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The Revised Authoritative Guide To Vaccine Legal Exemptions

Vaccines Have Serious Side Effects

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65 yr and older in a chronic care facility

30-40%

50-60%

80%

tion can prevent lower respiratory involvement or other secondary complications. Vaccination in closed settings (i.e., nursing homes and chronic care facilities) results in "herd immunity" and, if done prior to the influenza season, can decrease the number of hospitalizations and secondary complications in this population (Table 1) (1).

It is recommended that the following individuals have the influenza vaccine: (1) persons aged 65 yr and older; (2) residents of nursing homes or chronic care facilities who are at least 6 mo of age; (3) individuals 6 mo or older who have underlying medical conditions; (4) Individuals 6 mo to 18 yr of age who receive long-term aspirin therapy and have an increased risk for developing Reye's syndrome after being infected with influenza virus; (5) women who will be at or beyond 14 wk' gestation during the influenza season or at any stage if underlying medical conditions may result in secondary complications; and (6) employees of hospitals, outpatient settings, nursing homes, and other chronic care facilities that care for high-risk patients. To further decrease the risk of transmission, the household members of patients and employees should be vaccinated (6).

HIV-positive individuals with high CD4 counts may benefit from vaccination. Approximately 80% of travelers who return to the United States with a febrile illness have commonly acquired diseases such as influenza; thus travelers may also benefit from vaccination.

Many patients are misinformed about the side effects of the influenza vaccine, and are therefore hesitant to receive the vaccine. The vaccine cannot cause influenza. Respiratory disease following vaccination represents coincidental infection unrelated to the vaccine. Known side effects include:

1. Soreness at the injection site: This is the most common side effect and usually lasts for only 2 d. It is generally mild and only rarely interferes with the individuals daily activity.

2. Systemic symptoms: Fever, malaise, and myalgia are more common in individuals who have never been exposed to the antigens in the vaccine (i.e., children). The reaction usually begins 6-12 h after the vaccination and lasts for 1-2 d.

3. Immediate reaction: This includes hives, angioedema, allergic asthma, and systemic anaphylaxis. These reactions are probably due to hypersensitivity to a component of the vaccine (i.e., residual egg products). Therefore, individuals with allergies to egg products should not be vaccinated.

4. Guillain-Barré syndrome: This entity has been difficult to prove as a true side effect of the influenza vaccine. The possible one or two cases per million vaccinations does not add significant risk to withholding the vaccine in individuals who are at high risk of

Table 2

Influenza Vaccine Dosing Recommendations

Table 2

Influenza Vaccine Dosing Recommendations

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