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Contraindications and Precautions to Basic Childhood Immunizations

Author: RxPG, Posted on Saturday, July 03 @ 18:22:13 IST by RxPG  

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Paediatrics

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 conditions–cerebral palsy, well-controlled convulsions, developmental delay
• Limb swelling after 4 th dose (doesn’t 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 3–11 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 baker’s 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: children–2 mg/kg; adults–20 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.




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