1. Immunizations: Diseases, Common Concerns, and Answers to Your Questions

5. Disease: Hepatitis B Vaccine: [HepB] Risks  The earlier in life the exposure the more likely the chronic stage of the disease will develop (liver disease or liver cancer)  90% of infected infants will develop the chronic infection Patient with late stage hepatocellular carcinoma due to chronic Hepatitis B. Source: CDC

6. Disease: Hepatitis B Vaccine: [HepB] Did you know?  That an infected person often does not feel sick or show symptoms of the disease  About 33,000 children (under 10 years of age) born to moms who are not infected with HBV were infected each year before routine hepatitis B vaccination.  In household settings, non-sexual transmission of HBV occurs primarily from child to child, and young children are at highest risk of infection. We’re not sure exactly how transmission occurs, but saliva is one possibility. HBV remains infectious at mild temperatures for extended periods and can be found on and transmitted through sharing of inanimate objects such as toothbrushes. (pkids.org)

7. Hepatitis B United States, 1978-2007 Source: CDC 2009 Clinical Education Slide Set Vaccine licensed

8. Disease: Rotavirus Vaccine: [RV] Risks  Infection in infants and young children can cause severe diarrhea, vomiting that increases chances of dehydration, electrolyte imbalance, and metabolic acidosis Source: CDC

9. Disease: Rotavirus Vaccine: [RV] Did you know?  Before the rotavirus vaccine was introduced in the USA in 2006, rotavirus resulted in the hospitalization of approximately 55,000 children each year. Globally, rotavirus is estimated to cause 527,000 deaths in children annually.

10. Rotavirus Vaccine Decreases Hospitalizations Age Group% Reduction in Hospitalization Year 1 After Vaccine Was Introduced % Reduction in Hospitalizations Year 2 After Vaccine was Introduced Under 2 months50%64% 2-24 months65%80% Over 24 months20%64% Source: Rais M, Strens D, Vergison A, Verghote M, Standaert B. Reduction in Pediatric Rotavirus-related Hospitalizations After Universal Rotavirus Vaccination in Belgium. Pediatric Infectious Disease Journal: July 2011 - Volume 30 - Issue 7 - pp e120-e125.

11. Diseases: Diphtheria, Tetanus, Pertussis Vaccine: [DTaP] Diphtheria Risks  If not properly diagnosed and left untreated, serious complications such as breathing problems, paralysis, heart failure, and even death can occur Source: CDC

12. Diseases: Diphtheria, Tetanus, Pertussis Vaccine: [DTaP] Did you know?  Immunity from DTaP vaccination wanes over time; booster doses are required to maintain protective antibody levels.

13. Diseases: Diphtheria, Tetanus, Pertussis Vaccine: [DTaP] Tetanus Risks  Tetanus can cause serious complications such as bone fractures and abnormal heart rhythms  Tetanus leads to death in about 1 in 10 cases (http://www.cdc.gov/vaccines/pubs/pink book/downloads/tetanus.pdf)http://www.cdc.gov/vaccines/pubs/pink book/downloads/tetanus.pdf Source: Immunization Action Coalition

14. Diseases: Diphtheria, Tetanus, Pertussis Vaccine: [DTaP] Did you know?  Tetanus is the only disease that we vaccinate against that comes from the environment (i.e. soil, manure) and not shared by other humans. It is not contagious.

15. Tetanus United States, 1947-2007 Year *2005 provisional total Source: CDC 2009 Clinical Education Slide Set DTP vaccine introduced DTaP vaccine introduced

16. Diseases: Diphtheria, Tetanus, Pertussis Vaccine: [DTaP] Pertussis Risks  Infants are at highest risk for the complications of this disease: apnea, pneumonia, seizures, encephalopathy, and death Source: CDC

17. Diseases: Diphtheria, Tetanus, Pertussis Vaccine: [DTaP] Did you know?  This disease is most contagious before the coughing starts  Similar to diphtheria and tetanus, booster doses are needed to protect you over time

18. Pertussis in the News As of 11/10/11, in the state of California, 2,734 cases of pertussis have been reported in 2011 (6.9 cases /100,000) In 2010, 9,146 cases were reported in California (23.4 cases/100,000) Source: California Department of Public Health: Pertussis Summary Report. http://www.cdph.ca.gov/programs/immunize/Documents/PertussisReport2011-11-10.pdf

19. Pertussis in the News California has seen more cases in the 2010 and 2011 than the last 50 years. In 2010, 808 cases were hospitalized. 10 deaths have occurred, all in infants younger than 2 months old at the time they caught pertussis Source: California Department of Public Health: Pertussis Summary Report. http://www.cdph.ca.gov/programs/immunize/Documents/PertussisReport2011-11-10.pdf

20. Diseases: Diphtheria, Tetanus, Pertussis Vaccine: [DTaP] Some side effects of DTaP vaccine:  About 1 in 4 children had a fever  About 1 in 4 had redness, swelling, soreness or tenderness where the shot was given  About 1 in 3 were fussy  About 1 in 10 were tired or lost their appetite  About 1 in 50 vomited  About 1 in 1,000 cried for more than 3 hours after the shot.  Life-threatening allergic reactions from vaccines are very rare

21. Disease: Haemophilus influenza type b Vaccine: [Hib] Risks  Hib meningitis causes death in 1 in 20 children  Permanent brain damage occurs in 10% - 30% of survivors Patient has Hib buccal cellulitis. Source: CDC

22. Disease: Haemophilus influenza type b Vaccine: [Hib] Did you know?  Before the vaccine was introduced, this disease was the leading cause of bacterial meningitis among children younger than 5 years old in the U.S.  Every year about 20,000 children (younger than 5 yrs) got the disease and about1,000 died

23. Hib in the News “Hib Outbreak Kills Unvaccinated Child” WebMD Health News In 2008, a Hib meningitis outbreak in Minnesota sickened 4 children and killed 1 Of the 5 cases: 1 child was too young to have finished the vaccine series 1 child received all of the shots but had an immune deficiency The other 3 cases including the one death were in infants whose parents refused to vaccinate them Source: WebMD: http://children.webmd.com/vaccines/news/20090123/hib-outbreak-kills-unvaccinated-child

24. Disease: Haemophilus influenza type b Vaccine: [Hib] Side effects of Hib vaccine:  About 1 in 4 children redness, warmth, or swelling where the shot was given  About 1 in 20 had a fever over 101

25. Disease: Pneumococcal Conjugate Vaccine: [PCV] Risks  Pneumococcal disease can be fatal  In some cases, it can result in long-term problems, like brain damage, hearing loss, and limb loss Source: AAP

26. Disease: Pneumococcal Conjugate Vaccine: [PCV] Did you know?  Pneumococcus (a type of bacteria) is in many people's noses and throats and is spread by coughing, sneezing, or contact with respiratory secretions. Why it sometimes invades the body and causes disease is unknown.

27. Disease: Pneumococcal Conjugate Vaccine: [PCV] PCV vaccine side-effects:  About half of children were drowsy after the shot, had a temporary loss of appetite, or had redness or tenderness where the shot was given  About 1 in 3 had swelling where the shot was given  About 1 in 3 had a mild fever  About 1 in 20 had a higher fever (over 102.2°F).  Up to about 8 in 10 became fussy or irritable  Life-threatening allergic reactions from vaccines are very rare Source: http://www.cdc.gov/vaccines/vac-gen/side-effects.htm

28. Disease: Pneumococcal Polysaccharide Vaccine: [PPSV] § Who should receive PPSV ?  Anyone 2 – 64 who has :  Long-term health problems (such as heart disease, lung problems, sickle cell disease & other hemoglobinopathies, diabetes, cochlear implant or cerebrospinal fluid leaks)  Diseases or conditions that lowers the body’s resistance to infection (such as HIV, lymphoma, leukemia, kidney failure, Hodgkin’s disease, multiple myeloma, nephrotic syndrome, damaged or no spleen, organ transplant, congenital immunodeficiency, )  Taking a drug or treatment that lowers the body’s resistance to infection (such as long-term steroids, certain cancer drugs, radiation therapy)  Anyone 19 years of age or older who :  Is a smoker  Has asthma Source: CDC

29. Disease: Pneumococcal Polysaccharide Vaccine: [PPSV] § Risks?  About half of people who get PPSV have mild side effects such as redness or pain where the shot is given.  Less than 1% develop a fever, muscle aches, or more severe local reactions.  A vaccine, like any medicine, could cause a serious reaction. But the risk of a vaccine causing a serious harm, or death, is extremely small. Source: CDC

30. Disease: Inactivated Poliovirus Vaccine: [IPV] Risks  Fewer than 1% of polio cases result in permanent paralysis of the limbs (usually the legs)  Of those paralyzed, 5- 10% die when the paralysis strikes the respiratory muscles Source: CDC

31. Disease: Inactivated Poliovirus Vaccine: [IPV] Did you know?  Before the vaccine was introduced in 1955, polio used to be very common in the US  Up to 95% of people infected with polio virus have no symptoms

32. Poliomyelitis United States, 1950-2007 Source: CDC 2009 Clinical Education Slide Set Vaccine licensed

33. Disease: Inactivated Poliovirus Vaccine: [IPV] IPV vaccine side-effects:  Some people who get IPV get a sore spot where the shot was given.  IPV has not been known to cause serious problems, and most people don’t have any problems at all with it.  Life-threatening allergic reactions from vaccines are very rare Source: http://www.cdc.gov/vaccines/vac-gen/side-effects.htm

34. Disease: Influenza (Flu) Vaccine: [Influenza (yearly)] Risks  Young children are at high risk for serious flu complications such as bacterial pneumonia, ear and sinus infections, and dehydration. Source: CDC

35. Disease: Influenza (Flu) Vaccine: [Influenza (yearly)] Did you know?  Despite how common it is, influenza is a serious disease and every year 36,000 deaths and 200,000 hospitalizations occur in all age groups because of it  Healthy children can die from the flu; the younger the child is the higher the risk for serious flu complications

36. Disease: Influenza (Flu) Vaccine: [TIV- Shot] Who should get vaccinated?  Everyone 6 months and older Especially:  Individuals at high-risk for developing flu related complications  If you live with or care for people with high-risk for developing flu related complications Who should not get vaccinated?  People who have a severe allergy to chicken eggs  People who have had a severe reaction to the vaccine in the past  People who develop Guillain Barre Syndrome (GBS) after a prior dose of flu vaccine  People with moderate or severe illness

37. Disease: Influenza (Flu) Vaccine: [LAIV- Nasal Spray] Who should get vaccinated with the nasal spray?  Healthy people ages 2-49 are eligible for this type of vaccine Who should not get vaccinated with the nasal spray? (They should get the flu shot instead.)  Adults 50 years of age and older or children from 6 through 23 months of age.  Children younger than 5 years with asthma or one or more episodes of wheezing within the past year.  Pregnant women.  People who have certain long-term health problems, muscle or nerve disorders, or a weakened immune system.  Anyone in close contact with someone whose immune system is so weak they require care in a protected environment.  Children or adolescents on long-term aspirin treatment.

38. Does the shot cause the flu? No, the flu vaccine does not cause the flu The viruses in the vaccine are weakened (attenuated) or killed (inactivated) so the shot and the nasal spray won't cause you to get the flu The vaccine will prompt your body to develop the antibodies necessary to fight off the influenza viruses A slight reaction to the shot, such as soreness at the injection site, mild muscle ache or fever may occur

39. Disease: Influenza (Flu) Nasal Spray side-effects:  Some children and adolescents 2-17 years of age have reported: runny nose, nasal congestion or cough fever headache and muscle aches wheezing abdominal pain or occasional vomiting or diarrhea Shot side-effects  soreness, redness, or swelling where the shot was given  hoarseness; sore, red or itchy eyes; cough  fever aches headache itching fatigue

40. Diseases: Measles, Mumps, Rubella Vaccine: [MMR] Measles Risks  1 in 10 children with measles also gets an ear infection  1 in 20 gets pneumonia.  1 in 1,000 gets encephalitis  1 or 2 in 1,000 die  Measles can also make a pregnant woman have a miscarriage or give birth prematurely Source: CDC

41. Diseases: Measles, Mumps, Rubella Vaccine: [MMR] Did you know?  While measles is almost gone from the USA, it still kills nearly 200,000 people each year around the world.  It is so contagious that if an unvaccinated child is exposed to the disease he will mostly likely get it

42. Measles United States, 1950-2007 Vaccine Licensed Source: CDC 2009 Clinical Education Slide Set

43. Measles in the News From Jan. 1 through July 1, 2011, there have been 174 confirmed cases of measles in the USA. This is the highest reported number since 1996. Most cases (158) are from people traveling to countries where measles is common, usually in Europe and Asia. Children who are over 6 months and traveling outside of the USA need to be vaccinated. Source: http://aapnews.aappublications.org/content/early/2011/07/07/aapnews.20110707-1.full

44. Diseases: Measles, Mumps, Rubella Vaccine: [MMR] Mumps Risks  Inflammation of the testicles in males  Inflammation of the brain (encephalitis) and/or tissue covering the brain and spinal cord (meningitis)  Inflammation of the ovaries/breasts in females  Temporary or permanent deafness Source: CDC

45. Diseases: Measles, Mumps, Rubella Vaccine: [MMR] Did you know?  Most mumps transmission likely occurs before the salivary glands begin to swell

46. Mumps United States, 1968-2007 Year Source: CDC 2009 Clinical Education Slide Set Vaccine Licensed

47. Mumps in the News During January-May 2006 a multi- state outbreak of mumps occurred 11 states reported 2,597 cases of mumps  8 states (Illinois, Iowa, Kansas, Missouri, Nebraska, Pennsylvania, South Dakota, and Wisconsin) reported mumps outbreaks with ongoing local transmission or clusters of cases  3 states (Colorado, Minnesota, and Mississippi) reported cases associated with travel from an outbreak state Source: CDC MMWR: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm55d518a1.htm, http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5905a1.htmhttp://www.cdc.gov/mmwr/preview/mmwrhtml/mm55d518a1.htm http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5905a1.htm  In 2009-2010, 1,521 cases of mumps were reported in New York and New Jersey  The boy who started it was 11 and had just returned from a trip to the United Kingdom before going to summer camp.

48. Diseases: Measles, Mumps, Rubella Vaccine: [MMR] Rubella Risks  Birth defects if acquired by a pregnant woman: deafness, cataracts, heart defects, mental retardation, and liver and spleen damage  At least a 20% chance of damage to the fetus if a woman is infected early in pregnancy Source: CDC

49. Diseases: Measles, Mumps, Rubella Vaccine: [MMR] MMR vaccine side-effects:  About 1 in 6 have fever  About 1 in 20 has a mild rash  Rarely, people have swelling of glands in the cheeks or neck  Mostly teenagers and adult women, about 1 in 4, have temporary pain and stiffness in the joints  Seizure is caused by fever in about 1 in 3,000 doses  Life-threatening allergic reactions from vaccines are very rare Source: http://www.cdc.gov/vaccines/vac-gen/side-effects.htm

50. Disease: Varicella (Chickenpox) Vaccine: [Varicella] Risks  Severe side effects from the disease include: bacterial infection of the skin, swelling of the brain, and pneumonia.  Adolescents and adults are more at risk for severe disease. Source: AAP

51. Disease: Varicella (Chickenpox) Vaccine: [Varicella] Did you know?  Before the vaccine, which was licensed in 1995, there were 100 deaths and 12,000 hospitalizations per year in the U.S. due to varicella  It is not better to get chickenpox naturally. The potential risks of the disease are severe and no one can predict which child will develop a life-threatening case of chickenpox  Shingles is a complication from natural chickenpox

52. Disease: Varicella (Chickenpox) Vaccine: [Varicella] Varicella vaccine side-effects:  Mild Problems  Soreness or swelling where the shot was given (about 1 in 5 children and up to 1 in 3 adolescents and adults)  Fever (1 person in 10, or less)  Mild rash, up to a month after vaccination (1 person in 25). It is possible for these people to infect other members of their household, but this is extremely rare.  Moderate Problems  Seizure (jerking or staring) caused by fever (very rare)  Severe Problems  Pneumonia (very rare) Source: http://www.cdc.gov/vaccines/vac-gen/side-effects.htm

53. Disease: Hepatitis A Vaccine: [HepA] Risks  Because young children might not have symptoms, the disease is often not recognized until the child's caregiver becomes ill with hepatitis A Source: CDC

54. Disease: Hepatitis A Vaccine: [HepA] Did you know?  Unlike HepB, hepatitis A does not cause long- term illness or permanent liver damage  Still, about 100 people each year die from liver failure caused by severe hepatitis A infection

55. Disease: Hepatitis A Vaccine: [HepA] HepA vaccine side-effects:  Mild problems  soreness where the shot was given (about 1 in 2 adults, and up to 1 in 6 children)  headache (about 1 in 6 adults and 1 in 25 children)  loss of appetite (about 1 in 12 children)  tiredness (about 1 in 14 adults)  Severe problems  serious allergic reaction, within a few minutes to a few hours of the shot (very rare) Source: http://www.cdc.gov/vaccines/vac-gen/side-effects.htm

56. Disease: Meningococcal Vaccine: [MCV4] Risks  Even when the disease is diagnosed early and adequate treatment is started, 5% to 10% of patients die (typically within 24 to 48 hours after the onset of symptoms)  Bacterial meningitis may result in brain damage, hearing loss or a learning disability in 10% to 20% of survivors Source: CDC

57. Disease: Meningococcal Vaccine: [MCV4] MCV4 vaccine side-effects:  As many as half the people who get meningococcal vaccines have mild side effects, such as redness or pain where the shot was given.  A small percentage of people who receive the vaccine develop a mild fever.  Serious allergic reactions, within a few minutes to a few hours of the shot, are very rare.  Brief fainting spells can follow a vaccination. They happen most often with adolescents, and they can result in falls and injuries. Source: http://www.cdc.gov/vaccines/vac-gen/side-effects.htm

58. Disease: Human Papillomavirus Vaccine: [HPV] Risks  Most common sexually transmitted infection  Some strains can cause genital warts and others can cause abnormal cells that could develop into vulvar/vaginal, penile, oropharyngeal, anal, or cervical cancer if left undetected and untreated

59. Disease: Human Papillomavirus Vaccine: [HPV] Did you know?  A person can be infected with HPV for years with no sign or symptoms  Approximately 20 million Americans are currently infected with HPV  At least 50% of sexually active men and women get it at some point in their lives  Each year, about 12,000 women get cervical cancer in the US

60. How can I protect my children? Two vaccines are available to protect females against the types of HPV that cause most cervical cancers One of these vaccines also protects against most genital warts and some other types of cancers. Only this type is approved for males. Both vaccines are recommended for 11 and 12 year-old girls, and for females 13 through 26 years of age, who did not get any or all of the shots when they were younger. It is now recommended that males 9 through 21 years old also be vaccinated.

61. Disease: Human Papillomavirus Vaccine: [HPV] HPV vaccine side-effects:  About 8 in 10 people have pain where the shot was given.  About 1 in 4 has redness or swelling.  About 1 in 10 has a mild fever.  About 1 in 3 gets a headache.  Fainting. Brief fainting spells can happen after any medical procedure, including vaccination. Sitting or lying down for about 15 minutes after a vaccination can help prevent fainting and injuries caused by falls. Source: http://www.cdc.gov/vaccines/vac-gen/side-effects.htm

62. Common Concerns Recommendations and safety Understanding the immunization schedule Ingredients Questions about autism

63. Recommendations and Safety Question: Who decides which vaccines a child needs? Answer: Each year, top infectious disease experts and doctors who care for children work together to decide what to recommend that will best protect US children from diseases. The recommended schedule is evaluated each year based on the most recent scientific data available. This schedule is approved by the American Academy of Pediatrics, the Centers for Disease Control and Prevention, and the American Academy of Family Physicians.

64. Recommendations and Safety Question: What is herd immunity? Answer: Herd immunity refers to the type of immunity that occurs when the vaccinated portion of the population provides protection against a disease to the un-vaccinated individuals. Some children are too young or too sick to receive certain vaccines. People who are vaccinated help protect them from the spread of disease.

65. Recommendations and Safety Question: How are vaccines licensed to ensure their safety? Answer: The US has some of the strictest safety testing requirements in the world. Vaccines are first tested by manufacturers who present data to the FDA, which has to show they will work well in children and are both safe and effective. The CDC and AAP then review the data again before making a recommendation for or against the vaccine. Manufacturing plants must be licensed and are regularly inspected.

66. Recommendations and Safety Question: How are vaccines monitored to ensure their safety? Answer: Vaccines continue to be studied after they are licensed and recommended. The federal government created the Vaccine Adverse Event Reporting System (VAERS) and other systems as part of the National Childhood Vaccine Injury Act. All doctors must report serious side effects of vaccines to VAERS so they can be studied. If any problems are found, vaccines are taken off the market. Any new side effects are also communicated to your pediatrician.

67. Recommendations and Safety Question: What happens if someone is injured by a vaccine? Answer: Most people who get vaccines have no serious problems. However, vaccines, like any medicines, can rarely cause serious problems, such as severe allergic reactions. In those rare cases, the federal government has created the Vaccine Injury Compensation Program (VICP) to provide compensation to people found to be injured by certain vaccines. Individual who thinks they has been injured can file a claim, which is then heard by special judges.

68. Recommendations and Safety : Take Home Message Today’s vaccines are the most effective and safest in history and have protected and saved millions of lives from vaccine- preventable diseases. The FDA and CDC take great care in licensing and monitoring vaccines. The CDC, AAP, and AAFP recommend what they believe is best to protect the nation’s children.

69. Understanding the Immunization Schedule Question: Isn’t it overwhelming to a child’s immune system to give so many shots in one visit? Answer: Infants and children are exposed to many germs every day just by playing, eating, and breathing. Their immune systems fight those germs (also called antigens), to keep the body healthy. The amount of antigens that children fight every day (2,000-6,000) is much more than the antigens in any combination of vaccines on the current schedule (150 for the whole schedule).

70. Understanding the Immunization Schedule Question: Why are so many doses given? Answer: Researchers are always studying how well vaccines work. For many vaccines three or four doses are needed to fully protect the child. Some vaccines require a booster dose later in life.

71. Understanding the Immunization Schedule Question: Why is the schedule “one size fits all?” Answer: The vaccine schedule is designed to protect children as soon as possible, but the vaccine schedule is not “one size fits all.” The schedule is ideal for healthy children but there are exceptions. If a child has allergies, a weakened immune system, a chronic condition, or another medical treatment, vaccines may be delayed or sometimes not given at all. In some cases, vaccines may be given on an accelerated schedule.

72. Understanding the Immunization Schedule Question: Why can’t the shots be spread out over a longer period of time? Answer: Spreading out the shots leaves your child unprotected longer. There is no scientific information that says that spreading the shots out over a longer period of time is safer. Pediatrics June 2010 M.J. Smith et al.

73. Understanding the Immunization Schedule: Take Home Message Vaccines are the best way to prevent diseases. The immunization schedule is designed to work best with a child’s immune system at certain ages and at specific times. Top disease experts and doctors evaluate the schedule yearly based on the most up-to- date information. A pediatrician will have the best information on what is recommended for your child.

74. Ingredients Question : What ingredients are in vaccines? Answer : All vaccines contain antigens. Antigens are what make the vaccine effective and prompt the body to create the immune response needed to protect against infection. Antigen forms include:  Weakened live viruses  Inactivated (or killed) viruses  Parts of viruses  Parts of bacteria

75. Ingredients Question: What additional ingredients are in vaccines? Answer: Preservatives Thimerosal: Thimerosal is used as a preservative in some multidose vials of influenza vaccine. Thimerosal is used in the processing of certain vaccines; it is removed, however, trace amounts may be present. Adjuvants Aluminum salts Additives Gelatin Residuals of the vaccine production process Formaldehyde Antibiotics Egg protein

76. Ingredients Question: Are these ingredients safe? Answer: Yes, these ingredients have been studied and are safe in the amount found in vaccines. The amount of these ingredients in vaccines are much less than what a child encounters in his or her environment, food, and water.

77. Ingredients Question : I’ve heard a lot about thimerosal- what is it? Answer : Thimerosal is a preservative that is used in some vaccines to prevent contamination. Some people have concerns that it includes mercury. The type of mercury used in thimerosal is called ethyl mercury- “organic” mercury. It is processed quickly in the body. Some people confuse this with methyl mercury, which can build up in the body over time and cause damage. Thimerosal, has been studied many times and no association with serious side effects, including autism, has be found.

78. Ingredients: Take Home Message The amount of each additive used in vaccines is very small. In fact, we are exposed to much higher levels of these chemicals in our everyday lives. In vaccines, these ingredients are used to make the vaccine safer and more effective. Each vaccine is tested many times to make sure it is safe and works. Taking ingredients out might affect the ability of the vaccine to protect a child.

79. Questions about Autism Question: Does the measles-mumps-rubella (MMR) vaccine cause inflammation in the bowel and brain, leading to the development of autism? Answer: No, scientific data do not show a link between MMR and autism. Children receive the MMR vaccine at 12-15 months. Signs of autism often appear when a child is 15-18 months. Because children get the MMR vaccine just before the signs of autism appear, some people were concerned about a link. Pervasive Developmental Disorders in Montreal and Quebec, Canada: Prevalence and Links with Immunizations. Fombonne E et al. Pediatrics. 2006; 118(1):e139-50 Immunization Safety Review: Vaccines and Autism. Institute of Medicine, The National Academies Press: 2004 Age at First Measles-Mumps-Rubella Vaccination in Children with Autism and School-Matched Control Subjects: A Population-Based Study in Metropolitan Atlanta. DeStefano F et al. Pediatrics 2004; 113(2): 259-66

80. Questions about Autism Question : Does the mercury in thimerosal cause heavy metal buildup in the body, affecting brain function, and causing autism? Answer : The type of mercury used in thimerosal is called ethyl mercury- “organic” mercury. It is processed quickly in the body. Some people confuse this with methyl mercury, which can build up in the body over time and cause damage. Thimerosal, has been studied many times and no association with serious side effects, including autism, has be found. Various studies have been conducted to investigate this topic and all have come to the same conclusion. There is no scientific evidence that supports the claim that the thimerosal in vaccines causes autism. Continuing increases in autism reported to California's developmental services system: mercury in retrograde. Schechter and Grether, 2008, Archives of General Psychiatry. 65(1):19-24 Mercury Levels in Newborns and Infants After Receipt of Thimerosal-Containing Vaccines. Pichichero, et al., Pediatrics. Vol. 121 No. 2, 2008, pp. e208-e214 Early Thimerosal Exposure and Neuropsychological Outcomes at 7 to 10 Years. Thompson, et al. 2007, New England Journal of Medicine. 357:1281-1292

81. Questions about Autism Question: If vaccines do not cause autism, what does? Answer: Currently, the cause of autism is mostly unknown. Many experts believe that it is a genetically based disorder. This evidence is by no means exclusive and research continues to find other possible causes.

82. Questions about Autism: Take Home Message Although the cause of autism is still undetermined, the scientific evidence does not show a link between particular vaccines or vaccine ingredients and autism. Organizations, agencies, scientists, and doctors are working together to find the true cause of autism and the best treatment and prevention methods for this disease.

83. For More Information AAP www.aap.org/immunization CDC www.cdc.gov/vaccines National Network for Immunization Information www.nnii.org Vaccinate Your Baby www.vaccinateyourbaby.org Parents of Kids with Infectious Diseases www.pkids.org

84. Questions?