Guide
to contraindications* and precautions** to commonly used vaccines—Listed
by Vaccine |
Vaccine |
True
contraindications and precautions # |
Untrue
(vaccines can be administered) |
General
for all vaccines, including
diphtheria and tetanus toxoids & acellular
pertussis vaccine (DTaP); pediatric diphtheria-tetanus
toxoid (DT); adult tetanus-diphtheria toxoid
(Td); inactivated poliovirus vaccine (IPV);
measles-mumps-rubella vaccine (MMR); Haemophilus
influenzae type b vaccine (Hib); hepatitis
A vaccine, hepatitis B vaccine; varicella
vaccine; pneumococcal conjugate vaccine
(PCV); influenza vaccine; and pneumococcal
polysaccharide vaccine (PPV) |
Contraindications
-Serious allergic reaction (e.g., anaphylaxis) after a previous
vaccine dose
-Serious allergic reaction (e.g., anaphylaxis) to a vaccine
component
Precautions
-Moderate or severe acute illness with or without fever |
-Mild
acute illness with or without fever
-Mild to moderate local reaction (i.e.,
swelling, redness, soreness); low-grade
or moderate fever after previous dose
-Lack of previous physical examination in well-appearing person
-Current antimicrobial therapy
-Convalescent phase of illness
-Premature birth (hepatitis B vaccine is an exception in certain
circumstances)+
-Recent exposure to an infectious disease
-History of penicillin allergy, other
non-vaccine allergies, relative with
allergies, receiving allergen extract
immunotherapy
|
DTaP |
Contraindications
-Severe allergic reaction after a previous dose or to a vaccine
component
-Encephalopathy (e.g., coma, decreased level of consciousness;
prolonged seizures) within 7 days of administration of previous
dose of DTP or DTaP
-Progressive neurologic disorder, including
infantile spasms, uncontrolled epilepsy,
progressive encephalopathy; defer DTaP
until neurologic status clarified and
stabilized.
Precautions
-Fever of >40.5° C <48 hours after
vaccination with a previous dose of DTP or DTaP
-Collapse or shock-like state (i.e., hypotonic hyporesponsive
episode) <48 hours after receiving a previous dose
of DTP or DTaP
-Seizure <3 days of receiving a previous dose of
DTP/DTaP^
-Persistent, inconsolable crying lasting >3 hours
<48 hours after receiving a previous dose of DTP
or DTaP
-Moderate or severe acute illness with or without fever |
-Temperature
of <40.5° C, fussiness or mild drowsiness after a previous
dose of diphtheria toxoid-tetanus toxoid-pertussis vaccine DTP
or DTaP
-Family history of seizures^
-Family history of sudden infant death
syndrome
-Family history of an adverse event after
DTP or DTaP administration
-Stable neurologic conditions (e.g., cerebral palsy, well controlled
convulsions, developmental delay) |
DT,
Td |
Contraindications
-Severe allergic reaction after a previous
dose or to a vaccine component
Precautions
-Guillain-Barrè syndrome
<6 weeks after previous dose
of tetanus toxoid-containing vaccine
-Moderate or severe acute illness with
or without fever |
|
IPV |
Contraindications
-Severe allergic reaction to previous dose or vaccine component
Precautions
-Pregnancy
-Moderate or severe acute illness with or without fever |
|
MMR@ |
Contraindications
-Severe allergic reaction to previous dose or vaccine component
-Pregnancy
-Known severe immunodeficiency (e.g., hematologic
and solid tumors; congenital immunodeficiency;
long-term immunosuppressive therapy## or
severely symptomatic human immunodeficiency
virus [HIV] infection)
Precautions
-Recent (<11 months) receipt
of antibody-containing blood product (specific interval depends
on product) $$
-History of thrombocytopenia or thrombocytopenic purpura
-Moderate or severe acute illness with or without fever |
-Positive
tuberculin skin test
-Simultaneous TB skin testing++
-Breast-feeding
-Pregnancy of recipient's mother or other close or household
contact
-Recipient is child-bearing-age female
-Immunodeficient family member or household contact
-Asymptomatic or mildly symptomatic HIV infection
-Allergy to eggs |
Hib |
Contraindications
-Severe allergic reaction to previous dose or vaccine component
-Age <6 weeks
Precautions
-Moderate or severe acute illness with or without fever |
|
Hepatitis
B |
Contraindications
-Severe allergic reaction to previous dose or vaccine component
Precautions
-Infant weighing < 2,000 grams
-Moderate or severe acute illness with or without fever
|
-Pregnancy
-Autoimmune disease (e.g., systemic lupus erythematosis or rheumatoid
arthritis) |
Hepatitis
A |
Contraindications
-Severe allergic reaction to previous dose or vaccine component
Precautions
-Pregnancy
-Moderate or severe acute illness with or without fever
|
|
Varicella@ |
Contraindications
-Severe allergic reaction to previous dose or vaccine component
-Substantial suppression of cellular immunity
-Pregnancy
Precautions
-Recent (<11 months) receipt of antibody-containing
blood product (specific interval depends on product)
$$
-Moderate or severe acute illness with or without fever
|
-Pregnancy
of recipient's mother or other close or
household contact
-Immunodeficient family member or household
contact^^
-Asymptomatic or mildly symptomatic HIV
infection
-Humoral immunodeficiency (e.g., agammaglobulinema) |
PCV |
Contraindications
-Severe allergic reaction to previous dose or vaccine component
Precautions
-Moderate or severe acute illness with or without fever
|
|
Influenza |
Contraindications
-Severe allergic reaction to previous dose or vaccine component,
including egg protein
Precautions
-Moderate or severe acute illness with or without fever
|
-Non-severe
(e.g., contact) allergy to latex or thimerosal
-Concurrent administration of coumadin
or aminophylline |
PPV |
Contraindications
-Severe allergic reaction to previous dose or vaccine component
Precautions
-Moderate or severe acute illness with or without fever
|
|
*Contraindications
- A contraindication is a condition in a recipient that increases
the risk for a serious adverse reaction. A vaccine will not
be administered when a contraindication is present. Consult
the MMWR article, "General
Recommendations on Immunizations" for a full definition
including examples.
**
Precautions - A precaution is a condition
in a recipient that might increase the risk for a serious
adverse reaction or that might compromise the ability of the
vaccine to produce immunity. Injury could result, or a person
might experience a more severe reaction to the vaccine than
would have otherwise been expected; however, the risk for
this happening is less than expected with a contraindication.
Under normal circumstances, vaccinations should be deferred
when a precaution is present. However, a vaccination might
be indicated in the presence of a precaution because the benefit
of protection from the vaccine outweighs the risk for an adverse
reaction. Consult the MMWR article, "General
Recommendations on Immunizations" for a full definition
including examples.
#
Events or conditions listed as precautions
should be reviewed carefully. Benefits
and risks of administering a specific
vaccine to a person under these circumstances
should be considered. If the risk from
the vaccine is believed to outweigh the
benefit, the vaccine should not be administered.
If the benefit of vaccination is believed
to outweigh the risk, vaccine should
be administered. Whether and when to
administer DTaP to children with proven
or suspected underlying neurologic disorders
should be decided on a case-by-case basis.
+
Hepatitis B vaccination should be deferred for infants weighing
<2,000 grams if the mother is documented to be hepatitis
B surface antigen (HbsAg)-negative at the time of infant's
birth. Vaccination can commence at chronological age 1 month.
For infants born to HbsAg-positive women, hepatitis B immunoglobulin
and hepatitis B vaccine should be administered at or soon
after birth regardless of weight. See MMWR article, "General
Recommendations on Immunizations" text for details.
^
Acetaminophen or other appropriate antipyretic
can be administered to children with
a personal or family history of seizures
at the time of DTaP vaccination and every
4-6 hours for 24 hours thereafter to
reduce the possibility of post-vaccination
fever (Source: American Academy of Pediatrics.
Active immunization. In Pickering LK,
ed. 2000 Red Book:rep of the Committee
on Infectious Diseases. 25th ed. Elk
Grove Village, IL; American Academy of
Pediatrics, 2000).
@
MMR
and varicella vaccines can be administered on the same day.
If not administered on the same day, these vaccines should
be separated by >28 days.
##
Substantially immunosuppressive steroid dose is considered
to be >2 weeks of daily receipt of 20 mg or 2 mg/kg body
weight of prednisone or equivalent.
++
Measles vaccination can suppress tuberculin reactivity temporarily.
Measles-containing vaccine can be administered on the same
day as tuberculin skin testing. If testing cannot be performed
until after the day of MMR vaccination, the test should be
postponed for >4 weeks after the vaccination. If an urgent
need exists to skin test, do so with the understanding that
reactivity might be reduced by the vaccine.
$$
See text for details.
^^
If
a vaccinee experiences a presumed vaccine-related rash 7-25
days after vaccination, avoid direct contact with immunocompromised
persons for the duration of the rash.
|