cated the number of systemic reactions from 1970 to 1997 (total of 747 systemic reactions): 348 reports of swelling, lumps, soreness, stiff back, or stiff neck; 87 reports of itching hives; 79 reports of general malaise; 69 reports of chills and fever; 63 reports of headache; 63 reports of nausea, diarrhea, vomiting, and GI problems; and 38 reports of blurred vision or dizziness. The report implies that all of these reactions were of limited duration.

Conclusions on Human Studies

Studies have noted transient local and systemic effects of the botulinum toxoid vaccine. However, studies of the botulinum toxoid vaccine have not used active surveillance to systematically evaluate long-term health outcomes. This situation is unfortunately typical for all but a few vaccines.

The committee concludes that there is sufficient evidence of an association between botulinum toxoid vaccination and transient acute local and systemic effects (e.g., redness, swelling, fever) typically associated with vaccination.

The committee concludes that there is inadequate/insufficient evidence to determine whether an association does or does not exist between botulinum toxoid vaccination and long-term adverse health effects.

The latter finding means that the evidence reviewed by the committee is of insufficient quality, consistency, or statistical power to permit a conclusion regarding the presence or absence of an association between the vaccine and a health outcome in humans.

MULTIPLE VACCINATIONS

Military personnel often receive several vaccinations as they prepare for service in an environment with many endemic diseases. People have been expressed concerns that multiple vaccinations prior to and during Gulf War service may have caused adverse health effects. In this section, the committee examines the issue of multiple vaccinations.

Vaccination programs in the U.S. military began in 1777 when Continental Army recruits received inoculation against smallpox (Takafuji and Russell, 1990). As vaccines were developed for other endemic diseases that would take a heavy toll on the health of the military population (e.g., diphtheria, yellow fever, influenza), vaccinations were made mandatory for U.S. troops.

Each of the military services determines the immunization requirements for its personnel. However, there is general consensus, as evidenced in the triservice regulation on immunizations (Table 7.1). Some vaccinations (e.g., measles–ru-



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