Overview Introduction How Could Vaccines Cause Damage? Early Studies on Vaccine Complications The DPT Vaccine DPT and Brain Damage DPT and Autism DPT and Vaccine-Induced Neuropathies Diagnosis of Post-Vaccinal CNS Pathology Vaccine-Induced Demyelination Auto-Immunity, Vaccines and Autism Database of Vaccine Injury Vaccines and Mercury Origins of the Mercury Controversy Mercury Neurotoxicity Thimerosal and Neurotoxicity Is There a Link betwen Mercury Exposure and Autism? Ethylmercury and the DPT Vaccine Testing for Mercury Toxicity The MMR Vaccine MMR Vaccine and Autism MMR Vaccine and Other Complications Other Vaccination Concerns Concern About Vaccine Adjuvants Immunological Consequence of Vaccines Vaccination During Pregancy and Risks for Autism The Rubeola (Measles) Vaccine The Rubeola Vaccine, Measles and Autism The Risks of Not Vaccinating for Measles Conflict of Interest and Vaccine Development The Hepatitis B Vaccine Hepatitis B Vaccine: The Risks Hepatitis B: The Disease Available Data on the Safety of Hepatitis B Vaccines Information on Other Vaccines Polio Vaccine Pneumococcal Pneumonia Vaccine Hemophilus Meningitis Vaccine Appendix 1: Schedule for Routine Immunizations Appendix 2: Standards for Pediatric Immunization Practices  ' Appendix 3: Decline of Number of Vaccine-Preventable Cases over Time Appendix 4: Childhood Immunizations The Burden of Suffering Description of Preventive Measures Evidence of Effectiveness Public Policy Considerations Recommendations of Other Groups Rationale Statement Recommendations of the American College of Preventive Medicine

1. Immunization services are readily available.
   
   
2. There are no barriers or unnecessary prerequisites to the receipt of vaccines.
   
   
3. Immunization services are available free or for a minimal fee.
   
   
4. Providers use all clinical encounters to screen and, when indicated, immunize child.
   
   
5. Providers educate parents and guardians about immunization in general terms.
   
   
6. Providers question parents or guardians about contraindicators and before immunizing a child, inform them in specific terms about the risks and benefits of the immunization their child is to receive.
   
   
7. Providers follow only true contraindications.
   
   
8. Providers administer simultaneously all vaccine doses for which a child is eligible at the time of each visit.
   
   
9. Providers use accurate and complete recording procedures.
   
   
10. Providers co-schedule immunization appointments in conjunction with appointments for other child health services.
    
    
11. Providers report adverse events following immunization promptly, accurately and completely.
    
    
12. Providers operate a tracking system.
    
    
13. Providers adhere to appropriate procedures for vaccine management.
    
    
14. Providers conduct semiannual audits to assess immunization coverage levels and to review immunization records in the patient populations they serve.
    
    
15. Providers maintain up-to-date, easily retrievable medical protocols at all locations where vaccines are administered.
    
    
16. Providers operate with patient-oriented and community-based approaches.
    
    
17. Vaccines are administered by properly trained individuals.
    
    
18. Providers receive ongoing education and training on current immunization recommendations.

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1. Ad Hoc Working Group for the Development of Standards for Pediatric Immunization Practices. Standards for pediatric immunization practices. JAMA 1993;269:1817-22.