Is vaccination mandatory?

Virtually allU.S. states require proof of vaccination before children begin school.

Today's children require 16 to 24 doses of vaccines by age 2 to protect them from 10 diseases. Vaccines are given to children during their first two years of life so that they can be protected during their most vulnerable period.

This is especially important because many children attend daycare and other group care settings, where they are at higher risk of being exposed to infectious diseases.

Why does my child have to have vaccines?

Immunizations provide protection against many childhood diseases. The viruses and bacterial illnesses that cause vaccine-preventable disease and sometimes kill are still around. They have not been eradicated.

Moreover, with international travel widespread and common, it is easier than ever to spread these diseases from one population to another.

Most diseases that vaccines prevent are most easily transmitted when people gather in groups, as in schools. State laws requiring immunization prevent serious outbreaks of certain infectious diseases among school-aged children, and through them, to the rest of the population.

The availability of vaccines has drastically reduced the number of people who get infectious diseases along with the complications that these diseases can produce. Without vaccination, epidemics of vaccine-preventable diseases would return.

What if I don't want my child to be vaccinated?

All states permit exemption of children from vaccination for specific medical reasons. For example, children with compromised immune systems from illnesses such as cancer or AIDS may not be able to receive immunizations.

Since they cannot be vaccinated, these children remain vulnerable to diseases such as polio, measles, mumps, pertussis and diphtheria. They are dependent on their community to protect them against disease through vaccination of all medically eligible people.

Some states exempt children from vaccination due to the religious or philosophical beliefs of their parents. Since these children do not receive vaccines, they are not at risk from possible adverse reactions to vaccines. Unfortunately, they are also at risk for contracting the diseases that vaccines normally prevent.

Within the United States, communities with large numbers of people who do not accept vaccination have outbreaks of polio, measles, pertussis and congenital rubella. These diseases and their devastating effects are virtually unknown among vaccinated communities.

I don't want to give anything to my child that isn't completely safe. How safe are vaccines?

Vaccines are considered very safe and effective for children who do not have certain medical disorders that preclude immunization. Your doctor can clarify this for you and provide literature explaining what these disorders are.

Despite their safety and value in preventing disease, no vaccine can be 100 percent safe and effective for everyone who gets it. Vaccines can and often do cause mild and temporary reactions, including slight swelling or soreness at the injection site. They may cause a low-grade fever and rash.

Vaccines can cause serious reactions, although these are very rare. Serious reactions include seizures, swelling of the brain and severe allergic reactions. However, the risk of contracting a serious and potentially devastating childhood disease is many times greater than the risk of having a serious reaction to any of the childhood vaccines.

What do you mean that no vaccine can be 100 percent effective?

Very few things in life are perfect. Although vaccines are extremely effective for most people who get them, no vaccine guarantees immunity to everyone vaccinated. A small fraction of people may be vaccinated without developing immunity to the disease. However, since the vaccine works in most cases, as more and more people in the community are immunized, the chance of the nonimmune person contracting the disease decreases.

How do immunizations work?

Immunizations are a weakened form of a disease-causing germ that is introduced into the body either orally or by injection. By getting immunized, you are "tricking" your body into believing that the actual disease is present. This causes your body to react by producing antibodies. The antibodies stay in your system and protect you from getting the actual disease in case you are ever exposed to it.

Some immunizations need to be repeated throughout your life to make sure the level of antibodies in your body remains high enough to prevent the disease.

Where can I have my child vaccinated or get vaccinated myself?

Vaccines can be administered by your pediatrician, your personal doctor or your local health clinic. Some employers provide vaccinations on-site, and they are sometimes offered by communities at certain convenient times and places.

Your county health department can also provide you or your child with access to vaccinations at low cost or for free. Also, the Vaccines for Children Program offers free vaccines to needy children, including all those on Medicare, Native Americans and Alaskan Natives.

My child is healthy, but I still want to be careful about vaccines. What precautions should I take?

Your physician should do an overall medical assessment, including a physical examination and past medical history, on your child to find out if there are any contraindications to receiving a certain vaccine. Insist that this be done, and be sure to provide a complete medical history for your child.

You should also make sure you know the possible risks associated with a particular vaccine before it is given to your child. Keep the literature your child's physician gives you and read it over. Discuss any concerns about a particular vaccine with the doctor.

Be aware of the signs of both mild and serious reactions to vaccines. Know how to reach your doctor or a covering doctor after office hours. If your child appears ill after receiving a vaccine, call the doctor immediately.

And remember, in most cases, it is still far more risky for a child to remain unprotected against potentially deadly childhood diseases than to receive vaccines.

What if my child has a serious vaccine reaction?

Call your doctor, and make sure you make it clear that you believe your child is experiencing a severe or persistent reaction to vaccines. Take your child to see a doctor right away.

Later, write down what happened and the date and time. Ask the doctor, nurse or health department to file a vaccine adverse event report.

The National Vaccine Injury Compensation Program (VICP) in Rockville, Md. is a national program administered jointly by the U.S. Department of Health and Human Services and the U.S. Department of Justice. The program provides compensation for the extremely rare instances where profound injury results from vaccination.

The criteria for compensation through the VICP are strict. Most people never need the program, but it exists to address the extremely rare occasions when people do.

I've heard that good sanitation is the real reason why there are fewer childhood diseases now. So we don't really need vaccines, do we?

Good sanitation does decrease the risk of some diseases. And diseases may have natural "up" and "down" cycles. However, a permanent drop in the incidence of childhood diseases coincides with the widespread use of vaccines.

For example, the Hib vaccine, a vaccine against the Hemophilus bacteria - the leading cause of meningitis in children - has only been in use for about five years. But the incidence of meningitis caused by Hib has dropped more than 95 percent during the same period.

Between 1989 and 1991, the U.S. had a measles epidemic, which killed 120. This epidemic occurred mostly in urban communities with many unvaccinated children.

If my baby gets more than one shot at a time, will the immune system become overloaded?

Our immune system is very efficient and can respond to many foreign substances at any given time. Taking more than one vaccination at a time, in accordance with national guidelines, does not present much of a burden for a normal immune system. Current vaccine combinations have been studied and are recommended because the combinations have been found to be safe and effective. They are not combined at random.

Do DTP shots cause SIDS?

The Institute on Medicine reviewed controlled studies comparing immunized with non-immunized children for evidence linking diptheria-tetanus-pertussis (DTP) immunizations to sudden infant death syndrome (SIDS). They found no difference in risk for SIDS between immunized and non-immunized children, meaning that no link between the DTP shot and SIDS was apparent.

Do vaccines cause diabetes, autism, Crohn's disease or other chronic disorders?

After decades of vaccine use in the United States, research shows no reliable evidence implicating vaccines as a cause of chronic illness or conditions. Vaccine safety research is done regularly within the United States, including research into theories linking various diseases to vaccines. This is done to maximize public safety as much as possible.

Some researchers published articles bolstering their theories that vaccines cause various diseases. However, when other researchers try to duplicate their results, they often can't. The ability to duplicate scientific results is key to help validate a research finding.

If the risk and benefits of a vaccine change as a result of changing circumstances within a population, the recommendations relating to that vaccine also change. For example, natural cases of smallpox are no longer found because it is thought to have been eradicated worldwide. As a result, the risk of contracting smallpox is very low, so low that the risk of possible complications from the vaccine now outweighs the risk of smallpox. For that reason, the smallpox vaccine is no longer recommended for the general population.

What would happen if we didn't have vaccines?

The following diseases would once again become prevalent in the general population:


A rare but potentially fatal disease spread through sneezing and coughing, diphtheria affects the heart, kidneys and upper respiratory tract. Early symptoms include sore throat, fever, chills and runny nose. Heart failure or paralysis can also result.


Also known as whooping cough, this highly contagious disease is an acute illness affecting the respiratory tract that often begins as a mild cold and progresses to severe coughing and difficulty breathing. It is especially dangerous to young babies (younger than 9 months) because it can lead to pneumonia, seizures, encephalitis, permanent brain damage and death.


Also known as lockjaw, this disease can be transmitted through animal bites, dirty objects like a rusty nail or soil. The bacteria enter the body through an open wound and infect the central nervous system. Severe muscle spasms and death may result.

The DTaP vaccine protects against these three illnesses. It is given five times before age 6. Td booster shots are needed at 11 to 12 years if at least five years have elapsed since the last dose. Subsequent routine Td boosters are recommended every 10 years thereafter.


This is a highly contagious, potentially life-threatening viral disease spread through coughs and sneezes from an infected person. A high fever, runny nose, dry cough, small bright red spots on the skin and a diffuse red rash characterize measles. Secondary complications from measles include ear infections, pneumonia, encephalitis, convulsions, deafness, mental retardation and death.


This is a viral infection that results in fever, headaches and swollen salivary glands in the cheek and jaw region. Secondary complications include permanent hearing loss, meningitis and male sterility.


Also known as German measles, this is a viral infection that starts with a low-grade fever and raised rash beginning on the face and spreading to other parts of the body. Rubella is not a serious illness for children, but it is very serious for pregnant women. When contracted early in pregnancy (perhaps before a woman even realizes that she is pregnant), rubella can lead to miscarriage or devastating birth defects.

The MMR vaccine protects against these three diseases and is given in two doses, the first at 12 to 15 months of age and the second at 4 to 6 years.

Haemophilus influenza type B

Also known as Hib disease, this is a bacterial infection that is moderately contagious and is spread through coughing and sneezing. Hib infections can result in meningitis, overwhelming blood infections, permanent brain damage and death. Before the Hib vaccine was introduced, Hib disease was the most common cause of bacterial meningitis in the United States.

The Hib vaccine is typically given at 2 months, 4 months and 6 months with the final dose given between 12 and 15 months.


Neisseria meningitidis is an important cause of meningitis in children and young adults. There is a vaccine against the four common types (A, C, Y and W135). This vaccine, now required for young adults entering college, is safe with few side effects.

Pneumococcal vaccine

Streptococcus pneumoniae causes serious infections in young children younger than 2 years old. It causes meningitis, pneumonia and middle ear infections. A vaccine for children against this bacterium has been approved by the Food and Drug Administration (FDA). A similar vaccine has been available to adults for the last 25 years and is safe.


This is a viral infection that is transmitted in the stools of infected persons. The virus can cause permanent paralysis and death. The polio vaccine should be given at 2 months, 4 months and between 6 and 18 months of age.

The polio vaccine is available in two forms. The oral polio vaccine (OPV) is a live virus and can actually cause polio in very rare instances, or if a person who isn't immunized is exposed to someone who has just received the vaccine. The injectable polio vaccine (IPV) is inactivated and cannot cause the disease.

The American Academy of Pediatrics (AAP) recommends the first two doses of poliovirus vaccine should be IPV followed by two doses of OPV at 12 to 18 months old and 4 to 6 years of age.

Use of IPV is acceptable for and is recommended for patients whose immune systems are compromised or who live with other family members who may be immunosuppressed. The OPV remains the treatment of choice for mass immunization campaigns to control outbreaks due to wild poliovirus.

Hepatitis B

Hepatitis B is caused by the hepatitis B virus (HBV) that is present in the blood and body fluids of an infected individual. The virus can be transmitted in the womb as well as through unprotected sexual intercourse, nonsterilized needles and contact with infected blood products. HBV can cause an acute illness characterized by fatigue, loss of appetite, joint and muscle pain, abdominal discomfort, and yellowing of the skin and eyes. It can destroy the liver, cause liver cancer and lead to death.

The hepatitis B vaccine does not contain any live components. Vaccines available in the U.S. are made using recombinant DNA technology, and they contain only a portion of the outer protein of HBV.

The vaccine is usually administered shortly after birth and at ages 2 and 6 months. If you did not receive the vaccine during childhood, it can be administered in a three-dose series. Talk with your physician about whether or not you are a candidate for the hepatitis B vaccine.


Also known as varicella, this is a very common viral infection that is extremely contagious. It is spread through sneezing, coughing and saliva and is characterized by flu-like symptoms that lead to a generalized rash. The rash often begins on the abdomen and quickly spreads to other areas of the body. The typical lesions are fluid-filled and cause itching. Complications are relatively rare, but each year between 5,000 and 9,000 people are hospitalized for chickenpox, and as many as 100 people die.

The AAP recommends the varicella vaccine. But not all pediatricians are in favor of universal vaccination. When given, the vaccine is recommended at any time after the child's first birthday. Susceptible children 13 years or older should get two doses given at least one month apart.

What about the Lyme disease vaccine?

The Lyme disease vaccine is no longer available. LYMErix® was a vaccine that was taken off the market by its manufacturer, GlaxoSmithKline, citing poor sales. The Food and Drug Administration licensed LYMErix in 1998 to prevent Lyme disease, a bacterial infection transmitted by ticks. Initially, hundreds of thousands of people received the vaccine. However, sales plummeted after highly publicized reports that some users suffered arthritis-like symptoms, muscle pain and other ailments following vaccination. GlaxoSmithKline says that it is not discontinuing the product because of safety issues. The manufacturer maintains that the scientific record remains clear that the vaccine is safe and effective. The Centers for Disease Control and Prevention (CDC) confirmed that it found no unexpected safety problems with LYMErix after reviewing the data. The vaccine was only 80 percent effective in people who got all three shots.

Lyme disease is caused by bacteria called spirochetes. A tick that has Lyme disease may then pass it on to any animal or human that it bites. Lyme disease is more common in certain regions in the U.S.

Prevent tick bites by wearing long pants and long sleeved shirts in tall grasses and forested areas. Also be sure to use bug repellant. Also, check yourself and your children by inspecting for ticks after being outside.

Investigational vaccines on the horizon

* Respiratory syncytial virus (RSV) vaccine, to protect children from a major source of bronchitis and pneumonia

* Malaria vaccine

* Tuberculosis vaccine

* HIV/AIDS vaccine