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Frequently Asked Questions (FAQs) Vaccine save lives and protect people from illness and permanent disability. Young children need to be vaccinated because they are more likely to develop complications or die from vaccine-preventable diseases than older children and adults. 2. Why do we still need to vaccinate? Aren't these diseases gone? Vaccines are responsible for the control of many infectious diseases that were once common in this country. Vaccines have reduced, and in some cases, eliminated, many diseases (measles, diphtheria, pertussis, polio, etc.) that routinely killed or harmed many infants, children, and adults. However, the viruses and bacteria that cause vaccine-preventable disease and death still exist and can be passed on to people who are not protected by vaccines. Our current situation is a lot like bailing out a boat with a slow leak. When we started bailing, the boat was filled with water. But we have been bailing fast and hard, and now it is almost dry. We could say, "Good. The boat is dry now, so we can throw away the bucket and relax." But the leak hasn't stopped. Before long we'd notice a little water seeping in, and soon it might be back up to the same level as when we started. So vaccination keeps our communities free of disease. When we get vaccinated, we protect not only ourselves, but also our neighbors. There are a small number of people who cannot be vaccinated (because of severe allergies to vaccine components, for example), and a small percentage of people don't respond to vaccines. These people are susceptible to disease, and their only hope of protection is that people around them are immune and cannot pass disease along to them. A successful vaccination program, like a successful society, depends on the cooperation of every individual to ensure the good of all. We would think it irresponsible of a driver to ignore all traffic regulations on the presumption that other drivers will watch out for him or her. In the same way we shouldn't rely on people around us to stop the spread of disease; we, too, must do what we can. 3. What would happen if we stopped vaccinating? Before long we would see epidemics of diseases that are nearly under control today. More children would get sick and more would die. There are numerous examples of societies that have let their vaccination rates slip and then suffered the consequences Three countries- Great Britain, Sweden, and Japan - cut back on the use of pertussis vaccine because of fear about the vaccine. The effect was immediate and dramatic. In GB, a drop in pertussis vaccination in 1974 was followed by an epidemic of more than 100,000 cases and 36 deaths by 1978. In Japan, a drop in vaccination rates from 80% to 20-40% led to a jump in pertussis from 393 cases and no deaths in 1974 to 13,000 cases and 41 deaths in 1976. In Sweden, the incidence rate per 100,000 went from 700 in 1981 to 3,200 in 1985. 4. How do vaccines work? Vaccines are made from weakened or killed disease germs and are given by a shot, liquid drops, or an inhaled spray. After getting a vaccine, the body makes antibodies and activated lymphocytes that fight and destroy real disease germs. Vaccines help your children's immune system work better and protect your child from catching a disease. 5. Are vaccines safe? Vaccines are very safe and effective. Sometimes people will have minor reactions to a vaccine such as a sore arm or a slight fever. More serious complications from vaccines are very rare. However, the risk of catching a serious or even fatal diseases is greater than the risk of a bad reaction from a vaccine. 6. What diseases do vaccine prevent? Hepatitis B, Hepatitis A, Diphtheria, Tetanus, Pertussis, Polio, Measles, Mumps, Rubella, Haemophilus influenzae type b (Hib), Varicella (chickenpox), Pneumococcal disease, and Influenza. 7. I've heard that giving multiple vaccinations at the same visit will overwhelm my child's system. Is this true? Children (and adults) are exposed to many germs every day. Eating food introduces new bacteria into the body, and numerous bacteria live in the mouth and nose, exposing the immune system to still more antige ns. An upper respiratory viral infection exposes a child to 4 - 10 antigens, and a case of "strep throat" to 25 - 50. According to Adverse Events Associated with Childhood Vaccines, a 1994 report from the Institute of Medicine, "In the face of these normal events, it seems unlikely that the number of separate antigens contained in childhood vaccines . . . would represent an appreciable added burden on the immune system that would be immunosuppressive." And, indeed, available scientific data show that simultaneous vaccination with multiple vaccines has no adverse effect on the normal childhood immune system.A number of studies have been conducted to examine the effects of giving various combinations of vaccines simultaneously. In fact, neither the Advisory Committee on Immunization Practices (ACIP) nor the American Academy of Pediatrics (AAP) would recommend the simultaneous administration of any vaccines until such studies showed the combinations to be both safe and effective. These studies have shown that the recommended vaccines are as effective in combination as they are individually, and that such combinations carry no greater risk for adverse side effects. Consequently, both the ACIP and AAP recommend simultaneous administration of all routine childhood vaccines when appropriate. Research is under way to find ways to combine more antigens in a single vaccine injection (for example, MMR and chickenpox). This will provide all the advantages of the individual vaccines, but will require fewer shots. There are two practical factors in favor of giving a child several vaccinations during the same visit. First, we want to immunize children as early as possible to give them protection during the vulnerable early months of their lives. This generally means giving inactivated vaccines beginning at 2 months and live vaccines at 12 months. The various vaccine doses thus tend to fall due at the same time. Second, giving several vaccinations at the same time will mean fewer office visits for vaccinations, saving parents both time and money and may be less traumatic for the child. 8. I've heard that vaccination causes harmful side effects, including disease and death. Is this true? Vaccines are actually very safe, despite implications to the contrary in many anti-vaccine publications. There is a national tracking system for monitoring vaccine adverse events called Vaccine Adverse Events Reporting System (VAERS). Most vaccine adverse events are minor and temporary, such as a sore arm or mild fever. These can often be controlled by taking acetaminophen before or after vaccination. More serious adverse events occur rarely (on the order of one per thousands to one per millions of doses), and some are so rare that risk cannot be accurately assessed. As for vaccines causing death, again so few deaths can plausibly be attributed to vaccines that it is hard to assess the risk statistically. Of all deaths reported to the VAERS between 1990 and 2002, only one is believed to be even possibly associated with a vaccine. Each death reported to VAERS is thoroughly examined to ensure that it is not related to a new vaccine-related problem, but little or no evidence suggests that vaccines have contributed to any of the reported deaths. The Institute of Medicine in its 1994 report states that the risk of death from vaccines is "extraordinarily low." The smallpox vaccine is an exception to this rule. Recent events have raised the fear that smallpox or other biological agents might be used in 9. I've heard that vaccines contain mercury that may cause autism and other neurodevelopmental disorders? What about SIDS? Today, all vaccines in the recommended childhood immunization schedule that are licensed for use in the U.S. market contain no thimerosal or only trace amounts (less than 1 part per million per dose is considered a "trace,' or insignificant, amount). Some vaccines intended for adults or adolescents, such as influenza (flu) and tetanus and diphtheria vaccines (Td and DT), still contain thimerosal as a preservative. There is no evidence to suggest that thimerosal in vaccines causes any health problems in children or adults beyond local hypersensitivity reactions (swelling and redness at site). The original furor and recommendation that thimerosal be removed (July, 1999) had more to due with the perception that the cumulative mercury doses in infants (relatively small body mass) exceeded EPA recommendations and therefore might be harmful. But the EPA recommendations were actually based on methyl mercury levels and not ethyl mercury, which is the form of mercury found in thimerosal. Furthermore, EPA limits for exposure are usually set about 10 times lower than the amount likely to cause any toxicity in order to provide a buffer of protection. Recent studies from Denmark indicate that ethyl mercury (the thimerosal "mercury') is removed quite rapidly from the bloodstream of children and does not accumulate in the body, perhaps partly accounting for thimerosal's failure to cause any toxic effects. One myth that won't seem to go away is that DTP vaccine causes sudden infant death syndrome (SIDS). This belief came about because a moderate proportion of children who die of SIDS have recently been vaccinated with DTP; and on the surface, this seems to point toward a causal connection. But this logic is faulty; you might as well say that wearing diapers causes SIDS since nearly all children who develop SIDS also wear diapers. In other words, since most SIDS deaths occur during the age range when 3 shots of DTP are given, you would expect DTP shots to precede a fair number of SIDS deaths simply by chance. In fact, when a number of well-controlled studies were conducted during the 1980's, the investigators found, nearly unanimously, that the number of SIDS deaths temporally associated with DTP vaccination was within the range expected to occur by chance. In other words, the SIDS deaths would have occurred even if no vaccinations had been given. In fact, in several of the studies children who had recently gotten a DTP shot were less likely to get SIDS. The Institute of Medicine reported that 'all controlled studies that have compared immunized versus nonimmunized children have found either no association . . . or a decreased risk . . . of SIDS among immunized children" and concluded that "the evidence does not indicate a causal relation between [DTP] vaccine and SIDS.'" SIDS has recently been linked to the practice of putting infants to sleep on their stomachs rather than their backs or sides. But looking at risk alone is not enough - you must always look at both risks and benefits. Even one serious adverse effect in a million doses of vaccine cannot be justified if there is no benefit from the vaccination. If there were no vaccines, there would be many more cases of disease, and along with them, more serious side effects and more deaths. For example, according to an analysis of the benefit and risk of DTP immunization, if we had no immunization program in the United States, pertussis cases could increase 71-fold and deaths due to pertussis could increase 4-fold. Comparing the risk from disease with the risk from the vaccines can give us an idea of the benefits we get from vaccinating our children. 10. How can I best prepare for my children's vaccine visits? Always bring your children's immunization cards.
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