Parents PACK

Vaccine Educational Materials

The Vaccine Education Center provides informational materials in both English and Spanish.

Vaccines and Society

When a child enters school, one of the considerations is vaccines. Schools require proof of immunization or exemption at the time of registration. Here we address some of the things you may be thinking about at that time.

Tracking Disease Throughout the U.S.

Did you know that every day public health officials are monitoring certain diseases in an effort to prevent national public health crises? In fact, healthcare providers are required to report any cases of certain infectious diseases to their local health department, which watches for trends, monitors outbreaks and reports weekly data to the National Notifiable Diseases Surveillance System (NNDSS). The data are published each week in the CDC’s Morbidity and Mortality Weekly Report (MMWR), and each year, a summary is also published.

Public health officials typically monitor 72 infectious diseases throughout the country. Several of these are vaccine-preventable diseases: for example, diphtheria, measles, mumps and chickenpox.

Check out what diseases have been diagnosed in your state so far this year»

Read the CDC’s Summary of Notifiable Diseases»

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What is the National Immunization Survey (NIS)?

The NIS is an annual survey conducted by the CDC in two parts. First, homes with children between 19 and 35 months of age are randomly selected and parents complete a telephone survey to answer questions about which vaccines their toddlers have received. Second, with parental permission, healthcare providers of these children are mailed a survey to confirm parental recollections. Only with both sets of information is a child included in the analysis. A child is not individually identified in the analysis; rather the data are reviewed collectively.

The NIS provides the following information:

Why does the CDC collect this information?

The information collected in the NIS is important for understanding the likelihood of certain diseases spreading throughout the country, which vaccines are being used, at what rate, and by whom.

What does the NIS mean for individual families?

Since most families only hear about the NIS data in the media reports that immediately follow its release, they will go away feeling comfortable that vaccine coverage rates are sufficient in the U.S., and for the most part they are correct. Indeed for most vaccines, immunization rates in this country are high enough to stem outbreaks. Unfortunately, national rates do not tell the entire story because there are pockets of unvaccinated or undervaccinated people throughout this country that make some communities more susceptible to outbreaks than others.

See how your state or area compares»

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School and vaccines

School entry requirements

Are you unsure about which vaccines are required for your child to enter school? Are you going to be moving to a new state and need to check on vaccine requirements? The Immunization Action Coalition (IAC) has gathered all of this information into one place for you.

Exemptions and herd immunity

Some parents are confused about whether their children need vaccines. They may have heard that vaccines cause autism or other chronic conditions or that the vaccines were made using aborted-fetal tissue, or they may feel that vaccines are not necessary because they haven't seen anyone they know getting the diseases that vaccines prevent.

In most states, vaccines are required for entry into school or child care centers. However, there are cases in which a child may be able to go to school without having a particular vaccine. In these cases, the parent must exercise an "exemption," which is a legal option to forego a vaccine.

Different states have different laws regarding exemptions (see "School Entry Requirements" above). There are three kinds of exemptions:

Medical exemptions

These are allowed when a child has a medical condition or allergy that may make receiving the vaccine dangerous. All 50 states allow medical exemptions. For school entry purposes, these exemptions require a physician's note supporting the medical necessity of the exemption.

Religious exemptions

These are allowed when immunizations are not in agreement with the parents' religious beliefs. Forty-eight of the 50 states allow these exemptions.

Philosophical exemptions

These are allowed when non-religious, but strongly held beliefs, prevent a parent from allowing their child to be immunized. Twenty states allow these exemptions.

In certain situations an exemption can be challenged by the state. These situations include those that would put the child at a higher risk of disease than is reasonable (medical neglect) or those that would put society at risk (e.g., epidemic situations). Also, in some states, if an unvaccinated child is found to transmit a vaccine-preventable disease to someone else, the parents may be liable in a civil suit.

Because vaccines are considered medically necessary (except in the medical cases mentioned above), they are considered to be "best-care" practices. Therefore, if parents choose not to immunize their children, doctors will often have them sign a statement that they have discussed the risks and benefits of the vaccines and they understand that they are taking a risk in refusing vaccines for their children.

Risking disease

Many people incorrectly assume that a choice not to get a vaccine is a risk-free choice. But it isn't. The choice not to get a vaccine is a choice to risk the disease that the vaccine prevents. Studies have shown that unimmunized children are more likely to get vaccine-preventable diseases if there is an outbreak than those who have been immunized. Unimmunized children will be barred from school during an outbreak to protect them from the disease.

Here are some things to consider before making a decision not to immunize a child:

Harm to others

There are four ways that others in the community may be harmed by a parent's decision not to immunize their child:

Those who choose not to immunize their child may be considered to be "free riders" by those who have immunized their children. For example, a mother whose son recently experienced a severe bout with pertussis was angry that other children in the classroom were not immunized. In discussing vaccine safety as the reason that many parents give for not wanting to immunize, she wondered why their children should be protected by herd immunity when her child and all of the other immunized children bore the small risk of side effects. In addition, she wondered why she wasn't made aware that so many of the children in the school weren't immunized due to personal beliefs. She concluded by saying, "Had I known . . .I would never have enrolled him in that school."

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Were we exposed?

Charlotte A. Moser, Assistant Director, Vaccine Education Center at The Children’s Hospital of Philadelphia

Originally published in September 2011 Parents PACK newsletter

I can’t believe that summer is over already! Our family had a great summer, but it was really busy as we travelled with my teenage son and his baseball team. We were so excited in the spring when he was invited to participate on this team of mostly older boys, and he was over the moon as he heard about trips planned for up and down the east coast. As a family, we decided that at least one parent would accompany him on every trip, but that whenever we could, the whole family would go. My husband and I worked out the schedule in a way that we were both in and out of the office throughout this intense period of travel.

For me, being in the office meant monitoring information about disease reports. It meant learning about the measles outbreaks that were occurring in multiple states, hearing about cases of whooping cough that were continuing to be diagnosed, and receiving maps detailing weekly cases of influenza. When I wasn’t at work, I was driving from state to state, sometimes with multiple teenagers in the car, seeing opposing teams and their families from many other places, and watching typical team socialization, like sleeping in cabins, eating together and — cringe! — occasionally sharing water bottles. What about those “good game” lines after every match-up? How about all the restaurants we found ourselves eating in? Of course, we had our daughter with us, so what about all those tourist attractions, movies and malls along the way?

Measles outbreaks, influenza disease, pertussis coughs . . .

As a mom, I wanted my son to have a great time, but I also wanted everyone to be healthy. I knew these diseases were occurring in states we were visiting, in states other teams had come from, and even in our own county. Were boys from other teams well enough to play, but sick a few days later? What about the player who was too sick to come to the start of one tournament, only to show up and stay in the cabin two days later? Were parents or younger siblings who “just didn’t feel quite right” sharing the bleachers? What about that cashier coughing while she rang up our snacks for the team?

Measles vaccine, influenza vaccine, pertussis vaccine . . .

My family was up to date on our immunizations, but I also knew that was not a guarantee. A vaccine might not work for any number of reasons, and I knew there were not vaccines for every type of virus or bacteria that could cause an illness. But, I did take comfort in the fact that I had done what I could to protect my family. Measles vaccine? Got it. Influenza vaccine? Yes. Pertussis vaccine? You bet.

Now that I am back in the office, I have looked over the disease reports for that period a bit more closely. I saw reports of Haemophilus influenzae type b, meningococcal disease, hepatitis B, pneumococcus, chickenpox, hepatitis A and mumps. The reports were from states we had visited or from states that other teams called home. Were we exposed? Maybe. Maybe not. None of us got sick, so I’d like to think we weren’t, but we really don’t know. The vaccines may just have been doing their job.

Now school’s back in session. We should be good, right? Did I mention the email I just got that says about half the kids in my son’s school don’t have complete immunization records? I sit here hoping it is just the records and not the vaccines that are missing. And then I go through the mental list: Measles vaccine? Got it. Influenza vaccine? Yes. Pertussis vaccine? You bet.

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Protecting the herd

One of the contested concepts in vaccines these days is the idea of immunizing one’s children to protect others. People fearful about the safety of vaccines feel they may be risking the health of their children for someone else’s benefit. So, exactly what is herd immunity?

Herd immunity is the finding that if enough people in a community are immunized, even those living among them who have not been immunized are less likely to get a disease. Herd immunity is really a numbers game: the more people that are protected from the disease, the lower the number of susceptible hosts; therefore, the less virus or bacteria moving throughout the community. In fact, a study done by Susan Van den Hoff and colleagues in The Netherlands published in 2002 found that unimmunized people in a highly immunized community are better protected against measles than immunized people in a community with lower immunization rates.

The ability to protect community members (the “herd”) in this way depends upon a few things:

Because immunization rates in the U.S. have been high for many vaccines such as measles, mumps, rubella, Haemophilus influenzae type b (Hib), and polio among others, our communities have enjoyed herd immunity. Most of us have not seen these diseases in recent years. In fact, in many of our communities, this still holds true. Unfortunately, however, recent concerns about the safety of vaccines in certain communities have created pockets of susceptible people throughout the country. As a result, we are starting to see a breakdown of herd immunity in these places; we have had outbreaks of measles, mumps, and Hib disease in the last year, and we are seeing increasing numbers of people infected with pertussis (also known as whooping cough). As these diseases take hold in unvaccinated pockets of individuals locally, it will be difficult to prevent them from wider spread throughout entire regions and states.

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Spread of infectious diseases

We all understand that when we are around someone who is sick, we may get sick too. Most of us also realize that vaccines help decrease the spread of some diseases. However, the notion that the vaccines we receive can help protect those around us is sometimes more difficult to understand.

Researchers at Dartmouth have developed a board game, known as the POX game, to help players gain a better understanding of how the number of immunized people in a community, as well as the presence of people who are immune compromised, plays a role in how quickly diseases can spread throughout a community. The group is developing an online version of the game as well. To learn more about the game, go to http://www.tiltfactor.org/pox.

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Should we stop trying to defeat infectious diseases?

Originally published in March 2011 Parents PACK newsletter

A recent caller to a radio show suggested that when she looked into vaccines for her child, her moment of hesitation came when she thought about the chickenpox vaccine. She felt the disease wasn't that severe; therefore, the vaccine wasn't necessary. Her opinion led to her belief that convenience and profit were motivating the vaccine schedule. Did this caller think we should stop our fight against infectious diseases? Is there some level of severity above which we should do everything we can, but below which we should just let what happens happen?

Chickenpox: The disease

Chickenpox is caused by the varicella virus and is highly contagious. It spreads by respiratory secretions, such as through coughs and sneezes. Infected people typically have a fever and about 300 to 500 itchy blisters covering their entire body. While most people recover after several days, some experience complications such as pneumonia, encephalitis (swelling of the brain), or severe skin infections, such as those caused by “flesh-eating” bacteria. When a pregnant woman is infected with chickenpox, her baby can be born with birth defects or die.

Before the chickenpox vaccine, about 10,000 people were hospitalized with complications each year and about 100 died. Most of these were previously healthy children.

Vaccines and baby products

Our society is one filled with items to make taking care of baby easier, yet every year, we hear about infant deaths involving some of these products and often, associated recalls. In fact, in 2010:

As a society, we rightly demand that the products we use are safe and that the companies making them act responsibly. In fact, the Consumer Product Safety Commission has the sole responsibility to protect society from “unreasonable risks of injury or death.”

In the above-cited examples, the number of deaths was lower than those caused by chickenpox before a vaccine was available, yet the mom on the radio show seemed to suggest that the chickenpox vaccine was unnecessary. Would this same mom feel it was okay to keep the recalled products on the market? What if it was her child who died as a result of the product?

What is the difference?

The heart of the issue is the cause of death. In the case of product recalls, babies died as a result of products introduced by parents and produced by companies. In the case of chickenpox, babies died as a result of something that could not be controlled—however, that was before a vaccine to prevent the disease was available. So, after a vaccine is available, if it is not used and the child suffers the disease should someone be held responsible?

Learn more about chickenpox and the vaccine»

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Requirements versus recommendations

Are requirements and recommendations the same thing?

No. Recommendations made by the CDC are based on health and safety considerations. Requirements, on the other hand, are laws made by each state government determining which vaccines a child must have before entering school. To use an example, consider smoking. Experts tell us that smoking is bad for our health, but it is still our choice whether we smoke or not; that is like a recommendation. In contrast, no-smoking laws prohibit people from smoking in certain places and vary from state to state; this is similar to a requirement.

It is important to remember that even if a vaccine is not required, it may be the best health choice. Talk to your doctor about vaccines that are available and whether they are important for you or a loved one to receive.

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Editorial regarding disease rates and exemptions

The following editorial was written in response to a paper that appeared in November 2006 in the Journal of the American Medical Association. In the paper, Omer and colleagues found an association between rates of pertussis and the ease of obtaining exemptions.

In November 2006, the Journal of the American Medical Association (JAMA) published a study that received little attention from the press and, as a consequence, the public. The study examined the incidence of whooping cough (pertussis) in children whose parents had chosen not to vaccinate them; the results were concerning.

Vaccines are recommended by the Centers for Disease Control and Prevention (CDC) and professional societies, such as the American Academy of Pediatrics. But these organizations can't enforce their recommendations; only states can do that — usually when children enter day-care centers and elementary schools — in the form of mandates. State vaccine mandates have been on the books since the early 1900s; but aggressive enforcement of them didn't occur until much later, born from tragedy.

In 1963 the first measles vaccine was introduced in the United States. Measles is a highly contagious disease that can infect the lungs causing fatal pneumonia or the brain causing encephalitis. Before the measles vaccine, measles caused 100,000 American children to be hospitalized and 3,000 to die every year. In the early 1970s, public health officials found that states with vaccine mandates had rates of measles that were 50 percent lower than states without mandates. As a consequence, all states worked toward requiring children to get vaccines. Now every state has some form of vaccine mandates.

But not all children are subject to these mandates. All fifty states have medical exemptions to vaccines, such as a serious allergy to a vaccine component. Forty-eight states also have religious exemptions; Amish groups, for example, traditionally reject vaccines, believing that clean living and a healthy diet are all that are needed to avoid vaccine-preventable diseases. And twenty states have philosophical exemptions; in some states these exemptions are easy to obtain, by simply signing your name at the bottom of a form; and in others they're much harder, requiring notarization, annual renewal, a signature from a local health official, or a personally written letter from a parent.

The JAMA study examined the relationship between vaccine exemptions and rates of disease. The authors found that between 1991 and 2004 the percentage of children whose parents had chosen to exempt them from vaccines increased by 6 percent per year, resulting in a 2.5-fold increase. This increase occurred almost solely in states where philosophical exemptions were easy to obtain. Worse, states with easy-to-obtain philosophical exemptions had twice as many children suffering from pertussis — a disease that causes inflammation of the windpipe and breathing tubes, pneumonia and, in about twenty infants every year, death—than states with hard-to-obtain philosophical exemptions.

The finding that lower immunization rates caused higher rates of disease shouldn't be surprising. In 1991 a massive epidemic of measles in Philadelphia centered on a group that chose not to immunize its children; as a consequence nine children died from measles. In the late 1990s, severe outbreaks of pertussis occurred in Colorado and Washington among children whose parents feared pertussis vaccine. And in 2005 a 17-year-old unvaccinated girl, unknowingly having brought measles back with her from Romania, attended a church gathering of 500 people in Indiana and caused the largest outbreak of measles in the United States in ten years; an outbreak that was limited to children whose parents had chosen not to vaccinate them. These events showed that for contagious diseases like measles and pertussis it's hard for unvaccinated children to successfully hide among herds of vaccinated children.

Some would argue that philosophical exemptions are a necessary pop-off valve for a society that requires children to be injected with biological agents for the common good. But as anti-vaccine activists continue to push more states to allow for easy philosophical exemptions one thing is clear, more and more children will suffer and occasionally die from vaccine preventable diseases.

When it comes to issues of public health and safety we invariably have laws. Many of these laws are strictly enforced and immutable. For example, we don't allow philosophical exemptions to restraining young children in car seats or smoking in restaurants or stopping at stop signs. And the notion of requiring vaccines for school entry, while it seems to tear at the very heart of a country founded on the basis of individual rights and freedoms, saves lives. Given the increasing number of states allowing philosophical exemptions to vaccines, at some point we are going to be forced to decide whether it is our inalienable right to catch and transmit potentially fatal infections.

S. B. Omer, W. K. Y. Pan, et. al. "Nonmedical Exemptions to School Immunization Requirements" JAMA 2006; 296, 14, pp.1757-1763.

Paul A. Offit, MD is the director of the Vaccine Education Center at The Children's Hospital of Philadelphia.

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Vaccine recommendations and package inserts

I understand that the information included with a vaccine sometimes differs from more commonly available information. Can you explain why?

While a package insert provides information about the vaccine, it is important to realize that it is being provided by the company and, therefore, has legal requirements that must be followed in its preparation. During the development of a vaccine, safety studies are completed by comparing a group of people who received the vaccine to a group of people who did not, called the placebo group. If a side effect occurs more times in the vaccine group, it may be a result of the vaccine. However, the company, according to the Food and Drug Administration (FDA), must report any side effects that occurred in the vaccine group, even if the number of occurrences was similar to those in the placebo group. All of these side effects are then listed in the package insert.

Groups that make recommendations about vaccines to healthcare professionals, such as the Centers for Disease Control and Prevention (CDC) and the American Academy of Pediatrics (AAP), don't use the same criteria as the FDA to determine whether a side effect is caused by vaccines. When these groups make recommendations, they review the data in the context of whether a particular side effect occurs significantly more often in the vaccine group than the placebo group. If it does, these side effects are listed in educational materials to physicians. For this reason, the number of side effects listed in the package insert is much greater than that listed by the CDC and AAP.

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Immunization registries

What is an immunization registry?

An immunization registry is a confidential computerized information system that tracks which vaccines have been given to a child. One of the goals of the Healthy People 2010 initiative is to have at least 95% of children in the United States under 6 years old participating in a registry. By 2004, about 48% of children were included in a registry.

How will participation in a registry benefit my child?

Registries allow healthcare professionals to provide better care for your family because all of your child's immunization information is stored in one place. If you visit more than one doctor, change health insurance providers, no longer have access to records from a previous doctor, or are physically displaced, such as occurred to families after Hurricane Katrina, your records will remain up-to-date and intact. In the aftermath of Katrina, many children were relocated to different states where they attended schools that required proof of immunization. Most families did not have their medical records with them and family doctors could not be reached to forward the records. Because registries were in place in some of the affected areas, those families had less difficulty getting their children back to school. Another benefit of registries is that they ensure timely immunizations through reminders to parents and healthcare professionals. In addition, registries prevent unnecessary (duplicative) immunizations because there is a complete, official copy of a child's immunization history when needed by other healthcare professionals or to provide to schools, day cares, and camps.

What are the concerns about registries and how are they being addressed?

Concerns about registries focus on maintaining confidentiality and preventing misuse of information by outside agencies. However, parents can be reassured for several reasons. First, privacy and confidentiality have come to the forefront in medical institutions as they comply with the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and move toward electronic medical records for their patients. Second, any information reported about immunizations is only reportable from a population standpoint, so at no time can an individual's immunization status be shared with outside sources. Further, systems are being established that assure parental knowledge and consent for participation in a registry. This affords parents the opportunity to learn about the specific registry in their area. Finally, parents who are still hesitant about registries may opt not to participate in them.

Learn more about vaccine registries»

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Vaccines and societal perspectives

Perspective is something we all bring to every situation. It varies by individual and may change through time. In the case of vaccines, we can discuss societal perspectives as they relate to individual actions.

Perspective and the polio vaccine

In the 1950s and 1960s parents would have given anything to protect their children from polio. Parents were scared because they did not know what caused polio, so they did not allow their children to go swimming and they often sent them away from the city during the summer. Fortunately, a virus was determined to be the cause of polio, a vaccine was made, and children were again allowed to swim. Parents could not wait to get the vaccine; from a societal perspective the vaccine was a miracle. Today, parents are not afraid of polio. 

Perspective and the yellow fever vaccine

A few years ago, the first cases of yellow fever in Paraguay in 34 years were reported. Yellow fever kills about 30,000 people throughout the world every year. People with yellow fever can suffer from fever, jaundice, and vomiting, which may appear black due to the presence of blood. People formed long lines at hospitals demanding to receive a yellow fever vaccine; however, the country did not have enough vaccine to meet demand. As a result, several thousand people blockaded a major highway near the city of Asuncion, the country's capital. The reappearance of this disease after 34 years changed the societal perspective about receiving the yellow fever vaccine.

Perspective and the measles vaccine

A recent study in the United Kingdom showed a 17-fold increase in cases of measles between 1998 and 2007. Before a 1998 report suggesting that the measles, mumps, and rubella (MMR) vaccine caused autism, only about 50 cases of measles occurred per year in the U.K.; however, after the report, which was subsequently shown to be inaccurate, immunization rates dropped and cases of measles began to rise. In 2007 there were about 970 cases of measles throughout the U.K. and at least one boy died. The citizens of England had a change in perspective. Before 1998, parents felt they were protecting their children from three harmful diseases. After the report, many parents wondered if they were actually harming their children by giving them vaccines. Subsequent studies of the MMR vaccine and autism as well as the increase in cases of measles, suggest that societal perspective may not always be accurate.

Societal perspective

In each case, societal perspective changed through time. In the case of polio, there was disease without technology or understanding. For yellow fever, there was a re-emergence of disease and a lack of vaccine. For measles, bad science scared people away from a safe vaccine and a disease that was once almost gone began to re-emerge.

These examples suggest that individual actions are based on societal perception, which may or may not be accurate. When there is disease or a lack of vaccine, such as in the example of polio and yellow fever, there is a demand for vaccine. However, in the absence of disease (e.g., measles), there may be a perception that the vaccine is not necessary. Since societal perspective is often based on individual experiences, stories of these experiences, and media reports, it is important to determine why a particular perception is held by society, what it is based upon, and whether there is information available to support it. Unfortunately, some societal perceptions (e.g., measles) lead to unnecessary harm.

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Survey about vaccines

Researchers at the University of Michigan recently surveyed 750 parents of children 6 years old or younger regarding their beliefs about vaccines. They found:

The study results were published in the journal Pediatrics and were in agreement with results found in a larger study conducted this year by the CDC. The CDC study surveyed parents via telephone and, after receiving permission from those parents, surveyed their children’s healthcare providers to confirm immunizations. 

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Mandates and individual liberties

On March 26, 2008 a panel discussion about vaccine mandates titled "Should the Government Make You Do It?" was presented at the Franklin Institute in Philadelphia, Pennsylvania. One of the panelists that evening was Dr. Arthur Caplan, Chair of the Department of Medical Ethics at the University of Pennsylvania. This article is a summary of remarks Dr. Caplan made regarding liberty.

According to Webster's unabridged dictionary, liberty is "freedom from arbitrary or despotic government or control." When it comes to vaccine mandates, some individuals feel that vaccine mandates are contrary to liberty because they are requirements imposed by the government. 

Dr. Caplan argued that in certain cases liberty can ethically be restricted. These include:

Based on these criteria for revoking individual liberties, Dr. Caplan went on to argue that vaccine mandates are justified because they fall into all of these categories.

First, despite popular belief, individuals do not have enough information about vaccines to make informed choices. We rely on experts from the Centers for Disease Control and Prevention, American Academy of Pediatrics and American Association of Family Physicians to review the data and offer recommendations regarding best health practices surrounding vaccines. 

Second, vaccines involve a common good in the name of herd immunity. Herd immunity occurs when enough people in a society are immunized that the disease will not be likely to spread throughout the community. As a result, certain members of society will be protected from the disease even if they cannot get a vaccine or if the vaccine does not work for them. When a certain number of people in a population forego immunization, herd immunity does not work thereby affecting the common good. Recent outbreaks of measles in California, Arizona, Wisconsin and New York have resulted from a sufficient decrease in herd immunity.

Third, an individual's liberty to take advantage of herd immunity is affected by another's liberty to forego immunization, or said another way, "the right to swing my fist ends at the start of your nose." 

Finally, most vaccine mandates affect children who cannot represent themselves and whose interests, therefore, must be represented in the name of liberty.

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One size fits all vaccines

Recent discussions with parents concerned about the safety of vaccines have made mention of "one size fits all vaccines." Specifically, the concern is that the same vaccines are given to infants regardless of size, age or immunologic status. The following will address these concerns.

Infants versus adults

A popular misperception is that all vaccines are given at the same dose to infants and adults. However, there are specific adult and pediatric versions of hepatitis A, hepatitis B, and tetanus, diphtheria, and pertussis vaccines. In the cases of hepatitis A and hepatitis B vaccines, adults receive greater quantities of the components that afford protection in order to produce a protective response. However, in the case of the latter vaccines, the quantities of both diphtheria and pertussis are less than those found in pediatric doses because adults are more likely to experience side effects from these vaccines.

Vaccines and drugs are not created equal

Often, people are concerned about the dosing of vaccines because they compare them to drugs, which are given in different doses based on body weight. This is like comparing apples and oranges. Specifically, drugs work when a certain level is present in the bloodstream; therefore, the weight of a person is important. It takes more of a drug to see the same effect in a larger person than it does in a smaller person. This is similar to the effects of alcohol on a large man and a small woman.

Vaccines, however, do not function in the same way. For a vaccine to be effective, the cells of the immune system are important. Immune cells, called T cells and B cells, must be able to recognize the component of the vaccine, so that if a person comes into contact with that virus or bacteria again, these educated cells can become active and protect the person from an infection. Since these cells are throughout the body, they are usually educated near where the vaccine is given and then the cells, not the vaccines, travel throughout the body. Because of the way that vaccines work, they typically require very low quantities of active ingredients.

Vaccine doses

Vaccine doses are not chosen arbitrarily. During the four phases of vaccine development, different doses are tested to determine the lowest effective dose for the target age group. For example, the rotavirus vaccine was tested at quantities as low as one-tenth the current dose and up to 10 times the current dose.

Vaccine developers must practice good medicine and good economics. Giving larger doses of active ingredients than required would increase the side effects from and the costs of vaccines.

Learn more about vaccine development»

Individuals and public policy

Another common belief is that individuals are not considered when public policies are made. However, there are numerous special circumstances when people should or should not receive a particular vaccine based on their medical history. This is why people are typically advised to get vaccines in their doctor's offices where their medical records can be reviewed prior to the administration of any vaccines.

Some patients require vaccines not necessarily recommended for their age group because they are at an increased risk of getting a disease. For example, doctors caring for cancer and transplant patients follow special immunization recommendations because the patients' immune systems will be weakened as a result of their treatments. Similarly, children without a spleen or with an immune disorder called complement deficiency are suggested to get the meningococcal vaccine earlier than children without these conditions.

There are also circumstances when patients are not recommended to get vaccines based on their medical conditions. For example, adults with weakened immunity resulting from radiation or certain medications should not receive vaccines containing live viruses, such as measles, mumps, rubella, chickenpox, or shingles. Likewise, children or adults with egg allergies typically should not receive the influenza or yellow fever vaccines, and children with severe gelatin allergies may need to forego certain immunizations.

All 50 states allow individuals to forego immunizations that are not safe for them based on their medical histories.

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Updated: January 2012

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