polio, once a major killer of children, has nearly been wiped out worldwide.

WHAT IS THE VACCINE FOR PNEUMOCOCCAL PNEUMONIA?

Description of Pneumococcal Pneumonia

The pneumococcal bacterium (also called Streptococcus pneumoniae ) is responsible for many respiratory infections in the upper and lower airways. This bacterium is dangerous for people with serious underlying chronic medical conditions and illnesses and is the leading cause of ear infections and sinusitis in children. Its most serious infection is pneumonia. Community-acquired pneumonia is the most common type and develops outside of the hospital. Each year between two and four million people in the US develop community-acquired pneumonia, and 600,000 people are hospitalized because of it. Although the majority of pneumonias respond well to treatment, the infection can still be a very serious problem. Together with influenza, pneumonia is the sixth leading cause of death in the US and is the leading cause of deaths from infection.

Of particular concern is the increasing prevalence of pneumococcal bacteria that are resistant to many standard antibiotics. This has created a great sense of urgency in the medical community to find effective measures for preventing infection.

Vaccine Description

Pneumococcal vaccines contain material derived from the most common strains of pneumococci bacteria. (There are no living bacteria in the vaccine.) There are two effective vaccines available, one called a 23-valent polysaccharide vaccine for adults and a 7-valent conjugate vaccine (Prevnar or PCV7) for young children. Both vaccines are effective and becoming very important, particularly in light of the increase in antibiotic-resistant bacteria.

Candidates for the Pneumococcal Vaccine

Among age groups, the elderly (who have diminished cough and gag reflexes and faltering immune systems) and infants and young children (who have immature immune systems and narrow airways) are at greatest risk for pneumonia. Young children are at highest risk for invasive diseases caused by the pneumococcal bacteria (meningitis, wide spread infection). In the US the incidence of pneumococcal infections is higher in African-Americans than in Caucasians.

The vaccine is now recommended for the following infants and young children:

All children up to age two. The pneumococcal vaccine (Prevnar or PCV7) has now been added to the Recommended Childhood Immunization Schedule. The pneumococcal vaccine (Prevnar or PCV7) is very effective in children. Studies are suggesting that it prevents common ear infections as well as serious infections, such as pneumonia. In one study, a similar vaccine under investigation protected not only children in day care from serious respiratory infections, but their younger unvaccinated siblings had fewer infections as well.
Children up to age five who are at risk for pneumonia or complications of influenza, such as children with sickle disease, those with immune deficiencies, or children with chronic medical conditions.
Other children age two to five who are higher risk for serious pneumococcal infections should be considered for vaccinations. They include African or Native Americans, children in group child care, socially or economically disadvantaged children, or those who have had frequent or complicated acute middle ear infections within the past year. (In one study, the vaccine reduced the number of ear infections episodes by 6%.)

Many experts now recommend the vaccine for the following older children or adults:

All people over 65 years old. (Anyone vaccinated more than five years previously should be revaccinated.) According to a 2001 survey, over half of older people have now received a pneumococcal vaccination. Older African American and Hispanic adults, however, are far less likely to be vaccinated that older Caucasian people. This is particularly disturbing, since the mortality rates from pneumonia in these minority populations, particularly African Americans, are higher than in Caucasians.
Individuals with immune deficiencies (eg, HIV) or are undergoing treatments to suppress the immune system.
Patients with kidney disease or kidney transplants. Older people who have had transplant operations or those with kidney disease may require a revaccination after six years.
Patients with problems in the spleen.
Alcoholics (especially those with cirrhosis).

Adults with any condition that increases the risk for pneumonia should be vaccinated. Protection lasts for over six years in most people, although the protective value may be lost at a faster rate in elderly people than in younger adults. (Anyone at risk for serious pneumonia should be revaccinated six years after the first dose.)

Typical Immunization Schedule

The recommended schedule of immunization for Prevnar (PCV7) is four doses, given at two, four, six, and 12 to 15 months of age. Infants starting immunization between 7 and 11 months should have three doses. Children starting their vaccinations between 12 and 23 months only need two doses. And those who are over two years old need only one dose.

Side Effects of the Pneumococcal Pneumonia Vaccine

Side effects include pain and redness at the injection site, fever, and joint aches. Children are more likely to have fever within 48 hours if they receive other vaccines at the same time and also after the second dose. Rarely, such local reactions can be severe. Even if a person is mistakenly re-vaccinated before the effects of the first vaccination have worn off, the risk for severe side effects is very low. Allergic reactions are very rare. Because the vaccine is inactive, it is safe for pregnant women and people with immune deficiencies.

WHAT ARE THE VACCINES FOR VIRAL INFLUENZA?

Description of Viral Influenza

Influenza, commonly called the flu, is always caused by a virus. An estimated 20% of Americans contract the flu each year, although the incidence was lower in 2000 than in the previous year. In general, the flu is usually self-limited and not serious. Influenza is responsible, however, for 15% to 30% of the excess number of hospitalizations that occur in winter. About 1% of people who contract the flu end up in the hospital and, on average, 20,000 Americans die every year from complications of influenza.

Complications in High-Risk Groups. Pneumonia is the major serious complication of influenza. It can develop about five days after viral influenza. It is an uncommon outcome in healthy adults, however, and nearly always occurs in susceptible individuals about five days after onset. Such individuals include the following:

The very young. Children under 1 years old have a very high risk, not only for pneumonia but also for other complications, including meningitis and encephalitis (inflammations in central nervous system). The risk declines after age one but is still elevated in children aged three to five. It is often difficult to tell whether pneumonia in small children is related to influenza or caused by respiratory syncytial virus (RSV), the major viral cause of infant pneumonia. Experts estimate that about 25% of severe lung infections are due to influenza.
The very old.
People with compromised immune systems.
People with serious medication conditions, such as heart, lung, or circulation disorders. In fact, the higher than average number of winter deaths in people with heart disease may be due only to the occurrence of influenza during those months.

Pandemics. Every year, influenza strikes millions of people worldwide. Influenza epidemics are most serious when they involve a new strain against which most people are not immune. Such so-called pandemics can infect more than one fourth of the world's population within a three-month period. For example, the Spanish flu in 1918 and 1919 killed 20 million people in the US and Europe and 17 million in India. Although pandemics are still of great concern, there have been major improvements in private and public health since then, including the discovery of antibiotics to treat bacterial complications, new anti-viral agents and vaccines, and intensive world-wide surveillance of outbreaks.

Vaccines for Viral Influenza

Description of Vaccines. Vaccines are designed to recognize foreign agents (called antigens) in the body and to attack them. Vaccines against influenza currently employ inactivated (not live) viruses to produce an immune response that will then attack the active virus. Vaccines are now given by injection in the fall, usually between October and December.

A live but weakened intranasal vaccine has been investigated for some time. It is engineered to grow only in the cooler temperatures of the nasal passages, not in the warmer lungs and lower airways. It is known as a cold-adapted, live, attenuated, trivalent, intranasal influenza vaccine (CAIV-T) and is being developed in the US as FluMist. The vaccine boosts the specific immune factors in the mucous membranes of the nose that fight off the actual viral infections. It is employed using a nasal spray and in one study provided protection against the flu in up to 93% of children. A CAIV-T vaccine has been used for 10 years to immunize children in Russia, where it has reduced hospitalization and respiratory infection rates by 30% to 50%.

Annual Redesign. At this time, vaccines must be redesigned each year to match the current strain. The influenza virus contains two primary molecules (hemagglutinin and neuraminidase) that serve as antigens, targets of the vaccines that used to prevent influenza. Unfortunately, the antigens in these influenza viruses undergo genetic alterations (called antigenic drift ) over time, so they are likely to become resistant to a vaccine that worked in the previous year. Vaccines are then redesigned annually to match the current strain. The two major influenza viruses are called A and B depending on their stability:

Influenza A is a particular problem because it can infect other species, such as pigs or chickens, and undergo major genetic reassortments.
Influenza B viruses tend to be more stable than influenza A viruses, but they too vary.

Candidates for Viral Influenza Vaccines

The current flu vaccines may be slightly less effective in the elderly, the very young, and patients with certain chronic diseases than in healthy young adults. (Even vaccinated patients may still experience some flu symptoms, such as nasal congestion or sore throat.) Even in people with a weaker response, however, the vaccine is usually protective against serious flu complications, particularly pneumonia.

Influenza Vaccine in Children. The following children over six months should be vaccinated against influenza:

Any child with a condition that requires regular medical care.
Any child who has been hospitalized for a serious illness (particularly lung, kidney, diabetes, sickle-cell, or immune deficiencies).
Children who are receiving long-term aspirin therapy should also be immunized against the flu because they are at higher risk for Reye's syndrome, a life-threatening disease, if they get the flu.

Although such high-risk children have considerable risk for hospitalization from influenza, most of these children are not being vaccinated. Studies have been mixed on the effects of the influenza vaccine on children with asthma. Some have even reported worsened symptoms, while others, such as a 2000 study, reported no increased risk in asthmatic children. In fact, there was some indication that the vaccination helped reduce asthma attacks over time. Well-conducted studies are still needed to determine the effects of influenza vaccination on this major patient group.

Influenza Vaccines in Older Children and Adults. Anyone at risk for serious complications from the flu should be vaccinated. The following are examples of adults who may require vaccinations.

All adults over 50 years should receive the annual flu vaccine according to the US Advisory Committee on Immunization Practices (ACIP). Vaccinations are very important for adults with chronic health conditions and those over 65, particularly in nursing homes. According to a national survey, about two thirds of older people received the influenza vaccine in 1998. Older African American and Hispanic adults, however, are far less likely to be vaccinated that older Caucasian people.
Patients with heart disease, lung problems, immune deficiencies, diabetes, kidney disease, or chronic blood disease. In fact, studies in 2000 suggested that benefits of influenza vaccinations for older people may extend to their hearts. One reported a lower risk for cardiac arrest in vaccinated subjects and the other a lower risk for recurrent heart attack in vaccinated heart disease patients.
Health care workers and others who may expose other, high-risk people to the flu.
People with HIV should be vaccinated. Current studies suggest that influenza vaccinations are very effective for these individuals.
People at risk for complications for influenza and who are traveling to the tropics at any time or to the Southern Hemisphere between April and September.
Pregnant women who are at risk for complications of influenza and who will be in their second or third trimester during flu season. (Vaccinations should usually be given after the first trimester. Exceptions may be women who are in their first trimester during flu season and their risk from complications of the flu is higher than any theoretical risk to the baby from the vaccine.

Side Effects of the Influenza Vaccines

Allergic Reaction. Newer vaccines contain very little egg protein, but an allergic reaction still may occur in people with strong allergies to eggs.

Soreness at the Injection Site. Almost a third of people who receive the influenza vaccine develop redness or soreness at the injection site for one or two days afterward.

Flu-like Symptoms. Other side effects include mild fatigue and muscle aches and pains. They tend to occur between six and 12 hours after the vaccination and last up to two days. It should be noted that these symptoms are not influenza itself but an immune response to the virus proteins in the vaccine. Anyone with a fever, however, should not be vaccinated until the ailment has subsided.

Antiviral Agents for Prevention of Influenza

Although they are not vaccines, certain antiviral agents called M2 inhibitors and neuraminidase inhibitor have some preventive properties. (They are typically used to treat influenza.)

M2 inhibitors. Amantadine and rimantadine have been approved for prevention of the influenza A infection. They are effective in about half of individuals. Rimantadine is preferred for prevention during outbreaks of influenza A because it has fewer adverse side effects.
The neuraminidase inhibitors. Zanamivir is administered by inhalation twice daily, and oseltamivir is administered orally twice daily. Both agents help prevent both influenza A and B. To date oseltamivir has been approved for prevention of influenza A and B in people older than 13 years old. In one community study, zanamivir protected 30% and oseltamivir 50% of the population for contracting influenza. Protection rates have been even higher in families and nursing home patients exposed to the flu.

To date both M2 inhibitors and oseltamivir have been approved for prevention of influenza. Potentially these agents could be used for prevention in the following cases:

In combination with the flu vaccine during seasons where there is a poor match between the virus and vaccine.
During two-week periods after a vaccination when antibodies are developing and the individual is still vulnerable to the virus.
As supplementary protection for vaccinated people in high-risk groups, such as the elderly or people with compromised immune systems.
In people who cannot have vaccinations for whatever reason.

For people who prefer an antiviral agent to a vaccine.

WHAT ARE THE VACCINES FOR HAEMOPHILUS TYPE B?

Description of Haemophilus Influenzae Type B

Haemophilus influenza is a bacterium, which, despite its name, is entirely different from the viruses that cause influenza. [ See above. ] Before vaccination, Haemophilus influenzae type B was the most common cause of childhood bacterial meningitis, killing 600 American children every year and leaving others deaf, mentally retarded, or epileptic. It is rarely troublesome for adults, although it can be dangerous for anyone with chronic lung disease and those susceptible to infections.

Vaccine for Haemophilus Influenzae Type B

Three equally effective inactivated bacterial vaccines are available for Haemophilus influenzae type B (called Hib vaccines). All children under five should be vaccinated against Haemophilus influenzae . The vaccine is administered as an injection at two and four months. Depending on the vaccination preparation, a third in the series is administered at six months. A booster is required at some time between 12 and 15 months of age. In children older than 15 and 18 months, the Hib and DTaP vaccines are being combined in a single injection. Experts warn, however, that some physicians are administering this combined vaccine to infants six months and younger, which may reduce the effectiveness of the Hib component in such small children.

The Hib vaccine may also benefit older people who have had splenectomies or illnesses that put them at risk for pneumonia, including sickle cell disease, leukemia, and HIV infection.

Side Effects of Haemophilus Influenzae Type B Vaccine

Side effects of the Hib vaccine include redness and pain at the injection site, moderate fever, and, in rare cases, weakness, nausea, and dizziness.

Less Common Vaccinations

Disease	Who Should be Vaccinated	Side Effects and Comments
Rotavirus	Rotavirus is the most common cause of diarrhea, cramps, and vomiting in infants, and affects about 3.5 million children in the US each year. As many as 80% of small children become infected with the virus. Although most cases in this country are mild, more than 50,000 American children are hospitalized and as many as 125 die from severe diarrhea every year. Worldwide the virus can be devastating, causing up to one million infant deaths annually. There is also some strong evidence that the virus may lead to childhood diabetes.	An oral vaccine (Rotashield) has been withdrawn after reports of a severe and even life-threatening condition called intussusception following use of the vaccine. Intussusception occurs when the bowel slips inside itself like a telescope and obstructs the intestine. The risk was very small and occurred within a week or two of the vaccination. Any child who previously had the vaccination no longer incurs any increased risk. Preliminary reports suggest that newer rotavirus vaccines may be highly effective in preventing infection among infants, although more research is needed to confirm these findings and to determine its safety record in a large number of children. The association between diabetes and the virus itself raises some alarm that the vaccine may also increase the risk in children who are genetically susceptible to diabetes type 1. Nevertheless, because this is a deadly virus for many children worldwide, international groups believe that the few cases of intussusception does not warrant withdrawing its use at least for countries where the infection is so common and deadly.
Rabies	Anyone should be given the rabies vaccine who is exposed to secretions of an animal suspected of having rabies or to bats, whether or not there are indications of rabies. Exposed individuals should also receive immune globulin unless they were previously vaccinated. Veterinarians and animal handlers should be vaccinated. This does not eliminate the need for treatment if they are exposed to rabies, but it reduces the intensity of the treatment.	Pain, redness, and swelling at the injection site. Headache, nausea, stomach pain, muscle aches, and dizziness. Allergic response, which can occur after the first shot and as long as 21 days after a booster shot. Rare cases of neurologic disorders that cause pain and paralysis in the legs and arms, which clear up in about 12 weeks.
Plague	Veterinarians and assistants in the western US or anyone who works with potentially plague-infected animals; travelers to developing countries where outbreaks have occurred.	Not wholly protective; may only lessen severity of the disease. Preventive antibiotics needed for anyone exposed. Side effects include headache, malaise, fever, swollen lymph nodes. Occasionally, non-infected abscesses. Allergic reaction, particularly in those sensitive to beef, soy, milk, and phenol.
Anthrax	People who work with imported animal hides, furs, bone meal, wool, animal hair (especially goat hair), and bristles.
Yellow Fever	Travelers to developing countries where outbreaks have occurred, currently parts of Africa and Central and South America.	Anaphylactic reactions in those allergic to eggs. Lower immunity when given with cholera vaccine, the vaccines should be given three weeks apart.
Cholera	Travelers to developing countries where outbreaks have occurred.	Anaphylactic reactions in those allergic to eggs. Pain and swelling at injection site. Fever, malaise, and headache. Lower immunity when given with yellow fever vaccine. In general, the vaccine is only 50% protective. Vaccination of dubious benefit.
Typhoid	Travelers to developing countries where outbreaks have occurred.	Oral vaccine using weakened bacteria is preferred to older injected inactivated vaccine. Side effects of oral vaccine (uncommon): nausea, cramps, rash, or hives. Side effects of inactivated vaccine: irritation at the injection site. Oral vaccines do not protect young children or those with impaired immune systems. A new vaccine (Vi-rEPA) is proving to be safe and effective for children two to four.
Tuberculosis	Individuals exposed to infected people.	Bacille Calmette-Guerin vaccine has been the standard vaccine, but its effectiveness has been questioned. No longer recommended in US except for certain high-risk children. Adults and others at risk usually take the drug isoniazid for prevention.
Meningitis caused by meningococcal bacteria	People exposed to single cases or outbreaks; travelers to developing countries where outbreaks have occurred; patients with problems in the spleen.	Vaccines are available against four subtypes of meningococcal bacteria but not for serogroup B, which causes up to 40% of meningococcal disease in the US.

WHERE ELSE CAN INFORMATION BE OBTAINED ON IMMUNIZATIONS.

Immunization Action Coalition, 1573 Selby Avenue, St. Paul MN 55104. Call (651-647-9009) or (http://www.immunize.org/)

The National Immunization Program (NIP) Centers for Disease Control and Prevention 1600 Clifton Road, Mailstop E-05 Atlanta, Georgia 30333. Call (1-800-232-2522 for English) or (1-800-232-0233) for Spanish or (http://www.cdc.gov/nip)

VAERS (Vaccine Adverse Event Reporting System) is a government surveillance for monitoring side effects. Physicians can call (800-822-7967) to report adverse effects after a patient has a vaccination. Or patients and families can file a report by checking the web site. (http://www.fda.gov/cber/vaers/vaers.htm)

US Claims Court, 717 Madison Place, N.W., Washington, D.C. 20005. Call (202-633-7257) http://www.law.gwu.edu/fedcl/

This site is for persons wishing to file a claim for a vaccine injury.

Administrator National Vaccine Injury Compensation Program Health Resources and Services Administration, 6001 Montrose Road, Room 702 Rockville, MD 20852. Call (301-443-6593) http://www.safetyweb.org/ir-vacc.htm

Provides information on The National Vaccine Injury Compensation Program is a system under which compensation can be paid on behalf of an individual who died or was injured as a result of being given a vaccine. The program is intended as an alternative to civil litigation under the traditional torts system in that negligence need not be proven.

Good Internet Sites

The Immunization Gateway: Your Vaccine Fact-Finder is an excellent source of good information on vaccinations (http://www.immunofacts.com/)

The Vaccine Page (http://vaccines.org/)