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Immunization Worries
Many parents understand the benefits of immunization for their children. However, some parents question
the need for or safety of childhood vaccines. These parents may choose to delay or refrain from immunizing
their children from some or all of the recommended vaccines. Before making immunization decisions parents
should be fully informed, and try to be aware of differing views of vaccine risks and benefits and choose
effectively.

Immunization has been called one of the most important public health interventions in history, after safe
drinking water. It has saved millions of lives over the years and prevented hundreds of millions of cases of
disease. We all know that getting our children immunized can protect them from some very serious diseases.
Some children can’t get certain vaccines for medical reasons, other children don’t respond well to certain
vaccines. For these children, the immunity of people around them is their only protection.

Immunizations help the child’s immune system function. The child develops protection against future
infections, the same as if he or she had been exposed to the natural disease. Except with vaccines children
don’t have to get sick first to get that protection. The purpose of immunizations is to prevent disease.

Today, children in the United States routinely get vaccines that protect them from diseases. Some childhood
vaccines have been used since the 1940s, others have been around for only a short time. Currently there are
10 routinely used vaccines that protect children against the 14 diseases. 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.
     
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 2 to 4 weeks.
Diphtheria can initially cause a sore throat, fever and chills. But if it is not properly diagnosed and treated it
produces a toxin (poison) 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.

DTaP Vaccine

DTaP combines vaccines against three diseases, Diphtheria, Tetanus and Pertussis (Whooping Cough) 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 a substance that is normally toxic but
has been treated to destroy its toxic properties. They help the immune system develop protection against the
poisons 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. These vaccines are also sometimes given when a person gets a serious
wound that could contain tetanus bacteria.

Hepatitis A

Hepatitis A is a liver disease caused by the hepatitis A virus. Until 2004 it was the most frequently reported
type of hepatitis in the United States. Disease rates have been dropping since 1995, when a vaccine was
licensed. There are now estimated to be about 20,000 cases a year in the United States. 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 permanent liver damage, but about 100 people die
each year from liver failure caused by severe hepatitis A.

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, it’s yet unknown how long immunity
will last, but mathematical research 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.

As of 2005 hepatitis A vaccine has been routinely recommended for all children from 12 through 23 months
of age. Two doses of hepatitis A vaccine are recommended, the second dose given at least 6 months after
the first.

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. 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 become “chronically infected.” They might not feel
sick themselves, but they continue to carry the virus and can infect other people.

Pregnant women can infect their newborn babies. 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. More than a million people in the
United States are chronically infected with hepatitis B. In 1996 an estimated 200,000 people became
infected, and 4,000 to 5,000 people die each year from hepatitis B.

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 (any substance that can stimulate the production of
antibodies and combine specifically with them). 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 (a disease of the liver) 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 they 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 recommended at birth.
This is particularly important for children whose mothers are chronically infected.  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.

Hib disease (Haemophilus influenzae type b)

Not long ago Hib disease (Haemophilus influenzae type b) was 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.

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 (the condition that permits either natural
or acquired resistance to disease) you gain 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 it is
important to be vaccinated every year.

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.

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,
weakened vaccine, which is sprayed into the nose and was licensed in 2003. It is not licensed for children
younger than 2 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, and should be given at least a month apart.

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 get an ear infection, and up to 1 out of 20 get pneumonia.
About 1 out of 1,000 get encephalitis (inflammation of the substance of the brain) 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.

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 get the disease. It can occasionally cause encephalitis, 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 314 cases reported in 2005.

MMR - Measles, Mumps, and Rubella 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 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.        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.

Pertussis (Whooping Cough)

Pertussis (Whooping Cough) is caused by a bacterium called Bordetella pertussis. If you have ever seen a
child with Whooping Cough 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
2005, 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 Whooping Cough is similar to 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 Whooping Cough catch it from their
older brothers and sisters, or from their parents, who might not be aware they have the disease. About 1
child in 10 who get pertussis also gets pneumonia, and about 1 in 50 will have seizures. The brain is affected
in about 1 person out of 250 (this is called encephalopathy, any of various diseases of the brain). Pertussis
causes about 10–20 deaths each year in the United States.

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
authorized, 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
persistent pneumococcal disease each year. Pneumococcal disease is also a common cause of ear infections.

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 vulnerable to
pneumococcal disease, but some 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.

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 prevented by pneumococcal vaccine, 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. This vaccine is usually not given to children 5 years old and older. But
some older children (those with certain chronic diseases or damaged immune systems) still need
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.

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
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. Others have the symptoms of 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 (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.

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). Once another type of polio vaccine was used, 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 three doses.
Children should get four doses of polio vaccine, the first three doses at 2, 4, and 6–18 months of age, and a
booster dose at 4–6 years.

Rotavirus

Rotavirus is the most common cause of severe gastroenteritis (diarrhea and vomiting) in the world among
young children. It kills about 500,000 children a year worldwide.

Every year in the United States, rotavirus is responsible for:

•        2½ million cases of gastroenteritis
•        400,000 doctor visits
•        200,000 emergency room visits
•        55,000 - 70,000 hospitalizations
•        20-60 deaths

Most children will have been infected at least once by the time they reach 5 years of age. There are several
strains of rotavirus and children can be infected more than once, but the first case is usually the most
serious.

In addition to diarrhea and vomiting, rotavirus infections cause a fever of 102°F or higher in about one-third
of cases. Severe dehydration can be a serious complication associated with rotavirus infection. Rotavirus is
discarded in the stool. It can be spread by direct contact with an infected person, or by contact with
contaminated objects such as toys, or even food. The disease is spread within families, hospitals, and child-
care facilities. Caregivers and parents can also be infected, but infections in young children are much more
serious.  People with weakened immune systems are at higher risk. Rates of rotavirus illness are similar in
modern and less developed countries. This suggests that the disease can’t be eliminated through clean water
and good hygiene alone.

Rotavirus Vaccine

Rotavirus vaccine is a live vaccine, which is given orally rather than by injection.  Children should get a total
of three doses, one dose at 2, 4, and 6 months of age.  The vaccine protects against five different strains of
rotavirus, so even a child who has had a case of rotavirus disease should get the vaccine. The vaccine has
been very effective in preventing rotavirus gastroenteritis (about 74%) and even more effective in preventing
severe rotavirus gastroenteritis (about 98%).

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
(inflammation of in the joints) symptoms. 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.

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 2 out of every 10 people who get
tetanus die from it.

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 herpes 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 for a person 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 1 in
250,000 die. For older children, about 1 in 100,000 die. 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 (about 1 in 50 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.

Varicella Vaccine

Varicella vaccine is made with live, weakened varicella virus. 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. Individuals vaccinated during testing, before the vaccine
was licensed, are still immune.   

Two doses of varicella vaccine are recommended for children. The first dose is recommended at 12–15
months of age. It is usually given at the same time as MMR vaccine. The second dose is recommended at 4-
6 years, before entering kindergarten or first grade. It may be given sooner, as long as it is separated from
the first dose by at least 3 months. 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. It’s unknown why breakthrough infections occur.

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 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.

Some children also have allergies, and occasionally a child will have a severe allergy to a substance that is
part of a vaccine. There is a very small risk (estimated at around one in a million) that a vaccine could
trigger a severe reaction in a child who has such an allergy. Should one of these allergic reactions occur, it
would usually happen within several minutes to several hours after the vaccination, and would be
characterized by hives, difficulty breathing, paleness, weakness, a hoarse throat 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 allergies that you know of. . If your child shows these symptoms after getting
vaccinations, or if he/she shows other unusual symptoms, such as a high fever or behavior changes don’t
hesitate:

     - Call a doctor or get the child to a doctor right away.
     - Tell your doctor what happened, the date and time it happened, and when the vaccination was given.

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
ingredient 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.

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 who develops 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 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 needs.

Childhood Immunization Schedule

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

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 by calling the program
tool-free at
800-338-2382.
     
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.