Vaccinate: Yes or No

Picture Source:www.doctorsaputo.com

Vaccinate or Not to Vaccinate:  That is the Controversial Question

Vaccines are at the center of many debates among parents, health care providers, and health policy makers, just to name a few.  Although most of the credit for the success of vaccination goes to the “so-called” founder of vaccination, Dr. Edward Jenner, for his work on the eradication of smallpox, he was not the first to introduce inoculation or use this idea.  Innoculation techniques were forming in the 18th century in America, but long before that, countries like Africa, India, and China were practicing these techniques but calling it variolation.  Vaccination, inoculation, and variolation are all terms that are used interchangeably.   At no time in history has vaccination technique and the advanced science surrounding this method of human protection against disease and life threatening illness not been controversial.  It is human nature to have a strong opinion about something that directly affects your life or a loved one’s life, and it’s hard to meet anyone that doesn’t have a story about disease or illness and the emotions that come along it.  The question comes down to:  Which do you fear greater - the disease or the vaccine?

This picture, titled “The Cow Pock”, shows Dr. Edward Jenner giving smallpox vaccinations to people who then sprout cows out of their bodies.  This illustrates the fear of vaccination prevalent even in the 18th century.  Photo from yahoo images. www.blingcheese.com


The Pros – Vaccinate

People that are Pro vaccination will say that vaccinations were the greatest achievement to health care advancement in the 20th century.  Vaccines have eradicated many deadly illnesses such as rubella, diphtheria, and whooping cough that once killed millions of people.  The Pediatric Academic Society’s research concluded that childhood vaccinations in the US prevent about 10.5 million cases of infectious illness and 33,000 deaths per year.[1]  When a child who has received the vaccination contracts the disease, it is usually associated with much milder symptoms and less serious side effects.  This table represents the decrease in measles cases since the introduction of the measles vaccination provided by the Center for Disease Control.[2]
                                                    chart from yahoo images search
Diseases that seem to be eradicated can still pop up unexpectedly in unvaccinated groups. Vaccinations should be required for all children entering school. Choosing not to vaccinate puts the public’s health at risk.  Boulder, Colorado has the lowest school-wide vaccination rate in Colorado for whooping cough and one of the highest rates of whooping cough in the US as of 2002.[3]
 
There is speculation that vaccinations cause other diseases such as autism, ADHD, multiple sclerosis and most recently food allergies.  These studies have been discredited by studies that were conducted by top research facilities such as the Centers for Disease Control and Johns Hopkins University School of Public Health.  Just this year on March 12, 2010, in the case of Mead v. Secretary of Health and Human Services, the US Court of Federal Claims ruled that “the theory of vaccine-related causation of autism is scientifically unsupportable.”  Also, the claims that hepaitits B vaccination causes multiple sclerosis have been refuted.  The National Institute of Health funded a study done in the US during 2001 looking to examine the hepatitis B vaccination and the risk of multiple sclerosis in women.  This was a case-control study in two large cohorts of nurses.  For each woman with multiple sclerosis, five healthy women and one with breast cancer were selected as controls.  The study used mailed questionnaires and the information was confirmed by checking vaccination certificates.  The study states: “The null result that we found in this investigation is consistent with the recent observation that there was no increase in the number of cases of multiple sclerosis after the vaccination of more than 260,000 adolescents in Canada between 1992 and 1998.  There was also no increase in disease after hepatitis B vaccination in a retrospective cohort study among subjects included in a U.S. health care data base. These results and ours seem to contradict those of three previous case–control studies, including two in France that reported nonsignificant increases in risk.  However, these results indicate no association between hepatitis B vaccination and the development of multiple sclerosis.”[4]

It is also argued that vaccinations save people money on health care that would be paid out should an unvaccinated individual contract a vaccine preventable disease.  The Center for Disease Control and Prevention estimates that for “every $1 spent on vaccination saves the public $6.30 in medical costs with an aggregate savings of $10.5 billion. When including indirect costs to society, a measurement of losses due to missed work, death, and disability as well as direct medical costs, the CDC notes that every dollar spent on immunization saves $18.40, with an aggregate savings of $42 billion.”[5]   Here is a breakdown of the amount saved per specific vaccination:

       For every $1 spent 1:
DTaP saves
$27.00
MMR saves
$26.00
H. Influenza type b saves
$5.40
Perinatal Hep B saves
$14.70
Varicella saves
$5.40
Inactivated Polio (IPV) saves
$5.45
                                            Source: CDC website yahoo search
Information about vaccinations is readily available through many sources such as the internet, posters in doctors’ offices and schools, in material sent home from school, on billboards, and in a packet sent home from the hospital with new babies.  All of this material is Pro vaccinations.  Most of the material used can be summed up in the following statement by the Centers for Disease Control (CDC) in their Dec. 1, 2006 publication, "General Recommendations on Immunization: Recommendations of the Advisory Committee on Immunization Practices (ACIP)," published in the Morbidity and MortalityWeekly Report:

"The best way to reduce vaccine-preventable diseases is to have a highly immune population. Universal vaccination is a critical part of quality health care and should be accomplished through routine and intensive vaccination programs implemented in physicians’ offices and in public health clinics. Programs should be established and maintained in all communities to ensure vaccination of all children at the recommended age... Physicians and other health-care providers should simultaneously administer as many vaccine doses as possible, as indicated on the Recommended Child and Adolescent Immunization Schedule."




Photo Source:  Yahoo image search. http://www.ageofautism.com/

The Cons – Not to Vaccinate

People that are on the Con side of the vaccination debate will say the government should have no control over who gets vaccinated and who doesn’t.  It is not ethical nor does it abide by the 1st amendments of the USA to force and require immunizations.  Since the US is a melting pot of diversity, many religions and cultures are against vaccination.  Many people believe that vaccines are often given unnecessarily for diseases where the threat is not serious or the disease does not result in death.  As many claim, the mortality for childhood diseases such as whooping cough, measles, and scarlet fever (which there is no vaccine for) were already dropping drastically before immunization was available.  The decrease in mortality is most likely related to water purification, effective sewage disposal, better food and nutrition, and improved personal hygiene.  This graph illustrates that phenomenon.[6]

                                             Source: liberation-www.vaclib.org

Currently the American Academy of Physicians recommends immunization against 15 childhood illnesses.  “In the early 1950s, there were four vaccines: diphtheria, tetanus, pertussis and smallpox. Because three of these vaccines were combined into a single shot (DTP), children received five shots by the time they were 2 years old and not more than one shot at a single visit.  By the mid-1980s, there were seven vaccines: diphtheria, tetanus, pertussis, measles, mumps, rubella and polio. Because six of these vaccines were combined into two shots (DTP and MMR), and one, the polio vaccine, was given by mouth, children still received five shots by the time they were 2 years old and not more than one shot at a single visit.  Since the mid-1980s, many vaccines have been added to the schedule. Now, children could receive as many as 24 shots by 2 years of age and five shots in a single visit. The result is that the vaccine schedule has become much more complicated than it once was, and children are receiving far more shots than they ever did.  Vaccines are again in the process of being combined in the same way that the DTaP and MMR vaccines are already combined.”[7]   This raises the question - when is too many vaccinations not a good thing. 

Many people against vaccinations believe that vaccines are interfering with nature.  Some childhood illnesses are not life threatening and actually provide protection against certain diseases in the future of a child’s life.   When the child gets the illness, then natural immunity is built.   The vaccinations are not letting the immune system do its job and are actually causing autoimmune disorders, multiple sclerosis, lupus, Guillain-Barre Syndrome, autism, anaphylactic shock, developmental disabilities, brain inflammation, paralysis, and sudden death.  One of the first studies that linked vaccinations and autism was done by Dr. Andrew J. Wakefield.  In February of 2010 the study was retracted due to claims that the study did not have the children approved by the ethics committee.  The backlash caused Dr. Andrew J. Wakefield to have his medical license revoked.  He stated that this is a conspiracy against him to hide and discredit the information found in the study.  He claims that independent studies done in other countries support his findings.  When something is this controversial, the only findings that are going to be believable are independent studies where the research institute doesn’t have financial gain from the findings. 

Sometimes studies are not needed to prove an association that needs to be considered.  To illustrate this statement, here are some examples of deaths in New Jersey that were reported to VAERS (Vaccine Adverse Event Reporting System), available on their website: http://vaers.hhs.gov/index

VAERS ID 26799 Baby boy 3.6 months old died 2 days after receiving DPT, OPV on 9/24/90. Patient vaccinated with DTP/OPV child died. Autopsy showed baby had one kidney with chronic type changes, damage, hydronephrosis.

AERS ID 29348 Baby boy 4.8 months old died 2 days after receiving DTP, OPV, HIBV on 3/8/91. Child found by aunt cyanotic, hypotonic and "still" in crib. Rushed to ER Cardiac arrest-intubated and resuscitated-transferred to hospital.

VAERS ID 33687 Baby girl 16.8 months old died after receiving DTP,OPV on 7/12/90. Claimant's attorney reports that child is deceased; no other info is provided.

VAERS ID 34482boy aged 1.2 months old died 1 day after receiving DPT, OPV, HIBV on 7/31/91. Patient found dead during sleep on Aug. 1, 1991; Preliminary ME reports SIDS.

VAERS ID 37035 Baby boy aged 7.2 months died 0 days after receiving DPT, HIBV on 2/18/91. He expired having seizures; occurred 5 hours post vaccination.

VAERS ID 38820 Baby boy aged 2.4 months died 1 day after receiving OPV, HIBV, DPT on 9/14/91. Patient was found dead in crib about 24 hours post receiving DTP/OPV/HIB.

VAERS ID 41033 Patient died after receiving Hepatitis B vaccine. At time of report, cause of death was unknown. No further details were provided.

VAERS ID 41081 Baby boy aged 6 month died 1 day after receiving DTP, HIBV, OPV on 3/13/92. Patient received DTP/OPV/HIB on 3/13/92 and had no symptoms post vaccination. Slept that evening and awoke next morning; ate well and later in morning was put down for nap; patient stiffened and appeared to have a seizure; March 14 was taken to ER dead on arrival.

VAERS ID 42901 Baby girl aged 2.4 months died 0 days after receiving HIBV on 5/28/92. Patient received vaccine on 5/28/92 at 2 PM and at 5:30 PM had fever of 103.4. MD recommended APAP and sponge bath via phone. May 29 fever of 101; no other symptoms. May 30 at 5 AM temperature normal found dead in crib at 6:30 AM. Autopsy being performed.

VAERS ID 43165 Baby boy aged 4.8 months died 0 days after receiving HIBV, OPV, DTP on 6/8/92. Patient received HIB/OPV/DTP on June 8, 1992 at 10 AM and 3:30 PM. Temperature 101 and local reaction: APAP given by MD; put down to sleep; found dead in crib at 7 AM on June 9, 1992 estimated time of death between 4-5 AM; Autopsy being performed.

VAERS ID 51417 Baby girl aged 10.8 months died 3 days after receiving DPT, HIBV on 2/25/93. She also had a tine test placed that day-no reaction per parents. Patient was found dead in crib; was stable at time of exam and parent report no apparent illness prior to death; no fever, no local reaction to vaccine noted by parents; MD felt possible arrhythmia.

VAERS ID 51973 Female child died 9 days after receiving HIBV on 3/13/91. Plaintiff alleges that as a direct result of a HIB shot administered on Mar. 13, 1991 a previously healthy child died on March 22, 1991.

VAERS ID 57467 Baby boy aged 2.4 months died 1 day after receiving HIBV, HEP, DPT, OPV on 11/9/93. Fever, generalized seizure two times 19 hours later.

VAERS ID 58301 Baby boy aged 2.4 months died 3 days after receiving DTPH, OPV on 11/8/93. Patient received vaccinations on Nov. 8, 1993 and was found dead on Nov. 11, 1993. Patient had not experienced any side effect post vaccination and appeared happy. Autopsy performed SIDS; infant was given prophylactic Tylenol, had no post vaccine reactions.
VAERS ID 68517 Woman aged 66.5 years died 0 days after receiving a Flu shot on 11/4/94. Patient received vaccine; cardiac arrest with fibrillating ventricles several hours later. In hospital patient unconscious.

VAERS ID 76018 Baby boy aged 1.2 months died 11 days after receiving Hepatitis B vaccine on 6/15/95. Patient was reported to have died at hospital; SIDS.

VAERS ID 87397 Boy aged 17.9 years died 7 days after a Measles live virus vaccine on 7/26/88. One week post vaccination patient experienced loss of motor coordination and other neuro sequelae, with high spiking fevers; patient was hospitalized on Aug. 27, 1988 diagnosed with encephalitis, hepatitis, hypochloremic metabolic alkalosis, acute respiratory failure, thrombocytopenia, anemia.

Donald W. Miller, Jr., MD, Professor of Surgery at the University of Washington, states the following in his Dec. 10, 2004 article "A User-Friendly Vaccination Schedule," available at www.generationrescue.org:

"Fifty years ago, when the immunization schedule contained only four vaccines (for diphtheria, tetanus, pertussis, and smallpox), autism was virtually unknown... Today, one in every 68 American families has an autistic child… Four million American children have Attention Deficit Hyperactivity Disorder. One in six American children are now classified as 'Learning Disabled.'

Our children are also experiencing an epidemic of autoimmune disorders – Type I diabetes, rheumatoid arthritis, asthma, and bowel disorders…

There is a growing body of evidence that implicates vaccines as a causative factor in the deteriorating health of children. The hypothesis that vaccines cause neurologic and immune system disorders is a legitimate one – vaccines given in multiple doses, close together, to very young children following the CDC’s Immunization Schedule. This hypothesis should be tested by a large-scale, long-term randomized controlled trial…

New knowledge in neuroimmunology (the study of how the brain’s immune system works) raises serious questions about the wisdom of injecting vaccines in children less than two years of age...

Parents should have the freedom to select whatever vaccination schedule they want their children to follow, especially since health care providers and the government (except via its Vaccine Injury Compensation Program) cannot be held accountable for any adverse outcomes that might occur."

Parents need to be advised about vaccination risks and adverse outcomes. Children should not be required to receive hepatitis B vaccination.  Hepatitis B is a blood born disease and is most likely spread through intravenous drug use and sexual intercourse.  Children are not at great risk in those categories.  The DPT vaccine has showed to cause shallow breathing, sleep apnea and may be a causing factor in SIDS (Sudden Infant Death Syndrome).  The HPV (Human Papilloma Virus) vaccination should not be required because it was only approved in 2006; therefore the long term side effects are not known.  The vaccine only protects against 2 of the 15 strains of HPV that are thought to cause cervical cancer. 

Also, there may be a conflict of interest in developing and promoting vaccinations.  In a report on the Hearing before the Committee on Government Reform: House of Representatives held on June 15, 2000, the following were stated:

“How confident in the safety and need of specific vaccines would doctors and parents be if they learned the following: One, that members, including the chair of the FDA and CDC advisory committees who make these decisions own stock in drug companies that make the vaccines. Two, that individuals on both advisory committees own patents for vaccines under consideration, or affected by the decisions of the committees. Three, that three out of the five of the members of the FDA’s advisory committee who voted for the rotavirus vaccine had conflicts of interest that were waived. Four, that 7 individuals of the 15 member FDA advisory committee were not present at the meeting. Two others were excluded from the vote, and the remaining five were joined by five temporary voting members who all voted to license the product. Five, that the CDC grants conflict of interest waivers to every member of their advisory committee a year at a time, and allows full participation in the discussions leading up to a vote by every member, whether they have a financial stake in the decision or not. So they’re discussing it, influencing other members possibly, whether they have a financial stake or not. Sixth, that the CDC’s advisory committee has no public members, no parents have a vote in whether or not a vaccine belongs on the childhood immunization schedule. The FDA’s committee only has one public member. These are just a few of the problems we found.”[8]

A new concern has come about in the last decade - the fear that vaccinations cause food allergies and anaphylasis.  The law that protects the “trade secret” of the vaccine ingredients hides the fact that peanut oil was used as an adjunct to help preserve and stabilize vaccinations, and the continued use of peanut oil in vaccinations is unknown.  Peanut oil was a domestic crop and was cheap to produce so it was used in vaccinations.  Peanut allergy anaphylaxis is now thought to be caused by vaccinations. 

“It was during his famous 1901 vaccination experiments on dogs that French immunologist Charles Richet (1850-1935) discovered what he termed anaphylaxis.  Richet and his colleague Paul Portier were onboard the yacht of oceanographer Prince Albert 1 of Monaco to explore the possibility of producing a vaccine to physalia poison, a toxin from the tenticles of the Portuguese Man of War.  The scientists began injecting dogs with the toxin.  Dogs that survived were given time to recover and then re-injected.  Richet expected that the first exposure to the poison would have created a certain amount of immunity in the dogs.  Instead the initial exposure made the dogs hypersensitive.  A second, much smaller dose of toxin caused a violent reaction skin to serum sickness that quickly killed them.  In his lab, Richet soon discovered that even a small dose of protein injected into a dog followed by another small dose several weeks later produced the same result. […] Further research by Nicolas Arthus in 1903 and Richard Otto in 1905 showed that without exception all proteins toxic and non-toxic could produce anaphylaxis through injection-egg, milk, meat, diphtheria.  And although the key again was interval, this incubation period also varied between species and between substances.  To describe this phenomenon, Richet paired two Greek words in anaphylaxis-“ana” against and “phylaxis” protection-essentially the opposite outcome they sought with vaccination.  Richet described anaphylaxis as one of the three possible outcomes of vaccination.  These were: unchanged sensitivity or stability; diminished sensitivity or habituation; and heightened sensitivity.  Alimentary or food anaphylaxis, Richet discovered through experiments, was the body’s defensive response to proteins that has by-passes the modifying process of the digestive system and been introduced directly to the blood stream.”[9]


The Facts

The matter of vaccination safety is still being studied and tested.  The fact is that many parents are not given information so that they can make a decision about whether or not they would like to vaccinate their child.  Media plays a role in highlighting cases and studies whether good or bad and often leaves out facts and critical information.  This debate remains an ethical issue in regards to the freedom of choice in this country.  Should children be required to be immunized to attend public school?  And the answer is – it depends on who you ask and what ties they have to vaccinations, either emotional or financial.  I am including a simple timeline that illustrates the history of vaccinations and vaccine laws.[10]  But what I think this timeline also illustrates is that we are all human; the doctors, the researchers, the policymakers, the stakeholders, and the patients, and that all these people are still learning and do not have the answer about how the vaccinations of the past 100 years are going to affect the next 100 years.  Will vaccinations ruin the immune system or will they allow many more people to live longer lives?  We have not been at this vaccination thing for long compared to the history of humans and this new technology that looks promising could be detrimental to the long-term health of individuals.  For parents trying to make a decision to vaccinate or not vaccinate, I think it is only fair that they are presented material with both sides of this debate so they may make the decision on their own and not be scared into vaccination, but choose it for the right reasons for them. 


The History of Vaccination Timeline


First Generation of Vaccines (pre-1950s)
1798
Smallpox
1885
Rabies
1897
Plague
1917
Cholera
1917
Typhoid vaccine (parenteral)
1923
Diphtheria
1926
Pertussis
1927
Tuberculosis (BCG)
1927
Tetanus
1935
Yellow Fever
1940s
DTP
1945
The first influenza vaccines (flu) began being used.
1950s-1960s
1955
Inactivated polio vaccine licensed (IPV).
1955
Tetanus and diphtheria toxoids adsorbed (adult use, Td)
1959
World Health Assembly passes initial resolution calling for global smallpox eradication.
1961
Monovalent oral polio vaccine licensed.
1963
Trivalent oral polio vaccine licensed (OPV).
1963
The first measles vaccine licensed.
1964
Advisory Committee on Immunization Practices (ACIP), designed to provide CDC with recommendations on vaccine use, holds its first meeting.
1964-1965
20,000 cases of Congenital Rubella Syndrome occurred during the largest rubella epidemic in the United States.
1966
U.S. Measles eradication goal enunciated.
1967
Mumps vaccine licensed.
1969
Rubella vaccine licensed - 57,600 rubella cases reported this year.
1970s
1970
Anthrax vaccine manufactured by the Michigan Department of Public Health.
1971
Routine smallpox vaccination ceases in the United States.
1971
Measles, Mumps, Rubella vaccine licensed (MMR).
1976
Swine Flu: largest public vaccination program in the United States to date; halted by association with Guillain-Barré syndrome.
1977
Last indigenous case of smallpox (Somalia).
1978
Fluzone, the current flu vaccine that is made by Aventis pasteur, was licensed.
1979
Last case of polio, caused by wild virus, acquired in the United States.
1980s
1980
Smallpox declared eradicated from the world.
1981
Meningococcal polysaccharide vaccine, groups A, C, Y, W135 combined (Menomune)
1982
Hepatitis B vaccine becomes available.
1983
Pneumococcal vaccine, 23 valent
1986
The National Childhood Vaccine Injury Act establishes a no-fault compensation system for those injured by vaccines and requires adverse health events following specific vaccinations be reported and those injured by vaccines be compensated.
1988
Worldwide Polio Eradication Initiative launched; supported by WHO, UNICEF, Rotary International, CDC and others.
1989-1991
Major resurgence of measles in the United States - 55,000 cases compared with a low of 1,497 cases in 1983. Two-dose measles vaccine (MMR) is recommended.
1990s
1990
The Vaccine Adverse Reporting System (VAERS), a national program monitoring the safety of vaccines established.
1990
Haemophilus influenzae type B (Hib) polysaccharide conjugate vaccine licensed for infants.
1990
Typhoid vaccine (oral)
1991
Hepatitis B vaccine recommended for all infants.
1991
Acellular pertussis vaccine (DTaP) licensed for use in older children aged 15 months to six years old.
1993
Japanese encephalitis vaccine
1994
Polio elimination certified in the Americas.
1994
Vaccines for Children (VFC) program established to provide access to free vaccines for eligible children at the site of their usual source of care.
1995
First harmonized childhood immunization schedule endorsed by ACIP, the American Academy of Family Physicians and the American Academy of Pediatrics is published.
1995
Varicella vaccine licensed; before the vaccine an estimated 4 million infected annually in the United States.
1995
Hepatitis A vaccine licensed.
1996
Acellular pertussis vaccine (DTaP) licensed for use in young infants.
1998
First rotavirus vaccine licensed.
1999
Rotavirus vaccine withdrawn from the market as a result of adverse events.
1999
Lyme disease vaccine approved by the FDA.
1999
FDA recommends removing mercury from all products, including vaccines. Efforts are begun to remove thimerosal, a mercury based additive, from vaccines.
2000s
2000
Worldwide measles initiative launched; 800,000 children still die from measles annually. Measles declared no longer endemic in the United States.
2000
Pneumococcal conjugate vaccine (Prevnar) recommended for all young children.
2001
September 11 results in increased concern of bioterrorism. The United States establishes a plan to re-introduce smallpox vaccine if necessary, a vaccine thought never to be needed again.
2002
Lyme disease vaccine withdrawn from the market by the manufacturer because of lawsuits and lack of demand for the vaccine.
2003
Measles declared no longer endemic in the Americas.
2003
First live attenuated influenza vaccine licensed (FluMist) for use in 5 to 49 year old persons.
2003
First Adult Immunization Schedule introduced.
2004
Inactivated influenza vaccine recommended for all children 6 to 23 months of age.
2004
Pediarix,a vaccine that combines the DTaP, IPV, and Hep B vaccines, into one shot, is approved.
2005
Rubella declared no longer endemic in the United States.
2005
Boostrix and Adacel, Tdap vaccines, are approved for teens.
2005
Menactra, a new meningococcal vaccine is approved for people between the ages of 11 to 55 years of age.
2006
RotaTeq is a new rotavirus vaccine from Merck.
2006
ProQuad is a new vaccine that combines the MMR and Varivax vaccines for measles, mumps, rubella, and chicken pox into a single shot.
2006
Gardasil, the first HPV vaccine is approved.
2007
A booster dose of Varivax, the chickenpox vaccine, is now recommended for all children.
2007
The recommended age for Flumist, the nasal spray flu vaccine, was lowered to two years.
2008
Outbreaks of measles increasing across the U.S. as vaccination rates drop among some communities over vaccine safety fears.
2008
Rotarix, a two dose rotavirus vaccine is approved.
2008
Pentacel, a combination of DTaP, IPV and Hib is approved.
2008
Kinrix, a combination of DTaP and IPV that can be used for children between the ages of 4 and 6 is approved.



Sources:
[1] Zhou, et al., "Economic Evaluation of Routine Childhood Immunization with DTaP, Hib, IPV, MMR and Hep B Vaccines in the United States," Pediatric Academic Societies Conference, Seattle, Washington, May 2003
[2] Arthur Allen, "Bucking the Herd," Atlantic Monthly, Sep. 2002
[3] US Court of Federal Claims, “Mead v. Secretary of Health and Human   Services,”www.uscfc.uscourts.gov (assessed December 2010)
[4]   Hepatitis B Vaccination and the Risk of Multiple SclerosisAlberto Ascherio, M.D., Dr.P.H., Shumin M. Zhang, M.D., Sc.D., Miguel A. Hernán, M.D., Dr.P.H., Michael J. Olek, M.D., Paul M. Coplan, Sc.D., Kimberly Brodovicz, M.P.H., and Alexander M. Walker, M.D., Dr.P.H.N Engl J Med 2001; 344:327-332 February 1, 2001
[5] Every Child By Two, "Economic Value of Vaccines," www.ecbt.org (accessed December 2010)
[6] From: Vaccination, A Parents Dilema, Greg Beattle, c 1997, Oracle Press, Queensland, Australia, p. 36-57
[7] The Children’s Hospital of Philadelphia, Vaccination Education Center, “History of Vaccine Schedule,” www.chop.edu/service/vaccine-education-center (accessed December 2010)

[8] Vaccine Info, “Conflicts of Interest in Vaccine Policy Making”,www.vaccineinfo.net/issues/conflictofinterest (accessed December 2010)

[9]  From: The History of the Peanut Allergy Epidemic, Heather Fraser, c 2010, McMaster University Innovation Press, Hamilton, Ontario, p. 102-103
[10] Center for disease control,” Vaccination Timeline” www.cdc.gov (accessed December 2010)