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the contraindications to immunization. Every physician who cares for children or
authorizes immunizations should have a current copy of the Report of the Committee
on Infectious Disease published by the American Academy of Pediatrics (the “Red
Book”) and a copy of Communicable Diseases Manual, published by the American
Public Health Association. These books are storehouses of invaluable information
about immunizations and the management of communicable diseases. They set the
legal standard of care for this branch of medical practice.
The general medical concern is that persons with suppressed immune systems should
not be given live vaccine preparations. These include oral polio, oral typhoid,
measles, mumps, rubella, and BCG vaccines. Persons with normal immune function
develop antibodies to these agents and suffer a mild or subclinical infection. Persons
with suppressed immune systems may develop full symptomatic disease, including
adverse sequelae. Immunosuppressed persons, or patients who live with
immunosuppressed persons, should receive live vaccines only under controlled
circumstances.
Physicians must be careful to ensure that patients do not receive contraindicated
immunizations. As discussed in the Red Book, there are several short-term
contraindications to immunization, as well as the long-term contraindication of
immunosuppression. All patients must be questioned or examined to identify the
existence of medical contraindications. If these are present, they should be
documented in the patient’s medical record. Such patients should also be given a
medical exemption form to allow them to enter school without the requisite
immunizations. Unless required by state law, this exemption need not detail the
patient’s personal medical condition, only that the patient is not a candidate for
immunization. If the exemption is based on a short-term contraindication, this should
be reviewed on a subsequent visit and the child immunized as soon as medically
advisable.
Physicians should never grant medical exemptions that are not based on objective
medical findings. There are parents who are unwilling to claim a religious objection
for their children but do not want their children immunized. A physician who grants
such a child an exemption from immunization will be legally liable if the child
contracts a disease that could be prevented through immunization. Physicians who
exempt a child from immunization improperly may also be a party to child neglect.
This could result in a legal prosecution if the child were to suffer a permanent injury
from a preventable disease.
5. The Vaccine Compensation Act
Products liability losses by vaccine manufacturers have driven the cost of vaccines
beyond the reach of indigent patients and many health departments. In an effort to
control these losses, Congress passed the Vaccine Injury Compensation Act to
compensate persons injured by vaccines (see Appendix 12–A). This compensation
program is funded by a combination of tax revenues on vaccine sales and general tax
revenues. This law has two major flaws. One is that the tax on vaccine sales is very
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