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The Revised Authoritative Guide To Vaccine Legal Exemptions

Vaccines Have Serious Side Effects

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Fig. 15-1 Fall in the incidence of poliomyelitis, measles, rubella, and mumps in the United States following the introduction of vaccination against the diseases (arrows). Inactivated pol-lovirus vaccine was introduced in 1954, live vaccines in 1963 The other three, for measles (introduced in 1963), mumps (1967), and rubella (1969), are all live vaccines (Compiled from data kindly supplied by the U.S. Centers for Disease Control.)

as poliomyelitis, it is difficult to maintain enthusiasm for a program of universal immunization after the disease has become very rare. Consequent complacency has resulted in a degree of resurgence of poliomyelitis and measles in a number of countries with strong immunization programs. Continuation of routine vaccination after the threat of the disease has almost vanished is doubly essential because the absence of wild virus in the population has left unvaccinated people uniquely susceptible, by removing the protective effect of subclinical infections. For these reasons it is essential for all countries to maintain highly organized and resolute health services, which need to pay particular attention to unimmunized pockets, such as urban ghettos, immigrants, and certain religious minorities.

Acceptability of a vaccine by a community is governed by a complex equation, balancing efficacy against safety, fear of disease against fear of needles and side effects, and complacency and inertia against the persuasive powers of the health services. If the disease is lethal or debilitating, both the people and the vaccine-licensing authorities will accept a risk of even quite serious consequences of vaccination in a tiny minority of recipients. If, on the other hand, the disease is perceived as trivial, no side effects will be countenanced. Where more than one satisfactory vaccine is available, considerations such as cost and ease of administration tip the balance.

A significant impediment to comprehensive vaccine coverage of the com-

munily is the unnecessarily complicated immunization schedules officially recommended by some government health authorities. Most of the currently available vaccines, bacterial and vbal, are aimed at preventing diseases the risks of which are greatest in infancy; hence, these are given during the first 6 months of life for oral poliovaccine (and for diphtheria, pertussis, and tuberculosis) or after maternal antibody has disappeared in the case of the live vaccines for measles, mumps, and rubella (Table 15-1). Polyvalent vaccines, such as that available for measles-mumps-rubella (MMR vaccine), have a major practical advantage in minimizing the number of visits that the mother must make to the clinic. Characteristics of the major human viral vaccines in common use are shown in Table 15-2. Many more are in various stages of development or clinical trial, or are used only in the particular geographic locations where such diseases occur (e.g., various arboviral diseases). The vaccines used in particular diseases are discussed in the relevant chapters of Part II.

Passive Immunization

Instead of actively immunizing with viral vaccines it is possible to confer short-term protection by the intramuscular inoculation of antibody, either as immune serum or as immune (serum) globulin. Human immunoglobulin is

Table 15-1

Schedules for Immunization against Human Viral Diseases"

Table 15-1

Schedules for Immunization against Human Viral Diseases"

Vaccine

Primary course

Subsequent doses

Live vaccines

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