November 2024

Childhood Vaccinations
Top 12 questions answered with
the nuance you’re looking for

Are childhood vaccines safer than the

diseases themselves?
1
Yes, the benefits continue to outweigh the risks for routine vaccine-preventable diseases. For
example, the risks of side effects from a measles-mumps-rubella (MMR) vaccination are
vanishingly small, especially compared to the devastating effects of measles, as shown below.

Complications from 10,000 Complications from 10,000

children getting measles infections: children getting the MMR vaccine:

2,000 hospitalizations 3 fever-related seizures

10 cases of brain swelling 0-1 cases of abnormal blood
10-30 child deaths clotting
1,000 ear infections with 0.035 allergic reactions
potential permanent hearing loss
500 cases of pneumonia

Do children really need vaccinations, even if

the disease is not still around? 2
Although many diseases, like measles, are no longer widespread in most U.S. communities, children
still need vaccines to maintain their immunity. These diseases are still alive and well in other parts of
the world. In the U.S., we have cases of rubella, for example, but only from international travelers.

Think of population immunity like a water dam built to prevent flooding. Once it’s built, we won’t
have flooding anymore. But if the next generation comes along and says, “Hey, there’s no flooding
anymore—do we really need this dam?” and decides to get rid of it, the flooding would return quickly.
Your probability of encountering measles or polio is low because so many people around you are
vaccinated.

Protecting against flooding is most important for people who can’t save themselves—babies, the
elderly, and the sick. When adults and kids are vaccinated against common diseases, it helps protect
people whose immune system isn’t fully functioning or who haven’t been able to be vaccinated yet.

Created in collaboration with the Yale School of Public Health Page 1

How do we know vaccines are safe?
3
Are they ever taken off of the market?
Rigorous, ongoing scrutiny of vaccine safety continues long after clinical trials
conclude. This is important because even among the largest trials involving
tens of thousands of volunteers, scientists may not detect a very rare safety
concern that may emerge only after millions of doses.
The U.S. has a few monitoring systems to watch for the ongoing safety of vaccines:
Anyone can submit a report to the Vaccine Adverse Event Reporting System (VAERS), which
requires careful follow-up and additional study to figure out what if any, role vaccines played in
the reported medical conditions. VAERS reports are frequently misrepresented as proof of
vaccine safety issues, but they are unconfirmed reports that provide potential directions. If
enough reports are submitted, the U.S. does a far more rigorous follow-up study using VSD (see
next bullet).
Vaccine Safety Datalink (VSD) is a national network of medical records from healthcare
organizations and insurers that allows us to examine whether there is a link between
vaccinations and safety signals.
V-safe is a new program that started during the COVID-19 pandemic in which people text CDC
more actively after a vaccine about how they feel and follow up weeks and months afterward.
This allows CDC to watch for safety signals proactively.

Other monitoring systems exist, including FDA BEST. We also don’t rely solely on U.S. data. The
same vaccines are used worldwide, and other countries can flag potential safety issues that we can
interrogate.

Example of catching a safety signal quickly: In 1999, an approved

vaccine against rotavirus, a common cause of severe
gastrointestinal illness in children, was found to be associated with
a potentially fatal intestinal blockage. Within months of the
vaccine’s approval in 1998, reports to VAERS suggested a possible
association. The vaccine was halted while the issue was
investigated, and following confirmation of a link, the CDC
withdrew its recommendation that infants receive the vaccine. It
was never used again.

Example of how sensitive our systems are: During the COVID-19

pandemic, these systems also contributed to rapidly identifying
blood clots associated with the Johnson & Johnson COVID-19
vaccine, ultimately leading to recommendations against its use
and eventual withdrawal from the U.S. market. This safety signal
was detected after 6 cases (out of 6.8 million doses given).

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 4
Children receive so many more vaccines
these days. Why? Is this okay?
This is true; Children born before the 1990s received far fewer vaccines
than today’s kids. However, over the years, we have gotten better at
developing vaccines in two ways.

We target immune protection far more efficiently. Over the years, scientists got smarter at
targeting viruses and bacteria—exposing children to fewer and fewer parts of the microbe
(antigens) to stimulate the immune system.

1983 TODAY
Children under 2 received vaccines against Children under 2 receive vaccines against
7 diseases. 15 diseases.

These vaccine formulas were safe and These vaccine formulas target
effective
, but complex, targeting more 180 antigens and therefore ask ‘less’ of the
than 3,000 antigens. immune system.

This is one way scientists and physicians know that the number of childhood vaccines cannot
‘overwhelm’ immune systems. Also, this number of antigens is far less than the germs our immune
systems marshal a response to every day, almost always without us even knowing it. That’s the
immune system doing its job!

Advances in medical research have also led to many new vaccines that have further reduced
childhood illnesses. For example, a safe and effective Haemophilus influenza type b (“HiB”) vaccine
was developed in the late 1980s. It has dramatically lowered rates of childhood meningitis (brain
infections), pneumonia, and epiglottitis (infection of the epiglottis that prevents kids from
breathing). The same can be said for vaccines against varicella, pneumonia, rotavirus, and others
capable of causing severe illness and deaths of children.

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Do we need to be reinfected to keep the 5
immune system active? What about
boosters?
Contrary to rumors, we don’t need to get reinfected over and over for our
immune systems to be ready to respond. Everything in our life—our house,
pets, our own body—is filled with microbes. Although most of these
microbes aren’t harmful, they keep our immune systems active and ready to
defend against dangerous foreign invaders.

That said, to stay protected from certain diseases (like pertussis, aka “whooping cough”, or
tetanus, aka “lockjaw”), you may need a vaccine booster. This is for a few reasons:

1. Catching these diseases usually acts as a natural booster but would also put you and your
family at risk.

2. Even if you got infected, boosters can help. For example, a tetanus infection will not give
you any immunity—the dose of toxin is too low to activate an antibody response; you have
no protection from getting tetanus a second time if you are infected. A vaccine can help.

3. Some diseases need annual booster shots because viruses change quickly. For example,
the flu virus changes from year to year, so each year’s shot targets a different version of the
virus. Scientists are hard at work figuring out the details of how to make current vaccines
work better, but until those mysteries are unraveled, boosters it is.

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 6
Why can’t pharmaceutical companies
be sued for vaccine injury?
This varies by country. In the U.S., you cannot immediately sue the
pharmaceutical company. You have to go through the NCVIA first.

The National Childhood Vaccine Injury Act (NCVIA) was enacted in 1986, after
parent activists who believed their children were harmed by vaccines engaged in a series of
lawsuits against pharmaceutical companies seeking compensation for damages. While there
weren’t any major wins on the part of these groups, the cost of these trials eventually reached
a point where it was more than what vaccine manufacturers were earning from their products.
Consequently, many vaccine manufacturers stopped making vaccines; it didn't make financial
sense for them to do so–and the handful that remained were contemplating doing the same.

At that point, Congress stepped in with the National Childhood Vaccine Injury Act (NCVIA),
which created the National Vaccine Injury Compensation Program. This act granted
pharmaceutical companies certain legal protections and established a no-fault compensation
system operated by the Department of Health and Human Services with a reduced burden of
proof for petitioners who felt they had been harmed by vaccines. The system is paid for by an
excise tax on each vaccine dose. The program also established a table of known vaccine-related
adverse events–all of them quite rare–for which compensation is provided expeditiously.

This act also established a number of important oversights, including the previously mentioned
Vaccine Adverse Effects Reporting System and a non-governmental committee to determine
vaccine safety.

This system is imperfect, but it ensures that people harmed by vaccines have a path to
compensation and that we still have access to lifesaving vaccines.

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Why does the U.S. have different 7 7
recommendations than other countries?
Country-to-country differences tend to be pretty minor overall. When there
are differences, they reflect (a) differences in manufacturing capabilities,
(b) differences in the patterns of disease, and (c) differences in the payment and
distribution systems. Here are a few examples:

Behavioral: Universal vaccination recommendations work better than targeted vaccinations

because of convenience and education. The U.S. used to have targeted hepatitis B vaccine
recommendations, but uptake was poor. After a universal recommendation, there was a big
decline in disease, and many lives (and livers) were saved. The same happened with the flu
vaccine; universal recommendations increased uptake among high-risk groups.

Financial: Most countries’ governments pay for vaccines through national healthcare
systems with fixed budgets, so the cost-benefit analysis is a big consideration when making
policy decisions—for some countries, it would be too expensive for the government to
vaccinate everyone, so they try to find where the money will have the biggest impact.
Sometimes, this can have unexpected results. For example, modeling data suggests that
when resources are constrained, prioritizing school-aged children for flu vaccination has the
greatest benefit in minimizing flu deaths, even though the majority of deaths occur in the
elderly (because this would have the biggest effect on transmission). The U.S. is fortunate in
that, rather than having to pick and choose from a place of limited resources, it can offer the
vaccine to everyone.

Safety net: The U.S. has much less wiggle room because of worse healthcare access, social
support, healthcare capacity, and health. Casting a larger net through universal vaccine
recommendations is more critical than in other countries.

Availability and accessibility: Some countries use the oral polio vaccine instead of the
inactivated polio vaccine because the oral kind is easier to administer (you don’t need people
trained in giving injections), cheaper, and stops transmission better. The oral polio vaccine
has a different number and timing of doses than the inactivated polio vaccine. However,
because the oral vaccine contains actual poliovirus and can revert to paralytic polio if it
circulates in the environment, use of the oral vaccine is considered only in places where there
is a lot of polio (although even this is being reconsidered).

Epidemiological: Though the diseases themselves are the same, their behavior within a
particular country might differ. For example, meningitis caused by meningococcal B tends to
occur in adolescents and young adults (and in particular in congregant living settings like
college dorms), but throughout Europe, invasive meningococcal disease due to these
bacteria is more common among infants. For this reason, many European countries have a
recommendation for a meningococcal B vaccination in infancy, whereas the U.S. does not.

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Do doctors get paid an incentive for vaccinations? 8
Physicians do not get paid by pharmaceutical companies for vaccinations. Vaccination is often
billed to insurance companies. But these administration fees are rarely worth it. Surveys of
pediatricians report that most break even or even lose money from vaccination—because the
costs of vaccine storage, handling, and the doses themselves is so high. Some insurers have
regional programs offering small financial incentives to pediatric practices for maintaining a
certain level of vaccine uptake in their practices, but these programs are not universal, and the
incentives are indeed small. The cost of vaccinating kids has gotten so high that some pediatric
practices have stopped offering recommended vaccines.

How do we know that the rise in autism is not

linked to vaccines? 9
First, it’s important to note that a lot of research is still needed to evaluate the cause of autism.
The data we do have suggests that it is primarily the result of genetics.

What is clear is that vaccines, particularly MMR vaccines, do not cause autism. We know this
because of a few reasons:

1. This rumor became prominent in the mid-1990s after a fraudulent scientific study was
published by a scientist with conflicts of interest (trying to make his own measles vaccine)
who eventually lost his medical license.

2. Huge, robust studies (spanning millions of children across many countries) have not found a
link between autism and vaccines.

3. Scientists have learned that the hallmark of autism is dysregulation of brain development
starting in the prenatal period before childhood vaccines are introduced.

4. The rise in autism has been linked to physicians better recognizing the condition (changes in
diagnostic criteria) and autism being previously categorized as something else (called
diagnostic substitution). Studies that have compared autism rates across generations using
updated diagnostic criteria show that rates are roughly the same.

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 10
Why do babies need the hepatitis B
vaccine if they aren’t high-risk?

The highest risk factor for hepatitis B (or HBV) is a history of sexually
transmitted infections or multiple sex partners. So, if you’ve only had
one partner for a decade, is this even applicable to your baby?

Yes, because the hepatitis B virus is a tricky booger:

1. The majority of people with HBV globally are unaware they have it. Many who do have it
don’t know how they contracted it. If we only give it to people who believe they are high-
risk, we will miss many cases. Remember: it can take decades from the time you contract
hepatitis B virus before symptoms become apparent.

2. Hepatitis B virus requires only a very tiny dose to cause infections, which means that even
though it is bloodborne and sexually transmitted, it can be spread casually, like through
sharing a toothbrush or even through being bitten by an infected person (such as at
daycare).

3. It’s very stable in the environment, capable of remaining infectious for weeks and even
months on surfaces.

4. The outcomes can be severe. Mother-to-baby transmission at birth is the most common
cause of chronic HBV infection, which can lead to liver cancer, liver failure, and death. If
babies contract hepatitis B disease near birth, 95% develop the chronic form.

The HBV vaccine induces protective immune responses in nearly everyone (80-100%). The
vaccine risks are extremely low—the only safety signal found is rare allergic reactions (one
severe allergic reaction for every 2-3 million doses).

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Are there any long-term studies on whether
the HPV vaccine impacts fertility?
11
Some of these concerns stemmed from a case series that was published in 2012, describing
six girls who developed primary ovarian insufficiency (POI) from 8 months to 2 years after
they received the first human papilloma virus (HPV) vaccine dose. This stirred public concern
that the HPV vaccine could cause infertility.

However, case series often generate more questions than answers because they can’t assess
causality (correlation doesn’t equal causation). Fortunately, no rigorous lab or epidemiological
follow-up studies have found a link:
No effect of HPV vaccination on fertility has been found in 3 studies in rodents.
A strong study in North America followed women planning on getting pregnant. Some of
the women (and their partners) had their HPV vaccines, some of them didn’t. The
scientists found no difference in infertility. In fact, in some groups, vaccinated women had
higher fertility.
Another large study found that 120 of 199,078 female patients at hospitals had POI.
There was no difference between those with the HPV vaccine and those without.

It is also critical to note that being infected by the HPV virus can harm fertility because of the
procedures involved in treating HPV-related cancers. Some evidence has also suggested that
HPV itself may reduce male fertility.

Why do some children still get sick with a

disease after being vaccinated? 12
Vaccines significantly reduce the likelihood of getting sick from infectious diseases and, in many
cases also greatly reduce transmission. For example, since the chickenpox vaccination program
began in the United States, there has been an over 97% decrease in chickenpox cases. For
whooping cough, nearly all children (98 in 100) were protected within a year of their last shot
and about 7 in 10 children were protected five years after getting the last DTaP shot. Most
vaccines, however, do not completely eliminate the risk of becoming infected with the disease.

Upon infection, vaccines can also lessen the severity of several diseases. Most recently, this has
been demonstrated in a number of COVID-19 vaccine studies, which have found that
vaccinated individuals, compared with unvaccinated individuals, are less likely to become
severely ill.

For many vaccine-preventable diseases, immunity from an infection can be imperfect- it may
still make sense to get vaccinated even after recovering to help prevent serious illness from
reinfection and to reduce spread.

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 References
Are childhood vaccines still safer than the
diseases themselves?
1
1. Bester, Johan Christiaan (2016). Measles and Measles Vaccination. JAMA Pediatrics,
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Do children really need vaccinations, even if

2 the disease is not still around?
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 How do we know vaccines are safe? Are they
ever taken off of the market? 3
1. Jacqueline E. Tate, Catherine Yen, Claudia A. Steiner, Margaret M. Cortese, Umesh D.
Parashar; Intussusception Rates Before and After the Introduction of Rotavirus Vaccine.
Pediatrics September 2016; 138 (3): e20161082. 10.1542/peds.2016-1082
2. CDC. How Vaccine Safety Monitoring Works. Vaccine Safety Systems. 2024; Available
from: https://www.cdc.gov/vaccine-safety-systems/about/monitoring.html
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https://www.hrsa.gov/sites/default/files/hrsa/advisory-committees/vaccines/accv-
03082024-fda-update.pdf
4. FDA and CDC Lift Recommended Pause on Johnson & Johnson (Janssen) COVID-19
Vaccine Use Following Thorough Safety Review. FDA. 2021;Available from:
https://www.fda.gov/news-events/press-announcements/fda-and-cdc-lift-
recommended-pause-johnson-johnson-janssen-covid-19-vaccine-use-following-
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5. CDC. About CDC’s Vaccine Safety Monitoring Program. Vaccine Safety Systems.
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how pharmacovigilance rose to the challenge. Therapeutic Advances in Drug Safety
2022;13:204209862211189.

Children receive so many more vaccines

4 these days. Why? Is this okay?
1. Offit PA, Quarles J, Gerber MA, et al. Addressing Parents’ Concerns: Do Multiple Vaccines
Overwhelm or Weaken the Infant’s Immune System? PEDIATRICS 2002; 109: 124–9.
2. CDC. Multiple Vaccines at Once. Vaccine Safety. 2024. https://www.cdc.gov/vaccine-
safety/about/multiples.html.
3. CDC. Your child needs vaccines as they grow! Vaccines & Immunizations. 2024.
https://www.cdc.gov/vaccines/imz-schedules/child-easyread.html.
4. CDC. Chapter 8: Haemophilus influenzae. Epidemiology and Prevention of Vaccine-
Preventable Diseases. 2024; published online Sept 30.
https://www.cdc.gov/pinkbook/hcp/table-of-contents/chapter-8-haemophilus-
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(accessed Nov 22, 2024).

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 Do we need to be reinfected to keep the immune
system active? What about boosters? 5
1. World Health Organization. Tetanus. Who.int. 2024; published online July 12.
https://www.who.int/news-room/fact-sheets/detail/tetanus.
2. Berman M, Rupp R. You still need a flu shot even if you’ve already been ill. UTMB News.
2022; published online Dec 7. https://www.utmb.edu/news/article/health-
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3. Seasonal influenza vaccination strategies. European Centre for Disease Prevention and
Control. 2023; published online May 23. https://www.ecdc.europa.eu/en/seasonal-
influenza/prevention-and-control/vaccines/vaccination-strategies.

Why can’t pharmaceutical companies be sued

6 for vaccine injury?
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https://historyofvaccines.org/vaccines-101/ethical-issues-and-vaccines/vaccine-
injury-compensation-programs.
2. About the National Vaccine Injury Compensation Program | HRSA. www.hrsa.gov.
https://www.hrsa.gov/vaccine-compensation/about.
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Interpretation. AMA Journal of Ethics 2012; 14: 31–4.
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(Public Law 99-660). National Academies Press (US), 2010
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England Journal of Medicine 2011; 364: 1485–7.

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 Why does the U.S. have different
7 recommendations than other countries?
1. Global Vaccination Schedules. vaccineknowledge.ox.ac.uk. 2022; published online March 9.
https://vaccineknowledge.ox.ac.uk/vaccination-schedules-other-countries#Why-are-different-
vaccination-schedules-used-in-different-countries.
2. Guillaume D, Meyer D, Waheed D-N, et al. Factors influencing the prioritization of vaccines by
policymakers in low and middle income countries: A scoping review. Health Policy and Planning 2022;
published online Oct 31. DOI:https://doi.org/10.1093/heapol/czac092.
3. Kaur G. Routine Vaccination Coverage — Worldwide, 2022. MMWR Morbidity and Mortality Weekly
Report 2023; 72. DOI:https://doi.org/10.15585/mmwr.mm7243a1.
4. Vaccine Scheduler | ECDC. vaccine-schedule.ecdc.europa.eu. https://vaccine-
schedule.ecdc.europa.eu/Scheduler/ByDisease?SelectedDiseaseId=48&SelectedCountryIdByDisease=-1.
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constrained resources. PNAS Nexus 2024; 3. DOI:https://doi.org/10.1093/pnasnexus/pgae379.
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Strategy Commi?ee (SC) of the Global Polio Eradica-on Ini-a-ve (GPEI). 2024
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https://nmaus.org/nma-disease-prevention-information/serogroup-b-meningococcal-
disease/outbreaks-on-u-s-college-campuses/.

Do doctors get paid an incentive for vaccinations? 8

1. Allison MA, O’Leary ST, Lindley MC, et al. Financing of Vaccine Delivery in Primary Care
Practices. Academic Pediatrics 2017; 17: 770–7.
2. Coleman MS, Lindley MC, Ekong J, Rodewald L. Net Financial Gain or Loss From Vaccination in
Pediatric Medical Practices. Pediatrics 2009; 124: S472–91.
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shield-vaccine-bonus-for-pediatricians/ (accessed Nov 22, 2024).

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 How do we know that the rise in autism is not
9
linked to vaccines?
1. Sandin S, Lichtenstein P, Kuja-Halkola R, Hultman C, Larsson H, Reichenberg A. The Heritability
of Autism Spectrum Disorder. JAMA 2017; 318: 1182.
2. Godlee F, Smith J, Marcovitch H. Wakefield’s article linking MMR vaccine and autism was
fraudulent. BMJ 2011; 342: c7452–2.
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https://briandeer.com/wakefield/vaccine-patent.htm.
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meta-analysis of case-control and cohort studies. Vaccine 2014; 32: 3623–9.
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Clinical Infectious Diseases 2009; 48: 456–61.
6. Hviid A, Hansen JV, Frisch M, Melbye M. Measles, mumps, rubella vaccination and autism. Annals
of Internal Medicine 2019; 170: 513–20.
7. Courchesne E, Gazestani VH, Lewis NE. Prenatal Origins of ASD: The When, What, and How of
ASD Development. Trends in Neurosciences 2020; 43: 326–42.
8. King M, Bearman P. Diagnostic change and the increased prevalence of autism. International
Journal of Epidemiology 2009; 38: 1224–34.
9. Brugha TS, McManus S, Bankart J, et al. Epidemiology of autism spectrum disorders in adults in
the community in England. Archives of General Psychiatry 2011; 68: 459–65.

Why do babies need the hepatitis B vaccine if

10 they aren’t high-risk?
1. What causes hepatitis B? Immunization Action Coalition https://www.immunize.org/wp-
content/uploads/catg.d/p4205.pdf.
2. Achievements in Public Health: Hepatitis B Vaccination --- United States, 1982--2002. Cdc.gov.
2002; published online June 28.
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Nov 22, 2024).
3. Gavi Staff. Why a birth dose of hepatitis B vaccine could be life-changing. Gavi.org. 2023.
https://www.gavi.org/vaccineswork/why-birth-dose-hepatitis-b-vaccine-could-be-life-
changing (accessed Nov 22, 2024).
4. Give Birth to the End of Hep B | Immunize.org. Immunize.org. 2024; published online Aug 23.
https://www.immunize.org/vaccines/a-z/hepb/end-hepb/.
5. everychildbytwo. Why Infants Should Receive the Hepatitis B Vaccine at Birth - Vaccinate Your
Family. Vaccinate Your Family. 2024; published online March 26.
https://vaccinateyourfamily.org/why-infants-should-receive-the-hepatitis-b-vaccine-at-birth/.
6. US) M, Colvin HM, Mitchell AE. Hepatitis and Liver Cancer: A National Strategy for Prevention
and Control of Hepatitis B and C- Immunization. Nih.gov. 2010.
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7. CDC. Chapter 10: Hepatitis B. Epidemiology and Prevention of Vaccine-Preventable Diseases.
2024; published online July 10. https://www.cdc.gov/pinkbook/hcp/table-of-contents/chapter-
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8. Chen D-S. Hepatitis B vaccination: The key towards elimination and eradication of hepatitis B.
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 Are there any long-term studies on whether
the HPV vaccine impacts fertility?
11
1. McInerney KA, Hatch EE, Wesselink AK, et al. The Effect of Vaccination Against Human
Papillomavirus on Fecundability. Paediatric and Perinatal Epidemiology 2017; 31: 531–6.
2. Naleway AL, Mittendorf KF, Irving SA, et al. Primary Ovarian Insufficiency and Adolescent
Vaccination. Pediatrics 2018; 142. DOI:https://doi.org/10.1542/peds.2018-0943.
3. Silvestris E, Paradiso AV, Minoia C, et al. Fertility preservation techniques in cervical carcinoma.
Medicine 2022; 101: e29163.
4. Weinberg M, Sar-Shalom Nahshon C, Feferkorn I, Bornstein J. Evaluation of human papilloma
virus in semen as a risk factor for low sperm quality and poor in vitro fertilization outcomes: a
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5. Segal L, Wilby OK, Willoughby CR, Veenstra S, Deschamps M. Evaluation of the intramuscular
administration of CervarixTM vaccine on fertility, pre- and post-natal development in rats.
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6. Wise LD, Pauley CJ, Michael B, Wolf JJ. Lack of effects on male fertility from a quadrivalent HPV
vaccine in Sprague-Dawley rats. Birth Defects Research Part B: Developmental and Reproductive
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developmental toxicity of a quadrivalent HPV vaccine in Sprague-Dawley rats. Birth Defects
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Why do some children still get sick with a

12 disease after being vaccinated?
1. Centers for Disease Control and Prevention. Explaining How Vaccines Work. Vaccines &
Immunizations. 2024; published online Aug 10.
https://www.cdc.gov/vaccines/basics/explaining-how-vaccines-work.html.
2. Nirenberg E, Perencevich EN. Understanding and Improving Vaccine Effectiveness
Estimates in the Age of Widespread Background Immunity: A Step Toward Improved
Science Communication. Clinical Infectious Diseases 2023; 76.
DOI:https://doi.org/10.1093/cid/ciad124.
3. Eberhardt CS, Siegrist C-A. What Is Wrong with Pertussis Vaccine Immunity? Cold Spring
Harbor Perspectives in Biology 2017; 9: a029629.
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Disease by Covid-19 Vaccines. New England Journal of Medicine 2022; 386.
DOI:https://doi.org/10.1056/nejmoa2115481.
5. CDC. Chapter 22: Varicella. Epidemiology and Prevention of Vaccine-Preventable Diseases.
2024. https://www.cdc.gov/pinkbook/hcp/table-of-contents/chapter-22-varicella.html.
6. Cherry JD. The 112-Year Odyssey of Pertussis and Pertussis Vaccines—Mistakes Made and
Implications for the Future. Journal of the Pediatric Infectious Diseases Society 2019; 8:
334–41.

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