Front Matter

262 Vaccines and Autism

industrialized countries and were triggered by clinical observation of

the  onset of autism in the days immediately following vaccination [1–7].

In  England, these claims focused on the measles–mumps–rubella (MMR)

vaccine [2,3]. In the USA, the focus was on thimerosal, a preservative that

contains ethyl mercury, which was added to multi‐dose vials of many vac-

cines as a preservative to prevent bacterial and fungal growth. In multi‐dose

vaccine vials, needles are inserted into the vaccine bottle many times, which

can introduce contamination into the vial [1–4]. In the 1990s, thimerosal

was used in most pediatric vaccines. Although all of the vaccines on the

currently recommended Centers for Disease Control and Prevention (CDC)

early childhood vaccination schedule are available as thimerosal‐free, parental

perceptions that vaccines pose safety concerns are affecting vaccination

rates, particularly in light of the much expanded and more complex schedule

in place today.

Table  9.1 depicts the recommended childhood and adolescent immuniza-

tion schedules approved by the American Academy of Pediatrics, the Advisory

Committee on Immunization Practices of the CDC, the American Academy

of Family Physicians, and the American College of Obstetricians and

Gynecologists in 2017 (https://www.cdc.gov/vaccines/schedules/hcp/imz/

child‐adolescent.html).

In addition to the childhood vaccinations, adults also receive numerous

vaccines at different stages in their life. In Table 9.2 we list these highly recom-

mended vaccines that are administered regularly to adults in industrialized

nations. Many of these vaccines contain weakened live viruses (attenuated

viruses). Live virus based vaccines should be avoided in children and adults

with compromised immune systems. We will return to this topic later in the

chapter.

Politics Versus Science in the Vaccination Era

Currently, vaccination is a prominent topic on the political stage. On one side

are the autism deniers, who generally believe that vaccination has no side

effects. On the other side are vaccine safety advocates, who contend that many

vaccines are unsafe and are responsible for untold illnesses, particularly MMR,

which some believe is responsible for regressive autism (more later). However,

key errors and conflicts of interest continue to be discovered in papers describ-

ing studies trying to link vaccines to autism, leading to the papers being with-

drawn from publication in scientific journals [1–8].

It should be realized, however, that neither side could be correct. It should be

stated without any doubt that is always a small degree of risk associated with

any kind of medicine used today, including something as seemingly benign as

aspirin, and vaccines are prophylactic treatments to fend off more serious and

Table 9.1 Recommended immunization schedule for children and adolescents aged 18 years or younger (USA, 2017).

Vaccine Birth 1 mo 2 mos4 mos6 mos9 mos 12 mos15 mos18 mos 19–23mos 2–3 yrs4–6 yrs7–10 yrs11–12 yrs 13–15 yrs 16 yrs17–18 yrs

Hepatitis B^1 (HepB) 1 st dose^2 nd dose

Rotaviruseries); RV5 (3-dos^2 (RV) RV1 (2-dosse series)e 1 stdose 2 nd dose

1 stdose 2 nd dose 3 rd dose

3 rd dose

3 rd dose

4 th dose

4 th dose

1 stdose 2 nd dose

1 stdose 2 nd dose

2 nd dose

2 nd dose

2 nd dose

1 stdose

1 stdose

1 stdose

1 stdose

2 nd dose

footnote 2See

footnote 4See

4 th dose 5 th dose

Haemophilus influenzae (Hib) type b^43 See footnote 4rd or 4th dose,

Pneumococcal conjugate(PCV13)^5

Inactivated poliovirus(IPV: <18 yrs)^6

Influenza 7 (IIV) Annual vaccination (IIV) 1 or 2 doses Annual vaccination (IIV) 1 dose only

Measles, mumps, rubella^8 (MMR) See footnote 8

Varicella^9 (VAR)

Hepatitis A^10 (HepA) 2-dose series, See footnote10

≥6 weeks; MenACWY-D ≥9 mos;Meningococcal^11 (Hib-MenCY

MenACWY-CRM ≥2 mos) See footnote 11

Tetanupertussiss, diphtheria, (^12) (Tdap: & ac≥7 elluyrs)lar Tdap
Human papillomavirus^13 (HPV) See footnote 13
See footnote 11
Pneumococcal polysaccharide(PPSV23)^5 See footnote 5
Range of recommendedages for all children Range of recommended agesfor catch-up immunization Range of recommended agesfor certain high-risk groups Range of recommended ages fornon-high-risk groups that may receive vaccine, subject to
individual clinical decision making No recommendation
3 rd dose
Diphtheria, tetanus, & acellularpertussis (^3) (DTaP: <7 yrs)
Meningococcal B^11
Source: http://pediatrics.aappublications.org/content/133/2/357.