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Path: senator-bedfellow.mit.edu!dreaderd!not-for-mail Message-ID: <misc-kids/vaccinations/part1_1082200966@rtfm.mit.edu> Supersedes: <misc-kids/vaccinations/part1_1079601013@rtfm.mit.edu> Expires: 31 May 2004 11:22:46 GMT X-Last-Updated: 1999/10/23 Organization: none From: lynng@alsirat.com Newsgroups: misc.kids.info,misc.answers,news.answers Subject: misc.kids FAQ on Childhood Vaccinations, Part 1/4 Followup-To: misc.kids.health Approved: news-answers-request@MIT.EDU, kids-info-request@ai.mit.edu Reply-To: lynng@alsirat.com Originator: faqserv@penguin-lust.MIT.EDU Date: 17 Apr 2004 11:24:14 GMT Lines: 1273 NNTP-Posting-Host: penguin-lust.mit.edu X-Trace: 1082201054 senator-bedfellow.mit.edu 574 18.181.0.29 Xref: senator-bedfellow.mit.edu misc.kids.info:6227 misc.answers:17175 news.answers:269668 Archive-name: misc-kids/vaccinations/part1 Posting-Frequency: monthly Last-Modified: October 23, 1999 =3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D= =3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D= =3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D Collection maintained by: Lynn Gazis-Sax (lynng@alsirat.com)=20 To contribute to this collection, please send e-mail to the address given a= bove, and ask me to add your comments to the FAQ file on vaccination. Please try to be as concise as possible, as these FAQ = files tend to be quite long as it is. And, unless otherwise requested, your name and e-mail address will remain in the file, = so that interested readers may follow-up directly for more information/discussion.=20 Copyright 1994-1999, Lynn Gazis-Sax. All rights reserved. Use and copying o= f this information are permitted as long as (1) no fees or compensation are charged for use, copies or access to this infor= mation, and (2) this copyright notice is included intact.=20 For a list of other FAQ topics, ftp to the pub/usenet/misc.kids directory o= f rtfm.mit.edu, look for the FAQ File Index posted to misc.kids weekly, or tune in to misc.kids.info. =3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D= =3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D= =3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D [NOTE: this is information collected from many sources and while I have str= ived to be accurate and complete, I cannot guarantee that I have succeeded. This is not medical advice. For that, see = your doctor or other health care provider.]=20 [This version is updated to reflect the approval of the chicken pox and hep= atitis A vaccines by the FDA, the approval of an acellular pertussis vaccine for all shots, the approval of IPV for all poli= o shots, the rise and fall of the new rotavirus vaccine, new information about adverse events, and new information about vaccine res= earch. ] =3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D= =3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D= =3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D= =3D=3D=3D=3D Contents=20 Section 1. Introduction and General Information Q1.1 What is vaccination? Q1.2 What are active and passive vaccination? Q1.3 What is herd immunity? Q1.4 How effective is vaccination at producing immunity? Q1.5 What are some of the risks of vaccination? Q1.6 What are some contraindications to vaccinations? Q1.7 How common are the diseases vaccinated against? Q1.8 What percentage of children are vaccinated? Q1.9 What are some sources of further information about vaccinations? Section 2. The recommended vaccination schedule and official organizations Q2.1 What is the recommended vaccination schedule in the US for infants? Q2.2 What is the recommended vaccination schedule in the US for older child= ren who were not vaccinated in infancy? Q2.3 What is the recommended vaccination schedule in the US for adults? Q2.4 Who determines this schedule? Q2.5 What other US government organizations are concerned with vaccinations= ? Q2.5.1 What is the National Vaccine Injury Compensation Program (VICP)? Q2.5.2 What vaccines are covered? Q2.5.3 Who may file a claim? Q2.5.4 Who can I contact to get more information about the Program? Q2.5.5 = What is VAERS? Q2.5.6 Who can report to VAERS? Q2.5.7 What events should be reported to VAERS? Q2.5.8 Are all events reported to VAERS caused by vaccinations? Q2.5.9 How can I get rapid information on VAERS, such as how to file a repo= rt? Q2.5.10 Have there been any comprehensive scientific studies on adverse eve= nts following immunization? Q2.5.11 Are VAERS data available to the public? Q2.6 What vaccination schedules are used in other countries? Q2.7 What international bodies are concerned with vaccinations? Section 3. Specific vaccines Section 3a. DTP (diptheria, tetanus, and pertussis) and DT Q3a.1 What is diptheria, and what are the risks of the disease? Q3a.2 How common was diptheria before routine vaccination, and how common i= s it now? Q3a.3 How effective is the diptheria vaccine? Q3a.4 How long does the diptheria vaccine last? Q3a.5 What is pertussis, and what are the risks of the disease? Q3a.6 How common was pertussis before routine vaccination, and how common i= s it now? Q3a.7 How effective is the whole cell pertussis vaccine? Q3a.8 How long does the pertussis vaccine last? Q3a.9 What is tetanus, and what are the risks of the disease? Q3a.10 How common was tetanus before routine vaccination, and how common is= it now? Q3a.11 How effective is the tetanus vaccine? Q3a.12 How long does the tetanus vaccine last? Q3a.13 What are some of the risks of the DTP vaccine? Q3a.14 Did SIDS disappear in Japan after the Japanese changed their pertuss= is vaccination policy in 1975? Q3a.15 When is the DTP vaccine contraindicated? Q3a.16 What are the advantages and disadvantages of the new acellular pertu= ssis vaccine? Q3a.17 What are some of the risks of the DT (diptheria and tetanus) vaccine= ? Q3a.18 When is the DT vaccine contraindicated? Q3a.19 Under what circumstances is tetanus toxoid given to pregnant women?= =20 Section 3b. Polio Q3b.1 What is polio, and what are the risks of the disease? Q3b.2 How common was polio before routine vaccination, and how common is it= now? Q3b.3 How effective is the polio vaccine? Q3b.4 How long does the polio vaccine last? Q3b.5 What is the difference between oral polio vaccine (OPV) and inactivat= ed polio vaccine (IPV)? Q3b.6 I've heard that it is possible to contract polio from handling the di= apers of recently immunized infants. How long after receiving the vaccine does the child's excrement continue to contain the vi= rus? Q3b.7 What are some other risks of the polio vaccine? Q3b.8 When is the polio vaccine contraindicated? Q3b.9 Isn't it true that wild polio has been eliminated in the US? Q3b.10 Why are we still vaccinating for polio, then? Section 3c. MMR (measles, mumps, and rubella) Q3c.1 What is measles, and what are the risks of the disease? Q3c.2 How common was measles before routine vaccination, and how common is = it now? Q3c.3 How effective is the measles vaccine? Q3c.4 How long does the measles vaccine last? Q3c.5 What are some of the risks of the measles vaccine? Q3c.6 What is mumps, and what are the risks of the disease? Q3c.7 How common was mumps before routine vaccination, and how common is it= now? Q3c.8 How effective is the mumps vaccine? Q3c.9 How long does the mumps vaccine last? Q3c.10 What are some of the risks of the mumps vaccine? Q3c.11 What is rubella, and what are the risks of the disease? Q3c.12 How common was rubella before routine vaccination, and how common is= it now? Q3c.13 How effective is the rubella vaccine? Q3c.14 How long does the rubella vaccine last? Q3c.15 What are the pros and cons of vaccinating all infants for rubella ve= rsus vaccinating females only at puberty? Q3c.16 What are some of the risks of the rubella vaccine? Q3c.17 When is the MMR vaccine contraindicated? Section 3d. HiB (Hemophilus influenze B) Q3d.1 What is hemophilus influenze B, and what are the risks of the disease= ?=20 Q3d.2 How common was HiB before routine vaccination, and how common is it n= ow? Q3d.3 How effective is the HiB vaccine? Q3d.4 How long does the HiB vaccine last? Q3d.5 What are some of the risks of the HiB vaccine? Q3d.6 When is the HiB vaccine contraindicated? Q3d.7 What about rifampin prophylaxis? Section 3e. Hepatitis B gamma globulin and hepatitis B vaccine Q3e.1 What is hepatitis B, and what are the risks of the disease? Q3e.2 How common is hepatitis B? Q3e.3 What is hepatitis B gamma globulin, and when is it given? Q3e.4 How long does the immunity provided by hepatitis B gamma globulin las= t? Q3e.5 What are the risks and contraindications of hepatitis B gamma globuli= n?=20 Q3e.6 How effective is the hepatitis B vaccine? Q3e.7 How long does the hepatitis B vaccine last? Q3e.8 What are some of the risks of the hepatitis B vaccine? Q3e.9 When is the hepatitis B vaccine contraindicated? Q3e.10 Why did the ACIP and AAP change their recommendation about the hepat= itis B vaccine? Q3e.11 Does vaccination for hepatitis B affect one's ability to donate bloo= d? Q3e.12 Do people who have showed up positive on the blood banks' tests for = hepatitis B exposure still need to be vaccinated? Q3e.13 I will be travelling to an area where hepatitis B shots are recommen= ded, but I have less than six months before I leave. Is there an accelerated schedule for hepatitis B vaccination? Section 3f. Influenza Q3f.1 What is influenza, and what are the risks of the disease? Q3f.2 How common is influenza? Q3f.3 How effective is the influenza vaccine? Q3f.4 How long does the influenza vaccine last? Q3f.5 What are some of the risks of the influenza vaccine? Q3f.6 When is the influenza vaccine recommended? Q3f.7 When is the influenza vaccine contraindicated? Q3f.8 Is it OK to be vaccinated for influenza during pregnancy? Section 3g. Pneumococcal vaccine Q3g.1 What is pneumococcal disease, and what are the risks of the disease?= =20 Q3g.2 How common is pneumococcal disease? Q3g.3 How effective is the pneumococcal vaccine? Q3g.4 How long does the pneumococcal vaccine last? Q3g.5 What are some of the risks of the pneumococcal vaccine? Q3g.6 When is the pneumococcal vaccine recommended? Q3g.7 When is the pneumococcal vaccine contraindicated? Section 3h. Meningococcal vaccine Q3h.1 What is meningococcal disease, and what are the risks of the disease?= =20 Q3h.2 How common is meningococcal disease? Q3h.3 How effective is the meningococcal vaccine? Q3h.4 How long does the meningococcal vaccine last? Q3h.5 What are some of the risks of the meningococcal vaccine? Q3h.6 When is the meningococcal vaccine recommended? Q3h.7 When is the meningococcal vaccine contraindicated? Section 3i. Varicella (chicken pox) vaccine Q3i.1 What is chicken pox, and what are the risks of the disease? Q3i.2 How common is chicken pox? Q3i.3 What is Herpes Zoster? Q3i.4 What is the current recommendation for the chicken pox vaccine be par= t for children? Q3i.5 What is the current recommendation for adults? Q3i.6 How effective is the chicken pox vaccine? Q3i.7 How long does the chicken pox vaccine last? Q3i.8 What reactions have been reported following the chickenpox vaccine? Q3i.9 Will a second dose be necessary in younger children? Q3i.10 For which groups is the chicken pox vaccine especially recommended? Q3i.11 When is the chicken pox vaccine contraindicated? Q3i.12 Is there a gamma globulin for chicken pox? Section 3j. BCG (tuberculosis) vaccine Q3j.1 What is tuberculosis, and what are the risks of the disease? Q3j.2 How common is tuberculosis? Q3j.3 How effective is the BCG vaccine? Q3j.4 How long does the BCG vaccine last? Q3j.5 What are some of the risks of the BCG vaccine? Q3j.6 When is the BCG vaccine recommended? Q3j.7 When is the BCG vaccine contraindicated? Q3j.8 What are some other methods of controlling tuberculosis? Section 3k. Hepatitis A vaccine Q3k.1 What is hepatitis A and what are the risks of the disease? Q3k.2 How common is hepatitis A? Q3k.3 Who is at risk for acquiring hepatitis A? Q3k.4 Is there a vaccine to protect against hepatitis A? Q3k.5 How is it to be administered? Q3k.6 How effective is the vaccine? Q3k.7 How long does immunity last? Q3k.8 What are some of the risks of the vaccine? Q3k.9 When is hepatitis A vaccine contraindicated? Q3k.10 What groups at risk may be included in a recommendation to receive h= epatitis A vaccination? Q3k.11 Is it possible that hepatitis A vaccine (like hepatitis B vaccine) m= ight eventually be recommended for routine administration to children and adults? Section 3l. Rotavirus vaccine Q3l.1 What is rotavirus, and what are the risks of the disease? Q3l.2 How common is rotavirus? Q3l.3 What is the current status of the rotavirus vaccine? Q3l.4 How effective is the rotavirus vaccine? Q3l.5 Is the rotavirus vaccine effective for breastfeeding infants? Q3l.6 How long does the rotavirus vaccine last? Q3l.7 What is intussusception? Q3l.8 What is the relationship between the rotavirus vaccine and intussusce= ption? Q3l.9 Why was a connection between the rotavirus vaccine and intussusceptio= n not observed prior to FDA approval of the vaccine? Q3l.10 What other reactions have been reported following the rotavirus vacc= ine? Q3l.11 Can the rotavirus vaccine be effectively used in developing countrie= s? Q3l.12 When is the rotavirus vaccine contraindicated?=20 Section 3m. Other vaccines which are available Q3m.1 What other vaccines are available and when are they given? Section 3n. Vaccines under development Q3n.1 What vaccines are currently under development? Q3n.2 What other research is being done to improve vaccines? Section 4. References Section 5. Stories of Parents =3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D= =3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D= =3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D= =3D=3D=3D=3D Section 1. Introduction and General Information [This section last updated on September 25, 1999.]=20 Q1.1 What is vaccination?=20 The basic principle of vaccination is that a disease-causing agent is given= to a person in a killed or weakened form (or in the form of proteins genetically engineered to look like a disease-causing agen= t), in order to stimulate the production of antibodies to fight off the disease.=20 Q1.2 What are active and passive vaccination?=20 Active immunization involves trying to stimulate antibodies by giving a per= son a killed or weakened form of a disease-causing agent. Passive immunization involves giving a person antibodies from someon= e who was infected with the disease (these are called gamma globulins). Passive immunization doesn't last very long, but c= an be useful for someone who expects to be exposed to a disease (e.g. someone travelling to another country who takes = hepatitis A gamma globulin right before leaving), or to someone who has just been exposed to a disease. Most of the vaccinations= discussed in this FAQ fall under the active vaccination category.=20 Q1.3 What is herd immunity?=20 If a large enough percentage of a population is immune to a disease, their = immunity protects the rest of the "herd."=20 Some discussion of this concept from misc.kids follows:=20 ************************************************************************* From: pburch@cmb.bcm.tmc.edu (Paula Burch) |> >Paula Burch (pburch@cmb.bcm.tmc.edu) wrote: |> >: If one child remains unvaccinated, but all other children are |> >: vaccinated, the one child who does not get vaccinated is pretty safe |> >: from getting the disease. If many children remain unvaccinated, |> >: epidemics occur, and children die needlessly. |> dolson@ucsd.edu (Mark Dolson) writes:=20 |> >This is exactly what occured with measles in the 80's, BTW. Fewer |> >vaccinated, and the incidence skyrocketed, with resulting complications |> >of eye problems, etc, and even some deaths. I agree that people who |> >let their children remain unvaccinated are riding on the backs of=20 |> >everyone that does vaccinate, and I resent it. mblum@world.std.com (Cerebus) writes: |> To be fair, most of the major outbreaks (as well as most of the |> serious complications) were and are on college campuses, and occurred *n= ot* |> because of failure to vaccinate, but because the vaccine that was given |> to kids between '69-'76 turned out not to give total immunity. Many kid= s |> who were vaccinated were victims of measles, before people became consci= ous |> that it was necessary for many teens and young adults to be re-vaccinate= d. |> |> I had measles my first year in college, after vaccination at the appropr= iate |> age. After that outbreak my college began requiring re-vaccination. Bu= t it |> is not technically correct to blame the measles outbreak on the failure = of |> parents to vaccinate. It's true that that's what happended in that case, but it's not true for other cases, in which failure to vaccinate has been a major factor: "The nation [U.S.] has experienced a marked increase in measles cases=20 during 1989 and 1990. Almost one half of all cases have occurred in *unvaccinated* preschool children." (JAMA. 1991 Sep 18. 266(11). =20 P 1547-52.) "Beginning in October, 1990, a large measles outbreak involving predominantly *unvaccinated* preschool age children occurred in Philadelphia. By June, 1991, 938 measles cases had been reported to the Philadelphia Health Department. In addition to these cases, 486 cases and 6 measles-associated *deaths* occurred between November 4, 1990, and March 24, 1991, among members of 2 Philadelphia church groups that do not accept vaccination." (Pediatr-Infect-Dis-J. 1993 Apr= .=20 12(4). P 288-92.) "In 1989 and 1990 the United States experienced a measles epidemic with= =20 more than 18,000 and 27,000 reported cases. Nearly half of all persons with measles were *unvaccinated* preschool children under 5 years of age= ."=20 (Am-J-Public-Health. 1993 Jun. 83(6). P 862-7.) Measles is bad, but I'm more concerned myself about pertussis (whooping cou= gh): "From 1980 through 1989, 27,826 cases of pertussis were reported to the Centers for Disease Control....Infants less than 2 months of age=20 had the highest reported rates of pertussis-associated hospitalization= =20 (82%), pneumonia (25%), seizures (4%), encephalopathy (1%), and *death*= =20 (1%)." (Clin-Infect-Dis. 1992 Mar. 14(3). P 708-19.) [Many of these= =20 infants would not have caught the disease if enough older children were= =20 appropriately vaccinated.] "Two large *epidemics* of pertussis occurred in Britain during 1977-79 and 1981-83." (Commun-Dis-Rep-CDR-Rev. 1992 Dec 4. 2(13). P R155-6.) This explains the herd immunity concept rather well: "The epidemiology of whooping cough [pertussis] in Denmark is described = =20 on the basis of the notified cases of the disease. The frequency of whooping cough has decreased to approximately one sixteenth of the previous level in children following the introduction of vaccination for whooping cough in 1961....deaths from whooping cough still occurred in the eighties, all of these among *unvaccinated* infants. The risk of whooping cough in an *unvaccinated* child is approximately one sixth of the risk prior to introduction of vaccination. In a vaccinated child, the risk, as judged from the notified cases, is one twentieth of the risk during the time prior to introduction of vaccination. In all age groups "herd immunity" is considered to have contributed considerably to the reduced incidence. The incidence in Denmark is, however, high compared with the incidence in some other industrialized countries. A vaccination programme with more numerous whooping cough vaccinations...may be recommended on the basis of the=20 strategy aimed at keeping the incidence of whooping cough, and thus the= =20 risk of exposure, as low as possible." (Ugeskr-Laeger. 1990 Feb 26. =20 152(9). P 597-604.) Paula Burch pburch@bcm.tmc.edu not speaking for Baylor College of Medicine ************************************************************************* Q1.4 How effective is vaccination at producing immunity?=20 Vaccination does not always work. For one thing, vaccines can lose effectiv= eness when they aren't stored properly. And even if they are stored effectively, they will fail to stimulate immunity a cert= ain percentage of the time. The effectiveness of vaccines varies, depending on the vaccine. Effectiveness can also vary depending on = the age, sex, and health of the recipient. Sometimes different strains of a vaccine can have different effectiveness.=20 Vaccine effectiveness is measured in two ways. First, antibody levels are m= easured after a vaccine is given. Second, people are vaccinated and then followed to see whether they get the disease when they = are exposed to it. Estimates of effectiveness can vary in some cases depending on the level of antibodies which is considered= as passing, and the criteria for measuring whether someone has the disease (for instance, pertussis vaccine is more effective = at preventing full-blown pertussis than at preventing a mild cough). Also, some sources give estimates of field effectiveness which= take into account difficulties in storing vaccines in some areas; these estimates tend to be lower than estimates based on studie= s of vaccination in the US or other developed countries.=20 Estimates of effectiveness of individual vaccines are given in the section = for each vaccine (and, where I have found variations in estimates of effectiveness, I have noted that as well).=20 ************************************************************************* From=20J Thompson (jet14@columbia.edu):=20 In addition to all of the factors you mentioned which determine the variabi= lity of response to a vaccine, another very important factor is the genetic inheritance of every individual. To give an example I= feel sure of, I'll use the Hepatitis B vaccine. A certain small percentage of the population has no response at all to the recombinan= t Hep B vaccine. This occurs because these people lack the particular forms of major histocompatibility complex (MHC) protein= s which are necessary to "present" the _single_ protein in the vaccine to the immune system. These people can make a good r= esponse to the whole virus, but they have a problem with the protein in the vaccine.=20 This also highlights the need for "herd immunity," since people who cannot = make an immune response to a vaccine component will _never_ have a good response to the vaccine, regardless of how often i= t is given. ************************************************************************* Q1.5 What are some of the risks of vaccination?=20 Again, these risks vary with the vaccine. However, there are some risks whi= ch are common to several vaccines. People may be allergic to a component of the vaccine, such as eggs or neomycin. Occasiona= lly, these allergies can lead to anaphylactic shock (doctors keep epinephrine on hand when giving vaccinations to guard against= this risk). Vaccines can produce the same symptoms as the disease (in a milder form, and with less frequent incidence= of the risks associated with the disease). Live vaccines in particular can be risky for people with weakened immune systems= , who have less ability to resist even the weakened form of the disease. Common minor adverse reactions include sorene= ss or swelling at the injection site and fever. Because of the latter, vaccinations are often postponed if the recipient al= ready has a fever.=20 Another risk is the risk that the vaccination will wear off, and the recipi= ent will get the disease later. Depending on the illness, the disease could be either less or more harmful to adults. While this risk= can be dealt with by giving boosters, it is worth bearing in mind in setting vaccination policies and making vaccination dsci= sions, because in some case getting the vaccine and then *not* getting the booster might lead to increased risk.=20 Further information related to vaccination risks follows:=20 From=20Cyndy Brunken: I posted this for Kathleen over on sci.med then I realized that=20 misc.kidders might also benefit from the info contained herein. ***************************************************************** DISCLAIMER: THIS MESSAGE IS BEING POSTED FOR KATHLEEN STRATTON BY SOMEONE NOT AFFILIATED WITH THE MESSAGE. I have read-only access to USENET and have followed the immunization discussions in the last few weeks. I think some of the participants will have an interest in the following information. An Institute of Medicine (IOM) committee has concluded in a new report that a causal relation exists between certain common childhood vaccines and specific, but rare, health problems. The committee also determined that there appears to be no causal relation between some of those same vaccines and other specific health problems. The vaccines studied include those used against tetanus, diphtheria, measles, mumps, polio, hepatitis B, and Haemophilus influenzae type b (Hib). =20 The IOM is a private, non-profit organization that provides health policy advice under a congressional charter granted to the National Academy of Sciences. The IOM committee was NOT asked to assess risk- benefit or cost-benefit relations. Rather, the task was to evaluate all medical and scientific evidence bearing on the causal relation between childhood vaccines and specific, serious health outcomes. The report is entitled "Adverse Events Associated with Childhood Vaccines: Evidence Bearing on Causality". A previous IOM committee submitted a report in 1991 entitled "Adverse Effects of Pertussis and Rubella Vaccines". Both reports were mandated by the U.S. Congress in the 1986 National Childhood Vaccine Injury Act (P.L. 99-660). This law addressed many aspects of childhood immunization. Notably, it established a federal compensation program for those who have been injured by mandated childhood vaccines. The IOM committee reported that the evidence established a causal relation between diphtheria, tetanus, measles-mumps-and-rubella, and hepatitis B vaccines and anaphylaxis. The evidence established a causal relation between measles-mumps-and rubella vaccine and thrombocytopenia; between measles vaccine and death from measles infection (primarily in immunocompromised individuals); between oral polio vaccine and death from poliovirus infection (primarily in immunocompromised individuals); and between the oral polio vaccine and poliomyelitis disease. On the other hand, the committee found that the evidence favored rejection of a causal relation between diphtheria and tetanus vaccines and encephalopathy, infantile spasms, and SIDS. The committee found similarly regarding certain Hib vaccines and increased susceptibility to Hib disease. The committee investigated other serious health problems and classified their relation to vaccines in three other categories: no evidence, inadequate evidence to accept or reject a causal relation, and evidence favors acceptance of a causal relation. The specific relations are too numerous to list here. =20 The committee noted that in most cases it was impossible to calculate an incidence rate or relative risk for these reactions, but that they were, on the whole, extremely rare. The final report will be available in late October or early November from National Academy Press, 1-800-624-6242. It will cost approximately $60.00. (The report on pertussis and rubella is still available) A few prepublication copies of the Executive Summary of the new, 1993 report are available from the project director at no cost on a first come-first served basis. Anyone wishing specific information about this report can email me, Kathleen Stratton, directly. I am the study director for this project. My internet address is kstratto@nas.edu ************************************************************************* More information on the findings of the expert committee of the Institute o= f Medicine, along with a table showing in which categories they have placed various adverse events, and modified ACIP recom= mendations based on these findings, can be found in (MMWR 1996;45[No. RR-12]), or http://www.medscape.com/govmt/CDC/MM= WR/1996/sep/rr4512/rr4512.html. Between the publication of the 1993 report, and the publication of the 1996= update, two other IOM committees had met, and published findings concerning "concerning both the diphtheria and tetanus t= oxoids and pertussis vaccine (DTP) and chronic nervous system dysfunction ... and research strategies for vaccine-associat= ed adverse events" (MMWR 1996;45[No. RR-12]).=20 From=20Mike Dedek: ************************************************************************* New England Journal of Medicine 1987; 316: 1283-1288, May 14, 1987,=20 "Compensating Children with Vaccine-Related Injuries", Iglehart, John K. The federal immunization program, by virtually all economic, medical, an= d political measures, is a stunning success story because of its record of protecting millions of children against the common infectious diseases of t= he young. But in recent years the program has come under a legal cloud that is threatening its stability, slowing the development of new vaccines, and sending vaccine prices sharply upward. To address these problems, Congress = has created a new federal program to compensate children who suffer vaccine-rel= ated injuries, but how it will be funded and whether it will achieve its goals r= emain open questions. The legal cloud has formed because, even when the best vaccine products = are properly administered and used, vaccines pose minute risks to those who rec= eive them, and an increasing number of lawsuits are seeking damages on behalf of injured persons. Dr. Louis Z. Cooper, representing the American Academy of Pediatrics, testified before Congress on March 5 about the nature of these risks. Cooper stated: One case of polio-like disease will result from each 2.6 million doses = of oral polio vaccine OPV , and a serious, permanent neurological injury will result from every 310,000 doses of DTP diphtheria, tetanus, and pertussis vaccine . In extremely rare cases, an encephalitis or nerve deafness will develop from MMR measles, mumps, and rubella vaccine . Approximately 75 vaccine-related injuries per year are the price we pay to protect the more = than 3.8 million children born each year in this country. For five years, Congress has struggled to fashion legislation that addre= sses he complex issues related to the compensation of children injured by vaccin= es; in the process, it has explored virtually every conceivable policy option. ************************************************************************* Q1.6 What are some contraindications to vaccinations?=20 Contraindications vary with the vaccine, so contraindications for each spec= ific vaccine are given in the appropriate sections. Some common ones are: allergy to some substance contained in the vaccine (s= uch as eggs or thimerosal, a preservative used in some vaccines), a weakened immune system (which may make attenuated live va= ccines more risky), and pregnancy.=20 The allergies to worry about, in particular, are those with an anaphylactic= or anaphylactoid reaction, e.g. hives, swelling of mouth and throat, difficulty breathing, hypotension, or shock.=20 Breastfeeding is not a contraindication to vaccination. From Harrison's Int= ernal Medicine, "Breastfed infants can be immunized on a normal schedule. Breast feeding does not adversely affect the immunce = response and is not a contraindication for any vaccine. Breast-feeding mothers also may be vaccinated without any problem.= " (British Medical Journal 1994; 309:1073-5 contains an article which confirms that breastfeeding will not interfere wi= th vaccination, and provides references to a couple of relevant studies.)=20 Q1.7 How common are the diseases vaccinated against?=20 I have extracted from table number 190, in _Statistical Abstracts of the Un= ited States_, the following table, showing the frequency, in the US, of some diseases for which vaccinations are either av= ailable and diseases for which I knew a vaccine was being developed or researched (obviously with more success in some cases th= an in others). Table information extracted from:=20 No. 190. Specific Reportable Diseases - Cases Reported: 1970 to 1990 Disease 1970 1980 1983 1984 1985 AIDS (N/A) (N/A) 2,117 4,445 8,249 Chickenpox (1000) (N/A) 190.9 177.5 222.0 178.2 Diptheria 435 3 5 1 3 Hepatitis B (serum) (1000) 8.3 19.0 24.3 26.1 26.6 A (infectious) (1000) 56.8 29.1 21.5 22.0 23.2 Measles (1000) 47.4 13.5 1.5 2.6 2.8 Meningococcal infections 2,505 2,840 2,736 2,746 2,479 =20 Mumps (1000) 105.0 8.6 3.4 3.0 3.0 Pertussis (1000) 4.2 1.7 2.5 2.3 3.6 Plague 13 18 40 31 17 Poliomyelitis, acute 33 9 15 8 7 Rabies, animal 3,224 6,421 5,878 5,567 5,565 Rabies, human 3 _ 2 3 1 Rubella (1000) 56.6 3.9 1.0 1.0 0.6 Tetanus 148 95 91 74 83 Tuberculosis (1000) 37.1 27.7 23.8 22.3 22.2 Typhoid fever 346 510 507 390 402 Disease 1986 1987 1988 1989 1990 AIDS 13,166 21,070 31,001 33,722 41,595 Chickenpox (1000) 183.2 213.2 192.9 185.4 173.1 Diptheria _ 3 2 3 4 Hepatitis B (serum) (1000) 26.1 25.9 23.2 23.4 21.1 A (infectious) (1000) 23.4 25.3 28.5 35.8 31.4 Measles (1000) 6.3 3.7 3.4 18.2 27.8 Meningococcal infections 2,594 2,930 2,964 2,727 2,451 Mumps (1000) 7.8 12.8 4.9 5.7 5.3 Pertussis (1000) 4.2 2.8 3.5 4.2 4.6 Plague 10 12 15 4 2 Poliomyelitis, acute 8 6 9 5 7 Rabies, animal 5,504 4,658 4,651 4,724 4,826 Rabies, human _ 1 _ 1 1 Rubella (1000) 0.6 0.3 0.2 0.4 1.1 Tetanus 64 48 53 53 64 Tuberculosis (1000) 22.8 22.5 22.4 23.5 25.7 Typhoid fever 362 400 436 460 552 Measles: 45 million cases and around 1 million deaths estimated in developi= ng countries in 1990. (Clements, Strassburg, Cutts, and Torel)=20 Polio: 16,435 cases reported by 46 countries to the Expanded Programme on I= mmunization in 1990, a 39% decrease from 1989 when 26,916 cases were reported. (Hull and Ward)=20 "Neonatal tetanus claimed the lives of over 433,000 infants in 1991. It is = endemic in over 90 countries throughout the world." (Whitman, Belgharbi, Gasse, Torel, Mattei, and Zoffman)=20 Pertussis (whooping cough): 659,973 cases reported in 1987. (Galazka)=20 The incidence of some of these diseases has changed significantly since the= tables in this section. More up to date information on worldwide incidence of vaccine preventable diseases can be found at http= ://www.who.org.=20 Q1.8 What percentage of children are vaccinated?=20 Some estimates of vaccination rates, from articles in World Health Statisti= cs Quarterly, 45, 1992:=20 Measles: About 80% of the world's children aged less than 1 were reported t= o have received measles vaccine (a dramatic increase from 1983, when the figure was less than 20%). (Clements, Strassbu= rg, Cutts, and Torel)=20 Polio: Estimated vaccination rate of 85% worldwide in 1990. This rate isn't= equally distributed, though. The Western Pacific Region had a coverage rate of 95%, and the South-East Asia Region 91%, but = the Africa Region had a coverage rate of only 56%. (Hull and Ward)=20 DTP: Varies widely from country to country. The US, Canada, France, Norway,= Poland, Australia, China were among the countries with coverage rates over 80% in 1987-1989. (The article gives Yug= oslavia as also being in this category, but in view of the breakup of the country and the civil war there, I would suspect that= level hasn't been maintained.) England, Spain, Mexico, Turkey, and most of the countries in South America, as well as the = Soviet Union (now defunct) were in the 50-80% category. Sweden and many African countries had coverage rates of under 50%= . Coverage rates in the WHO regions were as follows: Africa 57%, Americas 75%, Eastern Mediterranean 80%, South-East As= ia 89%, Western Pacific 94%. (Galazka)=20 From=20_Statistical Abstracts of the United States, tables no. 189, Percent= of Children Immunized Against Specific Diseases, by Age Group: 1980 to 1985 (I am including the totals only, but the table also= includes a breakdown by race)=20 Disease All Respondents =20 1 to 4 years old =20 1980 1984 1985=20 Diptheria-tetanus-pertussis 66.3 65.7 64.9 Polio 58.8 54.8 55.3 Measles 63.5 62.8 60.8 Rubella 63.5 60.9 58.9 Mumps 56.6 58.7 58.9 Disease All Respondents =20 5 to 14 years old 1980 1984 1985=20 Diptheria-tetanus-pertussis 74.0 73.8 73.7 Polio 70.0 70.2 69.7 Measles 71.0 73.5 71.5 Rubella 74.0 72.4 70.2 Mumps 63.2 70.9 71.6 Respondents consulting records, 1985 (29 percent of white and 15 percent of= black or other respondents who consulted records for some or all vaccination questions)=20 Disease 1 to 4 years 5 to 14 years Diptheria-tetanus-pertussis 87.0 93.0 Polio 75.7 88.4 Measles 76.9 87.4 Rubella 73.8 85.3 Mumps 75.5 87.1 According to the California Morbidity for May 21, 1993, about one third of = infants were found not to be vaccinated, and more than half of all toddlers were behind schedule at their second birthday. Va= ccination rates were lower among black and Hispanic children. Only at school entry age did vaccination levels really rise, the = result of school requirements. By 1990, more than 90% of school age children were vaccinated. Immigration was cited as one factor= keeping vaccination rates low.=20 The May 1, 1994 HICNet Medical News, citing MMWR, reports on vaccination co= verage of 2 year old children in the US from 1992-1993,=20 "Vaccination coverage increased for three vaccines from 1992 to 1993: for t= hree or more doses of Hib, from 28.0% to 49.9% (p less than 0.05); for three or more doses of poliomyelitis vaccine, from = 72.4% to 78.4% (p less than 0.05); and for three or more doses of DTP/ diphtheria and tetanus toxoids (DT), from 83.0% to 87.2%= (p greater than 0.05). Coverage with measles-containing vaccine decreased from 82.5% to 80.8% (p greater than 0.= 05). Among 19-35-month-olds, 12.7% had received three or more doses of Hep B.=20 From=201992 to 1993, the proportion of children who had received a combined= series of four or more doses of DTP/DT, three or more doses of polio vaccine, and one dose of MMR increased from 55.3% to= 64.8% (p less than 0.05), primarily because of increased coverage with the fourth DTP/DT dose (from 59.0% to 71.1% [p l= ess than 0.05])."=20 More details on these statistics in that issue of HICNet Medical News. For = those who are interested, MMWR gives quarterly updates of vaccination coverage in the US, evaluating progress toward the n= ational goal of 90% coverage. These updates are included in HICNet Medical News when they come out, and MMWR itself can als= o be retrieved over the net. See the reference section in section 3 of this FAQ for information on retrieving MM= WR over the net. HiB and hepatitis B vaccination coverage has been increasing (as is to be expected, since those are the mos= t recently instituted vaccines). The March 5, 1995 HICNet includes an MMWR report which shows HiB coverage rising to a record = high of 70.6% and Hep B coverage rising to 25.5% during the first quarter of 1994. However, a report in JAMA, cited in= a summary in Journal Watch for Jan 15, 1995 (paper) or Feb 7, 1995 (electronic), "found that only 46 percent of white c= hildren and only 34 percent of black children had received adequate immunization by eight months of age (JAMA Oct 12, pp. 110= 5 and 1111)."=20 Q1.9 What are some sources of further information about vaccinations?=20 I don't have any addresses for information outside the US (except for the W= HO book on travel vaccinations); if people contribute them I'll add them.=20 Information on vaccinations is available from: The Academy of Pediatrics, C= ommittee on Infectious Diseases, Evanston, Illinois 60204; Centers for Disease Control, Atlanta, Georgia 30333; Council on Envi= ronmental Health, American Medical Association, Chicago, Illinois 60610. The CDC also has a Voice/Fax Informat= ion Service. To access the CDC Voice Information System, telephone (404) 332-4555; to access the CDC Fax Informa= tion System, telephone (404) 332-4565. Their Web site is http://www.aap.org.=20 Not specific to vaccinations, but useful in general for the effects of drug= s, illnesses, etc., during pregnancy is the UCSD Teratogen Registry (1-800-532-3749). Another general source of information = on illnesses is the National Foundation for Infectious Diseases, 4733 Bethesda Ave., Suite 750, Bethesda, Maryland 2081= 4 (USA).=20 Critics of routine vaccination have set up their own information center; it= is called the National Center for Information on Vaccination and is based in Virginia. Their telephone number is 1-800-909-S= HOT (for orders only) or 703-938-DPT3 and their address is 512 W. Maple Ave. #206, Vienna VA 22180. Their web site ca= n be found at http://www.909shot.com/default.htm.=20 Information on travel vaccinations is available from _Health Information fo= r International Travel_, published annually by the Centers for Disease Control, and available from: Superintendent of Document= s, US Government Printing Office, Washington, DC 20402. This publication also has a lot of other information on health-re= lated travel issues, and some information on the regular childhood vaccinations as well (it also includes a table, for all v= accinations, of which are contraindicated during pregnancy). It is also available in some public libraries. The CDC informs = all state and many city and county health departments twice monthly about changing risks and requirements. Another source is _INT= ERNATIONAL TRAVEL AND HEALTH: Vaccination Requirements and Health Advice_, copies of which may be ordered= from WHO Distribution and Sales, CH-1211, Geneva 27, telephone (41 22) 791 2476; fax (41 22) 788 0401. (More= sources of information about travel vaccinations can be found in the section of this FAQ which covers them.)=20 The reference section of this FAQ lists the sources I used in putting toget= her the FAQ. Some of the ones I used most heavily include Harrison's Principles of Internal Medicine, The Merck Manual, _Taki= ng Care of Your Child: A Parents' Guide to Medical Care_, by Pantell, Fries, and Vickery, The Physician's Desk Referen= ce, The American Hospital Formulary Service Drug Information, and _The Wellness Encyclopedia_ From the editors of the U= C Berkeley Wellness Letter, and, more recently, http://www.medscape.com. Here is a list of other people's suggest= ions (to which people are welcome to add):=20 Suggested by Heather Madrone:=20 Robert Mendelsohn _How to Raise a Healthy Child_ George Wootan _Take Charge= of Your Child's Health_=20 Suggested by Roger Barr:=20 recommend books by Harris Coulter among others: Shot in the Dark (about DPT= vaccinations) and another about violence in society due to neurological damage caused by vaccinations (autoimmune respo= nses leading to meningitis)=20 Suggested by John:=20 http://www.whale.to/vaccines.html=20 =3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D= =3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D= =3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D= =3D=3D=3D=3D Section 2. The recommended vaccination schedule [This section last updated on October 23, 1999.]=20 Q2.1 What is the recommended vaccination schedule in the US for infants?=20 The following schedule is based on the schedule published on January 15, 19= 99, published in MMWR 48(01);8-16 and the schedule on the AAP website as of August 1999.=20 Vaccine Recommended Age (or Range) Hepatitis B Birth to 2 mos, 2-4 mos, 6-18 mos=20 DTaP 2 mos, 4 mos, 6 mos, 15-18 mos, 4-6 yrs DT 11-12 yrs or 14-16 yrs, every ten years thereafter HiB 2 mos, 4 mos, 6 mos, 12-15 mos Polio (IPV) 2 mos, 4 mos, 6-18 mos, 4-6 yrs MMR 12-15 mos, 4-6 yrs Varicella 12-18 mos Notes: (1) At 11-12 years, hepatitis B, MMR, and Varicella vaccines to be a= ssessed and administered if necessary. (2) Hepatitis B vaccine schedule in infants depends on the mother's hepatitis B= surface antigen status; where this status is positive or unknown, hepatitis B vaccination is recommended within 12 hours of birth= , but where this status is negative, the vaccine may be given at any time between birth and 2 months. (3) Three different Hib co= njugate vaccines are licensed. Depending on which is used, the dose at 6 months may or may not be required. (4) As of July, 1= 999, the AAP recommended a temporary delay (until thimerosal-free Hepatitis B vaccine is available), for children of H= epatitis B surface antigen negative mothers, in the first shot, to six months. The CDC continues to recommend that the shot be given = at from 2-6 months. As of September, 1999, a hepatitis B vaccine without thimerosal has become available, so, as supplie= s of this vaccine are distributed, the temporary delay should come to an end. (5) In 1999, ACIP recommended hepatitis A vaccine fo= r all children aged 2 years and older in the 11 Western states where incidence is especially high (at least 20 cases per 10= 0,000 people, twice the national average). These states are: Arizona, Alaska, California, Idaho, Nevada, New Mexico, Oklahom= a, Oregon, South Dakota, Utah and Washington.=20 There has been a difference of opinion about when the second dose of MMR sh= ould be given. ACIP recommended 4-6 years, but the AAP recommended at entry to middle or junior high school. Health au= thorities in different states in the US have adopted one or the other of these requirements. The advantage of giving the= second dose at 4-6 years is that compliance may be higher if it is made a requirement of entrance to public schools. The ad= vantage of giving the second dose later is that it will be closer in time to the age at which measles outbreaks have been occuring,= and may increase immunity at that time. The AAP and ACIP have since coordinated their recommendations and agreed on 4-6 yea= rs.=20 This schedule is subject to change, and so, if you look at different medica= l and childcare books, you may see slightly different schedules. Recent changes include the addition of a new vaccine for haemoph= ilus influenzae B, the addition of the hepatitis B vaccine to the schedule, and the addition of a second dose of MMR at entry = to primary or middle school, in response to an increased incidence in measles among teenagers, and the addition of the chi= cken pox vaccine to the schedule. The FDA approved a couple of new vaccines in 1993: a combination of Haemophilus inf= luenzae B vaccine and DTP vaccine, and a new dosage for the hepatitis B vaccine. In 1992, a new acellular pertussis vacc= ine was approved. In 1995, the varicella zoster (chicken pox) vaccine was approved. On July 12, 1996, ACIP recommended that= this vaccine be added to the schedule. The newly approved hepatitis A vaccine was *not* added to the schedule; this va= ccine was recommended only for people at particular risk, such as travellers to countries where hepatitis A is more = prevalent (more recently, it has been recommended in states where hepatitis A is particularly prevalent). In 1996, an acellular = pertussis vaccine was approved for the earlier shots in the pertussis series (previously it had only been approved for the fourth a= nd fifth shots), so that it is now the preferred vaccine for all shots. As a result of progress in the global eradication of polio, = in 1997, ACIP recommended that the first doses of polio vaccine use the inactivated polio vaccine (IPV) rather than the oral polio = vaccine (OPV). In January, 1999, the AAP recommended that all doses use IPV, and on June 17, 1999, the ACIP followed= suit (this new ACIP recommendation will become effective on January 1, 2000).=20 Rotavirus vaccine was added to the schedule at 2, 4, and 6 months, after it= s approval on August 31, 1998, but on July 7, 1999, this recommendation was suspended, pending collection of further data= , based on early surveillance reports of intussusception (a type of bowel obstruction), and on October 15, 1999, the= vaccine was withdrawn from the market.=20 Q2.2 What is the recommended vaccination schedule in the US for older child= ren who were not vaccinated in infancy?=20 Schedules for people not vaccinated in infancy can be found, among other pl= aces, in the Merck Manual and in AMA Drug Evaluations Annual. There are two schedules, one for children under 7, and = one for people (children or adults) over 7. The reason is that pertussis vaccine should not be given to anyone over 7. Pert= ussis is a mild disease over the age of 7, but a serious one for the very young. For that reason, the risks of the vaccine outweigh = the risks of the disease after the age of 7. It is possible that, with the availability of a less reactogenic acellular vaccin= e, this recommendation may change, and pertussis vaccine be give to older people as well, but such a change will not occur w= ithout further study.=20 Q2.3 What is the recommended vaccination schedule in the US for adults?=20 If they haven't been vaccinated at all, see the answer to question 2.22.2. = If they have been vaccinated, then a tetanus and diptheria booster is recommended every ten years (or five years in case of = a very dirty wound). People in certain high risk groups are advised to get flu shots annually (see the section on the flu va= ccine).=20 Q2.4 Who determines this schedule?=20 Two bodies set these schedules. They are the Immunization Practices Advisor= y Committee (ACIP) of the Public Health Service, and the American Academy of Pediatrics Committee on Infectious Dis= eases. During 1994, these organizations were part of a working group which included representatives from the American Ac= ademy of Family Physicians which developed one schedule to incorporate ACIP and AAP recommendations. A new schedule wa= s been endorsed by these groups and became effective January 1995. In modifications of the schedule since then,= sometimes one group has differed slightly from the other, but in time they reconcile their schedules.=20 Q2.5 What other US government organizations are concerned with vaccinations= ?=20 Q2.5.1 What is the National Vaccine Injury Compensation Program (VICP)?=20 [Note: Answers to this and the following several questions are extracted fr= om a longer list of questions and answers put out by the National Vaccine Injury Compensation Program (1-800-338-2382).]=20 The National Childhood Vaccine Injury Act of 1986 (the Act) established the= VICP. This Program went into effect in October 1988 and is a Federal "no-fault" system designed to compensate those indivi= duals, or families of individuals, who have been injured by childhood vaccines, whether administered in the private or publi= c sector. The Program is administered jointly by the Court, the Department of Health and Human Services (HHS), and the Departmen= t of Justice (DOJ).=20 Q2.5.2 What vaccines are covered?=20 Diphtheria, tetanus, pertussis (DTP, DT, TT, or Td), measles, mumps, rubell= a (MMR or any components), and polio (OPV or IPV).=20 Q2.5.3 Who may file a claim?=20 A claim may be made for any injury or death thought to be a result of a cov= ered vaccine. These injuries may include, but are not limited to: anaphylaxis, paralytic polio, seizure disorders, and enceph= alopathy. The injured individual may file; or a parent, legal guardian, or trustee may file on behalf of a child or an incapacitate= d person.=20 Claims need to be filed within 36 months after the first symptoms appeared = and show that effects have continued for at least 6 months (in the case of vaccine related injuried) or be filed within 24 mont= hs of the death and within 48 months after the onset of the vaccine-related injury from which the death occurred. The time for fili= ng claims for injuries resulting from vaccines administered prior to October 1, 1988, has expired.=20 The petitioner must either prove that the vaccine caused the injury or sign= ificantly aggravated a preexisting condition, or the petitioner must show that an injury on the Vaccine Injury Table occurred (m= ost claims involve "Table Injuries" because it is easier to demonstrate a Table Injury than to prove that the vaccine caused = the condition). A modified Vaccine Injury Table is effective for claims filed on or after March 10, 1995.=20 Q2.5.4 Who can I contact to get more information about the Program?=20 1. The toll-free number for the National Vaccine Injury Compensation Progra= m is 1-800-338-2382 to obtain an information packet detailing how to file a claim, criteria for eligibility, and the doc= umentation required. For further information write to: National Vaccine Injury Compensation Program, Parklawn Building, Room 8A-35= , 5600 Fishers Lane, Rockville, Maryland 20857.=20 2. For information on the rules of the U.S. Court of Federal Claims, includ= ing requirements for filing a petition, call 1-202-219-9657 or write to: U.S. Court of Federal Claims, 717 Madison Place= , N.W., Washington, DC 20005.=20 Q2.5.5 What is VAERS?=20 [LG: Information about VAERS excerpted and summarized from material from VA= ERS. This section last updated in 1994.]=20 The National Childhood Vaccine Injury Act (NCVIA) of 1986 mandated the repo= rting of certain adverse events following vaccination. This Act led to the establishment of the Vaccine Adverse Event= Reporting System (VAERS) in November 1990 by the Department of Health and Human Services. VAERS provides a database m= anagement system for the collection and analysis of data from reports of adverse events following vaccination. VAER= S is operated jointly by the Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA). Bo= th the CDC and the FDA review data reported to VAERS.=20 Between January 1, 1991 and December 31, 1994, VAERS has received approxima= tely 45,000 reports. VAERS currently receives approximately 800-1000 reports each month.=20 Q2.5.6 Who can report to VAERS?=20 Any one can report to VAERS. VAERS reports are usually submitted by health = care providers, vaccine manufacturers, and vaccine recipients (or their parents/guardians). Patients, parents, and gua= rdians are encouraged to seek the help of a health-care professional in reporting to VAERS.=20 Q2.5.7 What events should be reported to VAERS?=20 The NCVIA requires the reporting of any events in the Reportable Events Tab= le which occur within the time period specified and any event listed in the manufacturer's package insert as a contraindica= tion to subsequent doses of the vaccine. A copy of the Table can be obtained by calling 1-800-822-7967. Although NCVIA only re= quires reporting of the events mentioned in the Table, VAERS encourages all reporting of any clinically significant adv= erse event occurring after the administration of any vaccine licensed in the United States.=20 On average, about 17% of the reports reflect adverse events resulting in li= fe-threatening illness, hospitalization, permanent disability, extended hospital stay or death. The remaining 83% of the repor= ts primarily describe events such as fever, local reactions transient crying or mild irritability, and other less serious exp= eriences.=20 Q2.5.8 Are all events reported to VAERS caused by vaccinations?=20 Again, VAERS accepts all reports of adverse events following vaccination, s= o not all events reported to VAERS are caused by vaccines. In fact, limitations such as differential reporting rates, sim= ultaneous administration of different vaccine antigens, temporal reporting bias and lack of background vaccination rate data genera= lly prevent the determination of vaccine-event causal associations using VAERS data.=20 Q2.5.9 How can I get rapid information on VAERS, such as how to file a repo= rt?=20 There is a toll-free VAERS information line that is currently receiving ove= r 650 calls per month.=20 A VAERS report form has been designed to facilitate and standardize the pro= cess of reporting adverse events following vaccination to VAERS. For a sample copy of the VAERS report form, see the l= ast page of the 1995 Physician=FFs Desk Reference (PDR) or page 34 of the 1994 Redbook.=20 Report forms can be obtained by calling VAERS at 1-800-822-7967. Xerox copi= es of the PDR or Redbook forms may also be used.=20 Q2.5.10 Have there been any comprehensive scientific studies on adverse eve= nts following immunization?=20 Yes. In 1986, the US Congress mandated the Institute of Medicine to conduct= a scientific review of the possible adverse events following commonly used childhood vaccines. The Institute convened a= n expert panel to implement this mandate and has published two reports on its findings. Both reports concluded that adverse = events caused by vaccines are rare.=20 1. Howson, et al., Adverse Effects of Pertussis and Rubella Vaccines. Washington, DC: National Academy Press, 1991. 2. Stratton, et al., Adverse Events Associated with Childhood Vaccines, Evidence Bearing on Causality. Washington, DC: National Academy Press, 1993. Q2.5.11 Are VAERS data available to the public?=20 Yes. Once any identifying information is removed, VAERS data are made avail= able to the public, for a fee, through the National Technical Information Service (NTIS) at:=20 National Technical Information Service 5285 Port Royal Road Springfield, VA 22161 (703-487-4650). Q2.6 What vaccination schedules are used in other countries?=20 Routine vaccination is practiced in many countries, but specific schedules = vary from country to country. The vaccine for tuberculosis is given in some countries where tuberculosis is common, but i= s not given in the US. Tetanus toxoid is given to pregnant women in countries where neonatal tetanus is common. Some countrie= s, like the US, vaccinate all infants against rubella, while others choose instead to vaccinate adolescent girls (as of 1= 992 - I am not sure whether this is still true, as I know that the UK, at least, has switched to infant vaccination since then). (Gal= azka). When this FAQ was first written, there were significant differences between countries in requirements and coverage for = the pertussis vaccine, but, with the introduction of the new acellular pertussis vaccine, countries which had increased the age = of pertussis vaccination or made it optional have returned it to their schedules.=20 There is also some variation in the schedules at which vaccines are given. = For example, schedules for DTP vaccine include 2, 3, and 4 months, or 3, 4, and 5 months, or 3, 5-6, and 7-15 months, and boo= ster doses are given in some countries at 12-14 months, and in some countries at 3-6 years (Galazka - two charts in this ar= ticle give DTP schedules for various countries in Europe and percentages of countries following different schedules in differ= ent regions of the world).=20 People outside the US are advised to consult their doctors about the specif= ics of vaccination schedules in their countries (keeping vaccination schedules for all the countries represented in misc.ki= ds current is probably too big a job for one FAQ maintainer). http://www.who.org is also a good source for vaccination sched= ules in various countries.=20 Q2.7 What international bodies are concerned with vaccinations?=20 The World Health Service Expanded Programme on Immunization works to increa= se the percentage of the world's children vaccinated against certain target diseases: poliomyelitis, measles, tubercu= losis, diptheria, and tetanus. The WHO/UNDP (United Nations Development Programme) Programme for Vaccine Development pr= omoted research into new and improved vaccines. The Children's Vaccine Initiative, founded in 1990 by UNICEF, UND= P, the Rockefeller Institute, the World Bank, and WHO, promoted new and better vaccines for the world's children, coopera= ting with the Programme for Vaccine Development and the EPI. (Hartveldt) WHO also has three centers which coope= rate with organizations in 79 countries to formulate the annual flu vaccine. (Ghendon)