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.
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?
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
“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.”
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.
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.
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:
adenovirus – a military vaccine
anthrax – vaccine only given if high risk
chicken pox – (Varivax, MMRV)
cholera – vaccine only given if high risk
dengue – vaccine not available in the United States
diphtheria – (DTaP/Tdap)
hepatitis A – (HepA)
hepatitis B – (HepB)
hepatitis E – vaccine not available in the United States
HPV – (Gardasil)
Haemophilus influenzae type b – (Hib)
measles – (MMR, MMRV)
meningococcal disease – (MCV4 and MenB and MenC)
pneumococcal disease – (Prevnar13 and PneumoVax23)
pertussis – (DTaP/Tdap)
polio – (bOPV and IPV)
Q-fever – vaccine not available in the United States
rabies – vaccine only given if high risk
rotavirus – (RV1, RV5)
rubella – (MMR, MMRV)
shingles – vaccine only given to seniors
smallpox – eradicated
tetanus – (DTaP/Tdap)
tick-borne encephalitis – vaccine not available in the United States
tuberculosis – (BCG) – vaccine only given if high risk
typhoid fever – vaccine only given if high risk
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.
Although vaccine shedding is a concern with some live vaccines, like the oral polio vaccine and the small pox vaccine, it is important to keep in mind that neither has been used in the United States for some time now.
Hospitals no longer warn patients about restricting exposure to people who have recently been vaccinated.
Were websites scrubbed of information about shedding as part of some conspiracy?
Of course not.
They were simply updated to keep up with the latest guidelines.
Can Immunocompromised Patients Have Visitors?
These guidelines about kids with cancer aren’t that new though.
As far back as 2001, an article in the journal Pediatrics & Child Health, “Practical vaccination guidelines for children with cancer,” recommended that household contacts of immunosuppressed children should receive:
all routine, age-appropriate vaccines, including DTaP, IPV, Hib, MMR, and Tdap, and that no special precautions are necessary because transmission of disease from these vaccines does not occur.
the varicella vaccine and that even in the event of a vaccine-associated vesicular rash, the transmission risk is low and the consequences of infection are limited by the attenuated nature of the vaccine virus.
receive either the inactivated influenza vaccine or live attenuated influenza vaccine, giving preference to the inactivated influenza vaccine only if the immunosuppressed person is a hematopoietic stem cell transplant (HSCT) recipient in a protected environment.
So hospitals should no longer be warning patients about restricting exposure to people who have recently been vaccinated.
In fact, the latest guidelines from the Immune Deficiency Foundation Advisory Committee state that except for the live oral poliovirus vaccine, close contacts can receive other standard vaccines because viral shedding is unlikely and these pose little risk of infection to a subject with compromised immunity.
The Immune Deficiency Foundation also warns that, “The increased risk of disease in the pediatric population, in part because of increasing rates of vaccine refusal and in some circumstances more rapid loss of immunity, increases potential exposure of immunodeficient children.”
In other words, they are concerned about the risk of disease from intentionally unvaccinated kids and not from those who were recently vaccinated!
So, what about visitors?
“Tell friends and family who are sick not to visit. It may be a good idea to have visitors call you first.”
The Johns Hopkins Hospital Patient Information Guide
Although you can’t prevent every cough and cold that might keep you from visiting a friend or family member who is being treated for cancer or has another immune system problem, keeping up to date on all vaccines can help to make sure that you don’t spread a vaccine-preventable disease, like measles or chickenpox, to them.
What To Know About The Johns Hopkins Vaccine Warning
Not only is Johns Hopkins Medical Center not telling cancer patients to avoid contact with children who recently received vaccines, they have gone out of their way to correct that misinformation from anti-vaccine websites.
Some folks haven’t gotten the message though and continue to push the idea that Johns Hopkins and other Hospitals warn cancer patients to avoid contact with recently vaccinated children.
Whenever there is a discussion about folks who intentionally choose to not vaccinate themselves or their kids, one of their arguments invariably is ‘why are you so worried if you and your kids are vaccinated?”
Here is an example:
“My argument is simple. If you are vaccinated, you should not have to fear an outbreak of any preventable disease. That’s what the vaccine is supposed to prevent, right? Therefore, why should anyone butt into someone else’s business and tell them they should vaccinate? If one and one’s dependents are vaccinated, why should they have to worry about my personal decision to not vaccinate?”
I personally don’t believe in vaccines
As most people understand, the argument is far from simple.
Who Is at Risk If You Don’t Vaccinate Your Kids?
There are many people who are at risk from those who are unvaccinated, including those who:
are too young to be vaccinated or fully vaccinated – remember, with the latest immunization schedule, kids don’t typically get their first MMR until age 12 months and their second until they are 4 to 6 years old
were vaccinated, but later developed an immune system problem and their immunity has worn off – might include children with cancer, AIDS, those receiving immunosuppressive therapy after a transplant, or a condition that requires immunosuppressive doses of steroids, etc.
These are the children and adults that can be, and should be, protected by herd immunity. At least they can be when most folks are vaccinated.
“We want to create a ‘protective cocoon’ of immunized persons surrounding patients with primary immunodeficiency diseases so that they have less chance of being exposed to a potentially serious infection like influenza.”
Medical Advisory Committee of the Immune Deficiency Foundation
So while some folks who are against vaccines try to scare others about shedding, those who take care of kids with immune system problems and their families go out of the way to get everyone around them vaccinated so their kids aren’t at risk of getting a vaccine-preventable disease!
“…the increased risk of disease in the pediatric population, in part because of increasing rates of vaccine refusal and in some circumstances more rapid loss of immunity, increases potential exposure of immunodeficient children.”
Medical Advisory Committee of the Immune Deficiency Foundation
Tragically, not everyone has gotten the message, and we continue to see and hear about kids who are too young to be vaccinated or who couldn’t be vaccinated get exposed to those who got sick because they simply chose to not get vaccinated.
What to Know About Risks from the Unvaccinated
Intentionally unvaccinated children and adults put others at risk for vaccine-preventable diseases.
Rabies is a little different than most vaccine-preventable disease.
While we do have a rabies vaccine, in fact, one of the first vaccines when it was developed in 1885 by Louis Pasteur, it is typically given after you have been exposed to the rabies virus. Most other vaccines are routinely given before you are ever exposed to the diseases they prevent.
And the rabies vaccine has changed a lot since Pasteur’s day.
Instead of getting daily shots for 14-21 days, the rabies vaccine is now given when you are exposed, with human rabies immune globulin (HRIG), with further doses of vaccine on days 3, 7, and 14.
Do you need a rabies vaccine after getting bit by an animal?
It depends on the animal and whether or not the animal can be quarantined (confined and observed for rabies symptoms for 10 days).
And while any mammal can get rabies, the ones that are most worrisome are:
raccoons, skunks, bats, foxes, and coyotes
cats, dogs, and ferrets
livestock, cattle, horses
Most importantly, note that “Recent data suggest that transmission of rabies virus can occur from minor, seemingly unimportant, or unrecognized bites from bats.”
The CDC states that “Small rodents like squirrels, hamsters, guinea pigs, gerbils, chipmunks, rats, and mice) and lagomorphs including rabbits and hares are almost never found to be infected with rabies and have not been known to transmit rabies to humans.”
FluMist, the live, attenuated influenza vaccine (LAIV) that is given intranasally, instead of like a traditional flu shot, was first approved by the FDA in 2003.
At that time, it could be given to healthy, nonpregnant persons aged 5 to 49 years.
The age indication was lowered to include healthy kids between the ages of 2 to 4 years in 2007, in time for the 2007-08 flu season.
Other changes to FluMist over the years include that:
the dose was lowered from 0.5ml to 0.2ml in 2007
FluMist stopped being shipped frozen in 2007, instead being shipped at a higher 35°F to 46°F
Flu Quadrivalent was approved in 2012, but didn’t become available until the 2013-14 flu season
MedImmune, the makers of FluMist, begin to investigate reports of “lower than expected effectiveness” during the 2013-14 flu season and “possible problems with thermostability” are fixed
for the 2014-15 flu season, FluMist became the preferred flu vaccine for children between the ages of 2 to 8 years
the preferential recommendation for FluMist was removed the next year, for the 2015-16 flu season, when either inactivated flu shots or FluMist were recommended
And of course, for the 2016-17 flu season, the ACIP and AAP recommended that FluMist not be used at all.
About 14 million doses of FluMist would have been available in the United States during the 2016-17 flu season. Although a small percentage of the 171 to 176 million total doses of available flu vaccine, FluMist has been very popular with pediatricians, parents and especially children, as it helps avoid a shot.
Based on data from observational studies showing lower than expected effectiveness of FluMist Quadrivalent from 2013 through 2016, on June 22, 2016, the Advisory Committee on Immunization Practices (ACIP), an advisory committee to the Centers for Disease Control and Prevention (CDC), voted to recommend that FluMist Quadrivalent should not be used during the 2016-2017 influenza season.
There are “discordant results among” studies though and experts aren’t sure why.
MMWR. Notice to Readers: Expansion of Use of Live Attenuated Influenza Vaccine (FluMist®) to Children Aged 2–4 Years and Other FluMist Changes for the 2007–08 Influenza Season. November 23, 2007 / 56(46);1217-1219
MMWR. Recommendations of the Advisory Committee on Immunization Practices — United States, 2016–17 Influenza Season. August 26, 2016 / 65(5);1–54.