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Effectiveness and Safety of Childhood Vaccination

By

Michael J. Smith

, MD, MSCE, Duke University

Last full review/revision Dec 2019| Content last modified Dec 2019
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Vaccination has been profoundly effective in preventing serious disease (see Table: Case Rates of Some Diseases Preventable by Vaccines). Given their modest cost (particularly in comparison to drugs that must be taken long-term), vaccines are one of the most cost-effective pharmaceutical products. Vaccines have been so effective that many health care practitioners currently in practice have seen few or no cases of diseases that were once extremely common and fatal.

Because the diseases that vaccines prevent have typically become rare in the US and because vaccines are given to otherwise healthy children, vaccines must have a high safety profile.

Table
icon

Case Rates of Some Diseases Preventable by Vaccines

Disease

Average Cases/Year Before Vaccine Development (20th century)

Cases in 2017 or 2016*

21,053

0

20,000 (estimated)

33

117,333 (estimated)

4,000*

Hepatitis B (acute)

66,232 (estimated)

20,900*

530,217

120

162,344

6,109

200,752

18,975

Pneumococcal infection (invasive, all ages)

63,067 (estimated)

30,400*

Pneumococcal infection (invasive, < 5 years)

16,069 (estimated)

1,700*

Polio (paralytic)

16,316

0

Rotavirus (hospitalizations < 3 years)

62,500 (estimated)

An estimated 30,625*

47,745

7

29,005

0

580

33

4,085,120 (estimated)

An estimated 102,128*

* These numbers are from 2016.

Adapted from Appendix E: Data and statistics: Impact of vaccines in the 20th and 21st centuries. In Epidemiology and Prevention of Vaccine-Preventable Diseases: The Pink Book, edited by Hamborsky J, Kroger A, and Wolfe S. Centers for Disease Control and Prevention, Washington D.C. Public Health Foundation, 2015, p. E-5. Available at the Centers for Disease Control and Prevention.

Before licensure, vaccines (like any medical product) are tested in randomized controlled trials (RCTs) that compare the new vaccine to placebo (or a previously existing vaccine if one exists). Such pre-licensing RCTs are designed primarily to assess vaccine efficacy and to identify common adverse events (eg, fever; local reactions such as injection site redness, swelling, and pain). However, some adverse events occur too rarely to be detected in an RCT of any practical size and may not appear until after a vaccine enters routine use. Thus, two surveillance systems, the Vaccine Adverse Event Reporting System (VAERS) and the Vaccine Safety Datalink (VSD), were created to monitor vaccine safety post-licensure.

VAERS is a safety program cosponsored by the FDA and the CDC; VAERS collects reports from individual patients who believe that they had an adverse event after a recent vaccination. Health care practitioners are also required to report certain events after vaccination and may report events even if they are unsure the events are vaccine-related. VAERS reports originate all across the country and provide a rapid assessment of potential safety issues. However, VAERS reports can show only temporal associations between vaccination and the suspected adverse event; they do not prove causation. Thus, VAERS reports must be further evaluated using other methods. One such method uses the VSD, which uses data from 9 large managed care organizations (MCOs) representing more than 9 million people. The data include vaccine administration (noted in the medical record as part of routine care), as well as subsequent medical history, including adverse events. Unlike VAERS, the VSD includes data from patients who have not received a given vaccine as well as those who have. As a result, the VSD can help distinguish actual adverse events from symptoms and disorders that occurred coincidentally after vaccination and thus determine the actual incidence of adverse events.

For specific adverse effects of specific vaccines, see Overview of Immunization.

More Information

  • Vaccine Adverse Event Reporting System (VAERS)

  • Vaccine Safety Datalink (VSD)

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