vaccines at a single visit or the timing of the immunizations. Providers are encouraged to explain to parents how each new vaccine is extensively tested when it is approved for inclusion in the recommended immunization schedule. However, when providers are asked if the entire immunization schedule has been tested to determine if it is the best possible schedule, meaning that it offers the most benefits and the fewest risks, they have very few data on which to base their response. Furthermore, although the 2010 National Vaccine Plan addresses the need to provide health care providers with more timely, accurate, and transparent information about the benefits and risks of vaccines, providers are not singled out in specific strategies offered by the U.S. Department of Health and Human Services.

Although the committee identified several studies that reviewed the outcomes of studies of cumulative immunizations, adjuvants, and preservatives (see Chapter 5), the committee generally found a paucity of information, scientific or otherwise, that addressed the risk of adverse events in association with the complete recommended immunization schedule, even though an extensive literature base about individual vaccines and combination immunizations exists. The committee also acknowledges that the public health community has in place monitoring systems that work very well for the detection of adverse events that occur in the short term after immunization and that could be enhanced for the detection of longer-term outcomes, as discussed in Chapters 3 and 6. The continuation of studies looking at immune phenotyping, such as those of the National Institutes of Health’s Human Immunology Project Consortium, is also important in the identification of populations that are potentially susceptible to adverse events (HIPC, 2012).

To achieve the goal of giving health care providers and parents information that addresses the concerns that correlate with delaying or declining childhood immunizations, the committee developed a list of priority areas in which more information or clear communication of existing research is needed. The committee summarizes the priority concerns into the following topics:

  1. Immune system overload. As several parents asked, are children given too many vaccines? Do immunizations start when babies are too young? Are immunizations administered too frequently?
  2. Immunization schedule. What is the evidence that the ACIP-recommended immunization schedule is better than other schedules? Could the health outcomes among children who are vaccinated according to the recommended schedule be compared with those among unimmunized children? Likewise, could the health outcomes among children vaccinated on the recommended schedule be compared with those among children vaccinated on alternative schedules?

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