GENERAL FOR ALL VACCINES
[DTaP, DT, Td,IPV, MMR, Hib,Hep A, Hep B,Var, PCV]
True Contraindications and Precautions
Moderate or severe acute illnesses with or without a fever
Anaphylactic reaction to a vaccine dose contraindicates further doses of that vaccine
Anaphylactic allergy to a vaccine constituent contraindicates administration of that vaccine
Not True (Vaccines May Be Given)
Mild acute illness with or without a low grade fever
Mild to moderate local reaction (soreness,redness, swelling) following a prior dose of an injectable vaccine; low-grade or moderate fever following prior vaccine dose
Lack of prior physical examination in wellappearing infant or child
Current antimicrobial therapy
Convalescent phase of illness
Prematurity (Use same dosages and timing as for normal, full-term infants. See also hepatitis B section.)
Recent exposure to an infectious disease
History of penicillin allergy, other nonspecific allergies, relatives with allergies, taking allergy shots
DTP
True Contraindications
Encephalopathy (eg: coma, decreased level of consciousness; prolonged convulsions) within 7 days of administration of previous dose of DTP/DTaP
Progressive neurologic disorder, including infantile spasms, uncontrolled epilepsy, progressive encephalopathy: Defer DTP/DTaP until neurologic status clarified. Consider substituting DT. Decisions must be individualized.
Precautions
Fever of ≥40.5°C (105° F) within 48 hours after vaccination with a prior dose of DTP/DTaP
Collapse or shocklike state (hypotonic-hyporesponsive episode) within 48 hours of receiving a prior dose of DTP/DTaP
Seizure(s) within 3 days of receiving a prior dose of DTP/DTaP (see below regarding management of children with a personal history of seizures at other times)
Persistent, inconsolable crying lasting ≥3 hours within 48 hours of receiving a prior dose of DTP/DTaP
Guillain-Barrι Syndrome within 6 weeks after prior DTP/DTaP dose
Not True (Vaccines May Be Given)
Temperature of <40.5°C (105°F), fussiness or mild drowsiness following a previous dose of DTP or DTaP
Family history of convulsions
Family history of sudden infant death syndrome
Family history of an adverse event following DTP or DTaP administration
Stable neurologic conditionscerebral palsy, well-controlled convulsions, developmental delay
Limb swelling after 4 th dose (doesnt contraindicate 5 th dose)
DT, Td
True Contraindications and Precautions
Neurological or severe hypersensitivity reaction to prior dose
IPV
True Contraindications
Anaphylactic allergy to neomycin
Precaution
Pregnancy
MMR
True Contraindications
Anaphylactic allergy to gelatin or to neomycin
Pregnancy
Known immunodeficiency (hematologic and solid tumors; congenital immunodeficiency; long-term immunosuppressive therapy, etc.)
Precaution
Recent (within 311 months) IG preparation, specific interval depends on preparation
Thrombocytopenic purpura history
Not True (Vaccines May Be Given)
Tuberculosis or positive PPD
Simultaneous TB skin testing
Breast-feeding
Mother of recipient or other household/close contact is pregnant
Recipient is child-bearing age female
Immunodeficient family member or household contact
Asymptomatic infection with HIV
Anaphylactic allergy to eggs
Hib
True Contraindications and Precautions
None
Hep B (Hepatitis B)
True Contraindications
Anaphylactic allergy to bakers yeast
Precaution
Weight <2000 grams and mother HbsAg-. But give if mother HbsAg+ even if infant <2000 grams.
Not True (Vaccines May Be Given)
Pregnancy
Hep A (Hepatitis A)
True Contraindications and Precautions
Anaphylactic allergy to alum (aluminum hydroxide)
Varicella (Var)
True Contraindications
Anaphylactic allergy to gelatin or neomyacin
Immunodeficient or immunosuppressed
Pregnancy
Precaution
IG preparation within last 5 months
Not True (Vaccines May Be Given)
Mother of recipient or other household/close contact is pregnant
Immunodeficient on immunosuppressed household or other close contact
PCV (Pneumococcal Conjugate)
True Contraindications and Precautions
None
--------------------------NOTE-----------------------------
The events or conditions listed as precautions, although not contraindications, should be carefully reviewed.
The benefits and risks of administering a specific vaccine to an individual under the circumstances should be considered.
If the risks are believed to outwe igh the benefits, the immunization should be withheld; if the benefits are believed to outweigh the risks (for example, during an outbreak or foreign travel), the immunizations should be given.
Whether and when to administer DTaP to children with proven or suspected underlying neurologic disorders should be decided on an individual basis.
It is prudent on theoretical grounds to avoid giving polio vaccine to pregnant women normally.
Acetaminophen given prior to administering DTaP and thereafter every 4 hours for 24 hours should be considered for children with a personal history of convulsions or a family history of convulsions in siblings or parents.
Varicella vaccine and MMR, if not given on same day, should be given ≥ 28 days apart.
Significantly immunosuppressive steroid dose is at least 2 weeks of daily receipt of equivalent of the following prednisone dose: children2 mg/kg; adults20 mg.
Measles and Varicella vaccination may temporarily suppress tuberculin reactivity.
If testing cannot be done until after the day of MMR or Varicella vaccination, the test should usually be postponed for 4-6 weeks.
However, if there is an urgent need to skin test right away, do so.
If Varicella vaccinee develops presumed vaccine-related rash 7-25 days after immunization, avoid direct or room contact with immunocompromised person(s) for duration of rash.
