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The Revised Authoritative Guide To Vaccine Legal Exemptions

Vaccines Have Serious Side Effects

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Country-wide elimination achieved

Yes'

No

Yes''

Financial incentive for assistance

Strong

Weak

Weak'

Records of vaccination required

No—scar

Yes

Yes

" As subacute sclerosing panencephalitis, but since no shedding occurs in this disease it is epidemiological^ irrelevant

'' Vaccination is ineffective in the presence of maternal antibody

' Before the Intensified Smallpox Eradication Programme commenced, in many countries. '' Before global eradication proposed, in several countries

< Hut since 1985 considerable help provided by UNICEF, the World Bank, and otheis.

" As subacute sclerosing panencephalitis, but since no shedding occurs in this disease it is epidemiological^ irrelevant

'' Vaccination is ineffective in the presence of maternal antibody

' Before the Intensified Smallpox Eradication Programme commenced, in many countries. '' Before global eradication proposed, in several countries

< Hut since 1985 considerable help provided by UNICEF, the World Bank, and otheis.

poliomyelitis by the year 2000. Regional offices of the WHO have declared their aims to reach this goal in their regions earlier than this: the Pan American Health Organization (PAHO) for the Americas by 1990 and the Western Pacific Region by 1995. The PAHO program has progressed very well, utilizing novel techniques for surveillance (flaccid paralysis notification) and for vaccination (national vaccination days, mopping up vaccination around recognized cases). As this book goes to print, in March 1994, no cases of paralytic poliomyelitis due to a wild poliovirus had been Tepoited in the Americas since August 1991.

Because cases become infectious before the subject becomes ill, it is not possible to control measles by vaccination supplemented by surveillance and containment, but rather only by attaining very high levels of effective immunization, estimated to be 96% in the United States. Such a level is very difficult to achieve, because it is almost impossible to reach this proportion of the population with a vaccine that is invariably potent. In addition, maternal antibody inhibits infection by the standard Schwarz vaccine until some time between 9 and 12 months after birth; hence, vaccination is not recommended before the infant is 12 months old. However, in developing countries where measles is still a common disease, many infections occur in children aged 9-12 months old. It has also become apparent that in the United States (and presumably in other countries where the basic immunity provided by vaccination is not being boosted by later subclinical infections), vaccination in infancy does not provide certain protection throughout life. It is therefore recommended that there should be a booster inoculation ol vaccine at school entry. Elimination of measles could be achieved in countries with a good health service and the political will to do it, but global eradication appears to be a distant and, in the face of the increasing world population and the increasing poverty of many developing countries, probably an unattainable goal.

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