**Word Doc. for 508 of Parents' Guide**

2005

For sale by the Superintendent of Documents

United States Government Printing Office

ISBN 0-16-050801

Department of Health and Human Services

Centers for Disease Control and Prevention

National Immunization Program

In 1736 I lost one of my Sons a fine Boy of 4 Years old, by the Small
Pox\...I long

regretted bitterly and I still regret that I had not given it to him by
Inoculation; This I mention for the Sake of Parents, who omit that
Operation on the Supposition that they should never forgive themselves
if a Child died under it; my example showing that the Regret may be the
same either way, and that therefore the safer should be chosen.

Benjamin Franklin

Autobiography

Table of Contents

PART ONE Introduction

Why Immunizations? 9

How Vaccines Work 10

PART TWO Thirteen Diseases

Why We Vaccinate Against Them 15

1\. Diphtheria 16

2\. Hepatitis A 16

3\. Hepatitis B 17

4\. Hib disease (Haemophilus influenzae type b) 18

5\. Influenza (Flu) 18

6\. Measles 19

7\. Mumps 19

8\. Pertussis (Whooping Cough) 20

9\. Pneumococcal Disease 21

10\. Polio 22

11\. Rubella (German Measles) 23

12\. Tetanus (Lockjaw) 24

13\. Varicella (Chickenpox) 25

PART THREE Nine Vaccines for Thirteen Diseases

Vaccine Side Effects 29

Vaccine Precautions 30

1\. DTaP Vaccine 30

2\. Hepatitis A Vaccine 33

3\. Hepatitis B Vaccine 34

4\. Hib Vaccine 35

5\. Influenza Vaccine 36

6\. MMR Vaccine 38

7\. Pneumococcal Vaccine 40

8\. Polio Vaccine 41

9\. Varicella Vaccine 42

Combination Vaccines 44

PART FOUR Appendix

Childhood Immunization Schedule 49

Diseases Summary 50

Questions and Answers 51

What to Do if Your Child has a Reaction 56

Other Vaccines 58

Immunization Trivia 59 Glossary 60

For More Information 63

Index 66

Acknowledgments 68

PART ONE Introduction

Why Immunizations?

Immunization has been called the most important public health

intervention in history, after safe drinking water. It has saved mil-

lions of lives over the years and prevented hundreds of millions of
cases of disease.

None of us wants to see our children get sick. And getting them
immunized can protect them from a number of very serious diseases.

But did you know that getting your children immunized\...

n Can also protect their friends, schoolmates, and others from those
same diseases? Some children can't get certain vaccines for medical
reasons, or some children are not able to respond to certain vaccines.
For these children, the immunity of people around them is their only
protection.

n Can help protect your grandchildren, their grandchildren, and future
generations from diseases? If enough parents fail to get their children
immunized, diseases that had been under control can come back to cause
epidemics. This has happened in several countries.

n Could, ultimately, even help rid the world of diseases that have been
crippling and killing children for centuries? Immunization allowed us
eradicate smallpox. Today polio is nearly gone, and in the future
measles and other diseases will follow.

Vaccines have a remarkable track record. For example\...

n Diphtheria used to be one of the most dreaded of childhood diseases,
killing over 10,000 people a year in the United States. After we started
vaccinating children in the 1930s and 1940s the disease began to
disappear. Today most doctors will never see a single case of
diphtheria, much less have a child die from it.

n In 1962, the year before measles vaccine was introduced, almost
500,000 cases of measles were reported in the United States, and many
more cases went unreported. Ten years later there were about 32,000
cases and 10 years after that fewer than 2,000. 2002 and 2003 combined
saw only 100 cases.

n Parents in the 1950s were terrified as polio paralyzed children by the
thousands. Then we learned how to prevent polio using the Salk and Sabin
vaccines. There has not been a case of wild virus polio in the United
States since 1979.

n Smallpox was one of the most devastating diseases the world has ever
known. It killed millions of people every year. In 1967 the World Health
Organization undertook an intensive, worldwide vaccination campaign.
Twelve years later the disease had ceased to exist. There hasn't been a
single case since. Smallpox is the first, and so far the only, disease
we have ever eradicated from the Earth; and it was thanks to
vaccination.

How Vaccines Work

What is Immunity?

When disease germs enter your body, they start to reproduce. Your immune
system recognizes these germs as foreign invaders and responds by making
proteins called antibodies. These antibodies' first job is to help
destroy the germs that are making you sick. They can't act fast enough
to prevent you from becoming sick, but by eliminating the attacking
germs, antibodies help you to get well.

The antibodies' second job is to protect you from future infections.
They remain in your bloodstream, and if the same germs ever try to
infect you again --- even after many years --- they will come to your
defense. Only now that they are experienced at fighting these particular
germs, they can destroy them before they have a chance to make you sick.
This is immunity. It is why most people get diseases like measles or
chickenpox only once, even though they might be exposed many times
during their lifetime.

This is a good system for preventing disease. The only drawback is
obvious --- you have to get sick before you become immune.

Vaccines to the Rescue

Vaccines offer a solution to this problem. They help you develop
immunity without getting sick first.

Vaccines are made from the same germs (or parts of them) that cause
disease --- measles vaccine is made from measles virus, for instance,
and Haemophilus influenzae type B (Hib) vaccine is made from parts of
the Hib bacteria. But the germs in vaccines are either killed or
weakened so they won't make you sick.

Vaccines containing these weakened or killed germs are introduced into
your body, usually by injection. Your immune system reacts to the
vaccine the same as it would if it were being invaded by the disease ---
by making antibodies. The antibodies destroy the vaccine germs just as
they would the disease germs --- like a training exercise. Then they
stay in your body, giving you immunity. If you are ever exposed to the
real disease, the antibodies are there to protect you.

Immunizations help your child's immune system do its work. The child
develops protection against future infections, the same as if he or she
had been exposed to the natural disease. Except with vaccines your child
doesn't have to get sick first to get that protection.

PART TWO Thirteen Diseases

Why We Vaccinate Against Them

he purpose of immunizations is to prevent disease. Today, children in
the United States routinely get vaccines that protect

them from 13 diseases. All of these diseases have, at one time or
another, been a serious threat to children in this country. Most of them
are now at their lowest levels in history, thanks to years of
immunization.

Selected Vaccine-Preventable Diseases, United States

Diphtheria

Hib (\<5 yrs old)

Measles

Mumps

Pertussis

Polio (paralytic)

Rubella

Smallpox

Tetanus

Cases per Year (Average) Before Vaccines

175,885

20,000 (est.)

503,282

152,209

147,271

16,316

47,745

48,164

1,314

Cases in 2003

1

259

56

231

11,647

0

7

0

20

Decrease in Cases per Year

99.9%

98.8%

99.9%

99.9%

92.1%

100.0%

99.9%

100.0%

98.5%

Sources

CDC. Impact of vaccines universally recommended for children --- United
States, 1900-1998.

MMWR 8(12):243-8

CDC. Notice to Readers: Final 2003 Reports of Notifiable Diseases. MMWR
2004;53(30):687

Because we don't see these diseases every day they might not seem as
scary as they used to. Some of them might not even be familiar to many
parents. Fifty years ago, for example, measles was one of the most
common diseases in the country --- virtually every child got it. But
today, most parents will never know a child with measles; in fact, most
doctors will never see a case.

But measles still infects about 23 million people around the world
annually and kills about 480,000 of them. People infected with these
diseases can travel to the United States, and we can travel anywhere in
the world. A single case of disease will remain a single case if
everyone around the infected person is immune. If they are not, a single
case can turn into an epidemic. These are 13 diseases we certainly do
not want to see become common everyday events for our children ever
again.

1\. Diphtheria

Diphtheria caused by a bacterium called Corynebacterium diphtheriae. It
lives in the mouth, throat and nose of an infected person and can be
spread to others by coughing or sneezing. A child with diphtheria can
infect others for about 2 to 4 weeks.

It can initially cause a sore throat, fever and chills. But if it is not
properly diagnosed and treated it produces a toxin (poison) in the body
that can cause serious complications such as heart failure or paralysis.
About 1 person out of 10 who get diphtheria dies from it.

Diphtheria used to be a major cause of childhood illness and death.
Through the 1920s about 150,000 people a year got diphtheria in the
United States, and about 15,000 of them died.

2\. Hepatitis A

Hepatitis A is a liver disease caused by the hepatitis A virus. It is
the most frequently reported type of hepatitis in the United States,
causing an estimated 125,000--200,000 cases each year. About a third of
these cases occur in children younger than 15. The virus is found mainly
in bowel movements and is spread through personal contact or by eating
contaminated food or drinking contaminated water.

Children under 6 often don't show any signs of illness, but for older
children signs include fever, loss of appetite, tiredness, stomach pain,
vomiting, dark urine, and yellow skin or eyes (jaundice). Hepatitis A
does not cause long-term illness or liver damage, but about 100 people
die each year from liver failure caused by severe hepatitis A.

3\. Hepatitis B

Hepatitis B is also a liver disease (the word "hepatitis" comes from the
Greek words for "liver" and "inflammation"). It is caused by the
hepatitis B virus. It is spread through contact with the blood, or other
body fluids, of an infected person. Adolescents and adults can be
infected through sharing drug needles or through unprotected sex, and
health-care and public safety workers are often exposed to blood in the
course of their jobs. Pregnant women can infect their newborn babies.
People infected with hepatitis B might not feel sick, or might suffer
loss of appetite or tiredness, muscle or stomach pains, diarrhea or
vomiting, or yellow skin or eyes (jaundice).

People usually recover from hepatitis B after several weeks, but others
may become "chronically infected." They might not feel sick themselves,
but they continue to carry the virus and can infect other people. A baby
who is born to a chronically infected mother has a 70%--90% chance of
being infected at birth. Many people who are chronically infected will
suffer from serious problems such as cirrhosis (scarring of the liver)
or liver cancer.

In the United States there are more than 1 million people who are
chronically infected. In 1996 an estimated 200,000 people became
infected, and 4,000 to 5,000 people die each year from hepatitis B.

4\. Hib disease (Haemophilus influenzae type b)

Hib disease (Haemophilus influenzae type b) used to be the leading cause
of bacterial meningitis in children less than 5 years old. As recently
as the mid-1980s it struck one child out of every 200 in that age group.
About 1 in 4 of these children suffered permanent brain damage, and
about 1 in 20 died.

Hib disease is spread through the air by coughing, sneezing, and even
breathing. If the bacteria stay in a child's nose and throat, the child
will probably not get sick. But if they spread to the lungs or
bloodstream, the child can get meningitis (inflammation of the covering
of the brain), pneumonia, epiglottitis (inflammation in the throat),
arthritis, or other problems. A child who is infected can spread the
disease to others for as long as the bacteria remain in the body.
Antibiotics can stop spread in 2 to 4 days.

5\. Influenza (Flu)

Influenza (Flu) is a seasonal illness, occurring mainly during the
winter. It is caused by influenza virus. Influenza viruses are
continually changing, meaning that immunity you acquire one year will
not necessarily protect you in future years. This makes influenza
different from most diseases, in that you can get it more than once. It
also means that annual immunizations are recommended.

Influenza is spread from person to person through sneezing, coughing or
breathing. Signs and symptoms include fever, sore throat, cough,
headache, chills and muscle aches. Young children might also have
vomiting and diarrhea. Complications can include ear and sinus
infections, pneumonia, myocarditis (inflammation of the heart), and
death. Influenza causes more deaths (about 36,000 per year) than any
other vaccine-preventable disease. Most of these are among the elderly,
but some children also die. Hospitalization rates are high among
children, particularly those less than

1 year old.

6\. Measles

Measles is a viral illness that causes a rash all over the body. It also
causes fever, runny nose and cough. About 1 out of 10 children with
measles also gets an ear infection, and up to 1 out of 20 gets
pneumonia. About 1 out of 1,000 gets encephalitis, and 1 or 2 out of
1,000 die. While measles is almost gone from the United States, it still
kills about half a million people a year around the world. Measles can
also make a pregnant woman have a miscarriage or give birth prematurely.

Measles spreads through the air by breathing, coughing or sneezing. It
is so contagious that any child who is exposed to it and is not immune
will probably get the disease. Before measles vaccine, nearly all
children got measles by the time they were 15. Each year about 450
people died because of measles, 48,000 were hospitalized, 7,000 had
seizures, and about 1,000 suffered permanent brain damage or deafness.
Today there are only about 50 cases a year reported in the United
States, and most of these originate outside the country.

7\. Mumps

Mumps is best known for the swelling of the cheeks and jaw that it
causes, a result of inflammation of the salivary glands. Mumps also
causes a fever and headache. It is usually a mild disease, but it leads
to meningitis in about 1 child in 10 who gets the disease. It can
occasionally causeencephalitis, deafness (about 1 in 20,000 cases), or
even death (about 1 in 10,000 cases).

Mumps is caused by the mumps virus, which is spread from person to
person through the air. Before a vaccine was available mumps was a very
common childhood illness. About 152,000 cases were reported each year.
Now mumps is very uncommon, with only 231 cases reported in 2003.

8\. Pertussis (Whooping Cough)

Pertussis (Whooping Cough) is caused by a bacterium called Bordetella
pertussis. If you have ever seen a child with pertussis you won't forget
it. The child coughs violently and rapidly, over and over, until the air
is gone from her lungs and she is forced to inhale with the loud
"whooping" sound that gives the disease its nickname, whooping cough.

Pertussis is a very contagious disease, and one that is fairly common in
the United States, even today. In 2004, over 25,000 cases were reported.
While this is down considerably from the approximately 150,000 cases a
year before the vaccine, it still makes it one of the most common
vaccine-preventable childhood diseases in the country. It is spread from
person to person through personal contact, coughing and sneezing.

At first pertussis behaves like a common cold, with sneezing, runny
nose, fever and a mild cough. But after 1 or 2 weeks the severe coughing
spells begin. Pertussis is most severe in infants less than 1 year old.
More than half of these infants who get the disease must be
hospitalized. Older children and adults can get pertussis too, but it is
usually not as serious. Many infants who get pertussis catch it from
their older brothers and sisters, or from their parents --- who might
not even know they have the disease.

About 1 child in 10 who get pertussis also gets pneumonia, and about 1
in 50 will have convulsions. The brain is affected in about 1 person out
of 250 (this is called encephalopathy). Pertussis causes about 10--20
deaths each year in the United States.

9\. Pneumococcal Disease

Pneumococcal disease caused by Streptococcus pneumoniae bacteria. It is
usually thought of as a disease of the elderly, but it also takes its
toll among our children. In 1998, before a vaccine for children was
licensed, about 188 of every 100,000 children younger than 2 years of
age developed invasive pneumococcal disease (for instance, meningitis or
blood infections). It is the leading cause of bacterial meningitis in
the country, hitting children under 1 year old the hardest. About 200
children died from invasive pneumococcal disease each year. Pneumococcal
disease is also a common cause of ear infections. There are about 90
subgroups (serotypes) of the pneumococcal bacterium, but 7 of these have
accounted for about 80% of infections among children younger than 6
years of age.

Pneumococcal disease is spread through the air. It can be spread by
anyone who is infected, even if they don't have symptoms. It is most
common during the winter and early spring. All children are susceptible
to pneumococcal disease, but some groups are more susceptible than
others, including African Americans, American Indians, Alaska Natives,
and children with certain medical conditions such as sickle cell disease
or HIV infection, or those who don't have a functioning spleen.

10\. Polio

Polio is a disease that has caused paralysis in millions of children
worldwide over the years. In the United States, 6,000 people died and
another 27,000 were paralyzed during a major epidemic in 1916. Polio
reached a peak in the United States. in the 1950s, when parents were
terrified that the disease would leave their children unable to walk or
force them to spend the rest of their life in an iron lung. With the
appearance of the Salk and Sabin polio vaccines the disease began to
disappear, and there is no longer any wild polio in

the country.

Polio is caused by a virus that lives in the throat and intestinal
tract. It is spread mainly through contact with the feces of an infected
person (for instance, by changing diapers). Some children who get polio
don't feel ill at all. For others, it might resemble a common cold,
sometimes accompanied by pain and stiffness in the neck, back and legs.
But some children get severe muscle pain, and within a week can be
paralyzed --- in other words, lose the use of their muscles. Usually
paralysis affects a child's legs, but it can also affect other muscles,
including those that control breathing. There is no treatment for polio,
and some children die from it.

Even though there is no polio in the United States, it is still common
in some parts of the world. We are working towards eliminating it from
the rest of the world within the next few years.

11\. Rubella (German Measles)

Rubella is sometime called German Measles or 3-day Measles. It is a
generally mild disease caused by the rubella virus. It usually strikes
in the winter and spring, and causes a slight fever, a rash on the face
and neck, and (when teenagers or adults get the disease) swollen glands
in the back of the neck and arthritis-like symptoms in the joints. It is
spread from person to person through the air, by coughing, sneezing or
breathing.

The greatest danger from rubella is to unborn babies. If a woman gets
rubella in the early months of her pregnancy, there is an 80% chance
that her baby will be born deaf or blind, with a damaged heart or small
brain, or mentally retarded. This is called Congenital Rubella Syndrome,
or CRS. Miscarriages are also common among women who get rubella while
they are pregnant.

The last major rubella epidemic in the United States was in 1964--1965,
when about 12.5 million people got the disease and 20,000 babies were
born with CRS. Several years later a vaccine was licensed, and the
disease has been disappearing ever since. Today there are fewer than 20
cases reported each year.

12\. Tetanus (Lockjaw)

Tetanus (lockjaw) differs from other vaccine-preventable diseases in
that it is not contagious. It does not spread from person to person.
Clostridium tetani bacteria are usually found in soil, dust, and manure,
and they enter the body through breaks in the skin. Children usually
become infected through deep puncture wounds or cuts, like those made by
nails or knives. But the bacteria can enter through even a tiny pinprick
or scratch. Children can also get tetanus following severe burns, ear
infections, tooth infections, or animal bites.

When tetanus gets into the body it can take up to 3 weeks for the first
symptoms to appear. These are usually a headache, crankiness, and spasms
of the jaw muscles. The bacteria produce a toxin (poison), which spreads
throughout the body, causing painful muscle spasms in the neck, arms,
legs, and stomach. These can be strong enough to break a child's bones.
Children with tetanus might have to spend several weeks in the hospital
under intensive care.

The number of tetanus cases in the United States has fallen from about
500 a year in the 1940s to only about 50 cases a year today. But 1 out
of every 10 people who get tetanus dies from it.

13\. Varicella (Chickenpox)

Varicella (Chickenpox) was, until recently, one of the most common of
childhood diseases. Before there was a vaccine, almost everyone got it
--- there were about 4 million cases a year in the United States.

Chickenpox is caused by the varicella zoster virus. Its most
recognizable feature is an itchy rash all over the body. It also causes
fever and drowsiness. It is spread from person to person through the
air, by coughing, sneezing or breathing, and can also be spread by
contact with fluid from the blisters. It usually takes 2--3 weeks from
the time of exposure to become ill, and an infected person is contagious
from 1 or 2 days before the rash appears until all the blisters are
dried up, usually 4 to 5 days after.

Chickenpox is usually mild, but it occasionally causes serious problems.
The blisters can become infected, and some children get encephalitis.
Among infants less than 1 year old who get the disease, about 4 in
100,000 die. For older children, about 1 in 100,000 dies. If a woman
gets chickenpox just before or after giving birth, her baby can get very
sick, and about 1 in 3 of these babies will die if not treated quickly.
About 1 child in 500 who gets chickenpox is hospitalized (this figure
increases to about 1 in 50 for adults). After a person has chickenpox
the virus stays in the body. Years later it can cause a painful disease
called herpes zoster, or shingles.

PART TWO Nine Vaccines for Thirteen Diseases

Some childhood vaccines have been used since the 1940s, others have been
around for only a few years. Currently there are 9 routinely-used
vaccines that protect children against the 13 diseases described in Part
Two of this booklet. All of them have done an excellent job of reducing
the burden of certain diseases to their lowest point in history (see the
table on page 15).

Because the diseases they prevent are, for the most part, diseases that
affect children, the vaccines are routinely given to children. We will
describe each vaccine, and then show the routine schedule for receiving
all these vaccines on page 49. Contrary to a fairly common
misperception, children have very robust immune systems, and can easily
cope with several vaccines given on the same day.

Vaccine Side Effects

While vaccines are very safe, like any medicine they do sometimes cause
reactions. Mostly, these are mild "local" reactions (soreness or redness
where the shot is given) or a low-grade fever. They may last a day or
two and then go away. Sometimes more serious reactions are associated
with vaccines. These are much less common. Some of them are clearly
caused by the vaccine; some have been reported after vaccination but are
so rare that it is impossible to tell if they were caused by the vaccine
or would have happened anyway. We will mention any side effects
specifically associated with each vaccine in the descriptions below.

Some children also have allergies, and occasionally a child will have a
severe allergy to a substance that is component of a vaccine. There is a
very small risk (estimated at around one in a million) that any vaccine
could trigger a severe reaction in a child who has such an allergy.
Should one of these allergic reactions occur, it would happen within
several minutes to several hours after the vaccination, and would be
characterized by hives, difficulty breathing, paleness, weakness,
hoarseness or wheezing, a rapid heart beat, and dizziness. Doctors'
offices are equipped to deal with these reactions. Always tell your
provider if your child has any known allergies.

Vaccine Precautions

A child who has had a severe (life-threatening) allergic reaction to a
previous dose of any vaccine should not get another dose of that
vaccine. A child with a known severe (life-threatening) allergy to any
vaccine component should not get a vaccine containing that component.

If a child has any moderate or severe illness on the day any vaccine is
scheduled, it should probably be delayed until the child has recovered.
A mild illness or fever is usually not a reason to delay an
immunization.

We will mention any additional precautions for each vaccine in the
following descriptions.

1\. DTaP Vaccine

DTaP combines vaccines against three diseases, Diphtheria, Tetanus and
Pertussis into one shot. (The small "a" in the name stands for
"acellular," which means that the pertussis component of the vaccine
contains only parts of the pertussis bacterium rather than the whole
cell.) The diphtheria and tetanus components of the vaccine are not
technically vaccines, but "toxoids." In other words, they help the
immune system develop protection against the toxins produced by the
diseases rather than against the disease bacteria themselves. All three
components of DTaP are "inactivated" (killed). Tetanus, diphtheria and
pertussis (DTP) vaccines have been in common use since the 1940s. DTaP
vaccine (with the acellular pertussis component) was first licensed in
1991.

Children need five DTaP shots for maximum protection. The first three
shots are given at 2, 4, and 6 months of age. The fourth (booster) shot
is given between 15 and 18 months, and a fifth shot --- another booster
--- is given when a child enters school, at 4--6 years. When it is given
according to this schedule, DTaP protects most children from all three
diseases (80%--85% from pertussis, 95% from diphtheria, nearly 100% from
tetanus). Protection can fade with time, so booster doses (using Td or
Tdap vaccine, see below) are recommended every 10 years. Tetanus toxoid
is also sometimes given when a person gets a serious wound that could
contain tetanus bacteria.

DTaP Vaccine Side Effects

Up to one third of children who get DTaP have local reactions
(tenderness, pain, redness, swelling). These are most common after the
4th or 5th doses. When they occur it is usually within 2 days after the
shot. Some children also experience swelling of the entire arm or leg
after the 4th or 5th DTaP dose. This happens within 3 days of the shot
and usually lasts around 4 days, with no after-effects. Up to about 1
child in 20 will get a fever of over 101°F --- also more often after the
4th or 5th dose. And up to about 1 child in 5 may become fussy or lose
their appetite for a day or two; nearly half may become drowsy after the
shot.

More serious side effects include a fever of 104°F or higher (1 in
3,000), continuous crying for 3 hours or more (separate studies have
found this in 1 in 900 to 1 in 8,000), and convulsions (1 in 14,000).
Convulsions that occur after DTaP are usually not caused directly by the
vaccine, but by a fever, which in turn was triggered by the vaccine.
These are called "febrile seizures" and, while they might be alarming,
children recover from them quickly and they do not cause permanent harm.
Some experts recommend giving a non-aspirin pain reliever, such as
acetaminophen, to reduce the chances of a fever.

Over the years several cases of permanent brain damage were reported
following DTP vaccine (an earlier version of DTaP). Whether these were
true vaccine reactions or merely coincidence is impossible to say,
because they occurred so infrequently. Some people used to believe that
DTP vaccine could cause Sudden Infant Death Syndrome (SIDS), but studies
have discredited this theory.

DTaP Vaccine Precautions

In addition to the normal precautions for all vaccines, shown on page
30, a child who developed encephalopathy (brain illness) within 7 days
after a dose of DTaP should not get another dose of pertussis-containing
vaccine (see DT vaccine, below).

There are several other conditions that might cause a doctor to
recommend not getting DTaP. These are: a temperature of 105°F, a
collapse or "shock-like" state, or continuous crying for 3 or more
hours, occurring within 48 hours of a previous dose; or convulsions
occurring within 3 days after a previous dose. If your child had any of
these conditions after a previous dose of DTaP, be sure to talk with
your doctor before getting another dose of the vaccine. He or she might
recommend getting a non-pertussis containing vaccine.

Other Related Vaccines

n DT is a tetanus/diphtheria vaccine, which does not contain pertussis.
It is used for children younger than 7 years old who should not get
pertussis vaccine (for example, because they have had a reaction to
pertussis vaccine in the past).

n Td is a version of DT for children 7 years old and older and for
adults. It has a lower concentration of diphtheria toxoid than DT. It is
used for routine 10-year boosters.

n Tdap was licensed in 2005. It contains a full concentration of tetanus
and lower concentrations of both diphtheria and pertussis. It is the
first pertussis-containing vaccine licensed in the United States for
children 7 years of age and older, adolescents, and adults. It is
currently recommended as a once-only booster for adolescents.

2\. Hepatitis A Vaccine

Hepatitis A vaccine is made from inactivated (killed) hepatitis A virus.
It is 94%--100% effective in preventing hepatitis A. Because it has been
available only since 1995, we don't know yet how long immunity will
last, but mathematical modeling suggests that it should protect for 20
years or more. The vaccine is not licensed for children younger than 1
year of age.

Until late 2005 hepatitis A vaccine was recommended only for certain
children: those who live in states where risk of hepatitis A is highest
and those who live in communities with high levels of hepatitis A,
including Alaska Native villages, American Indian reservations, some
Hispanic communities, and some religious communities. Travelers to
countries where the disease is common should also get the vaccine.

In October of 2005 it was decided to change the recommendation to
include routine vaccination of all children between 12 and 23 months of
age. At the time this booklet is being written, this recommendation has
not been formally published.

Two doses of hepatitis A vaccine are recommended, the second dose given
6--18 months after the first. For travelers who don't have time to get
the second dose before their departure, one dose provides good
short-term protection.

Hepatitis A Vaccine Side Effects

Mild local reactions, like pain or swelling where the shot is given, are
reported in up to half of people who get the vaccine. Less than 1 person
in 10 reports fatigue or mild fever. No serious reactions have been
associated with the vaccine.

Hepatitis A Vaccine Precautions

In addition to the normal precautions for all vaccines, shown on page
30, children who are known to have a severe allergy to alum should not
get hepatitis A vaccine.

3\. Hepatitis B Vaccine

Hepatitis B vaccine is an inactivated (killed) vaccine that is made from
a small, non-infectious part of the hepatitis B virus, called hepatitis
B surface antigen. The vaccine was licensed in 1986, and 98%--100% of
children who get the vaccine develop immunity.

Some parents question why infants and young children should be
vaccinated against hepatitis B when they don't have the risk factors
(drug use, sexual activity, professional risk) that lead to many
infections. There are two reasons. One is that babies and children can
become infected too. If a mother infects her baby during birth, for
example, and the baby is not immunized immediately, it will probably
become chronically infected too. One out of 4 of these children will
eventually die from cirrhosis or liver cancer. The other reason is that
vaccinating only high-risk adolescents and adults has proved not to be a
very effective way to control the disease. It was only after we began
routine childhood vaccination that rates of disease began to drop
significantly.

Three doses of hepatitis B vaccine are needed for full protection. The
first dose is usually given at birth. This is particularly important for
children whose mothers are chronically infected. For other babies the
first dose can be given between birth and 2 months of age. The second
dose is recommended at 1--4 months and the third at 6--18 months. These
three doses should protect children for life. No additional booster
doses are needed.

Hepatitis B Vaccine Side Effects

About 3--9 children out of 100 have some soreness where the shot is
given, and up to 6 in 100 develop a mild fever. Up to 2 out of 10 might
become tired or irritable. More serious reactions are extremely rare.

Hepatitis B Vaccine Precautions

In addition to the normal precautions for all vaccines, shown on page
30, children who are known to have a severe allergy to baker's yeast
(the kind used for making bread) should not get hepatitis B vaccine.

4\. Hib Vaccine

There are several brands of Haemophilus influenzae type b (Hib) vaccine
used in the United States. They are all inactivated (killed) vaccines,
made from a only a small part of the Hib bacterium. All brands work
equally well, protecting 95%--100% of children from Hib disease. The
first Hib vaccine was licensed in 1985, and several improved versions
have become available since then.

Children should get either 3 or 4 doses of Hib vaccine, depending on
which brand your doctor uses. The vaccine is recommended at 2, 4, 6, and
12--15 months of age. The 6-month dose not given with one brand of
vaccine.

Hib Vaccine Side Effects

Hib is a very safe vaccine. It cannot cause Hib disease or meningitis,
and is not known to cause any other serious reactions. About 2 children
in every 100 who get Hib vaccine have redness, swelling or warmth where
the shot was given, or a fever over 101°F. These reactions usually begin
within 24 hours after the shot and last 2 or 3 days.

Hib Vaccine Precautions

In addition to the normal precautions for all vaccines, shown on page
30, Hib vaccine should not be given to children younger than 4 weeks of
age. This is not because it is not safe but because it might not protect
as well if given too early.

5\. Influenza Vaccine

There are two types of influenza vaccine. The first is an inactivated
(killed) vaccine given as a shot, which has been used for many years. It
can be given to anyone 6 months of age and older. The second is a live,
attenuated (weakened) vaccine, which is sprayed into the nose and was
licensed in 2003. It is not licensed for children younger than 5 years
old. Because influenza viruses change from year to year, new vaccines
must also be formulated each year, and annual vaccination is
recommended.

The inactivated influenza vaccine is 70%--90% effective in healthy
children, and the live, intranasal vaccine is about 87% effective in
healthy children 5--7 years of age. Many other infections have the same
symptoms as influenza and are often mistakenly called "flu." Neither
vaccine is effective against infections that are not actually caused by
influenza viruses.

One dose of vaccine (either type, depending on age) is recommended
annually, beginning around October or November. For children younger
than 9 who are getting influenza vaccine for the first time, 2 doses are
recommended, at least a month apart (inactivated vaccine) or 6--10 weeks
apart (live vaccine).

Influenza Vaccine Side Effects

Inactivated Vaccine

About 15%--20% of those who get inactivated influenza vaccine have a
mild local reaction, such as soreness or redness where the shot was
given. These generally last 1 or 2 days. A very small number, less than
1%, may get a fever, chills or muscle aches. Because the virus in this
vaccine has been killed, it cannot cause influenza.

Some inactivated influenza vaccine contains a preservative called
thimerosal, which contains mercury. Some people believe that thimerosal
in vaccines has been associated with developmental problems, including
autism. In 2004 the Institute of Medicine reviewed scientific studies
looking for a connection between thimerosal and these problems, but
concluded that there is no evidence of such a connection. Parents can
ask their providers about the availability of thimerosal-free vaccine.

Live, intranasal vaccine

Some children have gotten a runny nose or nasal congestion, fever,
headaches or muscle aches, abdominal pain or vomiting. Since these
symptoms are fairly common among all children, it is difficult to tell
whether their presence after vaccination is due to the vaccine. Although
the vaccine contains live influenza virus, it has been weakened and
altered in other ways so it does not cause influenza.

Influenza Vaccine Precautions

Inactivated vaccine

In addition to the normal precautions for all vaccines, shown on page
30, children who are known to have a severe allergy to eggs should not
get inactivated influenza vaccine.

Live, Intranasal Vaccine

In addition to the normal precautions for all vaccines, shown on page
30, children who have a severe allergy to eggs should not get live
influenza vaccine. Children who have a weakened immune system, who have
chronic medical conditions such as asthma, reactive airways disease,
diabetes, renal disease, or sickle cell disease, or who are receiving
long-term therapy with aspirin or other salicylates should also not get
this vaccine. The vaccine is not known to be harmful to these people,
but it has not yet been thoroughly tested in them.

6\. MMR Vaccine

MMR combines vaccines for Measles, Mumps and Rubella into one shot. MMR
has been around since 1971, although its three components were licensed
separately during the 1960s. It is a live vaccine, containing measles,
mumps and rubella viruses that have been "attenuated" (weakened), so
they won't cause disease. Most children who get the vaccine develop
immunity to all three diseases (over 99% for measles and 95% for mumps
and rubella). Protection is believed to be life-long.

Two doses of vaccine are recommended, with the first dose given at
12--15 months of age. The second dose may be given 4 weeks after the
first, but it is usually given at 4--6 years. No boosters are needed.

Measles, mumps and rubella vaccines may be given separately, although
these individual vaccines are not always readily available. Doctors
usually prefer not to give the vaccines this way because it means giving
a child 3 shots instead of one. MMR Vaccine Side Effects

Some children (about 1 in 5) get a mild rash or fever after MMR vaccine.
These reactions begin a week or two after the vaccination and usually
last for 1--3 days. About 1 child in 7 may get swollen lymph glands, and
1 child in 100 may have pain or stiffness in the joints that can last
from a few days to a few weeks. There is a smaller risk of painful
swelling of the joints (arthritis). These joint symptoms occur more
often in adults, especially women.

Febrile seizures (seizures caused by a fever) have occasionally been
reported after MMR vaccination. These usually happen 1 or 2 weeks after
the shot and are caused by the fever than can accom-pany the vaccination
rather than by the vaccine itself. Children recover from febrile
seizures quickly and they do not cause permanent harm.

There have been reports of children getting encephalitis (inflammation
of the brain) after an MMR shot. This happens so rarely --- less than
once in a million shots --- that experts can't be sure whether the
vaccine is the cause or not. Remember, though, that if the same million
children were infected with measles, about 1,000 of them would get
encephalitis.

MMR Vaccine Precautions

In addition to the normal precautions for all vaccines, shown on page
30, children who are known to have a severe allergy to gelatin or the
antibiotic neomycin should not get MMR. A child who has a suppressed
immune system, either because of a disease such as cancer or HIV
infection or a medication such as steroids, should be evaluated by a
doctor before getting MMR. A child who has recently gotten a transfusion
or other blood product might have to wait up to several months before
getting MMR.

Two live vaccines (for example, MMR and varicella) may be given on the
same day or separated by at least 4 weeks. But they should not be given
less than 4 weeks apart, because they might interfere with each other.
MMR and inactivated (killed) vaccines may be given together, or at any
time in relation to each other.

Children who have gotten MMR vaccine can not infect people they come in
contact with.

7\. Pneumococcal Vaccine

Pneumococcal conjugate vaccine was licensed in 2000. It is an
inactivated (killed) vaccine, which gives immunity against the 7 strains
of the pneumococcal bacterium that have caused most of the serious
infections in children. It is more than 90% effective against invasive
disease (for example, blood infections and meningitis). Some ear
infections are caused by Streptococcus pneumoniae, but many are caused
by other organisms, and the vaccine will not prevent these.

Four doses of pneumococcal vaccine are recommended, at 2, 4, 6, and
12--15 months of age. Children who are late starting the series may need
fewer doses. Check with your doctor or clinic for the recommended
schedule if your child starts late. Children 5 years old and older
should usually not get pneumococcal conjugate vaccine. But some older
children (those with certain chronic diseases or damaged immune systems)
should still get a pneumococcal vaccine. There is a different vaccine
--- called pneumococcal polysaccharide vaccine --- that can be given to
these children and to adults. Pneumococcal vaccine may be given at the
same time as other childhood vaccines.

Pneumococcal Vaccine Side Effects

Local reactions have been reported in 10%--20% of children getting the
vaccine. Of these, only about 3% were considered severe (for example,
tenderness that interferes with arm or leg movement). These local
reactions occur most frequently after the 4th dose. Some children also
report a mild fever. More severe reactions are extremely uncommon.

Pneumococcal Vaccine Precautions

Other than the normal precautions for all vaccines, shown on page 30,
there are no precautions for pneumococcal vaccine.

8\. Polio Vaccine

The polio vaccine used in the United States contains 3 types of
inactivated (killed) polio virus. It is sometimes called IPV
(Inactivated Polio Vaccine). We once used another type of polio vaccine
--- a liquid that was swallowed, called OPV (Oral Polio Vaccine). This
vaccine is no longer available in the United States but is still used in
other parts of the world. The first inactivated polio vaccine (the Salk
vaccine) was licensed in 1955, and the vaccine we use today (an improved
version) has been in use since 1987. The vaccine protects 99% of
children who get at least 3 doses.

Children should get four doses of polio vaccine, the first 3 doses at 2,
4, and 6--18 months of age, and a booster dose at 4--6 years.

Polio Vaccine Side Effects

Inactivated polio vaccine is a very safe vaccine. It is not known to
produce any side effects other than a little soreness and redness where
the shot is given. The old oral vaccine, OPV, could actually cause
polio, although rarely. This cannot happen with IPV.

Polio Vaccine Precautions

In addition to the normal precautions for all vaccines, shown on page
30, a child who is known to have a severe allergy to the antibiotics
neomycin, streptomycin, or polymyxin B should not get polio vaccine.

9\. Varicella Vaccine

Varicella vaccine is made with live, attenuated (weakened) varicella
virus. It has been used in some parts of the world, such as Japan, for
more than 20 years. It was licensed in the United States in 1995. It
prevents chickenpox in 70%--90% of people who get it, and it prevents
severe chickenpox in more than 95%. It is expected to provide life long
immunity. The vaccine used in Japan is still protecting people who were
vaccinated 20 or more years ago, and in the United States, people who
were vaccinated during testing, before the vaccine was licensed, are
still immune.

A single dose of varicella vaccine is recommended for children at 12--18
months of age. It is usually given at the same time as MMR vaccine.
Children who miss this shot can still get a single dose of the vaccine
until their 13th birthday. After the 13th birthday, 2 doses are
recommended, given 4 to 8 weeks apart. Anyone who has had chickenpox
does not need the vaccine.

Each year, about 1% of people who have gotten varicella vaccine develop
chickenpox in spite of having responded to the vaccine. This is called
"breakthrough" infection. Breakthrough infections are much milder than
normal chickenpox. Patients generally have fewer than 50 lesions, which
do not form blisters. They also do not get a fever and have no
complications. We don't know why breakthrough infections occur.

Varicella Vaccine Side Effects

About 1 child in 5 gets some redness or soreness where the shot was
given. Some children also get a mild rash (about 5 spots) 1 to 3 weeks
after the shot. About 15% of children get a fever, but most of these
fevers have been shown to have causes other than the vaccine. Febrile
seizures (seizures caused by fever) have occurred in less than 1 out of
1,000 children. Other serious problems, such as inflammation of the
brain (encephalitis) or loss of muscle coordination, have been reported
very rarely --- so rarely that it is not certain that the vaccine is the
cause.

Varicella Vaccine Precautions

In addition to the normal precautions for all vaccines, shown on page
30, children who are known to have a severe allergy to gelatin or the
antibiotic neomycin should not get varicella vaccine. A child who has a
suppressed immune system, either because of a disease such as cancer or
HIV infection, or a medication such as steroids, should be evaluated by
a doctor before getting varicella vaccine. A child who has recently
gotten a transfusion or other blood product might have to wait up to
several months before getting varicella vaccine.

Two live vaccines (for example, varicella and MMR) may be given on the
same day or separated by at least 4 weeks. But they should not be given
less than 4 weeks apart, because they might interfere with each other.
Varicella and inactivated (killed) vaccines may be given together, or at
any time in relation to each other.

There is a very small risk that a child who has gotten varicella vaccine
could infect a susceptible family member --- particularly one with a
suppressed immune system. This appears to happen very rarely, and only
when the vaccinated child develops a rash. To be safe, anyone with a
suppressed immune system should consider avoiding contact with a child
with a varicella vaccine-related rash.

Combination Vaccines

Several vaccines are sometimes combined into a single shot. These are
called combination vaccines. Some combination vaccines are used
routinely --- DTaP is a combination; so is MMR. There are currently four
other combination vaccines available for children. One combines DTaP and
Hib vaccines; the second Hib and hepatitis B; the third combines DTaP,
hepatitis B, and polio, and the fourth combines measles, mumps, rubella
and varicella. The advantage of combination vaccines is, of course, that
your children get the protection of all the component vaccines while
getting fewer injections.

Each of these vaccines has certain restrictions, and not all providers
carry them. But ask your provider about them if you are interested in
reducing the number of shots your child must get for complete vaccine
coverage.

PART FOUR Appendix

Childhood Immunization Schedule

accines work best when they are given at certain ages. For example,
measles vaccine is not usually given to children until

they are at least a year old. If it is given earlier it might not work
as well. For vaccines requiring multiple doses, the doses should not be
given too close together.

This chart shows the routine childhood immunization schedule for the
United States. It tells you what vaccines are recommended and the ages
at which they should be given. A bar spanning several ages means the
dose may be given at any time during that age range. For example, the
3rd dose of polio vaccine may be given any time between 6 and 18 months.

While these are the recommended ages for vaccine doses, the schedule is
not inflexible. If a child doesn't get a dose of vaccine at the
recommended age, he can catch up later. Sometimes a child needs to get a
dose earlier than the recommended age. Within limits, this can be done
too. Your provider can give you more information.

This is the childhood immunization schedule as of November 2005. An
updated schedule will be published in January 2006. It will be available
online at
[www.cdc.gov/nip/recs/child-schedule.htm](http://www.cdc.gov/nip/recs/child-schedule.htm).

Childhood Immunization Schedule, United States

Diseases Summary

Caused by

Spread by

Signs and Symptoms

Complications

Diphtheria

Hepatitis A

Hepatitis B

Hib disease

Influenza

Measles

Mumps

Pertussis

Pneumococcal

Polio

Rubella

Tetanus

Varicella

Bacterium --- Corynebacterium diphtheriae

Virus --- Hepatitis A

Virus --- Hepatitis B

Bacterium --- Haemophilus influenzae type b

Virus --- Influenza

Virus --- Measles

Virus --- Mumps

Bacterium --- Bordetella pertussis

Bacterium --- Streptococcus pneumoniae

Virus --- Poliomyelitis

Virus --- Rubella

Bacterium --- Clostridium tetani

Virus --- Varicella Zoster

Air, direct contact

Personal contact; contaminated food or water

Contact with blood or body fluids

Air, direct contact

Air, direct contact

Air, direct contact

Air, direct contact

Air, direct contact

Air, direct contact

Person to person

Air, direct contact

Exposure through breaks in skin

Air, direct contact

Sore throat, mild fever, membrane in throat, swollen neck

Fever, stomach pain, loss of appetite, fatigue, vomiting, jaundice, dark
urine

Fever, headache, malaise, vomiting, arthritis

May be no symptoms unless bacteria enter blood

Fever, muscle pain, sore throat, cough

Rash, fever, cough, runny nose, pinkeye

Swollen salivary glands, fever, headache, malaise, muscle pain

Severe cough, runny nose, fever

Pneumonia (fever, chills, cough, chest pain)

May be no symptoms, sore throat, fever, nausea

Rash, fever, lymphadeno-pathy, malaise

Stiffness in neck, difficulty swallowing, rigid abdominal muscles,
muscle spasms, fever, sweating, elevated blood pressure

Rash, fever

Heart failure, paralysis, pneumonia, death

Liver failure, death

Chronic infection, cirrhosis, liver failure, liver cancer, death

Meningitis, epiglotittis, pneumonia, arthritis, death

Pneumonia, Reye syndrome, myocarditis, death

Pneumonia, ear infections, encephalitis, seizures, death

Meningitis, encephalitis, inflammation of testicles or ovaries, deafness

Pneumonia, seizures, brain disorders, ear infection, death

Bacteremia (blood infection), meningitis, death

Paralysis, death

Encephalitis, arthritis/arthralgia, hemorrhage, orchitis

Broken bones, breathing difficulty, death

Bacterial infections, meningitis, encephalitis, pneumonia, death

Questions and Answers

Why do children need so many shots?

Some of us may have gotten only 3 vaccines as children: DTP, polio, and
smallpox. There were no vaccines for measles, chickenpox, mumps, and
other diseases --- which meant that many of us also got those diseases!
The simple answer to why children get so many shots is because they can.
Scientists have developed vaccines against more diseases, and we give
them to our children to protect them from those diseases. Children don't
get smallpox vaccine any more because we have eradicated the disease.
Within our lifetimes, we may also eradicate polio, and that vaccine too
will no longer be needed. More combination vaccines may also reduce the
number of shots children will need. At the same time, vaccines may be
developed to protect us against even more diseases.

Why are vaccines given at such an early age?

Vaccines are given at an early age because the diseases they prevent can
strike at an early age. Some diseases are far more serious or common
among infants or young children. For example, up to 60% of severe
disease caused by Haemophilus influenzae type b occurs in children under
12 months of age. Of children under 6 months of age who get pertussis,
72% must be hospitalized, and 84% of all deaths from pertussis are among
children less than 6 months of age. The ages at which vaccines are
recommended are not arbitrary. They are chosen to give children the
earliest and best protection against disease.

What if my child misses a dose of vaccine?

They can continue the series where they left off. Vaccinations are not
rendered invalid and do not have to be repeated when there is a
longer-than-recommended interval between doses in a series.

How safe are vaccines?

They are very safe. But like any medicine, they are not perfect. They
can cause reactions. Usually these are mild, like a sore arm or slight
fever. Serious reactions are very uncommon. Your health-care provider
will discuss the risks with you before your child gets each vaccine, and
will give you a form called a Vaccine Information Statement, which
describes the vaccine's benefits and risks. The important thing to
remember is that vaccines are much safer than the diseases they prevent.

Do vaccines always work?

Vaccines work most of the time, but not always. Most childhood
vaccinations work between 90% and 100% of the time. Sometimes, though, a
child may not respond to certain vaccines, for reasons that aren't
entirely understood. This is one reason why it is important for all
children to be immunized. A child who does not respond to a vaccine has
to depend on the immunity of others around her for protection. If my
child is immune to measles, he can't pass the disease along to your
child who failed to respond to measles vaccine. But if my child never
got the vaccine, he can not only get measles himself, he can pass it
along to others who are not immune.

What will happen if my child doesn't get his vaccinations?

One of two things could happen:

1\. If your child goes through life without ever being exposed to any of
these diseases, nothing will happen.

2\. If your child is exposed to one of these diseases, there is a good
chance he will get it. What happens then depends on the child and the
disease. Most likely he would get ill and have to stay in bed for a few
days up to 1--2 weeks. But he could also get very sick and have to go to
the hospital. At the very worst, he could die. In addition, he could
also spread the disease to other children or adults who are not immune.

What are my child's chances of being exposed to one of these

diseases?

Overall, quite low. Some of these diseases have become very rare in the
United States (thanks to immunizations), so the chances of exposure are
small. Others, such as varicella and pertussis, are still relatively
common. Some are rare in the U.S. but common elsewhere in the world, so
there is risk not only to travelers, but also to anyone exposed to
travelers from other countries visiting here.

If my child's risk of exposure to disease is so low, why should I bother
getting him immunized?

This is a good question. One answer, of course, is that even if the risk
of getting these diseases is low, it is not zero. Even if only one child
in the whole country gets diphtheria this year, that child has a 1 in 10
chance of dying. Vaccination would have protected him.

But there is also another answer. With diseases growing more uncommon,
parents should think not only of their own children but also of other
children and of future generations of children.

What would happen if enough parents stopped immunizing their children?
We know the answer, because it has already happened in several
countries, including Great Britain and Japan, where many people in the
1970s stopped using pertussis vaccine because they were afraid it was
not safe. In 1974, Japan had only 393 cases of pertussis and no deaths.
Then within the next few years pertussis vaccination rates dropped from
80% to 10%, and in 1979 the country suffered a major pertussis epidemic
with more than 13,000 cases and 41 deaths.

What ingredients go into vaccines, and why?

The major ingredient of any vaccine is a killed or weakened form of the
disease organism the vaccine is designed to prevent. Therefore, measles
vaccine is mostly measles virus. Pneumococcal vaccine is mostly the
surface coating from pneumococcal bacteria.

In addition, vaccines can contain:

n Diluents A diluent is basically a liquid used to dilute a vaccine to
the proper concentration. It is usually saline or sterile water.

n Adjuvants Adjuvants are chemicals added to vaccines to make them
provide stronger immunity. Various forms of aluminum salts are the most
commonly used adjuvants in vaccines.

n Preservatives Preservatives are included in some vaccines (mainly ones
that come in multi dose vials that might be used several times) to
prevent bacterial growth that could make the vaccine unsafe.

n Stabilizers Some vaccines contain stabilizers (for example, gelatin or
lactose-sorbitol), to keep them safe and effective under different
conditions or different temperatures.

n Remnants from manufacturing Chemicals are often used during the
vaccine manufacturing process, and then removed from the final product.
For example, formalin might be used to kill a vaccine virus, or
antibiotics might be used to prevent bacterial contamination. When these
chemicals are removed, a tiny trace may remain. While some of these
chemicals might be harmful in large doses, the trace amounts left in
vaccines are too small to have a toxic effect.

The "package insert" that comes with each vial of vaccine lists all the
contents of the vaccine and explains why each substance is there.

What to Do if Your Child Has a Reaction

Most children do not have any reactions to vaccines. Among those who do,
the large majority are minor local reactions (pain, swelling or redness
at the injection site) or a mild fever. These go away within a day or
two and don't normally require any special treatment.

But what if your child has a more serious reaction, such as a severe
allergic reaction?

Signs of a severe allergic reaction can include difficulty breathing,
hoarseness or wheezing, hives, paleness, weakness, a fast heart beat or
dizziness. If your child shows these symptoms after getting vaccinations
--- or if she shows other unusual symptoms, such as a high fever or
behavior changes --- don't hesitate:

n Call a doctor or get the child to a doctor right away.

n Tell your doctor what happened, the date and time it happened, and
when the vaccination was given.

Reporting Adverse Reactions

In the event your child has a vaccine-associated injury --- or even if
you think a medical problem your child has might have been caused by a
vaccine --- you should report the problem.

VAERS (the Vaccine Adverse Event Reporting System) collects reports of
suspected vaccine injuries. Generally, the doctor fills out a VAERS
report and sends it to the program. But a parent or individual can also
file a VAERS report. You can get more information about VAERS from their
toll-free information line at 800-822-7967, or visit their website at
www.vaers.hhs.gov

Often reactions reported to VAERS turn out not to have been caused by
the vaccine, but to have been unrelated events that just happened to
occur after immunization. VAERS expects this, and you shouldn't let
doubt about whether a reaction was really caused by a vaccine stop you
from filing a report. One of the purposes of VAERS is to collect enough
data to reveal patterns that might help researchers identify previously
unknown side effects, or to show that some reactions are not caused by
vaccines. All reports contribute to this useful database.

If your child were to suffer a serious injury that proves to have been
caused by a vaccination, a program called the National Vaccine Injury
Compensation Program will provide compensation to help with their care.
You can learn more about the National Vaccine Injury Compensation
Program from their website at www.hrsa.gov/osp/vicp, or by calling the
program toll-free at

800-338-2382.

Other Vaccines

In addition to the routine childhood vaccinations covered in this
booklet, there are other vaccines that children may need under certain
circumstances.

Rabies vaccine might be recommended for children bitten by animals, or
otherwise thought to have been exposed to rabies, and for small children
who will be living in a country where rabies is common.

Children traveling abroad may need other vaccines, depending on what
diseases are present in the countries they are visiting. These vaccines
can include Japanese encephalitis, typhoid, meningococcal, and yellow
fever.

Meningococcal vaccine is also recommended for adolescents at their
11--12 year doctor's visit, as is Tdap (see page 32).

Your health-care provider can advise you about use of these vaccines.

Immunization Trivia

n The first Nobel Prize in medicine was awarded in 1901 to the scientist
who developed the first antitoxin for diphtheria.

n The "March of Dimes" began in 1938 as a fund-raising campaign for
polio. People were asked to mail one dime directly to the White House to
help fight the disease. In the first 3 days, the White House received
230,000 dimes. President Franklin D. Roosevelt, whose profile is now on
the dime, was himself paralyzed by polio.

n The word "measles" probably comes from a Latin word meaning
"miserable."

n The reason varicella is called chickenpox has nothing to do with
chickens. It got its name because its blisters look like chick peas.

n The last person in the world to get a natural case of smallpox was a
23-year-old cook in Somalia, in 1977. In recent years he has made public
appearances to help with Somalia's polio eradication campaign.

n Although it is called Haemophilus influenzae, Hib is not related to
influenza. Hib bacteria were first discovered in people who died from
influenza during the 1889 pandemic, and were mistakenly believed to be
the cause of that disease.

n Mumps is considered mainly a childhood disease. But it used to be
known as a disease afflicting armies. Mumps was one of the leading
causes of hospitalization during World War I.

n In 1970, astronaut Ken Mattingly was scrubbed from the Apollo XIII
moon mission because he had been exposed to measles.

n During World War I, German measles (rubella) was referred to as
"Liberty Measles."

n The famous dog-sled race, the Iditarod, commemorates a dog-sled run in
1925 to rush serum to Nome, Alaska to treat an epidemic of diphtheria.

n There is a patron saint of tetanus --- Saint Osmund.

n About one-fourth of the U.S. population, including President Woodrow
Wilson, got influenza during the 1918 pandemic.

Glossary

Acetominophen --- A non-aspirin drug that reduces pain and lowers fever.
It goes by several brand names, including Tylenol®.

Antibody --- A protein produced by the immune system that helps identify
and destroy foreign germs (viruses or bacteria) that attack the body.

Bacteremia --- Presence of bacteria in the blood.

Convulsion --- See seizure.

Encephalitis --- Inflammation of the brain.

Encephalopathy --- Any illness that affects the brain.

Epidemic --- A large outbreak of disease (see outbreak). An epidemic
could include many people from the same city or community, or even from
an entire country. A world-wide epidemic is called a pandemic.

Exposure --- Contact with the germs that cause disease. A person must be
both exposed to a disease and susceptible to it (see susceptible) to get
sick from the disease.

Febrile Seizure --- A seizure caused by a high fever (see seizure).

Immune --- Protected from a disease, even when exposed to it. People can
become immune after getting a disease or by getting vaccinated against
the disease. Opposite of susceptible.

Immunity --- Protection from disease. Having antibodies to a disease
organism generally makes a person immune.

Local Reaction --- a reaction that is restricted to a small area. With
vaccines, a local reaction is usually redness, soreness, or swelling
where the injection was given. A reaction that affects the whole body,
such as a fever or bacteremia, is called a systemic reaction.

Meningitis --- Inflammation of the covering of the brain or spinal cord.

Outbreak --- An unusually large number of cases of a disease occurring
around the same time and place, involving people who all got the disease
from the same source or from each other.

Paralysis --- Inability to move the muscles. Paralysis usually occurs in
the arms or legs, but any muscles can become paralyzed, including those
that control breathing.

Schedule --- (Or vaccination schedule.) The ages and/or intervals at
which children should get the various childhood vaccinations.

Seizure --- A spell in which the muscles may jerk uncontrollably, or in
which the patient simply stares at nothing. Usually, a seizure lasts
only a brief time and doesn't cause permanent harm. A seizure can have
many causes, including epilepsy or other brain disorders, or a high
fever (see febrile seizure). Also called convulsion or fit.

Susceptible --- Vulnerable to disease. Someone who has never had a
disease or been vaccinated against it is susceptible to that disease.
Opposite of immune. A person who is immune is no longer susceptible.

Toxin --- Poison.

For More Information

With the Parents' Guide we have tried to give you the important facts
about immunization in a relatively small package. Naturally we have not
been able to include everything. The short section about immunity on
page 10 is a simplified explanation of a much more complex process.
Whole books have been written on topics we try to cover in a page or
two. If you would like to learn more about childhood diseases and
immunization, here are some places to look:

Books

n What Every Parent Should Know About Vaccines by Paul A. Offit, MD and
Louis M. Bell, MD. This is a good introduction to immunization, which
covers essentially the same topics as this booklet, but in much more
detail. It also has chapters about vaccines needed for foreign travel,
how vaccines work, how they are made, vaccine safety, and vaccines of
the future.

n Vaccinating Your Child: Questions & Answers for the Concerned Parent
by Sharon G. Humiston, MD and Cynthia Good. Another good introduction to
immunization for parents, containing sections on vaccine use, routine
childhood vaccinations, and other vaccines. It answers many of the
questions parents have about childhood vaccinations.

n Epidemiology & Prevention of Vaccine-Preventable Diseases (The "Pink
Book") by William L. Atkinson, MD et al. CDC Publication. A
comprehensive introduction to the principles of vaccination and routine
childhood vaccines and vaccine-preventable diseases. This book is
intended for doctors, nurses, and others who give vaccinations. It also
contains information of interest to parents. Available online or through
the Public Health Foundation --- see
www.cdc.gov/nip/publications/pink/default.htm.

n The Immune System --- How it Works by Lydia Woods Schindler. National
Institutes of Health (NIH Publication #96-3229). This is a colorful,
25-page booklet written for a general audience, but still somewhat
technical, describing the workings of the human immune system.

Vaccines 4th Edition, edited by Stanley A. Plotkin, MD, and Walter A.
Orenstein, MD. This is a very important and comprehensive source of
immunization information. It is written for health professionals, and
can be very technical, but it contains a wealth of information about
vaccines and vaccine-preventable diseases.

Telephone

Your State Health Department's Immunization Program. To find the phone
number for your state go to this internet address:
www.immunize.org/nslt.d/n18/coord18.htm and look for the state
immunization coordinator for your state. (Thanks to the Immunization
Action Coalition for maintaining this list.)

CDC-INFO. Talk with a trained operator who can answer individual
questions about vaccines and vaccine-preventable diseases. Call (800)
232-4636 (CDC-INFO) 24 hours a day.

Internet

n CDC Websites

National Immunization Program www.cdc.gov/nip

Division of Viral Hepatitis www.cdc.gov/hepatitis

Influenza Information www.cdc.gov/flu

International Travel Information: www.cdc.gov/travel

n American Academy of Pediatrics

www.aap.org/new/immpublic.htm

n World Health Organization's Pages on Vaccines and Immunization
www.who.int/vaccines

n "A Miracle of Medicine" Vaccine Education Center at the Children's
Hospital of Philadelphia www.vaccine.chop.edu

n National Network for Immunization Information www.immunizationinfo.org

n Dr. Reddy's Pediatric Office on the Web www.drreddy.com/shots

n National Vaccine Injury Compensation Program www.hrsa.gov/osp/vicp

n Vaccine Adverse Event Reporting System
[www.vaers.hhs.gov](http://www.vaers.hhs.gov/)

Index

A

acetominophen, 60

allergy/allergic, 29, 30, 33, 34, 37, 39, 41, 43

antibody/antibodies, 10, 11, 60

arthritis, 18, 23, 39

B

bacteremia, 60

bacteria/bacterium, 11, 18, 21, 24, 35, 40, 54, 59

booster, 31, 32, 34, 38, 41

C

chickenpox see varicella

convulsion, 20, 31, 32, 60

D

diphtheria, 9, 16, 30, 31, 32, 53, 59

DTaP Vaccine, 30--32, 44

E

encephalitis, 19, 20, 25, 39, 42, 58, 60

encephalopathy, 20, 32, 60

epidemic, 9, 15, 22, 23, 53, 59, 60

exposure,25, 53, 60

F

febrile seizure, 31, 39, 42, 60

flu see Influenza

H

Haemophilus influenzae type b see Hib disease

hepatitis A, 16

hepatitis A vaccine, 33

hepatitis B, 17

hepatitis B vaccine, 34, 44

Hib disease (Haemophilus influenzae type b), 11, 18, 35, 59

Hib vaccine, 11, 35, 44

I

immunity, 9, 10, 11, 18, 33, 34, 38, 40, 42, 52, 54, 60

influenza (flu), 18, 36, 59

influenza vaccine, 36--38

L

lockjaw see tetanus

M

measles, 9, 10, 11, 15, 19, 38, 39, 44, 49, 51, 52, 54, 59

meningitis, 18, 19, 21, 35, 40, 60

MMR vaccine, 38--39, 42, 43, 44

mumps, 19--20, 38, 44, 51, 59

O

outbreak, 60

P

paralysis, 16, 22, 61

pertussis (whooping cough), 20, 30--32, 51, 53

pneumococcal disease, 21, 40, 54

pneumococcal vaccine, 40, 54

pneumonia, 18, 19, 20, 21, 40

polio, 9, 10, 22, 41, 59

polio vaccine, 41, 44, 49, 51

R

rash, 19, 23, 25, 39, 42, 43

rubella (German measles), 23, 38, 44, 59

S

schedule, immunization, 29, 31, 40, 49, 61

seizure, 19, 31, 39, 42, 61

shingles, 25

smallpox, 9, 10, 51, 59

susceptible, 21, 43, 61

T

tetanus (lockjaw), 24, 30--32, 59

toxin, 16, 24, 31, 59, 61

V

varicella (chickenpox), 25, 38, 53

varicella vaccine, 38, 42--43, 44, 59

W

whooping cough see Pertussis

Acknowledgments

The following are thanked for submitting their drawings for use in this
publication:

D'Asia Autman, Monica Averhoff, Akash Bhatt, Jamie Marie Chu, Simon
David, Lucie Farrall, Hunter Hale, Aqil Herb, Yasmeen Herb, Dana
Johnson, Jocelyn Kopfman, Gabrielle Kroger, Jasmine LaGuins, Kashta
Lambert, Davis Lamberton, Mason Lamberton, Clay Lamberton, Morgan
McClelland, Katherine Morelli, Muhamed Ndiaye, Mustafa Ndiaye, Evan
Smith, Olivia Smith, Kyle Wilkins, Skye Wilkins, Desiree Wilson, Depra
Yusuf.

Ms. Belknap's second grade class, Meadow Creek Elementary School,
Gwinnett County, Georgia.

Mrs. Megan Smith's first grade class, Sweet Apple Elementary School,
Fulton County, Georgia.

This document can be found on the CDC website at:

<http://www.cdc.gov/vaccines/vpd-vac/downloads/pg_parentsguide_508.doc>