By two years of age, healthy infants in the United States can receive up to 20 vaccinations to protect against 11 diseases. Although most people know that vaccines effectively protect against serious infectious diseases, approximately one-quarter of parents in a recent survey believe that infants get more vaccines than are good for them, and that too many immunizations could overwhelm an infant's immune system. The Immunization Safety Review Committee reviewed the evidence regarding the hypothesis that multiple immunizations increase the risk for immune dysfunction. Specifically, the committee looked at evidence of potential biological mechanisms and at epidemiological evidence for or against causality related to risk for infections, the autoimmune disease type 1 diabetes, and allergic disorders.

Contents

• THE NATIONAL ACADEMIES
• IMMUNIZATION SAFETY REVIEW COMMITTEE
• REVIEWERS
• Foreword
• Acknowledgments
• Executive Summary
  • ABSTRACT
  • UNDER REVIEW
  • SCIENTIFIC ASSESSMENT
  • SIGNIFICANCE ASSESSMENT
  • RECOMMENDATIONS REGARDING PUBLIC HEALTH RESPONSE
  • SUMMARY
  • REFERENCES
• Immunization Safety Review: Multiple Immunizations and Immune Dysfunction
  • THE CHARGE TO THE COMMITTEE
  • THE STUDY PROCESS
  • THE FRAMEWORK FOR SCIENTIFIC ASSESSMENT
  • UNDER REVIEW: MULTIPLE IMMUNIZATIONS AND IMMUNE DYSFUNCTION
  • SCIENTIFIC ASSESSMENT
  • SIGNIFICANCE ASSESSMENT
  • RECOMMENDATIONS FOR PUBLIC HEALTH RESPONSE
  • SUMMARY
  • REFERENCES
• Appendix A Chronology of Important Events Regarding Vaccine Safety
• Appendix B Committee Conclusions and Recommendations from Previous Reports
• Appendix C Immunization Safety Review Committee
• Appendix D Methods of Identifying the Literature for the Causality Assessment

Support for this project was provided by the Centers for Disease Control and Prevention and the National Institute of Allergy and Infectious Diseases of the National Institutes of Health as part of a National Institutes of Health Task Order No. 74. The views presented in this report are those of the Institute of Medicine Immunization Safety Review Committee and are not necessarily those of the funding agencies.

NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance.