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1.5 What are some of the risks of vaccination?


This article is from the Childhood Vaccinations FAQ, by Lynn Gazis-Sax lynng@alsirat.com with numerous contributions by others.

1.5 What are some of the risks of vaccination?

Again, these risks vary with the vaccine. However, there are some
risks which are common to several vaccines. People may be allergic to
a component of the vaccine, such as eggs or neomycin. Occasionally,
these allergies can lead to anaphylactic shock (doctors keep
epinephrine on hand when giving vaccinations to guard against this
risk). Vaccines can produce the same symptoms as the disease (in a
milder form, and with less frequent incidence of the risks associated
with the disease). Live vaccines in particular can be risky for people
with weakened immune systems, who have less ability to resist even the
weakened form of the disease. Common minor adverse reactions include
soreness or swelling at the injection site and fever. Because of the
latter, vaccinations are often postponed if the recipient already has
a fever.

Another risk is the risk that the vaccination will wear off, and the
recipient will get the disease later. Depending on the illness, the
disease could be either less or more harmful to adults. While this
risk can be dealt with by giving boosters, it is worth bearing in mind
in setting vaccination policies and making vaccination dscisions,
because in some case getting the vaccine and then *not* getting the
booster might lead to increased risk.

Further information related to vaccination risks follows:

From Cyndy Brunken:

I posted this for Kathleen over on sci.med then I realized that
misc.kidders might also benefit from the info contained herein.

USENET and have followed the immunization discussions in the last few
weeks. I think some of the participants will have an interest in the
following information.

An Institute of Medicine (IOM) committee has concluded in a new report
that a causal relation exists between certain common childhood vaccines
and specific, but rare, health problems. The committee also determined
that there appears to be no causal relation between some of those same
vaccines and other specific health problems. The vaccines studied
include those used against tetanus, diphtheria, measles, mumps, polio,
hepatitis B, and Haemophilus influenzae type b (Hib).

The IOM is a private, non-profit organization that provides health
policy advice under a congressional charter granted to the National
Academy of Sciences. The IOM committee was NOT asked to assess risk-
benefit or cost-benefit relations. Rather, the task was to evaluate all
medical and scientific evidence bearing on the causal relation between
childhood vaccines and specific, serious health outcomes.

The report is entitled "Adverse Events Associated with Childhood
Vaccines: Evidence Bearing on Causality". A previous IOM committee
submitted a report in 1991 entitled "Adverse Effects of Pertussis and
Rubella Vaccines". Both reports were mandated by the U.S. Congress in
the 1986 National Childhood Vaccine Injury Act (P.L. 99-660). This law
addressed many aspects of childhood immunization. Notably, it
established a federal compensation program for those who have been
injured by mandated childhood vaccines.

The IOM committee reported that the evidence established a causal
relation between diphtheria, tetanus, measles-mumps-and-rubella, and
hepatitis B vaccines and anaphylaxis. The evidence established a causal
relation between measles-mumps-and rubella vaccine and thrombocytopenia;
between measles vaccine and death from measles infection (primarily in
immunocompromised individuals); between oral polio vaccine and death
from poliovirus infection (primarily in immunocompromised individuals);
and between the oral polio vaccine and poliomyelitis disease.

On the other hand, the committee found that the evidence favored
rejection of a causal relation between diphtheria and tetanus vaccines
and encephalopathy, infantile spasms, and SIDS. The committee found
similarly regarding certain Hib vaccines and increased susceptibility to
Hib disease. The committee investigated other serious health problems
and classified their relation to vaccines in three other categories: no
evidence, inadequate evidence to accept or reject a causal relation, and
evidence favors acceptance of a causal relation. The specific relations
are too numerous to list here.

The committee noted that in most cases it was impossible to calculate an
incidence rate or relative risk for these reactions, but that they were,
on the whole, extremely rare.

The final report will be available in late October or early November
from National Academy Press, 1-800-624-6242. It will cost approximately
$60.00. (The report on pertussis and rubella is still available) A few
prepublication copies of the Executive Summary of the new, 1993 report
are available from the project director at no cost on a first come-first
served basis. Anyone wishing specific information about this report can
email me, Kathleen Stratton, directly. I am the study director for this
project. My internet address is kstratto@nas.edu


More information on the findings of the expert committee of the
Institute of Medicine, along with a table showing in which categories
they have placed various adverse events, and modified ACIP
recommendations based on these findings, can be found in (MMWR
1996;45[No. RR-12]), or
Between the publication of the 1993 report, and the publication of the
1996 update, two other IOM committees had met, and published findings
concerning "concerning both the diphtheria and tetanus toxoids and
pertussis vaccine (DTP) and chronic nervous system dysfunction ... and
research strategies for vaccine-associated adverse events" (MMWR
1996;45[No. RR-12]).

From Mike Dedek:

New England Journal of Medicine 1987; 316: 1283-1288, May 14, 1987,
"Compensating Children with Vaccine-Related Injuries", Iglehart, John K.

The federal immunization program, by virtually all economic,
medical, and political measures, is a stunning success story
because of its record of protecting millions of children against
the common infectious diseases of the young. But in recent years
the program has come under a legal cloud that is threatening its
stability, slowing the development of new vaccines, and sending
vaccine prices sharply upward. To address these problems, Congress
has created a new federal program to compensate children who suffer
vaccine-related injuries, but how it will be funded and whether it
will achieve its goals remain open questions.

The legal cloud has formed because, even when the best vaccine
products are properly administered and used, vaccines pose minute
risks to those who receive them, and an increasing number of
lawsuits are seeking damages on behalf of injured
persons. Dr. Louis Z. Cooper, representing the American Academy of
Pediatrics, testified before Congress on March 5 about the nature
of these risks. Cooper stated:

One case of polio-like disease will result from each 2.6 million
doses of oral polio vaccine OPV , and a serious, permanent
neurological injury will result from every 310,000 doses of DTP
diphtheria, tetanus, and pertussis vaccine . In extremely rare
cases, an encephalitis or nerve deafness will develop from MMR
measles, mumps, and rubella vaccine . Approximately 75
vaccine-related injuries per year are the price we pay to protect
the more than 3.8 million children born each year in this country.

For five years, Congress has struggled to fashion legislation that
addresses he complex issues related to the compensation of children
injured by vaccines; in the process, it has explored virtually
every conceivable policy option.



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