Vaccines Have Serious Side Effects

The Revised Authoritative Guide To Vaccine Legal Exemptions

Comprehensive, authoritative information about vaccine exemptions you can trust, from Alan Phillips, J.D., a leading vaccine rights attorney with years of experience helping clients throughout the U.S. legally avoid vaccines in a wide variety of vaccine-refusal settings. Critical details for parents, students, immigrants, healthcare employees, military personnel and contractors, agencies, attorneys and clientsvirtually anyone concerned with legally avoiding vaccines in the United States. This Guide provides and explains: Important background information about the legal system; How state and federal statutes, regulations, constitutions and legal precedent interact to define the boundaries of your legal exemption rights; How to deal with local authorities and to avoid mistakes that cost others their exemption; Where legal technicalities and practical reality differand what to do about it; Read more...

The Revised Authoritative Guide To Vaccine Legal Exemptions Summary


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All the modules inside this book are very detailed and explanatory, there is nothing as comprehensive as this guide.

Pre Pregnancy Vaccination

It's clear that prevention will never be sufficient. That's why we need a vaccine that will be safe. Screening for Vaccine-Preventable Diseases Before you conceive, it is advisable to get yourself screened for vaccine-preventable illnesses. Should you contract any of these diseases during pregnancy, they could have a serious impact on you and your baby's wellbeing. Once you are up to date with your vaccinations, you can proceed with your plans to conceive. Fortunately, rubella is no longer common because most babies are immunized against it as part of the MMR (measles, mumps, rubella) vaccine when they are 12 months old.

Vaccines and immunoglobulins

Vaccination and pregnancy Cholera vaccine Hemophilus influenza b (HIS) vaccine Hepatitis A vaccine Hepatitis B vaccine Human Papillomavirus (HPV) vaccine Influenza vaccine Measles and mumps vaccines Meningococcal meningitis vaccine Pneumococcal vaccination Poliomyelitis vaccine Rabies vaccine Rubella vaccine Tetanus and diphtheria vaccines Typhoid vaccine Varicella vaccine Yellow fever vaccine

271 Vaccination and pregnancy

Protective and booster immunizations should be carried out before pregnancy. Even though no embryotoxic or teratogenic effects have been proven for any vaccine, the indications for immunization, especially in the first Irimester, should be limited strictly to rare situations. With live vaccincs, the risk of a fetal infection from the vaccine is more of a theoretical nature, but routine immunization should be avoided during pregnancy. Another reason for avoiding vaccinations in early pregnancy is the possible risk of maternal hyperthermia (see Chapter 2.6) as a reaction to the vaccine. This risk is moderate, but common to almost all types of vaccines, if fever occurs, it should be treated with paracetamol (acetaminophen) as soon as it occurs. A third reason for avoiding vaccinations, especially in later stages of pregnancy, would be that postnatally the developing child might not recognize the antigen and since the immune system has become tolerant no seroconversion would be the...

273 Hemophilus influenza b HIB vaccine

Hemophilus b conjugate vaccine is a combination of the capsular polysaccharides or oligosaccharides purified from HIB type b bound with various proteins. Two reports and a review have described the maternal immunization with the capsular polysaccharide vaccine of HIB during the third trimester of prcgnancy to achieve passive immunity in the fetus and newborn. No adverse effects were observed in the newborns (review in Briggs 2005). Recommendation. Vaccination results in pregnancy are lacking discussion about the innocuity and effectivity are still ongoing.

274 Hepatitis A vaccine

Hepatitis A vaccine contains inactivated hepatitis A viruses that are cultivated from human cell cultures. Its use in pregnancy has EJ not been systematically investigated. However, there is no indica- tion of developmental toxicity. Recommendation. Pregnant women without immunity to hepatitis A need protection before traveling to developing countries. Based on the experience with other inactivated viral vaccines, hepatitis A vaccine can be given to the pregnant woman at high risk of infection. Immune globulin is safe and effective in preventing hepatitis A, but immunization with one of the hepatitis A vaccines gives a more complete and prolonged protection.

275 Hepatitis B vaccine

A biotechnologically produced non-reproducible surface antigen is used as hepatitis B vaccine (HBV), It is therefore a non-infectious vaccine, and no risks to the fetus have been reported following vaccination of their mothers in pregnancy (ACOG 1993). Immunization of groups at risk is recommended if possible, it should be given after the twelfth week of pregnancy. Ayoola (1987) described a series of 72 pregnant Nigerians who were seronegative for hepatitis B and were given two intramuscular doses of vaccine in the third trimester. One month after the second dose, 84 were anti-HBs positive. No significant adverse effects were observed in the mothers or their newborns. Passive transfer of anti-HBs occurred in 59 of the newborns. The antibodies disappeared rapidly in these infants, and by 3 months only 23 had detectable antibodies (Ingardia 1999, Reddy 1994). No HBsAg carrier status developed in this g1 group. In contrast, the infants born to HBsAg-positive mothers had a cumulative rate...

276 Human Papilloma Virus HPV vaccine

In )une 2006 the US FDA licensed the first vaccine developed to prevent cervical cancer and other diseases in females caused by certain types of genital human papillomavirus (HPV) types (6, 11, 16 and 18), responsible for 70 of cervical cancers and 90 of genital warts. The duration of the protection is unclear. Current studies (with 5-year follow-up) indicate that (he vaccine is effective for at least 5 years (Anonymous 2006), The vaccine has not been causally associated with adverse outcomes of pregnancy or adverse reactions to the developing fetus. However, data on vaccination in pregnancy are limited. Recommendation. The HPV vaccine is not recommended in pregnancy. Inadvertant exposure during pregnancy is not a reason for invasive diagnostics or for interruption of pregnancy.

277 Influenza vaccine

Pregnant women are supposed to have an increased risk of influenza infection and complications. Evaluation of more than 2000 pregnancies exposed to influenza vaccine could not demonstrate an increased risk of maternal complications or adverse fetal outcomes associated with the vaccine (Waleway 2006, Munoz 2005). The selected vaccine should be the vaccine advised for that influenza season. The American College of Obstetricians and Gynecologists (ACOG) (1991) recommended that the vaccine should be given only to pregnant women with serious underlying diseases (chronic diseases or pulmonary problems). In contrast, the Advisory Committee on Immunization Practices recommends standing orders, programs or reminders for patients and providers as strategies to improve vaccination rates during pregnancy, which are estimated to be less than 10 . The Joint Committee on Vaccination and Immunisations (JCVI 2006) in the UK agreed in June 2006 that pregnant women were at an increased risk of morbidity...

278 Measles and mumps vaccines

There is insufficient documented experience with the use of these vaccines during pregnancy. Measles (rubeola) vaccine is a live attenuated virus vaccine. Although transplacental passage of this vaccine has never been demonstrated, the vaccine should not be used during pregnancy because fetal infection with the attenuated virus cannot be excluded. Because this vaccine is normally administered together with the rubella vaccine, its contraindications arc similar. The American College of Obstetricians and Gynecologists lists the vaccine as con-traindicated in pregnancy and also recommends a 3-month interval before conception (ACOG 1993). In case of a significant exposure risk in a non-immune patient, a vaccination during the third trimester is suggested. Mumps vaccine is also a live attenuated virus vaccine. Mumps occurring during pregnancy may result in an increased rate of firsttrimester abortion. Although a fetal risk from the vaccine has not been confirmed, the vaccine should not be...

279 Meningococcal meningitis vaccine

The polyvalent meningococcal meningitis vaccine may be administered during pregnancy if the woman is entering an area where the disease is endemic. From the use of this vaccine, mostly in the third trimester of pregnancy, it is concluded that there are no indications for harm of the unborn (Letson 1998). Protecting antibodies have been found to cross the placenta. In breast milk and in the serum of the newborn, significantly higher IgA and IgG levels were found in 157 individuals vaccinated in the third trimester, in comparison with controls (Shahid 2002). Recommendation. Vaccination, if necessary, is not known to be associated with developmental disorders.

2710 Pneumococcal vaccination

Pneumococcal vaccination during pregnancy was thought to be the way of preventing pneumococcal disease during the first month of life. From studies with 280 participants (Chaithongwongwatthana 2006), it was concluded that there was no adverse effect on pregnancy and on the health of the newborn. However, there was no evidence that pneumococcal vaccination during pregnancy reduced neonatal infection. Recommendation. There are no indications to vaccinate against neonatal pneumococcal infection during pregnancy. On the other hand, vaccination does not seem to be harmful for the fetus, and does not require any intervention.

2714 Tetanus and diphtheria vaccines

These vaccines are bacteriological vaccines that contain the relevant toxoids, and there arc no indications of embryotoxic properties in these vaccines, which have been used for many decades - also in pregnant women. The suspicion of an increased risk of funnel thorax and clubfoot as a result of tetanus toxoid, suggested about 30 years ago and never confirmed, is of anecdotal character Heinonen 1977). A large case-control pair analysis conducted in Hungary (Czeizel 1999) failed to dctect any teratogenic effect of tetanus toxoid.

2717 Yellow fever vaccine

The yellow fever vaccine contains attenuated live viruses. Fifty-eight pregnancies followed by the European Network of Teratology Information Services (ENTIS) gave no substantial indication of embryo-or fetotoxic effect after first-trimester vaccination (Robert 1999). In a small number of women who received this vaccine during various stages of pregnancy there was no evidence of transplacental passage of the attenuated virus, although in most mothers who produced neutralizing antibodies these antibodies either crossed the placenta or were transferred to neonates through the colostrum. No adverse effects associated with prenatal exposure to this vaccine were observed at birth or during a 3- to 4-year follow-up period (Nasidi 1993). There is one report on congenital infection after first-trimester vaccination (Tsai 1993), but no other report has confirmed this potential risk. Finally, a small case-control study conducted in Brazil (Nishioka 1998) compared 39 women who attended a...

2711 Poliomyelitis vaccine

Oral polio vaccine (Sabin) contains attenuated live poliomyelitis viruses of all three poliovirus types. It is no longer recommended for routine vaccinations because in very rare cases it may cause poliomyelitis. The inactivated form of the vaccine (Salk), mostly in combinations with other vaccines (injection), is now preferred. When there were outbreaks of poliovirus in Israel and Finland, mass oral polio vaccinations of the population, including pregnant women, were performed. Based on the observation of more than 15 000 pregnancies, there was no increased risk of spontaneous abortion and no increase in birth defects or prematurity (Harjulehto-Mervaala 1995, Ornoy 2006, 1993, 1990). The authors consider the oral poliovirus vaccine as safe for pregnant women however, it should not be used in the last month of pregnancy, to avoid contamination of delivery rooms by the virus-shedding mother. Live attenuated poliovirus is no longer relevant as a result of practical extinction of the...

Four Types of Vaccines

An attenuated virus vaccine, like the measles, mumps, and rubella (MMR) vaccine, is made with weakened live viruses. 2. The injected inactivated poliovirus vaccine (IPV) uses killed virus. 3. Toxoid vaccines, like those for diphtheria and tetanus, contain a deactivated (making it harmless) form of the toxin produced by the bacteria. 4. Biosynthetic vaccines, such as the Hemophilus influenzae type b (Hib) vaccine, contain part of the killed bacteria attached to another substance that helps trigger a stronger immune response, making the vaccine work well even in young infants. of serious side effects from common vaccines is very low, you should always call your child's doctor if you have any questions or if your child experiences problems after receiving the vaccine. Reports linking vaccines to multiple sclerosis, sudden infant death syndrome, and autism have not been substantiated by scientific studies.

Diphtheria Tetanus and Pertussis DTaP Vaccine

DTaP vaccine protects against diphtheria, tetanus, and pertussis The DTaP vaccination is given in five injections, usually at 2 months, 4 months, 6 months, 15 to 18 months, and 4 to 6 years. Later, at age 11 or 12, a child should be given a Td booster, for tetanus and diphtheria, if at least 5 years have elapsed since the last DTaP dose. This Td booster should then be given every 10 years. Sometimes a child will experience mild side effects after DTaP is given, such as fever, soreness, crankiness, drowsiness, and loss of appetite. The pertussis portion of the vaccine causes most of these reactions. These problems were seen more frequently in the past with the previously used version of the vaccine (DTP). Today, the AAP recommends the use of the newly developed form of the vaccine (DTaP), which contains only certain parts of the pertussis cell instead of the entire killed If you are planning to travel out of the country, check with your child's doctor about which immunizations may be...

Hemophilus Influenzae Type B Hib Vaccine

Children who receive the Hib vaccine are protected against meningitis, pneumonia, and other infections caused by the Hemophilus influenzae type b bacteria. Needle-Free Vaccines You know how important it is to immunize your child, but your heart aches when the shot causes fears and tears. If only there were a way to immunize your child without needles, it would be so much easier, right Researchers are currently working on needle-free injection devices that would not only reduce the amount of pain involved but would also be able to deliver multiple vaccines at once. The most common type of needle-free device is the jet injector, which works by using compressed gas or a spring that delivers a vaccine in a stream that's fast enough to penetrate the skin. The vaccine is given at ages 2 months, 4 months, and 6 months. At ages 12 to 15 months, a child receives a booster shot. The possible side effects include fever and soreness at the site of injection. Your child's doctor will probably...

Inactivated Poliovirus Vaccine

The inactivated poliovirus vaccine (IPV) is given as protection against polio a gastrointestinal viral infection that can affect the nervous system and cause permanent paralysis. IPV is given by injection at 2 months, 4 months, 6 to 18 months, and four to six years. The possible side effects include fever, soreness at the site of injection, and rash. However, the vaccine should not be given to people who are allergic to the antibiotics neomycin, streptomycin, or polymyxin B because these are used in the preparation of the vaccine.

Measles Mumps and Rubella MMR Vaccine

Measles, mumps, and rubella were common childhood illnesses until the development of vaccines (now usually given in combined form) effective against these viral infections The MMR vaccine is given by injection in two doses one at 12 to 15 months and the second at four to six years. It gives 90 percent of children protection against these childhood illnesses. Some children develop a rash and occasionally a slight fever about a week after vaccination it usually goes away in a few days. Your child's doctor may recommend delaying or not giving the MMR vaccine if your child has more than a minor illness has a serious allergy (more than just a mild rash) to neomycin has received gamma globulin in the past three months has immune system problems related to cancer, leukemia, or lymphoma or is taking steroids (such as prednisone). In the past, doctors sometimes worried about giving measles vaccine to individu- Helping Your Child Cope with Vaccine Injections You can help make vaccinations less...

Fear of Contracting Disease from the Vaccination

Another common misconception that keeps some parents from getting their children vaccinated is the belief that a vaccine will give the child the disease it is intended to prevent. The truth is, it is impossible to get the disease from a vaccine that is prepared with dead bacteria or viruses or that is made with only a part of the bacteria or virus. The only risk of contracting disease from a vaccine comes from vaccines made from live or weakened viruses, like the oral (but not the injectable) polio vaccine and the chicken pox vaccine (varicella). But even this risk is very small For every 2.4 million oral polio vaccinations given each year, there is approximately one reported case of the disease resulting from the vaccine. But the U.S. Centers for Disease Control and Prevention now recommends that a vaccine carrying only the killed polio virus be used entirely eliminating the risk of children contracting the disease from the vaccine. The few blisters and mild fever that may occur in...

272 Cholera vaccine

The cholera vaccine contains inactivated vibrios of the serotypes Inaba and Ogawa. There are no studies on the use of this vaccine during pregnancy. Protection is incomplete and only short-term. Antibiotic treatment of a cholera infection is obviously the choice during pregnancy, it should, however, be considered that there is already a high antibiotic resistance among vibrios. Thus, no universally valid recommendations for infection prophylaxis in pregnancy can be made, because the appropriate procedure depends on the situation of the individual case (e.g. length of the trip, destination, housing conditions). Pregnant women who must travel in epidemic areas should, in any case, strictly adhere to the basic hygienic measures boil it, cook it, peel it or forget it. Recommendation. If compellingly indicated, assuming that travel to an endemic area cannot be postponed, vaccination should also be performed during pregnancy.

2713 Rubella vaccine

Rubella immunization uses attenuated live virus vaccine. Antibody levels of 10-15 international units IgG ml are considered protective. Naturally acquired rubella generally confers a lifelong and usually high degree of immunity against the disease for the majority of individuals. Rubella immunization is contraindicated shortly before and during pregnancy (Tookey 2001), despite the facl that in all surveillance studies to date (including more then 700 pregnancies) no child has been born with congenital rubella syndrome after vaccination of its seronegative mother during pregnancy (see, for example, Hamkar 2006, Endcrs 2005, Best 1991, Tookey 1991). A study led by the Motherisk Program of Toronto in Canada, quoted by Josefson (2001), compared the rates of fetal malformations in the infants of 94 women who mistakenly received rubella vaccinations while pregnant with 94 pregnant women who were not vaccinated during pregnancy. The rate of fetal anomalies was similar in both groups. In...

Hepatitis B Vaccine

Hepatitis B is a virus that infects the liver people with the illness can develop serious problems such as cirrhosis (liver disease) or liver cancer. People can also become chronic carriers of the disease, infecting others. The vaccination gives children a long-term immunity to hepatitis B, reducing the increased risk of developing liver cancer and chronic liver disease that follows infection with the hepatitis B virus. Taking the Tears Out of Vaccines If your child is like most, he probably cries when he's given vaccinations at the doctor's office. To take the sting out of shots, ask your child's doctor about new methods of controlling vaccine pain. A topical anesthetic cream and spray are both being explored as ways to cut crying time at the doctor's office and may be available to your child now or in the near future. A hepatitis B vaccine (HBV) will probably be your child's first immunization. The vaccine is given in three rounds. If an infant's mother is a hepatitis B carrier, the...

Pneumococcal Vaccine

Pneumococcus (Streptococcus pneumoniae) is the most common cause of severe bacterial diseases such as meningitis, bloodstream infection, and otitis media (middle ear infection). Until recently, the only available pneumococcal vaccine worked only for those over age two, leaving many of the children at highest risk for these infections without an effective vaccine to protect them. However, a newly developed biosynthetic pneumococcal vaccine, trade name Prevnar, was recently released and has been recommended by the AAP for routine immunization of infants and children. The recommended schedule includes four doses given at 2 months, 4 months, 6 months, and 12 to 15 months. If your child is over two years old and has a chronic illness (such as a lung condition or sickle-cell anemia), consult your child's doctor to see if your child might benefit from this vaccine.

Special Case Vaccines

Other childhood vaccines may be recommended by your child's doctor. Some children with asthma, cystic fibrosis, sickle-cell anemia, diabetes, or other chronic conditions may receive influenza vaccine to protect against the complications that could result if a child with one of these conditions gets the flu. Rabies vaccine may be necessary if your child is bitten by an animal that is rabid or might possibly have rabies, or if the animal's rabies vaccination record is unknown. Dogs, skunks, raccoons, foxes, coyotes, and bats are most commonly infected. If your child is bitten by an animal, call your child's doctor or the health department for advice about rabies vaccine. Hepatitis A vaccine is recommended for children who are traveling to or living in areas in which infection with the hepatitis A virus is common.

458 Rubella vaccine

Rubella vaccine is a live virus of the RA 27 3 strain grown in human diploid cell cultures and attenuated. It can be given in a combination vaccine (MMR). The early postpartum period, when risk of pregnancy is lowest, is the best time to be immunized. The risk to the breastfeeding infant is minimal with the recent techniques for vaccinc preparation. The original preparations in the 1970s were associated with several cases of rubella. While the virus may appear in the milk, as reported in several studies (Losonsky 1982, Isacson 1971), symptoms in these infants were rare (Landes 1980).

456 Polio vaccine

Oral polio vaccine (Sabin) is live attenuated vaccine combining three strains of the virus. The transfer of these vaccine viruses to an unvaccinated contact person, i.e. via a smear infection, can lead to a normal vaccination reaction and immunity against infection with the wild virus. However, it is also possible that the person will become ill with contact vaccine poliomyelitis. This complication -occurring once in 15.5 million immunizations - is very rare. In two cases, it has been reported in infants Mertens 1983, Heyne 1977), When immunization is urgent for the mother, the killed virus vaccine can be given to her intramuscularly. In the immunized mother, polio antibodies are present in the milk at a level comparable to the mother's plasma levels. High concentrations of anti-polio virus antibody in the milk could theoretically interfere with the response of the breastfeeding infant to immunization, but no such outcomc has ever been reported. Recommendation. Live oral vaccine...

Varicella Vaccine

The varicella vaccine protects children against chicken pox a common viral illness that almost all children came down with in the past. Varicella causes the characteristic itchy, blistering rash and fever. Complications of the infection can include secondary bacterial skin and bloodstream infections, pneumonia, and encephalitis. Prior to the introduction of the vaccine, chicken pox was a major cause of missed school for children and missed workdays for their parents. The vaccine is given between ages 12 and 18 months. It prevents chicken pox in 70 to 90 percent of children, and if a child still does get the disease after receiving the vaccine, it's usually a mild case. Serious reactions are rare, although a child may experience soreness, fever, fatigue, and a rash, which may occur up to a month after vaccination and will go away on its own.

2712 Rabies vaccine

The rabies vaccine contains attenuated live virus matter, which is produced nowadays from human cell cultures. This vaccine, which has been available since 1980, has, in contrast to earlier vaccines, virtually no side effects. Case reports on active and or passive immunization during a pregnancy indicate an uncomplicated course of pregnancy (Chutivongse 1995, Chabala 1991, Fescharek 1989). A study was published regarding the safety and immunogenicity of purified vero cell rabies vaccine (PVRV) during pregnancy (Sudarshan 1999). Twenty-nine pregnant women exposed to rabies were vacci natcd with PVRV, and none of the women experienced any adverse side effects to the vaccine. The intrauterine growth and development monitored by ultrasound examination was found to be normal, and the outcome of pregnancy was satisfactory. There were no congenital anomalies in any of the infants born, and they were healthy with normal growth and development during the 1-year follow-up period. The...

14 Reproductive and developmental toxicology

An essential aim of public health is prevention. Primary prevention of developmental disorders can be defined as an intervention to prevent the origin of a developmental disorder - for example, by rubella vaccination, or by correction of an aberrant lifestyle such as alcohol abuse. Moreover, primary prevention of developmental disorders can be achieved when a chemical substance is identified as a reproductive toxicant and either is not approved for marketing, or is approved with specific pregnancy labeling, restricted in use or removed from the market. This is in contrast to secondary prevention of developmental disorders, which means the prevention of the birth of a child with a developmental defect - usually by abortion. In this context, tertiary prevention indicates an early detection of a metabolic disorder so that, for example, in the case of phenylketonuria (PKU) as an intervention a special diet low in phenylanaline is indicated to prevent mental retardation (phenylpyruvic...

From Here to Maternity

Checking out your health and family history Preparing your body for pregnancy Understanding the effects of medications and vaccines Making it happen Conception made easy In this chapter, we go over what you need to know before you conceive. (We also provide some information on medications and vaccines that those who are already pregnant may be interested in, too.) The first step is to visit your practitioner and go over your family and personal health history. That way, you can discover whether you're in optimal shape to get pregnant, or whether you need to take some time to gain or lose weight, improve your diet, quit smoking, or discontinue medications that could be harmful to your pregnancy. We also give you some basic advice about the easiest way to conceive, and we touch on the topic of infertility.

Why Some Children Arent Immunized Even When They Should Be

Newborn babies have temporary partial natural immunity to some serious childhood diseases, a gift from their mothers in the form of antibodies passed through the placenta. Breast-feeding continues to boost the infant's antibodies. Breast-feeding, however, is not a substitute for vaccines. Breast milk does not completely protect a child against all diseases, and, in any case, the natural immunity eventually wears off, making vaccinations just as important for breast-fed children. too low. In 1998, only 79 percent of children ages 19 to 35 months had received a complete series of vaccines. This puts all children at risk. Let's take a look at some of the reasons kids aren't immunized even when they should be.

Fear of Bad Reactions

Some parents worry that their child may have a bad reaction to the vaccination. While some children have minor reactions including redness and swelling where the shot was given, fever, and sometimes rash more severe problems rarely occur. As with any medicines, a child can have a serious allergic reaction to a vaccine, but this is rare. A small number of children may have a brief seizure due to a fever caused by vaccines (just as can happen in children with a high fever from any cause), but this does not cause any permanent harm to the child. Although the risk To guarantee that all American children can receive childhood immunizations on time, the U.S. government has dedicated money for free vaccines for those who can't afford to pay. For information on free immunizations in your area, call the National Immunization Hotline toll free at (800) 232-2522 (English) or (800) 232-0233 (Spanish).

Need More Information

Vaccines1 are listed under routinely recommended ages. Bars indicate range of recommended ages for immunization. Any dose not given at the recommended age should be given as a catch-up immunization at any subsequent visit when indicated and feasible. (Ovals) indicate vaccines to be given if previously recommended doses were missed or given earlier than the recommended minimum age. Age Vaccine y

Preconception Issues And Care

Mothers should be counselled of the importance of immunisation of their newborn and, if they are HbeAg positive, the need for hepatitis B immunoglobulin (HBIG). It has been established that the administration of immunisation and HBIG in high risk infants reduces the vertical transmission risk by 90 13. There is no vaccine to prevent HCV infection. Vaccination for Hepatitis A and B are often required for travel to high prevalence countries and should be administered prior to pregnancy Vaccination differentials are outlined in Appendix 12.1

Nonpregnancy Treatment And Care

Prophylactic penicillin V by mouth daily, folic acid 1 mg daily both long term. Other measures may include hyroxyurea to induce increased levels of fetal haemoglobin (HbF), exchange blood transfusion, anti-thrombotic measures, family history to determine the requirement for partner haemoglobinopathy screening and counselling. Pneumococcal vaccine may be given. Renal, hepatic and retinal function are assessed regularly.

4415 Acyclovir antiretroviral drugs and other virustatics

Breastfeeding may continue when acyclovir or valaciclovir are administered externally or systemically. The other virustatics and antiretroviral substances, if really indicated, require an individual decision about continuing breastfeeding. In the case of drugs developed for HIV infection, an additional consideration is the risk of virus transmission via the mother's milk (see Chapter 4.15) here, guidelines only clearly recommend exclusive breastfeeding in those regions where lack of clean water for preparing infant formula and feeding equipment would pose a greater risk for the infant. If chronic hepatitis B requires lamivudin therapy, breastfeeding might be tolerable after active plus passive vaccination of the child.

451 Maternal immunization

A woman who has not received all the recommended immunizations before or during pregnancy may be immunized in the postpartum period even though she is breastfeeding. The presence of live viruses in the milk does not present a problem because the viruses have been attenuated. According to the statement of the American Academy of Pediatrics Committee on Infectious Diseases (2006), breastfeeding women may be immunized with both killed and live vaccines. All vaccines and immunoglobulins used for mothers are considered safe for the infant during breastfeeding. Lactating women can be A lactating woman can be given inactivated poliovirus vaccine, for instance, if necessary. The administration of live vaccine (oral vaccine) should be delayed in the mother (or parents) of a young infant until the infant has been vaccinated with killed virus regardless of the feeding mode. With some vaccines, i.e. against meningococcal or pneumococcal disease (Shahid 2002, 1995) and cholera, there is discussion...

How to Use This Chapter

Immunizations, which are among the most important developments in the history of medicine, have controlled or wiped out diseases that used to claim or wreck millions of lives. More vaccines are on the way. (Be sure to read Chapter 16, Immunizations. ) Still, the majority of childhood infections can't be prevented by immunizations.

Ear Infection Middle Ear Otitis Media

Prevention Ear infections occur less frequently in breast-fed infants, which may be because immune cells and antibodies are passed on from the mother in breast milk and because the feeding position may be better for the functioning of the eustachian tube. If you are bottle-feeding, hold your child semiupright rather than letting him lie down flat. Don't let your child take the bottle to bed, which can increase the risk of ear infections as well as tooth decay. Exposure to cigarette smoke also seems to increase the risk of ear infection in children. A child's contact with large groups of children, such as in child-care centers, increases the likelihood of contacting the germs that cause colds and lead to ear infections. The pneumococcal conjugate vaccine which is the newest of the immunizations given routinely to infants less than two years of age will likely play a significant role in prevention of ear infections caused by Streptococcus pneumoniae, especially in younger children. This...

Rubella German or Three Day Measles

Prevention The rubella vaccine is usually given as part of the measles-mumps-rubella (MMR) vaccine given at 12 to 15 months of age. A second shot is given at 4 to 6 or 11 to 12 years of age. Pregnant women should not be given rubella virus vaccine, and women should not become pregnant for three months after being vaccinated.

The ABC of Hepatitis1

Vaccine Two doses of vaccine to anyone over one year of age. HBV vaccine prevents HDV infection. Vaccination. Immune globulin within two weeks of exposure. Washing hands with soap and water after going to the toilet. Use household bleach (10 parts water to 1 part bleach) on surfaces contaminated with faeces, such as changing tables. Safer sex. Vaccination provides protection for 20 plus years. Hepatitis B immune globulin within one week of exposure. Clean up infected blood with household bleach and wear protective gloves. Do not share razors, toothbrushes, or needles. Safer sex. Hepatitis B vaccine to prevent HBV HDV infection. Safer sex.

4127 Vein therapeutics and other local therapeutics

Genital or veneral warts are condylomata acuminata caused by the human papilloma virus (HPV) of several types, especially 6 and 11. Treatment is usually by electrocautery, laser, cryotherapy, or surgical excision. Chemical abalation can be used, and involves the use of topical antimitotics such as podophyllotoxin, podophyllin, or 5-fluorouracil, or caustics such as trichloroacetic acid. Interferon-inducers such as imiquimode are also used, and again require multiple applications. Information about these chemicals while breastfeeding is not available, but both the area treated and the dosage are small. Interferon is known to be a large molecule that does not pass into milk even during systemic treatment. The development of the HPV vaccine has shown a decrease in the incidence of these lesions, and will perhaps decrease the need for these medications.

452Efficacy of immunization in breastfed infants

Many myths have circulated regarding the efficacy of immunization of the infant during breastfeeding. Actually, the immunogenicity of some vaccines is increased by breastfeeding, but long-range enhancement of efficacy has not been studied. In any case the response to vaccines while breastfeeding is not diminished, and the usual vaccination schedules should be followed. 4.5.3 Hepatitis A vaccine Hepatitis A vaccine is available in two preparations which are prepared from cell culture-adapted hepatitis A virus which has in turn been cultured in human fibroblasts and inactivated. It has not been studied in breastfeeding or in children under 2 years of age. Recommendation. Hepatitis A vaccine is unlikely to present a problem during lactation and is not contraindicated. 4.5.4 Hepatitis B vaccine Hepatitis B vaccine is a highly effective and safe vaccine which is produced by recombinant DNA technology. The vaccine is an inactivated non-infectious hepatitis B surface antigen vaccine, and...

Breast Feeding During Illness

Mothers with hepatitis B can breast-feed their infants if the infant receives the hepatitis B vaccine during the first few days after birth. There is no evidence that hepatitis C is transmitted by breast-feeding. Mothers with chronic hepatitis C are often advised that they can nurse their infants, but they should discuss this with their physician. Other types of infections need to be evaluated by the obstetrician and pediatrician, but nearly all are likely to be safe for breast-feeding.

Chicken Pox Varicella

How It Spreads The virus is spread in nasal secretions and in fluid from inside the blisters. It is very contagious epidemics are especially common in late winter and early spring. Ninety percent of all nonimmune children (those who haven't had chicken pox or vaccine) will catch it when exposed. Prevention The vaccine against chicken pox is 70 to 90 percent effective. Vaccinated children who contract the virus have a milder case. A single injection of the vac Other Issues Questions remain about how long the vaccine's protection lasts. Studies indicate that it should last for at least 10 years. It is not yet known if a booster is needed later in life.

4158 Herpes zoster shingles chickenpox

Perinatal varicella infection can lead to severe infection in the infant if the maternal rash develops 5 days or less before delivery, or within 2 days after delivery. Illness in the infant usually develops before 10 days of age, and is more severe because of lack of maternal antibodies. The infant should receive varicella zoster immunoglobulin (VZIG). The infant can be infected by aerosolized virus from lesions or the maternal respiratory track. Postnatal varicella can develop from non-maternal sources, and is usually mild if the mother has had varicella or the vaccination. Recommendation. When the mother develops chickenpox 2-4 days after the birth, the baby is given varicella immunoglobulin and perhaps prophylactic acyclovir. The milk can be expressed and fed to the baby. If the mother becomes ill after this point, prophylactic measures are not needed and the baby can be breastfed. If the baby becomes ill, varicella infections normally proceed without complications. With herpes...

Common Illnesses in Child Care Settings

Rash-producing illnesses, usually caused by viruses such as chicken pox, spread easily in a child-care setting. Because increasing numbers of children now receive the vaccination for chicken pox, this disease is becoming less of a concern for children in child care and for their parents. But if your child has not been immunized and develops chicken pox, expect to keep your child home from day care for about 10 days, until the blisters are scabbed over.

Transplacental infection

Chicken pox is caused by the herpes varicella zoster virus (HZV). Maternal primary infection in early pregnancy may lead to serious fetal anomalies (congenital varicella syndrome), including central nervous system damage and eye deformities, although these are rare. Neonatal morbidity is highest when the mother develops the rash in the week surrounding the birth, and it is associated with a mortality rate of approximately 30 (ACOG 1993). Babies born to infectious mothers should be referred to a paediatrician for possible treatment with acyclovir and or vaccination.


This is very serious in the first trimester (Wang & Smaill 1989), with an 80 rate of infection in babies. Fetuses infected in the first 8 weeks run a high risk of abnormality, including eye defects and deafness. Spontaneous abortion may occur. Deafness can also occur with infection after 14 weeks. Intrauterine growth retardation is common and the baby may be born with abnormalities. It is important to note that a baby born with infection can excrete rubella in its urine for up to 10 years, and so can continue to be a risk to pregnant women. Women are screened antenatally for rubella and are offered rubella vaccination if they do not have immunity.


The schedule of health visits for infants and young children is built in part around the timing of immunizations. The development of highly safe, effective vaccines to prevent a range of potentially fatal and crippling diseases has been a towering human triumph. Making sure your child gets these immunizations is one of the most important things you can do to ensure your child's health. Work with your child's doctor to make sure that your child not only gets all recommended vaccines but also gets them on schedule. Delays in immunization can leave your child unnecessarily vulnerable to illness. (See Chapter 16, Immunizations, for all the details.)

4511 Immunoglobulins

Immunoglobulin is used with specific immunoglobulins in higl titer, such as immunoglobulin hepatitis B (Hepatitis B Imniuni Globulin) (IIBIG), which is used when there is known exposure t hepatitis B. If the mother is hepatitis-positive, the recommende regime is to give the newborn immunoglobulin within 12 hours o birth, plus the first dose of hepatitis B vaccine. If a mother i exposed to hepatitis B while breastfeeding, HBIG would not put th child at any risk via the breast milk. If the child required HBIG a the same time, it would be necessary to medicatc the child directlj


Prevention The incidence of epiglottitis has decreased dramatically since the vaccine against Hemophilus influenzae type B was introduced. Infants should be immunized against this bacterium, which also causes meningitis and pneumonia. If your child develops epiglottitis, your child's doctor may recommend that anyone in the household not fully vaccinated (except pregnant women) receive a course of the antibiotic rifampin. The doctor may recommend the same for anyone not fully vaccinated at your child's school or child-care center.

Infectious Disease

Both the CDC (128) and OSHA (129) recommend hepatitis B vaccine for susceptible workers with no contraindication cited for pregnant women. In an HBV-susceptible woman exposed to HBV, the CDC recommends administration of hepatitis B immune globulin (0.06 mL kg i.m.) within 24 hours and initiation of a vaccine series.

Measles Rubeola

Prevention The measles vaccine is given as part of the mumps-measles-rubella (MMR) shot, given at 12 to 15 months and then again at 5 to 6 years or 11 to 12 years. The measles vaccine is not usually given to infants younger than 12 months unless there is a measles outbreak. The vaccine should not be given to pregnant women or people with weakened immune systems. People who have had a very severe allergic reaction to eggs or to the antibiotic neomycin should not take the vaccine (for more information, see Allergies in Chapter 32, Health Problems in Early Childhood ). Infants, pregnant women, or those with a weakened immune system can be protected from infection by an injection of gamma globulin within six days of exposure.


Prevention The Hemophilus influenzae type B vaccine, given to infants beginning at two months, is 70 to 100 percent effective in protecting against this cause of meningitis. Children younger than two years and children with weakened immune systems should be vaccinated against Streptococcus


Prevention If your child is bitten by an animal, wash the area of the bite thoroughly with soap and water for 10 minutes and call your child's doctor, who will clean the wound thoroughly and check to make sure tetanus shots are up to date. You may also call the local animal control authorities to help find the animal that caused the bite. If the doctor decides to treat your child to prevent rabies, the treatment will involve shots of human diploid cell vaccine and human rabies immune globulin into a muscle, which should begin the day the child was bitten to be most effective. Part of human rabies immune globulin is usually injected near the bite area. Warn your child not to touch or feed stray animals, even dogs or cats. Report any stray animals to


No vaccine exists to prevent toxoplasmosis. The best way to avoid the disease is to minimize your exposure to raw or undercooked meat. Skip the carpac-cio. Order your steaks cooked at least medium. Also avoid cat feces. If you have an outdoor cat, ask someone else to change the litter. (Indoor cats that have never been outdoors and never come in contact with mice or rats are extremely unlikely to have the parasite.) If no one else can do it, wear rubber gloves when you change the litter. Also wear gloves if you work in a garden that neighborhood cats may play in.

Tetanus Lockjaw

Cause Tetanus is caused by a toxin released into the nerves and muscles by the bacterium Clostridium tetani, which is found in soil, dust, and the feces of some animals. The disease occurs very rarely in the United States, in part due to the availability and routine use of the tetanus vaccine. Prevention Tetanus can be prevented by receiving the recommended routine immunizations with tetanus vaccine usually as part of the DTaP (diphtheria-tetanus-pertussis) vaccine at 2, 4, 6, and 15 to 18 months and again at 4 to 6 years. Boosters should be given thereafter at 10-year intervals. Although cleaning a dirt- or soil-contaminated wound is not a substitute for immunization, be sure to clean all wounds.


Prevention Prevention depends on avoiding contact with those (usually adults) who have active disease, testing those who are at high risk for the disease, and promptly and adequately treating those with active infections to control spread to others. A vaccine called BCG can prevent TB in some situations, but it is not routinely given in this country due to the low likelihood of contracting the disease. It is recommended for children who are at high risk of long-term, close exposure to untreated or ineffectively treated adults.

4154 Hepatitis B

Hepatitis B is only rarely transmitted via the placenta, In contrast, there is a great risk of infection during the birth. For this reason, newborns whose mothers carry hepatitis antigens (HBs-Ag and HBc-Ag), which indicate the possibility of infection, are simultaneously vaccinated immediately after birth. HBs-Ag has also been detected in mothers' milk (Boxall 1974). However, various studies have shown that there is no increased risk of illness for infants when their mothers are only HBs-Ag carriers (Gonzalez 1995, Tseng 1988, Beasley 1975). No infection via breast milk was observed in the infants of 100 mothers with chronic hepatitis B. The infants had rcccived simultaneous vaccination, and 11 mothers were HBc-Ag positive (Hill 2002). Nevertheless, the authors interpret their data with caution because of the small cohort of HBe-Ag-positive mothers with potentially higher infection risk. Recommendation. Regardless of how the infant will be fed, every child born to a...

4182 Mercury

Elemental or metallic mercury is used in mercury thermometers and (in combination with silver and other metals) in dental amalgam. In China, dental amalgam was used to fill teeth over 1000 years ago (cited in Drexler 1998). Inorganic mercury, e.g. mercury chloride, has been used as a disinfectant. Organic mercury (ethyl mercury) is used for the preservation of vaccines, and is accumulated in contaminated seafood (methyl mercury). Apart from high doses elemental mercury is hardly absorbed via intestine (


Cause Pneumonia is a general term referring to an infection of the lungs caused by viruses, bacteria, fungi, and parasites. In otherwise healthy children, viral pneumonia is most common. Viruses causing pneumonia include respiratory syncytial virus (RSV), parainfluenza, influenza, and aden-oviruses. Among bacteria, Streptococcus pneumoniae, Streptococcus pyogenes (group A Streptococcus), and Staphylococcus aureus are the most common causes. Since the introduction of the Hib vaccine, Hemophilus influenzae type B is less often a cause. The sexually transmitted bacterium Chlamydia trachomatis can be passed on from the mother to the baby during delivery, leading to pneumonia. The microbe Mycoplasma pneumoniae also accounts for many cases Prevention Children younger than two years, those with weakened immune systems, and other high-risk children should be vaccinated against Streptococcus pneumo-niae. The influenza vaccine is also recommended for high-risk children, including those with...

Hepatitis B

Chapter 2 Pre-Pregnancy Vaccination To prevent the baby from being infected, he she should be vaccinated with an injection of the Hepatitis B vaccine and anti-bodies immediately after delivery. Once the baby is vaccinated against Hepatitis B, the mother can continue to breastfeed even if she is a carrier. 1. Does vaccination carry any risks for the developing fetus There is no evidence that vaccinating pregnant women poses any risk to the developing fetus. The pregnant woman may be vaccinated with killed (inactivated) viruses, bacterial vaccines or toxoids. Examples of killed vaccines are flu, Hepatitis B and tetanus vaccines. We recommend that you avoid live virus vaccines (like measles, mumps, and rubella) that contain small parts of the actual virus. They may cause miscarriage or birth defects if they are transmitted to the baby. This risk is very small though. Other examples of live virus vaccines include chicken pox, smallpox, Bacillus Calmette-Guerin (BCG) and poliomyelitis...

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