Disease: Vaccination FAQs

    Why do people need vaccines? What is immunization? What is immunity?

    Vaccines are medications that boost our ability to fight off certain diseases. Many of the vaccine-preventable diseases are highly contagious and even fatal in non-immunized individuals (Table 1). Prior to the development of vaccines, these diseases disabled or killed millions of people. Many people living in developed countries today do not appreciate the value of immunizations because the successful use of vaccines has almost eradicated many of these diseases. These diseases are still dangerous and can kill people who are not adequately protected from them.

    Table 1: Vaccine-preventable diseases
    (http://www.cdc.gov/vaccines/vpd-vac/default.htm)Anthrax
    Cervical cancer
    Diphtheria
    Haemophilus influenza type B (Hib)
    Hepatitis A
    Hepatitis B
    Human papillomavirus (HPV)
    Influenza (flu)
    Japanese encephalitis (JE)
    Lyme disease
    Measles
    Meningococcal disease
    Monkeypox
    Mumps
    Pertussis (whooping cough)
    Pneumococcal disease
    Poliomyelitis (polio)
    Rabies
    Rotavirus (severe diarrhea)
    Rubella (German measles)
    Shingles
    Smallpox
    Tetanus (lockjaw)
    Varicella (chickenpox)
    Yellow fever

    Immunization is the act of receiving a vaccine. Immunity is the ability of the body to recognize specific infecting organisms as foreign and thereby protect against them.

    How can people become immune (protected)?

    Immunity (protection) can occur one of two ways:

    • The first way to become immune is by actually getting the natural disease. For many organisms, this confers immunity for life. When the person is exposed again to the organism, the immune system quickly reestablishes protection.
    • The second way to become immune is through the use of a vaccine. The vaccine interacts with the immune system and creates the same protection as if the person had the natural infections. This is done without being exposed to the risks involved with getting the natural infection.

    Are there different types of vaccines?

    There are two major categories of vaccines.

    • The first category of vaccine is made from live viruses that have been "attenuated" or weakened so that they do not cause the disease (Table 2). Usually, any symptoms caused by the vaccine is milder than the natural disease. The attenuated viruses elicit a strong immune response as the virus is very close to the virus that causes the disease.
    • The second category of vaccine, inactivated vaccine, is produced by growing the bacterium or virus in culture and then inactivating it (killing it) by using heat or chemicals (Table 3). These vaccines cannot cause the disease, but allow the body to develop immunity. While these vaccines are safer, they do not produce protection as good as that from the live vaccines.
    Table 2: Live attenuated vaccinesMeasles
    Mumps
    Rubella
    Vaccinia
    Varicella
    Zoster
    Yellow fever
    Rotavirus
    Intranasal influenza
    Oral polio
    BCG
    Oral typhoidTable 3: Inactivated (killed) vaccinesDiphtheria
    Tetanus
    Polio shot
    Hepatitis A
    Hepatitis B
    Rabies
    Influenza shot
    Pertussis
    Acellular pertussis
    Human papillomavirus
    Anthrax
    Typhoid shot
    Cholera
    Pneumococcus
    Meningococcus
    Salmonella
    Haemophilus influenza type b

    Can people receive multiple vaccinations during one visit to the doctor?

    Simultaneous administration (vaccines given at the same visit but not in the same shot) of most commonly used vaccines does not decrease the response to the vaccines or increase the risk for adverse reactions. The simultaneous administration of vaccines was instituted to increase compliance with recommended immunization schedules. If people have to come back many times to get additional shots, there is an increased chance that they will not get all recommended vaccinations. In children, there are now a few combination shots that contain multiple vaccines in a single shot. None of these are approved for use in adults except the one containing measles/mumps/rubella (MMR). There is an ongoing controversy in the public media about giving "too many" vaccines at one time to little children. Physicians, however, do not find that children are at risk from "too many" vaccinations given at one time.

    Are there any dangers to being immunized?

    There is no such thing as a risk-free vaccine. However, the health risk of not being vaccinated is real and is clearly greater than that of being vaccinated. Most side effects from vaccinations are mild and limited to local reactions at the injection site and/or a mild fever. Unfortunately, there are rare serious and even fatal side effects related to vaccines. While these events are sad, not taking the vaccine could also result in death or disability.

    Can people with severe egg allergies still get an annual influenza vaccination?

    Starting in 2013, there is now an influenza vaccine specifically for people with egg allergy. Most influenza vaccines are made using eggs. Therefore, people with severe egg allergy had previously been recommended not to receive the influenza vaccine. However, the new vaccine, recombinant hemagglutinin influenza vaccine (RIV), is not made using eggs. This vaccine is safe for patients with egg allergy.

    What reactions are likely after an immunization?

    Most reactions to vaccines are mild and self-limited. These are usually limited pain, swelling, and redness at the site of the vaccination. These occur in up to 80% of individuals and start within hours of the vaccination. Some people can get more generalized symptoms, including fever, muscle aches, headache, loss of appetite, and feeling generally tired. These systemic (generalized) reactions are seen more commonly with live attenuated vaccines and usually occur seven to 21 days after the vaccine was given. The worst (and very uncommon) reaction is anaphylaxis (a severe allergic reaction). These reactions usually occur shortly after the vaccine is given and can be life-threatening. Fortunately, these reactions only occur two times for every million doses of vaccine given.

    Who should not receive a vaccine?

    There are two types of contraindications (reasons not to give a vaccine): permanent and temporary.

    • The following are permanent contraindications to vaccination:
      • severe allergic reaction to a vaccine component (animal proteins [eggs], antibiotic, stabilizer, or preservative) or following a previous dose of the vaccine;
      • encephalopathy within seven days of a pertussis vaccination (not from another identifiable cause).
    • The following are precautions/temporary contraindications to vaccination:
      • Pregnancy: Although the risk of vaccination during pregnancy is mostly theoretical, caution is advised. Therefore, women who are known to be pregnant should not receive any of the live vaccines (Table 2). Inactivated vaccines are considered generally safe during pregnancy and should be used when indicated (Table 3). See the CDC for a complete listing of approved vaccines during pregnancy.
      • Immunosuppression: People with active cancer, leukemia, or lymphoma (or people taking high doses of steroids) should not receive live vaccines but can receive inactivated vaccines.
      • Human immunodeficiency virus (HIV): Vaccination depends on the severity of the illness. In asymptomatic (without symptoms) individuals, many vaccines are considered safe. In general, the inactivated vaccines are safe for both symptomatic and asymptomatic individuals infected with HIV.
      • Moderate to severe illness: If someone is ill with more than a simple cold, earache, diarrhea, or other minor illness, vaccination should be postponed until the illness is over.

    What vaccines can women receive while pregnant?

    Women who are pregnant should not receive the MMR, varicella, or zoster vaccines. These vaccines are made from live attenuated viruses and potentially could cause a problem. Pregnant women may receive tetanus and influenza vaccines as needed. It is safe to receive hepatitis A & B, meningococcal, and pneumococcal vaccines.

    What are invalid reasons for postponing vaccination?

    Vaccination should not be postponed for any of the following reasons:

    • Mild illness: Low-grade fever, colds, upper respiratory-tract infections, and mild diarrhea are not reasons to put off vaccination.
    • Antibiotics: The current administration of antibiotics is not a reason to put off vaccination.
    • Household contacts of pregnant women or immunosuppressed patients: Living in a house with a pregnant woman or an immunosuppressed patient is not a reason to put off vaccination. Two exceptions are the live attenuated nasal influenza vaccine and smallpox vaccine.
    • Breastfeeding: Breastfeeding is not a reason for either the mother or baby to put off vaccination.
    • Preterm birth: Preterm birth is not a reason to put off vaccination.
    • Generalized allergies: Children with allergies, but no history of reactions to vaccine components, should receive vaccines as recommended.
    • Family history: Having a family member who had an adverse reaction to a vaccine is not a reason to put off vaccination.

    Why do people keep getting vaccines if the numbers of cases of the vaccine preventable diseases are at a record low in the United States?

    Vaccine-preventable diseases are indeed infrequent in the United States because of the success of the vaccine program. However, if people stop receiving vaccines, these diseases will come back rapidly. This occurred with measles in the early 1990s and resulted in many deaths.

    Is there any financial help for people who have been injured by vaccines?

    In 1986, the United States government set up the National Childhood Vaccine Injury Act. This act provides a "no fault" compensation mechanism for people injured by vaccines.

    Is there anything different that health-care workers need to do compared with non-health-care workers?

    Health-care workers are treated a little differently than other adults for two reasons. First, a health-care worker is more likely to be exposed to certain risks of infection (such as hepatitis B) than the normal population. Second, if a health-care worker becomes infected, they may transmit those infections to their patients (chickenpox, pertussis).

    Special recommendations
    • Tetanus/diphtheria/pertussis (Td/Tdap)
      • It is recommended that any health-care worker who may have patient contact receive a Tdap shot if they have not received one as an adolescent (as long as it has been two years since their last Td shot). This helps prevent the spread of pertussis.
    • Hepatitis B
      • Health-care workers who have not been vaccinated should receive the three-dose series and obtain anti-hepatitis B serology testing one to two months after their third dose.
    • Measles/mumps/rubella (MMR)
      • There must be either documented evidence of all three diseases (measles, mumps, and rubella) or serologic evidence of immunity (determined by a blood test) in anyone born after 1957. If there is no serologic evidence of immunity, the health-care worker should receive two doses of MMR separated by 28 days or more.
    • Varicella
      • All health care workers must have a history of varicella disease (chickenpox), prior vaccination, or serologic evidence of immunity. If not, the worker should receive two doses of vaccine 28 days apart.
    • Influenza
      • Health-care workers should receive one dose of either the flu shot or the nasal flu vaccine annually.

    Are there different types of vaccines?

    There are two major categories of vaccines.

    • The first category of vaccine is made from live viruses that have been "attenuated" or weakened so that they do not cause the disease (Table 2). Usually, any symptoms caused by the vaccine is milder than the natural disease. The attenuated viruses elicit a strong immune response as the virus is very close to the virus that causes the disease.
    • The second category of vaccine, inactivated vaccine, is produced by growing the bacterium or virus in culture and then inactivating it (killing it) by using heat or chemicals (Table 3). These vaccines cannot cause the disease, but allow the body to develop immunity. While these vaccines are safer, they do not produce protection as good as that from the live vaccines.
    Table 2: Live attenuated vaccinesMeasles
    Mumps
    Rubella
    Vaccinia
    Varicella
    Zoster
    Yellow fever
    Rotavirus
    Intranasal influenza
    Oral polio
    BCG
    Oral typhoidTable 3: Inactivated (killed) vaccinesDiphtheria
    Tetanus
    Polio shot
    Hepatitis A
    Hepatitis B
    Rabies
    Influenza shot
    Pertussis
    Acellular pertussis
    Human papillomavirus
    Anthrax
    Typhoid shot
    Cholera
    Pneumococcus
    Meningococcus
    Salmonella
    Haemophilus influenza type b

    Can people receive multiple vaccinations during one visit to the doctor?

    Simultaneous administration (vaccines given at the same visit but not in the same shot) of most commonly used vaccines does not decrease the response to the vaccines or increase the risk for adverse reactions. The simultaneous administration of vaccines was instituted to increase compliance with recommended immunization schedules. If people have to come back many times to get additional shots, there is an increased chance that they will not get all recommended vaccinations. In children, there are now a few combination shots that contain multiple vaccines in a single shot. None of these are approved for use in adults except the one containing measles/mumps/rubella (MMR). There is an ongoing controversy in the public media about giving "too many" vaccines at one time to little children. Physicians, however, do not find that children are at risk from "too many" vaccinations given at one time.

    Are there any dangers to being immunized?

    There is no such thing as a risk-free vaccine. However, the health risk of not being vaccinated is real and is clearly greater than that of being vaccinated. Most side effects from vaccinations are mild and limited to local reactions at the injection site and/or a mild fever. Unfortunately, there are rare serious and even fatal side effects related to vaccines. While these events are sad, not taking the vaccine could also result in death or disability.

    Can people with severe egg allergies still get an annual influenza vaccination?

    Starting in 2013, there is now an influenza vaccine specifically for people with egg allergy. Most influenza vaccines are made using eggs. Therefore, people with severe egg allergy had previously been recommended not to receive the influenza vaccine. However, the new vaccine, recombinant hemagglutinin influenza vaccine (RIV), is not made using eggs. This vaccine is safe for patients with egg allergy.

    What reactions are likely after an immunization?

    Most reactions to vaccines are mild and self-limited. These are usually limited pain, swelling, and redness at the site of the vaccination. These occur in up to 80% of individuals and start within hours of the vaccination. Some people can get more generalized symptoms, including fever, muscle aches, headache, loss of appetite, and feeling generally tired. These systemic (generalized) reactions are seen more commonly with live attenuated vaccines and usually occur seven to 21 days after the vaccine was given. The worst (and very uncommon) reaction is anaphylaxis (a severe allergic reaction). These reactions usually occur shortly after the vaccine is given and can be life-threatening. Fortunately, these reactions only occur two times for every million doses of vaccine given.

    Who should not receive a vaccine?

    There are two types of contraindications (reasons not to give a vaccine): permanent and temporary.

    • The following are permanent contraindications to vaccination:
      • severe allergic reaction to a vaccine component (animal proteins [eggs], antibiotic, stabilizer, or preservative) or following a previous dose of the vaccine;
      • encephalopathy within seven days of a pertussis vaccination (not from another identifiable cause).
    • The following are precautions/temporary contraindications to vaccination:
      • Pregnancy: Although the risk of vaccination during pregnancy is mostly theoretical, caution is advised. Therefore, women who are known to be pregnant should not receive any of the live vaccines (Table 2). Inactivated vaccines are considered generally safe during pregnancy and should be used when indicated (Table 3). See the CDC for a complete listing of approved vaccines during pregnancy.
      • Immunosuppression: People with active cancer, leukemia, or lymphoma (or people taking high doses of steroids) should not receive live vaccines but can receive inactivated vaccines.
      • Human immunodeficiency virus (HIV): Vaccination depends on the severity of the illness. In asymptomatic (without symptoms) individuals, many vaccines are considered safe. In general, the inactivated vaccines are safe for both symptomatic and asymptomatic individuals infected with HIV.
      • Moderate to severe illness: If someone is ill with more than a simple cold, earache, diarrhea, or other minor illness, vaccination should be postponed until the illness is over.

    What vaccines can women receive while pregnant?

    Women who are pregnant should not receive the MMR, varicella, or zoster vaccines. These vaccines are made from live attenuated viruses and potentially could cause a problem. Pregnant women may receive tetanus and influenza vaccines as needed. It is safe to receive hepatitis A & B, meningococcal, and pneumococcal vaccines.

    What are invalid reasons for postponing vaccination?

    Vaccination should not be postponed for any of the following reasons:

    • Mild illness: Low-grade fever, colds, upper respiratory-tract infections, and mild diarrhea are not reasons to put off vaccination.
    • Antibiotics: The current administration of antibiotics is not a reason to put off vaccination.
    • Household contacts of pregnant women or immunosuppressed patients: Living in a house with a pregnant woman or an immunosuppressed patient is not a reason to put off vaccination. Two exceptions are the live attenuated nasal influenza vaccine and smallpox vaccine.
    • Breastfeeding: Breastfeeding is not a reason for either the mother or baby to put off vaccination.
    • Preterm birth: Preterm birth is not a reason to put off vaccination.
    • Generalized allergies: Children with allergies, but no history of reactions to vaccine components, should receive vaccines as recommended.
    • Family history: Having a family member who had an adverse reaction to a vaccine is not a reason to put off vaccination.

    Why do people keep getting vaccines if the numbers of cases of the vaccine preventable diseases are at a record low in the United States?

    Vaccine-preventable diseases are indeed infrequent in the United States because of the success of the vaccine program. However, if people stop receiving vaccines, these diseases will come back rapidly. This occurred with measles in the early 1990s and resulted in many deaths.

    Is there any financial help for people who have been injured by vaccines?

    In 1986, the United States government set up the National Childhood Vaccine Injury Act. This act provides a "no fault" compensation mechanism for people injured by vaccines.

    Is there anything different that health-care workers need to do compared with non-health-care workers?

    Health-care workers are treated a little differently than other adults for two reasons. First, a health-care worker is more likely to be exposed to certain risks of infection (such as hepatitis B) than the normal population. Second, if a health-care worker becomes infected, they may transmit those infections to their patients (chickenpox, pertussis).

    Special recommendations
    • Tetanus/diphtheria/pertussis (Td/Tdap)
      • It is recommended that any health-care worker who may have patient contact receive a Tdap shot if they have not received one as an adolescent (as long as it has been two years since their last Td shot). This helps prevent the spread of pertussis.
    • Hepatitis B
      • Health-care workers who have not been vaccinated should receive the three-dose series and obtain anti-hepatitis B serology testing one to two months after their third dose.
    • Measles/mumps/rubella (MMR)
      • There must be either documented evidence of all three diseases (measles, mumps, and rubella) or serologic evidence of immunity (determined by a blood test) in anyone born after 1957. If there is no serologic evidence of immunity, the health-care worker should receive two doses of MMR separated by 28 days or more.
    • Varicella
      • All health care workers must have a history of varicella disease (chickenpox), prior vaccination, or serologic evidence of immunity. If not, the worker should receive two doses of vaccine 28 days apart.
    • Influenza
      • Health-care workers should receive one dose of either the flu shot or the nasal flu vaccine annually.

    Source: http://www.rxlist.com

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