Tag: live vaccines

When a Vaccine Doesn’t Count and Needs to Be Repeated

Of course, anti-vaccine folks are wrong when they say that vaccines don’t work.

Vaccines work and they work well to protect us from many different vaccine preventable diseases.

At least they do when you get the right vaccine at the right time and it is given properly. If an error is made, sometimes a vaccine dose needs to be repeated.

When a Vaccine Doesn’t Count and Needs to Be Repeated

While it would be unfortunate to have to repeat a vaccine dose, in most cases, if you didn’t, it would leave the child without full protection.

Why might a vaccine dose not count?

The Menomune vaccine has been discontinued, but this label is a good example of things to check before giving a vaccine.
The Menomune vaccine has been discontinued, but this label is a good example of things to check before giving a vaccine.

Although it doesn’t happen often, it is possible that:

  • the wrong vaccine was given
  • the vaccine was given too early, either before the next dose was due or when the child was too young. Although there is some leeway for when most vaccines can be given, there are still some specific rules to follow, especially the minimum time between doses, the earliest age you can get a dose, and the age requirement for booster doses. (sticking to the standard immunization schedule can help avoid these types of errors)
  • the vaccine was mixed improperly (many vaccines are now premixed, making this error less likely to occur)
  • part of the vaccine leaked out when it was being injected, which can happen when kids move, if they aren’t being held well as the shot is being given (rotavirus doses aren’t repeated if a child spits up though)
  • the vaccine had expired or had not been stored properly
  • two live vaccines (except for the typhoid vaccine) were given on separate days, but less than 28 days apart (again, sticking to the standard immunization schedule can help avoid this types of error)
  • the vaccine was given by the wrong route, although depending on the vaccine, this dose might still be valid (most vaccines, except hepatitis B and rabies)

Still, instead of a vaccine dose not counting, the much more common reason for a vaccine dose to be repeated is for folks to lose their vaccine records.

Do You Really Have to Repeat That Vaccine Dose?

Are you worried now that your kids might get a vaccine dose that has to be repeated?

Don’t be. It doesn’t happen very often.

It helps that we don’t actually have a one-size-fits-all immunization schedule and

  • there is a range of recommended ages for most vaccines
  • there is a range of recommended ages for catch-up immunization, which is basically an accelerated immunization schedule, which is why infants can typically start getting their vaccines as early as age 6 weeks and get the first few sets as early as 4 weeks apart

Also, you typically have a grace period, during which early vaccine doses will still count.

“…administering a dose a few days earlier than the minimum interval or age is unlikely to have a substantially negative effect on the immune response to that dose. Known as the “grace period”, vaccine doses administered ≤4 days before the minimum interval or age are considered valid…”

AICP on Timing and Spacing of Immunobiologics

The grace period doesn’t count for the rabies vaccine and while it is an ACIP guideline, it might be superseded by local or state mandates. The grace period also can’t be used to shorten the interval between two live vaccines, which must be at least 28 days.

One last way to get away without repeating an invalid dose would be checking your child’s titers.

When Do You Repeat the Invalid Vaccine Dose?

The next question that comes up after you realize that you have to repeat a dose of a vaccine is when should you repeat it?

It depends.

  • give the correct vaccine as soon as possible if the problem was that the wrong vaccine was given
  • repeat the dose as soon as possible if the problem was an expired, improperly stored, or a dose that had leaked out
  • if the dose was given too early, then you need to wait for the appropriate interval or when your child is old enough to get the dose. Keep in mind that when you repeat the dose, you would generally restart counting your interval from the invalid dose, not from the previous dose. That’s because the invalid dose might interfere with mounting a good immune response.

And in all cases, report the error to the ISMP National Vaccine Errors Reporting Program (VERP) or VAERS.

What to Know About Vaccine Errors

Although they aren’t common, vaccine errors sometimes lead to the need to repeat your child’s vaccines.

More on Vaccine Errors

Myths About the Yellow Fever Vaccine

Endemic yellow fever was eliminated in the United States in 1905, way before the first yellow fever vaccine was developed (1935) and licensed (1953).

How did that work?

Yellow fever is a now vaccine preventable disease that is spread by mosquito bites.

In the United States, it was actually eliminated by controlling the Aedes aegypti mosquitoes that spread the yellow fever virus before the vaccine was even developed. These control efforts were also done in Cuba, Panama, and Ecuador, etc., places where yellow fever was common and led to outbreaks in the United States.

Why Haven’t We Eradicated Yellow Fever?

So why is yellow fever still a problem if we can control the the Aedes aegypti mosquitoes that carry the yellow fever virus?

“Mosquitoes breed in tropical rainforests, humid, and semi-humid environments, as well as around bodies of still water in and close to human habitations in urban settings. Increased contact between humans and infected mosquitoes, particularly in urban areas where people have not been vaccinated for yellow fever, can create epidemics.”

Yellow fever: Questions and Answers

It’s because we can control the mosquitoes in urban areas, in and around cities. You can’t really control or eliminate mosquitoes in tropical rain forest regions, which is why it is difficult to eradicate yellow fever, malaria, dengue fever, and other mosquito borne diseases.

But we have a vaccine, don’t we?

“Eradication of yellow fever is not feasible since we are unable to control the virus in the natural animal hosts.”

Yellow fever: Questions and Answers

Unfortunately, we aren’t the only ones who can become infected with yellow fever. Monkeys get infected with the yellow fever virus in rain forests, infect Haemagogus and Sabethes mosquitoes, which bite people in those areas.

“Urban transmission of yellow fever virus occurs when the virus is spread from human to human by the Aedes aegypti mosquitoes.”

Yellow fever – Brazil

That likely means that yellow fever will never be completely eradicated, unlike small pox.

Yellow Fever Vaccines Myths

But just because yellow fever can’t be eradicated doesn’t mean that it can’t be eliminated.

A single dose of the yellow fever vaccine is safe and provides life-long protection for 99% of people.

“Vaccination is the most powerful known measure for yellow fever prevention: a single dose can provide life-long immunity at a cost of approximately US$1.”

WHO on Eliminating Yellow Fever Epidemics (EYE) Strategy: Meeting demand for yellow fever vaccines

And as cases of yellow fever increase in some countries, like Brazil, getting more people vaccinated is the only way to stop this deadly disease.

People line up to get a yellow fever vaccine near Kinshasa.
People line up to get a yellow fever vaccine near Kinshasa. Photo by WHO/E. Soteras Jalil

Tragically, anti-vaccination myths and misinformation may be keeping folks from getting vaccinated and protected. Propaganda and anti-vaccine scare videos have them thinking that the yellow fever vaccine is dangerous, part of a conspiracy to depopulate the world, or that it doesn’t work.

It is also important to know that:

  • When traveling to or from some countries, a yellow fever vaccine isn’t enough – you need an International Certificate of Vaccination proving that you were vaccinated.

    You should not skip getting the yellow fever vaccine if you are traveling to an area where yellow fever is endemic, including many parts of areas of Africa and South America.

  • While you are most at risk during the rainy season, especially during outbreaks, it is also possible to get yellow fever during the dry season.
  • Yellow fever is a serious, life-threatening disease.
  • There is no cure for yellow fever.
  • While serious side effects to the yellow fever vaccine have been reported, including anaphylaxis, yellow fever vaccine-associated neurologic disease (YEL-AND), and yellow fever vaccine-associated viscerotropic disease (YEL-AVD), they are very rare.
  • The yellow fever vaccine is a live virus vaccine, but shedding is not an issue. Unless at a high risk of exposure, getting the yellow fever vaccine is usually not recommended if you are pregnant or breastfeeding though.
  • It is not usually necessary to get a booster dose of the yellow fever vaccine.
  • Some countries require proof of yellow fever vaccination if you have traveled from a country where there is still a risk of getting yellow fever, so that you don’t import yellow fever into their country.

As yellow fever cases are on the rise in Brazil, with an associated increase in travel associated cases, it is important that everyone understand that vaccines are safe and necessary.

What to Know About Yellow Fever Vaccine Myths

Yellow fever cases are increasing and so are anti-vaccine myths about the yellow fever vaccine, which are keeping some folks from getting vaccinated and protected, even as they are threatened by a potential outbreak.

More on Yellow Fever Vaccines Myths

FluMist Is Coming Back

FluMist is a live, attenuated nasal spray flu vaccine.

While pediatricians, parents and kids loved it, since it wasn’t a shot, it hasn’t been available since 2016 because it was found to be less effective than flu shots against the H1N1 strain of flu.

The History of FluMist

FluMist had been a good option for kids who don't want to get a flu shot every year.
FluMist had been a good option for kids who don’t want to get a flu shot every year. Photo by Vincent Iannelli, MD

The FluMist nasal spray was first approved in 2003 for healthy kids over age 5 years and adults up to age 49 years.

In 2007, the age range was expanded to included healthy children between the ages of 2 and 5 years.

It quickly became a favorite of kids who didn’t like the idea of getting a flu shot each year, although some kids didn’t like getting something sprayed into their nose.

Next, in 2012, FluMist Quadrivalent, with protection against four strains of flu virus, was approved.

While some experts initially thought it might work better than traditional flu shots and it actually became the preferred flu vaccine for kids in 2014, by 2016, FluMist was no longer recommended in the United States.

The Return of FluMist

On February 12, 2017, at a meeting of the Advisory Committee on Immunization Practices (ACIP), members voted to once again recommended FluMist Quadrivalent to prevent the flu. It will be available for next year’s flu season, although the recommendation still has to be approved by the director of the CDC.

What happened to FluMist?

“In the 2013-2014 influenza season, when lower than expected effectiveness of FluMist Quadrivalent was first observed, Influenza A (H1N1) was the predominant circulating influenza virus strain. When the data showing lower than expected vaccine effectiveness became available, FDA began working with MedImmune to investigate potential reasons for this finding.”

FDA Information Regarding FluMist Quadrivalent Vaccine

Although they worked on a fix after the 2013-2014 influenza season, the following season showed poor effectiveness for all flu vaccines because of a drifted flu strain. So it wasn’t until the following year that it was noticed that FluMist still didn’t work as well as a flu shot against H1N1 flu strains, at least not in the United States.

Surprisingly, studies in other countries, including Finland and the UK showed that FluMist did work.

And now MedImmune, the company that makes FluMist, has replaced the H1N1 seed virus it uses to make FluMist, and preliminary testing shows that it is more effective and should be as effective as a flu shot.

That’s why the ACIP voted 12-2 to make FluMist available for the 2018-2019 flu season.

Will you get it for your kids next year, instead of a regular flu shot? If the number of parents and kids asking for FluMist this year is any guide, many will be glad it’s back.

What to Know About the Return of FluMist

FluMist has hopefully been improved, been made more effective, and will be ready to help prevent the flu for the 2018-2019 flu season. It will be an especially good option for those kids who don’t want a shot.

More on the Return of Flumist

Abuse of Vaccine Exemptions

Every state has laws mandating vaccines to attend school and daycare.

Every state also allows exemptions to those mandates, including:

The way that  these laws and exemptions are set up leaves a lot of room for abuse though.

Abuse of Religious Exemptions

How many religions are actually against kids getting vaccinated?

That’s right, almost none.

So why are there so many religious vaccine exemptions in most states, especially in states that don’t have a personal belief exemption?

Right again.

Folks who don’t want to vaccinate their kids, and can’t use a personal belief exemption, just say that vaccinating them would be against their religion.

Abuse of Medical Exemptions

There are some children who shouldn’t be vaccinated.

These children can get a true medical exemption to one or more vaccines because they have a real contraindication or precaution to getting vaccinated.

“If a child has a medical exemption to immunization, a physician licensed to practice medicine in New York State must certify that the immunization is detrimental to the child’s health. The medical exemption should specify which immunization is detrimental to the child’s health, provide information as to why the immunization is contraindicated based on current accepted medical practice, and specify the length of time the immunization is medically contraindicated, if known.”

Dear Colleague letter regarding guidelines for use of immunization exemptions

Fortunately, these medical reasons to skip or delay vaccines are not very common and are often temporary. They can include the contraindications and precautions listed in the package insert for each vaccine and by the Advisory Committee on Immunization Practices, with the most common medical exemptions being:

  • a severe allergic reaction to a previous dose
  • a severe allergic reaction to a vaccine component
  • a known severe immunodeficiency and live vaccines
  • a moderate or severe acute illness with or without fever (precaution)
  • a progressive neurologic disorder (precaution)
A family history of these conditions would not be a reason to skip or delay any vaccines.
Although it will get you a medical exemption for just $120 in California, a family history of these conditions would not be a reason to skip or delay any vaccines.

Most other things are “incorrectly perceived as contraindications to vaccination” and should not be a medical exemptions, including having :

  • a mild acute illness with or without fever
  • a mild to moderate local reaction
  • relatives with allergies
  • a family history of seizures
  • a stable neurologic condition
  • an autoimmune disease
  • a family history of an adverse event after DTP or DTaP administration

A medical exemption can also exist if your child already had the disease and so has natural immunity. In most cases, except for chicken pox disease, titers will likely need to be done to prove that your child already has immunity.

Stopping the Abuse of Vaccine Exemptions

We know that vaccine exemptions are being abused.

How do you stop it?

“Permitting personal belief exemptions and easily granting exemptions are associated with higher and increasing nonmedical US exemption rates. State policies granting personal belief exemptions and states that easily grant exemptions are associated with increased pertussis incidence.”

Omer et al on Nonmedical exemptions to school immunization requirements: secular trends and association of state policies with pertussis incidence.

You likely have to make it harder to get a vaccine exemption.

Strong exemption laws, which are needed in many states, make it clear that:

  • many exemptions are temporary
  • medical exemptions are based on ACIP guidelines, current accepted medical practice, and evidence based medicine – not anecdotes
  • religious exemptions specifically exclude philosophical exemptions and must reflect a sincere religious belief
  • exempted students will be excluded from school during outbreaks
  • exemptions should include a signed affidavit that is notarized
  • exemptions should be recertified each year
  • a separate exemption application will be needed for each vaccine

Getting an exemption shouldn’t be easier than getting vaccinated! And it should include some degree of education against the myths and misinformation that scares parents away from vaccinating their kids.

“Because rare medically recognized contraindications for specific individuals to receive specific vaccines exist, legitimate medical exemptions to immunization requirements are important to observe. However, nonmedical exemptions to immunization requirements are problematic because of medical, public health, and ethical reasons and create unnecessary risk to both individual people and communities.”

AAP on Medical Versus Nonmedical Immunization Exemptions for Child Care and School Attendance

You could also get rid of nonmedical vaccine exemptions.

Of course, for that to work, you can’t allow just anything to count as a medical exemption.

“Review of all medical exemption requests will be conducted at the Mississippi State Department of Health by the State Epidemiologist or Deputy State Epidemiologist.”

Mississippi Medical Exemption Policy

In Mississippi, for example, where medical exemptions are reviewed and approved by the State Epidemiologist or Deputy State Epidemiologist, there were just 208 medical exemptions in the whole state during the 2016-17 school year.

In some states, rates of medical exemptions might be six or seven times higher. This is mostly seen in states that don’t allow personal belief exemptions and make it difficult to get a religious exemption.

That seems to be the case in Nebraska, where there are no personal belief exemptions and you have to submit a notarized statement to get a religious exemptions. Their high rates of medical exemptions likely reflect some abuse and the fact that medical exemptions aren’t reviewed or approved by anyone, they just reflect “that, in the health care provider’s opinion, the specified immunization(s) required would be injurious to the health and well – being of the student or any member of the student’s family or household.”

As we are seeing, that simply invites vaccine exemption abuse.

Very few states currently require that exemption applications go to the health department for review. Those that do include Alabama, Arkansas, Michigan, Minnesota, Mississippi, and West Virginia.

California is notably absent. I guess they didn’t see the potential for abuse when they passed their latest vaccine law. I mean, who could have guessed that doctors would actually be selling medical exemptions to parents based on unrelated conditions, like a family history of diabetes, celiac disease, or autism?

The non-medical vaccine exemption form in Colorado includes information on the risks of each vaccine-preventable disease.
The non-medical vaccine exemption form in Colorado includes information on the risks of each vaccine-preventable disease.

At the very least, until we have stronger exemption laws, parents who want to get a nonmedical exemption should acknowledge that they understand the risks they are taking when they skip or delay their child’s vaccines.

What to Know About Abuse of Vaccine Exemptions

While medical exemptions are necessary for kids who have true contraindications to getting vaccinated, stronger laws can help decrease the abuse we see in medical, religious, and personal belief vaccine exemptions.

More Information on Abuse of Vaccine Exemptions

 

Precautions vs Contraindications When Vaccinating Your Kids

Believe it or not, there are some anti-vaccine folks who believe that all vaccines are dangerous and unnecessary. And they believe that pediatricians push vaccines on kids in all situations, using a one-size-fits-all kind of immunization schedule.

Of course, neither is true.

Vaccines are safe and necessary.

There are some true medical contraindications and precautions to getting vaccinated though. Still, it is important to remember that even more things are simply “conditions incorrectly perceived as contraindications to vaccination.”

Contraindications To Vaccinating Your Kids

There are actually some good reasons to delay or skip one or a few of your child’s vaccines, but only in some very specific situations.

These very specific situations are called contraindications and are what count as medical exemptions.

“A vaccine should not be administered when a contraindication is present; for example, MMR vaccine should not be administered to severely immunocompromised persons.”

CDC on Vaccine Contraindications and Precautions

Fortunately, there are not that many of these contraindications, they are usually specific to just one or a few vaccines, and they are usually, but not always, temporary.

That’s why it would be really unusual to get a true permanent medical exemption for all vaccines. Even if you had a severe allergy to a vaccine that contained yeast, latex, or gelatin, since vaccines contain different ingredients, you would very likely be able to safely get the others.

Remember, your doctor can’t, or at least shouldn’t, just make up contraindications and exemptions to help you avoid getting your kids vaccinated and help you keep them in school.

“I do not believe vaccines had anything to do with my child’s autism. I never noticed any change in his speech, behavior or development with vaccines. I believe the protection and benefits of vaccines far outweigh the risks!”

Michele Han, MD, FAAP

Autism, for example, has been shown to not be associated with vaccines, so it is not a contraindication to getting vaccinated. That’s why many parents vaccinate and protect their autistic kids!

Precautions To Vaccinating Your Kids

In addition to contraindications to getting vaccinated, there is an accompanying list of  precautions.

“A precaution is a condition in a recipient that might increase the risk for a serious adverse reaction, might cause diagnostic confusion, or might compromise the ability of the vaccine to produce immunity (e.g., administering measles vaccine to a person with passive immunity to measles from a blood transfusion administered up to 7 months prior). A person might experience a more severe reaction to the vaccine than would have otherwise been expected; however, the risk for this happening is less than the risk expected with a contraindication. In general, vaccinations should be deferred when a precaution is present. However, a vaccination might be indicated in the presence of a precaution if the benefit of protection from the vaccine outweighs the risk for an adverse reaction.”

CDC on Vaccine Contraindications and Precautions

Again, we are fortunate that most of the conditions that are listed as precautions are temporary.

The vaccine information sheet that you get with each vaccine will list contraindications and precautions on who should not get the vaccine.
The vaccine information sheet that you get with each vaccine will list contraindications and precautions on who should not get the vaccine.

In fact, the most common is having a “moderate or severe acute illness with or without fever.”

Don’t want to get your child vaccinated when he or she has a severe illness?

Don’t worry.

Your pediatrician usually doesn’t want to vaccinate your child in that situation either.

It is easy enough to wait a few days or a week to get vaccinated, when the illness has passed, keeping in mind that a “mild acute illness with or without fever” is neither a precaution nor a contraindication to getting vaccinated. So you can still get your child their recommended vaccines if they just have a cold, stomach bug, or ear infection, etc.

What to Know About Precautions and Contraindications to Vaccines

Although there are some true medical exemptions or contraindications and precautions to getting vaccinated, most are vaccine specific and many are temporary, so they shouldn’t keep you from getting your child at least mostly vaccinated and protected.

More on Precautions and Contraindications to Vaccines

Expert Statements on Vaccines

The AAP published their first recommendations on vaccines in 1938.
The AAP published their first recommendations on vaccines in 1938.

Some parents are still confused about who they should listen to for advice about vaccines.

Is there really a controversy or a real debate going on about whether or not getting vaccinated is a good decision?

What do the experts say?

They say that:

And no, it’s not just one or two of them…

“Vaccines protect the health of children and adults and save lives. They prevent life – threatening diseases, including forms of cancer. Vaccines have been part of the fabric of our society for decades and are one of the most significant medical innovations of our time.”

More than 350 medical, professional and advocacy organizations in a 2017 letter to President Trump

It is the hundreds of thousands of experts at every major health organization around the world!

American Academy of Pediatrics

The American Academy of Pediatrics, an organization of 66,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists, has long advocated for the health and safety of our children.

“Vaccines are safe. Vaccines are effective. Vaccines save lives.

Claims that vaccines are linked to autism, or are unsafe when administered according to the recommended schedule, have been disproven by a robust body of medical literature. Delaying vaccines only leaves a child at risk of disease. Vaccines keep communities healthy, and protect some of the most vulnerable in our society, including the elderly, and children who are too young to be vaccinated or have compromised immune systems.”

Fernando Stein, MD, FAAP, President and Karen Remley, MD, MBA, MPH, FAAP, CEO/Executive Vice President, American Academy of Pediatrics

Vaccine friendly pediatricians who are pushing non-standard, parent-selected, delayed protection vaccine schedules are leaving kids at risk for vaccine-preventable diseases.

“Pediatricians who routinely recommend limiting the numbers of vaccines administered at a single visit such that vaccines are administered late are providing care that deviates from the standard evidence-based schedule recommended by these bodies.”

AAP on Countering Vaccine Hesitancy

Vaccines are necessary.

“Because rare medically recognized contraindications for specific individuals to receive specific vaccines exist, legitimate medical exemptions to immunization requirements are important to observe. However, nonmedical exemptions to immunization requirements are problematic because of medical, public health, and ethical reasons and create unnecessary risk to both individual people and communities.”

AAP on Medical Versus Nonmedical Immunization Exemptions for Child Care and School Attendance

Society of Pediatric Nurses

“Immunizations are safe and effective in promoting health and preventing disease.”

SPN Position Statement on Immunizations

National Association of Pediatric Nurse Practitioners

Established in 1973, with more than 8,500 members, the National Association of Pediatric Nurse Practitioners (NAPNAP) is the professional association for pediatric nurse practitioners (PNPs) and all pediatric-focused advanced practice registered nurses (APRNs).

“NAPNAP supports the prioritization of immunization education for parents, guardians and other caregivers of infants, children, and adolescents. This education must include the most current scientific evidence related to vaccine safety, risk, benefits and current resources available to ensure that parents and caregivers receive adequate information about immunizations. This includes, when necessary, relaying the risk of not immunizing their child and potential devastation that can occur when a child is infected with a vaccine-preventable disease. It is incumbent that a PNP also be aware of misinformation in the public domain and provides the correct information to the public as well as the health care community.”

NAPNAP Position Statement on Immunizations

American College of Preventive Medicine

“Vaccine-preventable diseases were a major cause of mortality and morbidity in the United States in the 20th century. With the advent of immunizations, there have been dramatic rates of decline in these diseases. Clinical studies have shown vaccines to be efficacious and cost effective.  ”

ACPM on Childhood Immunizations

American College of Obstetricians and Gynecologists

Founded in 1951, the American College of Obstetricians and Gynecologists (The College) represents more than 58,000 members.

“Health care providers and patients should be aware that the reassuring safety data for use of the aforementioned vaccines in pregnancy are compelling, and there is no link to vaccine administration and miscarriage. An added benefit to immunizing during pregnancy is the potential for disease prevention in newborns by way of passive antibody transfer to the fetus. Hence, offering pregnant patients influenza and Tdap vaccines is an avenue to protect newborn infants at a critically vulnerable time and before neonates can be vaccinated.”

ACOG on Immunization for Pregnant Women

American Public Health Association

The American Public Health Association was founded in 1872, the APHA represents over 25,000 public health professionals.

“And further noting that the Institute of Medicine has recently released a report10 describing the U.S. immunization system as “a national treasure that is too often taken for granted” and calling for substantial increases in federal and state allocation of funds to support immunization infrastructure; therefore

Reaffirms its support for immunization as one of the most cost-effective means of preventing infectious diseases;”

APHA on The Need for Continued and Strengthened Support for Immunization Programs

American Medical Association

The American Medical Association, which was founded in 1847, has just over 240,000 members.

“The AMA fully supports the overwhelming body of evidence and rigorous scientific process used by the Advisory Committee on Immunization Practices which demonstrate vaccines are among the most effective and safest interventions to both prevent individual illness and protect the health of the public.”

William E. Kobler, MD, member of the AMA Board of Trustees.

Immune Deficiency Foundation

“The development of immunizations for common bacterial and viral infections has represented a major advance in the battle against microbial organisms that constantly threaten the welfare of humankind and particularly the pediatric population. However, the alarming increase in nonimmunized persons could lead to a return of the epidemics seen in the past.

…critical need for maintenance of herd immunity in the population at large. It is particularly important for family members of patients with defective T and B lymphocyte–mediated immunity to receive all of the available standard immunizations (excluding live poliovirus).”

Medical Advisory Committee of the Immune Deficiency Foundation on Recommendations for live viral and bacterial vaccines in immunodeficient patients and their close contacts

American Nurses Association

The American Nurses Association (ANA), founded in 1896, represents “the interests of the nation’s 3.6 million registered nurses.”

“To protect the health of the public, all individuals should be immunized against vaccine-preventable diseases according to the best and most current evidence outlined by the Centers for Disease Control and Prevention (CDC) and the Advisory Committee on Immunization Practices (ACIP). All health care personnel (HCP), including registered nurses (RNs), should be vaccinated according to current recommendations for immunization of HCP by the CDC and Association for Professionals in Infection Control and Epidemiology (APIC).

As stated in the Code of Ethics for Nurses (ANA, 2015, p. 19), RNs have an ethical responsibility to “model the same health maintenance and health promotion measures that they teach and research…,” which includes immunization against vaccine-preventable diseases.”

ANA Position Statement on Immunizations

Autism Science Foundation

“Multiple studies have been completed which investigated the measles, mumps and rubella vaccination in relation to autism. Researchers have also studied thimerosal, a mercury-based preservative, to see if it had any relation to autism. The results of studies are very clear; the data show no relationship between vaccines and autism.”

Autism Science Foundation on Vaccines and Autism

The American Association of Immunologists

The American Association of Immunologists (AAI) is the largest professional association of immunologists in the world, representing more than 7,600 basic and clinical immunologists.

“Recent outbreaks have brought increased attention to vaccine- preventable diseases and have highlighted the need for robust and timely immunization to reduce preventable sicknesses and deaths. AAI strongly urges full adherence to recommended vaccination schedules and views vaccines as efficacious for individuals and crucial to public health.

Research has repeatedly confirmed that vaccinations are safe and highly effective for all healthy children and adults, and any suggestions to the contrary have been discredited. Ongoing vaccine research continually reaffirms its safety and efficacy, including the number of vaccines administered at any one time and the recommended vaccination schedule.”

The American Association of Immunologists Statement on Vaccines

American Osteopathic Association

“The American Osteopathic Association supports the Centers for Disease Control and Prevention in its efforts to achieve a high compliance rate among infants, children and adults by encouraging osteopathic physicians to immunize patients of all ages when appropriate ; supports the HHS National Vaccine Implementation Plan; and encourages third- party payers to reimburse for vaccines and their administration.”

AOA on Immunizations

National Association of School Nurses

#TodaysSchoolNurse is “grounded in ethical and evidence-based practice, are the leaders who bridge health care and education, provide care coordination, advocate for quality student-centered care, and collaborate to design systems that allow individuals and communities to develop their full potential.”

“It is the position of the National Association of School Nurses (NASN) that immunizations are essential to primary prevention of disease from infancy through adulthood.

The school nurse is well-poised to create awareness and influence action to increase the uptake of mandated and recommended immunizations. The school nurse should use evidence-based immunization strategies, such as school-located vaccination clinics, reminders about vaccine schedules, state immunization information systems (IIS), strong vaccination recommendations, and vaccine education for students, staff, and families.”

NASN Immunizations Policy Statement

American Academy of Family Practice

“With the exception of policies which allow for refusal due to a documented allergy or medical contraindication, the AAFP does not support immunization exemption policies.”

AAFP Immunization Policy Statement

American Academy of Allergy, Asthma & Immunology

The American Academy of Allergy, Asthma & Immunology (AAAAI) is a professional organization with over 7,000 members, including allergists/ immunologists, in the United States and 73 other countries.

“Immunization is perhaps the greatest public health achievement of all time, having significantly reduced the morbidity and mortality of many infectious diseases. Routine immunization of children, adolescents, and adults provides substantial protection from a large number of infectious diseases…

Patients who have experienced adverse reactions to vaccines might unnecessarily be advised to avoid subsequent immunization, which could have important adverse personal and population health consequences. Although there are some adverse reactions to vaccines that constitute absolute contraindications to administration of future doses, most such reactions do not preclude subsequent immunization. Patients who have experienced an apparent allergic or other serious adverse reaction after receiving a vaccine warrant evaluation by an allergist/immunologist. Also, patients with preexisting health conditions that might predispose to adverse reactions to vaccines could benefit from such an evaluation. In most cases, a risk-benefit analysis will favor subsequent immunization.”

AAAAI Practice Paramater on Adverse Reactions to Vaccines

CJ First Candle

“There seems to be a common misconception that vaccines are somehow associated with SIDS deaths. This is not true! Experts warn that the risk of leaving your baby unprotected is 1,000 times greater than any increased risk for SIDS. Because infants receive many immunizations during the critical development period from two to six months of age, and 90 percent of SIDS deaths occur within this time frame, it is only logical that many SIDS victims have recently received vaccines. This does not mean that the immunization had anything to do with the infant’s subsequent sudden and unexpected death. The cause and effect of immunizations and SIDS has been comprehensively studied for more than two decades. In fact, in countries where immunization schedules are different from those in the United States, the peak incidence of SIDS is still between two to four months.”

CJ First Candle on Immunizations

Infectious Disease Society of America

Founded in 1963, the Infectious Diseases Society of America (IDSA), with over 9,000 members, represents physicians, scientists and other health care professionals who specialize in infectious diseases.

“The Infectious Diseases Society of America (IDSA) recognizes the great benefits that vaccines provide for the public health. Substantial scientific evidence demonstrates vaccines’ enormous value in protecting individuals and populations from serious and life-threatening infections. Scientific evidence also demonstrates the overall safety of vaccines. Communities are most effectively protected when all are immunized.

Studies demonstrate that the easier it is to receive an exemption, the higher the rate of exemptions in a particular state. As the number of exemptions increases, the risk of vaccine – preventable disease increases. Therefore, states must make every effort to minimize the number of its citizens exempted from immunization mandates. Such exemptions make the state legislatures who grant them, as well as the individuals who receive them, responsible for placing the remaining state population at greater risk of acquiring potentially fatal infections.”

IDSA Policy Statement on State Immunization Mandates

The Arc of the United States

“Prior to widespread immunization in the United States, infectious diseases killed or disabled thousands of children each year. The near elimination of intellectual disability due to measles encephalitis, congenital rubella syndrome, and Haemophilus influenzae type b meningitis or Hib can be contributed to vaccines.”

The Arc Facts About Childhood Immunizations

American College Health Association

“The American College Health Association (ACHA) strongly supports the use of vaccines to protect the health of our individual students and our campus communities. In recognition of the vital role that vaccine coverage plays in community immunity (herd immunity), ACHA discourages use of nonmedical exemptions to required vaccines.”

ACHA on Immunization Recommendations for College Students

What to Know About Expert Statements on Vaccines

Over the years, hundreds of organizations representing millions of families, health care providers, researchers, patients, and consumers,  have repeatedly expressed their unequivocal support for vaccines, because they understand that vaccines work and that they are safe and necessary.

More on Expert Statements on Vaccines

Vaccine-Preventable Diseases

The latest immunization schedule from the CDC and AAP.
The latest immunization schedule from the CDC and AAP.

Today, in the United States, children typically get:

  • 36 doses of 10 vaccines (HepB, DTaP, Hib, Prevnar, IPV, Rota, MMR, Varivax, HepA, Flu) before starting kindergarten that protect them against 14 vaccine-preventable diseases
  • at least three or four more vaccines as a preteen and teen, including a Tdap booster and vaccines to protect against HPV and meningococcal disease, plus they continue to get a yearly flu vaccine

So by age 18, that equals about 57 dosages of 14 different vaccines to protect them against 16 different vaccine-preventable diseases.

While that sounds like a lot, keep in mind that 33% of those immunizations are just from your child’s yearly flu vaccine.

Vaccine-Preventable Diseases

Of course, kids in the United States don’t get all available vaccines and aren’t protected against all possible vaccine preventable diseases. Some vaccines are just given if traveling to a high risk area or in other special situations.

Vaccine-preventable diseases (in the United States, children and teens are routinely protected against the diseases highlighted in bold) include:

  1. adenovirus – a military vaccine
  2. anthrax – vaccine only given if high risk
  3. chicken pox – (Varivax, MMRV)
  4. cholera – vaccine only given if high risk
  5. dengue – vaccine not available in the United States
  6. diphtheria – (DTaP/Tdap)
  7. hepatitis A – (HepA)
  8. hepatitis B – (HepB)
  9. hepatitis E – vaccine not available in the United States
  10. HPV – (Gardasil)
  11. Haemophilus influenzae type b – (Hib)
  12. influenza
  13. measles – (MMR, MMRV)
  14. meningococcal disease – (MCV4 and MenB and MenC)
  15. mumps
  16. pneumococcal disease – (Prevnar13 and PneumoVax23)
  17. pertussis – (DTaP/Tdap)
  18. polio – (bOPV and IPV)
  19. Q-fever – vaccine not available in the United States
  20. rabies – vaccine only given if high risk
  21. rotavirus – (RV1, RV5)
  22. rubella – (MMR, MMRV)
  23. shingles – vaccine only given to seniors
  24. smallpox – eradicated
  25. tetanus – (DTaP/Tdap)
  26. tick-borne encephalitis – vaccine not available in the United States
  27. tuberculosis – (BCG) – vaccine only given if high risk
  28. typhoid fever – vaccine only given if high risk
  29. yellow fever – vaccine only given if high risk

Discontinued vaccines also once protected people against Rocky mountain spotted fever, plague, and typhus.

These vaccine-preventable diseases can be contrasted with infectious diseases for which no vaccines yet exist, like RSV, malaria, norovirus, and HIV, etc., although vaccines are in the pipeline for many of these diseases.

What To Know About Vaccine Preventable Diseases

Available vaccines are helping to eliminate or control a number of vaccine-preventable diseases, like polio, measles, and diphtheria, but a lot of work is left to be done.

More About Vaccine Preventable Diseases