Immunizations: Diseases, Common Concerns, and Answers to Your Questions.

Immunizations: Diseases, Common Concerns,

and Answers to Your Questions

Disease: Hepatitis B Vaccine: [HepB]

Risks The earlier in life the

exposure the more likely the chronic stage of the disease will develop (liver disease or liver cancer)

90% of infected infants will develop the chronic infection

Patient with late stage hepatocellular carcinoma due to chronic Hepatitis B.

Source: CDC

Disease: Hepatitis B Vaccine: [HepB]

Did you know? That an infected person often does

not feel sick or show symptoms of the disease

About 33,000 children (under 10 years of age) born to moms who are not infected with HBV were infected each year before routine hepatitis B vaccination.

In household settings, non-sexual transmission of HBV occurs primarily from child to child, and young children are at highest risk of infection. We’re not sure exactly how transmission occurs, but saliva is one possibility. HBV remains infectious at mild temperatures for extended periods and can be found on and transmitted through sharing of inanimate objects such as toothbrushes. (pkids.org)

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Source: CDC 2009 Clinical Education Slide Set

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Disease: Rotavirus Vaccine: [RV]

Risks Infection in infants and

young children can cause severe diarrhea, vomiting that increases chances of dehydration, electrolyte imbalance, and metabolic acidosis

Source: CDC

Disease: Rotavirus Vaccine: [RV]

Did you know? Before the rotavirus

vaccine was introduced in the USA in 2006, rotavirus resulted in the hospitalization of approximately 55,000 children each year. Globally, rotavirus is estimated to cause 527,000 deaths in children annually.

Rotavirus Vaccine Decreases HospitalizationsAge Group % Reduction in

Hospitalization Year 1 After Vaccine Was Introduced

% Reduction in Hospitalizations Year 2 After Vaccine was Introduced

Under 2 months 50% 64%

2-24 months 65% 80%

Over 24 months 20% 64%

Source: Rais M, Strens D, Vergison A, Verghote M, Standaert B. Reduction in Pediatric Rotavirus-related Hospitalizations After Universal Rotavirus Vaccination in Belgium. Pediatric Infectious Disease Journal: July 2011 - Volume 30 - Issue 7 - pp e120-e125.

Diseases: Diphtheria, Tetanus, Pertussis

Vaccine: [DTaP] Diphtheria Risks If not properly diagnosed

and left untreated, serious complications such as breathing problems, paralysis, heart failure, and even death can occur

Source: CDC


Vaccine: [DTaP] Did you know? Immunity from DTaP

vaccination wanes over time; booster doses are required to maintain protective antibody levels.


Vaccine: [DTaP] Tetanus Risks Tetanus can cause

serious complications such as bone fractures and abnormal heart rhythms

Tetanus leads to death in about 1 in 10 cases (http://www.cdc.gov/vaccines/pubs/pinkbook/downloads/tetanus.pdf) Source: Immunization Action Coalition


Vaccine: [DTaP] Did you know? Tetanus is the only

disease that we vaccinate against that comes from the environment (i.e. soil, manure) and not shared by other humans. It is not contagious.

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Vaccine: [DTaP] Pertussis Risks Infants are at highest risk

for the complications of this disease:

apnea, pneumonia, seizures, encephalopathy, and death

Source: CDC


Vaccine: [DTaP] Did you know? This disease is most

contagious before the coughing starts

Similar to diphtheria and tetanus, booster doses are needed to protect you over time

Pertussis in the News

As of 11/10/11, in the state of California, 2,734 cases of pertussis have been reported in 2011 (6.9 cases /100,000)

In 2010, 9,146 cases were reported in California (23.4 cases/100,000)

Source: California Department of Public Health: Pertussis Summary Report.

http://www.cdph.ca.gov/programs/immunize/Documents/PertussisReport2011-11-10.pdf

Pertussis in the News

California has seen more cases in the 2010 and 2011 than the last 50 years.

In 2010, 808 cases were hospitalized.

10 deaths have occurred, all in infants younger than 2 months old at the time they caught pertussis

Source: California Department of Public Health: Pertussis Summary Report.

http://www.cdph.ca.gov/programs/immunize/Documents/PertussisReport2011-11-10.pdf


Vaccine: [DTaP] Some side effects of DTaP vaccine: About 1 in 4 children had a fever About 1 in 4 had redness, swelling, soreness or

tenderness where the shot was given About 1 in 3 were fussy About 1 in 10 were tired or lost their appetite About 1 in 50 vomited About 1 in 1,000 cried for more than 3 hours after the

shot. Life-threatening allergic reactions from vaccines are

very rare

Disease: Haemophilus influenza type b

Vaccine: [Hib] Risks Hib meningitis causes

death in 1 in 20 children Permanent brain damage

occurs in 10% - 30% of survivors

Patient has Hib buccal cellulitis. Source: CDC


Vaccine: [Hib] Did you know? Before the vaccine

was introduced, this disease was the leading cause of bacterial meningitis among children younger than 5 years old in the U.S.

Every year about 20,000 children (younger than 5 yrs) got the disease and about1,000 died

Hib in the News

“Hib Outbreak Kills Unvaccinated Child”WebMD Health News

In 2008, a Hib meningitis outbreak in Minnesota sickened 4 children and killed 1

Of the 5 cases: 1 child was too young to have finished the

vaccine series 1 child received all of the shots but had an

immune deficiency The other 3 cases including the one death

were in infants whose parents refused to vaccinate them

Source: WebMD: http://children.webmd.com/vaccines/news/20090123/hib-outbreak-kills-unvaccinated-child


Vaccine: [Hib] Side effects of Hib vaccine: About 1 in 4 children redness, warmth, or swelling

where the shot was given About 1 in 20 had a fever over 101

Disease: PneumococcalConjugate Vaccine: [PCV]

Risks Pneumococcal disease

can be fatal

In some cases, it can result in long-term problems, like brain damage, hearing loss, and limb loss

Source: AAP


Did you know? Pneumococcus (a type

of bacteria) is in many people's noses and throats and is spread by coughing, sneezing, or contact with respiratory secretions. Why it sometimes invades the body and causes disease is unknown.


PCV vaccine side-effects: About half of children were drowsy after the shot, had a temporary

loss of appetite, or had redness or tenderness where the shot was given

About 1 in 3 had swelling where the shot was given About 1 in 3 had a mild fever About 1 in 20 had a higher fever (over 102.2°F). Up to about 8 in 10 became fussy or irritable Life-threatening allergic reactions from vaccines are very rare

Source: http://www.cdc.gov/vaccines/vac-gen/side-effects.htm

Disease: PneumococcalPolysaccharide Vaccine: [PPSV] Who should receive PPSV?

Anyone 2 – 64 who has: Long-term health problems (such as heart disease, lung problems,

sickle cell disease & other hemoglobinopathies, diabetes, cochlear implant or cerebrospinal fluid leaks)

Diseases or conditions that lowers the body’s resistance to infection (such as HIV, lymphoma, leukemia, kidney failure, Hodgkin’s disease, multiple myeloma, nephrotic syndrome, damaged or no spleen, organ transplant, congenital immunodeficiency, )

Taking a drug or treatment that lowers the body’s resistance to infection (such as long-term steroids, certain cancer drugs, radiation therapy)

Anyone 19 years of age or older who: Is a smoker Has asthma Source: CDC

Disease: PneumococcalPolysaccharide Vaccine: [PPSV] Risks?

About half of people who get PPSV have mild side effects such as redness or pain where the shot is given.

Less than 1% develop a fever, muscle aches, or more severe local reactions.

A vaccine, like any medicine, could cause a serious reaction. But the risk of a vaccine causing a serious harm, or death, is extremely small.

Source: CDC

Disease: Inactivated PoliovirusVaccine: [IPV]

Risks Fewer than 1% of polio

cases result in permanent paralysis of the limbs (usually the legs)

Of those paralyzed, 5-10% die when the paralysis strikes the respiratory muscles

Source: CDC


Did you know? Before the vaccine

was introduced in 1955, polio used to be very common in the US

Up to 95% of people infected with polio virus have no symptoms

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IPV vaccine side-effects: Some people who get IPV get a sore spot where the shot was

given.

IPV has not been known to cause serious problems, and most people don’t have any problems at all with it.

Life-threatening allergic reactions from vaccines are very rare


Disease: Influenza (Flu) Vaccine: [Influenza (yearly)]

Risks Young children are at

high risk for serious flu complications such as bacterial pneumonia, ear and sinus infections, and dehydration.

Source: CDC

Disease: Influenza (Flu) Vaccine: [Influenza (yearly)]

Did you know? Despite how common it

is, influenza is a serious disease and every year 36,000 deaths and 200,000 hospitalizations occur in all age groups because of it

Healthy children can die from the flu; the younger the child is the higher the risk for serious flu complications

Disease: Influenza (Flu)Vaccine: [TIV- Shot]

Who should get vaccinated? Everyone 6 months and

older Especially:

Individuals at high-risk for developing flu related complications

If you live with or care for people with high-risk for developing flu related complications

Who should not get vaccinated? People who have a severe

allergy to chicken eggs People who have had a

severe reaction to the vaccine in the past

People who develop Guillain Barre Syndrome (GBS) after a prior dose of flu vaccine

People with moderate or severe illness

Disease: Influenza (Flu)Vaccine: [LAIV- Nasal Spray]

Who should get vaccinated with the nasal spray? Healthy people ages 2-49 are eligible

for this type of vaccine

Who should not get vaccinated with the nasal spray? (They should get the flu shot instead.) Adults 50 years of age and older or

children from 6 through 23 months of age.

Children younger than 5 years with asthma or one or more episodes of wheezing within the past year.

Pregnant women. People who have certain long-term

health problems, muscle or nerve disorders, or a weakened immune system.

Anyone in close contact with someone whose immune system is so weak they require care in a protected environment.

Children or adolescents on long-term aspirin treatment.

Does the shot cause the flu? No, the flu vaccine does not cause the flu The viruses in the vaccine are weakened

(attenuated) or killed (inactivated) so the shot and the nasal spray won't cause you to get the flu

The vaccine will prompt your body to develop the antibodies necessary to fight off the influenza viruses

A slight reaction to the shot, such as soreness at the injection site, mild muscle ache or fever may occur

Disease: Influenza (Flu)

Nasal Spray side-effects: Some children and adolescents 2-17 years of age have

reported: runny nose, nasal congestion or cough fever headache and muscle aches wheezing abdominal pain or occasional vomiting or diarrhea

Shot side-effects soreness, redness, or swelling where the shot was given hoarseness; sore, red or itchy eyes; cough fever • aches • headache • itching • fatigue

Diseases: Measles, Mumps, Rubella

Vaccine: [MMR] Measles Risks 1 in 10 children with

measles also gets an ear infection

1 in 20 gets pneumonia. 1 in 1,000 gets

encephalitis 1 or 2 in 1,000 die

Measles can also make a pregnant woman have a miscarriage or give birth prematurely Source: CDC


Vaccine: [MMR] Did you know? While measles is

almost gone from the USA, it still kills nearly 200,000 people each year around the world.

It is so contagious that if an unvaccinated child is exposed to the disease he will mostly likely get it

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Measles in the News

From Jan. 1 through July 1, 2011, there have been 174 confirmed cases of measles in the USA. This is the highest reported number since 1996.

Most cases (158) are from people traveling to countries where measles is common, usually in Europe and Asia.

Children who are over 6 months and traveling outside of the USA need to be vaccinated.

Source: http://aapnews.aappublications.org/content/early/2011/07/07/aapnews.20110707-1.full


Vaccine: [MMR] Mumps Risks Inflammation of the

testicles in males Inflammation of the brain

(encephalitis) and/or tissue covering the brain and spinal cord (meningitis)

Inflammation of the ovaries/breasts in females

Temporary or permanent deafness

Source: CDC


Vaccine: [MMR] Did you know? Most mumps

transmission likely occurs before the salivary glands begin to swell

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YearSource: CDC 2009 Clinical Education Slide Set

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Mumps in the News

During January-May 2006 a multi-state outbreak of mumps occurred

11 states reported 2,597 cases of mumps 8 states (Illinois, Iowa, Kansas,

Missouri, Nebraska, Pennsylvania, South Dakota, and Wisconsin) reported mumps outbreaks with ongoing local transmission or clusters of cases

3 states (Colorado, Minnesota, and Mississippi) reported cases associated with travel from an outbreak state

Source: CDC MMWR: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm55d518a1.htm,

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5905a1.htm

In 2009-2010, 1,521 cases of mumps were reported in New York and New Jersey

The boy who started it was 11 and had just returned from a trip to the United Kingdom before going to summer camp.


Vaccine: [MMR] Rubella Risks Birth defects if acquired

by a pregnant woman: deafness, cataracts, heart defects, mental retardation, and liver and spleen damage

At least a 20% chance of damage to the fetus if a woman is infected early in pregnancy

Source: CDC


Vaccine: [MMR] MMR vaccine side-effects: About 1 in 6 have fever About 1 in 20 has a mild rash Rarely, people have swelling of glands in the

cheeks or neck Mostly teenagers and adult women, about 1 in 4,

have temporary pain and stiffness in the joints Seizure is caused by fever in about 1 in 3,000

doses Life-threatening allergic reactions from vaccines

are very rareSource: http://www.cdc.gov/vaccines/vac-gen/side-effects.htm

Disease: Varicella (Chickenpox) Vaccine: [Varicella]

Risks Severe side effects from

the disease include: bacterial infection of the skin, swelling of the brain, and pneumonia.

Adolescents and adults are more at risk for severe disease.

Source: AAP


Did you know? Before the vaccine, which was

licensed in 1995, there were 100 deaths and 12,000 hospitalizations per year in the U.S. due to varicella

It is not better to get chickenpox naturally. The potential risks of the disease are severe and no one can predict which child will develop a life-threatening case of chickenpox

Shingles is a complication from natural chickenpox


Varicella vaccine side-effects: Mild Problems Soreness or swelling where the shot was given (about 1 in 5

children and up to 1 in 3 adolescents and adults) Fever (1 person in 10, or less) Mild rash, up to a month after vaccination (1 person in 25). It is

possible for these people to infect other members of their household, but this is extremely rare.

Moderate Problems Seizure (jerking or staring) caused by fever (very rare)

Severe Problems Pneumonia (very rare)


Disease: Hepatitis A Vaccine: [HepA]

Risks Because young children

might not have symptoms, the disease is often not recognized until the child's caregiver becomes ill with hepatitis A

Source: CDC


Did you know? Unlike HepB, hepatitis

A does not cause long-term illness or permanent liver damage

Still, about 100 people each year die from liver failure caused by severe hepatitis A infection


HepA vaccine side-effects: Mild problems soreness where the shot was given (about 1 in 2 adults,

and up to 1 in 6 children) headache (about 1 in 6 adults and 1 in 25 children) loss of appetite (about 1 in 12 children) tiredness (about 1 in 14 adults)

Severe problems serious allergic reaction, within a few minutes to a few

hours of the shot (very rare)


Disease: Meningococcal Vaccine: [MCV4] Risks

Even when the disease is diagnosed early and adequate treatment is started, 5% to 10% of patients die (typically within 24 to 48 hours after the onset of symptoms)

Bacterial meningitis may result in brain damage, hearing loss or a learning disability in 10% to 20% of survivors Source: CDC

Disease: Meningococcal Vaccine: [MCV4]

MCV4 vaccine side-effects: As many as half the people who get meningococcal

vaccines have mild side effects, such as redness or pain where the shot was given.

A small percentage of people who receive the vaccine develop a mild fever.

Serious allergic reactions, within a few minutes to a few hours of the shot, are very rare.

Brief fainting spells can follow a vaccination. They happen most often with adolescents, and they can result in falls and injuries.


Disease: Human Papillomavirus Vaccine: [HPV]

Risks Most common sexually

transmitted infection

Some strains can cause genital warts and others can cause abnormal cells that could develop into vulvar/vaginal, penile, oropharyngeal, anal, or cervical cancer if left undetected and untreated


Did you know? A person can be infected

with HPV for years with no sign or symptoms

Approximately 20 million Americans are currently infected with HPV

At least 50% of sexually active men and women get it at some point in their lives

Each year, about 12,000 women get cervical cancer in the US

How can I protect my children?

Two vaccines are available to protect females against the types of HPV that cause most cervical cancers

One of these vaccines also protects against most genital warts and some other types of cancers. Only this type is approved for males.

Both vaccines are recommended for 11 and 12 year-old girls, and for females 13 through 26 years of age, who did not get any or all of the shots when they were younger. It is now recommended that males 9 through 21 years old also be vaccinated.


HPV vaccine side-effects: About 8 in 10 people have pain where the shot was

given. About 1 in 4 has redness or swelling. About 1 in 10 has a mild fever. About 1 in 3 gets a headache. Fainting. Brief fainting spells can happen after any medical

procedure, including vaccination. Sitting or lying down for about 15 minutes after a vaccination can help prevent fainting and injuries caused by falls.


Common Concerns

Recommendations and safety Understanding the immunization schedule Ingredients Questions about autism

Recommendations and Safety

Question: Who decides which vaccines a child needs?

Answer: Each year, top infectious disease experts and doctors who care for children work together to decide what to

recommend that will best protect US children from diseases. The recommended schedule is evaluated each year based on the most recent scientific data available. This schedule is

approved by the American Academy of Pediatrics, the Centers for Disease Control and Prevention, and the American Academy of Family Physicians.


Question: What is herd immunity?

Answer: Herd immunity refers to the type of immunity that occurs

when the vaccinated portion of the population provides protection against a disease to the un-vaccinated individuals.

Some children are too young or too sick to receive certain vaccines. People who are vaccinated help protect them

from the spread of disease.


Question: How are vaccines licensed to ensure their safety?

Answer: The US has some of the strictest safety testing requirements in the world. Vaccines are first tested by manufacturers

who present data to the FDA, which has to show they will work well in children and are both safe and effective. The CDC

and AAP then review the data again before making a recommendation for or against the vaccine.

Manufacturing plants must be licensed and are regularly inspected.


Question: How are vaccines monitored to ensure their safety?

Answer: Vaccines continue to be studied after they are licensed and recommended. The federal government created the

Vaccine Adverse Event Reporting System (VAERS) and other systems as part of the National Childhood Vaccine Injury

Act. All doctors must report serious side effects of vaccines to VAERS so they can be studied. If any problems are

found, vaccines are taken off the market. Any new side effects are also communicated to your pediatrician.


Question: What happens if someone is injured by a vaccine?

Answer: Most people who get vaccines have no serious problems. However, vaccines, like any medicines,

can rarely cause serious problems, such as severe allergic reactions. In those rare cases, the federal government has created the Vaccine Injury Compensation Program (VICP) to provide compensation to people found to be injured by certain vaccines. Individual who thinks they has been injured can file a claim, which is then heard by special judges.

Recommendations and Safety :Take Home Message

Today’s vaccines are the most effective and safest in history and have protected and saved millions of lives from vaccine-preventable diseases. The FDA and CDC take great care in licensing and monitoring vaccines. The CDC, AAP, and AAFP recommend what they believe is best to protect the nation’s children.

Understanding the Immunization Schedule

Question: Isn’t it overwhelming to a child’s immune system to give so many shots in one visit?

Answer: Infants and children are exposed to many germs every day just by playing, eating, and breathing. Their immune

systems fight those germs (also called antigens), to keep the body healthy. The amount of antigens that children fight every day (2,000-6,000) is much more than the antigens in any combination of vaccines on the current schedule

(150 for the whole schedule).


Question: Why are so many doses given?

Answer: Researchers are always studying how well vaccines work.

For many vaccines three or four doses are needed to fully protect the child. Some vaccines require a booster dose

later in life.


Question: Why is the schedule “one size fits all?”

Answer: The vaccine schedule is designed to protect children as soon as possible, but the vaccine schedule is not “one size fits all.” The schedule is ideal for healthy children but there are

exceptions. If a child has allergies, a weakened immune system, a chronic condition, or another medical treatment, vaccines may be delayed or sometimes not given at all.

In some cases, vaccines may be given on an accelerated schedule.


Question: Why can’t the shots be spread out over a longer period of time?

Answer: Spreading out the shots leaves your child unprotected longer. There is no scientific information that says that spreading the shots out over a longer period of time is safer.

Pediatrics June 2010 M.J. Smith et al.

Understanding the Immunization Schedule:

Take Home MessageVaccines are the best way to prevent diseases. The immunization schedule is designed to work best with a child’s immune system at certain ages and at specific times. Top disease experts and doctors evaluate the schedule yearly based on the most up-to-date information. A pediatrician will have the best information on what is recommended for your child.

Ingredients

Question: What ingredients are in vaccines?

Answer: All vaccines contain antigens. Antigens are what make the vaccine effective and prompt the body to create the immune response needed to protect against infection.

Antigen forms include:

Weakened live viruses Inactivated (or killed) viruses Parts of viruses Parts of bacteria

Ingredients Question: What additional ingredients are in vaccines?

Answer: Preservatives

Thimerosal: Thimerosal is used as a preservative in some multidose vials of influenza vaccine. Thimerosal is

used in the processing of certain vaccines; it is removed, however, trace amounts may be present.

AdjuvantsAluminum salts

AdditivesGelatin

Residuals of the vaccine production processFormaldehydeAntibioticsEgg protein

Ingredients

Question: Are these ingredients safe?

Answer: Yes, these ingredients have been studied and are safe in

the amount found in vaccines. The amount of these ingredients in vaccines are much less than what a child encounters in his or her environment, food, and water.

Ingredients

Question: I’ve heard a lot about thimerosal- what is it?

Answer: Thimerosal is a preservative that is used in some vaccines to prevent contamination. Some people have concerns that it includes mercury. The type of mercury used in thimerosal is called ethyl mercury- “organic” mercury. It is processed quickly in the body. Some people confuse this with methyl mercury, which can build up in the body over time and cause damage. Thimerosal, has been studied many times and no association with serious side effects, including autism, has be found.

Ingredients: Take Home Message

The amount of each additive used in vaccines is very small. In fact, we are exposed to much higher levels of these chemicals in our everyday lives. In vaccines, these ingredients are used to make the vaccine safer and more effective. Each vaccine is tested many times to make sure it is safe and works. Taking ingredients out might affect the ability of the vaccine to protect a child.

Questions about Autism

Question: Does the measles-mumps-rubella (MMR) vaccine cause inflammation in the bowel and brain, leading to the development of autism?

Answer: No, scientific data do not show a link between MMR and autism. Children receive the MMR vaccine at 12-15 months.

Signs of autism often appear when a child is 15-18 months. Because children get the MMR vaccine just before the signs of autism appear, some people were concerned about a link.

•Pervasive Developmental Disorders in Montreal and Quebec, Canada: Prevalence and Links with Immunizations. Fombonne E et al. Pediatrics. 2006; 118(1):e139-50•Immunization Safety Review: Vaccines and Autism. Institute of Medicine, The National Academies Press: 2004•Age at First Measles-Mumps-Rubella Vaccination in Children with Autism and School-Matched Control Subjects: A Population-Based Study in Metropolitan Atlanta. DeStefano F et al. Pediatrics 2004; 113(2): 259-66

Questions about Autism Question: Does the mercury in thimerosal cause heavy metal

buildup in the body, affecting brain function, and causing autism?

Answer: The type of mercury used in thimerosal is called ethyl mercury- “organic” mercury. It is processed quickly in the body. Some people confuse this with methyl mercury,

which can build up in the body over time and cause damage. Thimerosal, has been studied many times and no

association with serious side effects, including autism, has be found. Various studies have been conducted to investigate this topic and all have come to the same conclusion. There is no scientific evidence that supports the claim that the thimerosal in vaccines causes autism.

•Continuing increases in autism reported to California's developmental services system: mercury in retrograde. Schechter and Grether, 2008, Archives of General Psychiatry. 65(1):19-24•Mercury Levels in Newborns and Infants After Receipt of Thimerosal-Containing Vaccines. Pichichero, et al., Pediatrics. Vol. 121 No. 2, 2008, pp. e208-e214 Early Thimerosal Exposure and Neuropsychological Outcomes at 7 to 10 Years. Thompson, et al. 2007, New England Journal of Medicine. 357:1281-1292

Questions about Autism

Question: If vaccines do not cause autism, what does?

Answer: Currently, the cause of autism is mostly unknown. Many experts believe that it is a genetically based disorder. This evidence is by no means exclusive and research continues to find other possible causes.

Questions about Autism: Take Home Message

Although the cause of autism is still undetermined, the scientific evidence does not show a link between particular vaccines or vaccine ingredients and autism. Organizations, agencies, scientists, and doctors are working together to find the true cause of autism and the best treatment and prevention methods for this disease.

For More Information AAP

www.aap.org/immunization

CDCwww.cdc.gov/vaccines

National Network for Immunization Informationwww.nnii.org

Vaccinate Your Babywww.vaccinateyourbaby.org

Parents of Kids with Infectious Diseaseswww.pkids.org

Questions?