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Adverse
Effects of
Vaccines
Evidence
and
Causality
Editors
Kathleen Stratton,
Andrew Ford,
Erin Rusch,
Ellen Wright Clayton
Adverse
Effects of
Vaccines
Evidence and Causality
Committee to Review Adverse Effects of Vaccines
Board on Population Health and Public Health Practice
Kathleen Stratton, Andrew Ford, Erin Rusch, and Ellen Wright Clayton,
Editors
THE NATIONAL ACADEMIES PRESS
500 Fifth Street, N.W.
Washington, DC 20001
NOTICE: The project that is the subject of this report was approved by the Governing
Board of the National Research Council, whose members are drawn from the councils of
the National Academy of Sciences, the National Academy of Engineering, and the Institute
of Medicine. The members of the committee responsible for the report were chosen for their
special competences and with regard for appropriate balance.
This study was supported by Contract No. HHSH230200446009I, Task Order 13 between the
National Academy of Sciences and the Health Resources and Services Administration of the
U.S. Department of Health and Human Services. The Centers for Disease Control and Preven-
tion and the National Vaccine Program Ofice also provided support through that contract.
Any opinions, indings, conclusions, or recommendations expressed in this publication are
those of the author(s) and do not necessarily relect the view of the organizations or agencies
that provided support for this project.
Library of Congress Cataloging-in-Publication Data
Institute of Medicine (U.S.). Committee to Review Adverse Effects of Vaccines.
Adverse effects of vaccines : evidence and causality / Committee to Review Adverse Effects
of Vaccines, Board on Population Health and Public Health Practice ; Kathleen Stratton ...
[et al.], editors.
p. ; cm.
Includes bibliographical references and index.
ISBN 978-0-309-21435-3 (hardcover) — ISBN 978-0-309-21436-0 (PDF)
I. Stratton, Kathleen R. II. Title.
[DNLM: 1. Vaccines—adverse effects. 2. Bacterial Infections—prevention & control. 3.
Causality. 4. Virus Diseases—prevention & control. QW 805]
615.3’72—dc23
2012007052
Additional copies of this report are available from the National Academies Press, 500 Fifth
Street, N.W., Keck 360, Washington, DC 20001; (800) 624-6242 or (202) 334-3313; Internet,
http://www.nap.edu.
For more information about the Institute of Medicine, visit the IOM home page at:
www.
iom.edu.
Copyright 2012 by the National Academy of Sciences. All rights reserved.
Printed in the United States of America
The serpent has been a symbol of long life, healing, and knowledge among almost
all cult
ures
and religions since the beginning of recorded history. The serpent adopted as a logotype by
the Institute of Medicine is a relief carving from ancient Greece, now held by the Staatliche
Museen in Berlin.
Suggested citation: IOM (Institute of Medicine). 2012.
Adverse effects of vaccines: Evidence
and causality.
Washington, DC: The National Academies Press.
“Knowing is not enough; we must apply.
Willing is not enough; we must do.”
—Goethe
Advising the Nation. Improving Health.
The
National Academy of Sciences
is a private, nonproit, self-perpetuating society
of distinguished scholars engaged in scientiic and engineering research, dedicated to
the furtherance of science and technology and to their use for the general welfare.
Upon the authority of the charter granted to it by the Congress in 1863, the Acad-
emy has a mandate that requires it to advise the federal government on scientiic
and technical matters. Dr. Ralph J. Cicerone is president of the National Academy
of Sciences.
The
National Academy of Engineering
was established in 1964, under the charter
of the National Academy of Sciences, as a parallel organization of outstanding en-
gineers. It is autonomous in its administration and in the selection of its members,
sharing with the National Academy of Sciences the responsibility for advising the
federal government. The National Academy of Engineering also sponsors engineer-
ing programs aimed at meeting national needs, encourages education and research,
and recognizes the superior achievements of engineers. Dr. Charles M. Vest is presi-
dent of the National Academy of Engineering.
The
Institute of Medicine
was established in 1970 by the National Academy of
Sciences to secure the services of eminent members of appropriate professions in
the examination of policy matters pertaining to the health of the public. The Insti-
tute acts under the responsibility given to the National Academy of Sciences by its
congressional charter to be an adviser to the federal government and, upon its own
initiative, to identify issues of medical care, research, and education. Dr. Harvey V.
Fineberg is president of the Institute of Medicine.
The
National Research Council
was organized by the National Academy of Sci-
ences in 1916 to associate the broad community of science and technology with the
Academy’s purposes of furthering knowledge and advising the federal government.
Functioning in accordance with general policies determined by the Academy, the
Council has become the principal operating agency of both the National Academy
of Sciences and the National Academy of Engineering in providing services to
the government, the public, and the scientiic and engineering communities. The
Council is administered jointly by both Academies and the Institute of Medicine.
Dr. Ralph J. Cicerone and Dr. Charles M. Vest are chair and vice chair, respectively,
of the National Research Council.
www.national-academies.org
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