Chapter 116. Immunization Principles and Vaccine Use (Part 9) pptx

Chapter 116. Immunization Principles
and Vaccine Use
(Part 9)
Table 116-3 Valid and Invalid Contraindications to Vaccination


Vaccine Valid
Contraindication
a


Invalid
Contraindication
Serious allergic
reactions (e.g., anaphyla
xis)
to a previous vaccine dose or
a vaccine component
Mild acute illness with
or without fever
All vaccines in
general
Precaution:
Moderate
Mild to moderate local
or severe concurrent illness
with or without fever
reactions; low-
grade or
moderate fever after a
previous dose

Lack of previous
physical examination in a
well-appearing person

Current antimicrobial
therapy (except certain live
bacterial vaccines)

Convalescent phase of
illness

Premature birth
(except hepatitis B in some
circumstances)
Recent expos
ure to
infectious diseases

History of penicillin
allergy, other nonvaccine
allergies; relatives with
allergies; receiving
desensitization treatment
Severe allergic
reaction to a previous dose
or a vaccine component
Temperature of
<40.5°C; fuss
iness; mild

drowsiness after a prior dose
of DTP or DTaP
Encephalopathy (e.g.,
coma, decreased level of
consciousness, prolonged
seizures) within 7 days of a
previous dose of DTP or
DTaP
Family history of
seizures, sudden infant death
syndrome, or advers
e event
after DTP or DTaP
DTaP
b


Progressive
neurologic disorder,
including infantile spasms,
Stable neurologic
conditions (e.g., cerebral
palsy, well-
controlled
uncontrolled epilepsy,
progressive encephalopathy:
defer DTaP until neurologic
status is clarified and
stabilized
convulsions, developmental

delay)
Precaution:
Fever of
≥40.5°C at ≤48 h after a
previous dose of DTP or
DTaP

Collapse or shock-
like
state (i.e., hypotonic
hyporesponsive episode
≤48
h after a previous dose of
DTP or DTaP)

Seizure
≤3 days after
a previous dose of DTP or
DTaPPersistent, inconsolable
crying lasting
≥3 h/≤48 h

after a previous dose of DTP
or DTaP
Moderate or severe
acute illness with or without
fever

Severe allergic
reaction after a previous dose

or to a vaccine component

Precaution: Guillain-
Barré syndrome
≤6 weeks
after a previous dose of
tetanus toxoid–
containing
vaccine

DT, Td
Moderate or severe
acute illness with or without
fever

Severe allergic
reaction to a previous dose
or a vaccine component

IPV
Precautions:
Pregnancy; moderate or
severe acute illness with or
without fever

Severe allergic
reaction to a previous dose
or a vaccine component
Positive tuberculin
skin test; simultaneous TB

skin testing
Pregnancy Breast-feeding
MMR
Known
severe
immunodeficiency (e.g.,
hematologic and solid
tumors, congenital
immunodeficiency, long-
term immunosuppressive
Pregnancy of
recipient's mother or other
close or household contact;
recipient is childbearing-
age
female or immunodeficient
family member or household
therapy, or severely
symptomatic HIV infection)
contact; asymptomatic or
mildly symptomatic HIV
infection; allergy to eggs
Precautions:
Recent
(
≤11 months) receipt of
antibody-
containing blood
products (specific interval
depends on product

); history
of thrombocytopenia and
thrombocytopenic purpura;
moderate or severe acute
illness with or without fever


Severe allergic
reaction to a previous dose
or a vaccine component

Age <6 weeks
Hib
Precaution:
Moderate

or severe acute illness
with
or without fever
Severe allergic
reaction to a previous dose
or a vaccine component
Pregnancy;
autoimmune disease (e.g.,
systemic lupus erythematosus
or rheumatoid arthritis)
Hepatitis B
Precautions:
Infant
weighing <2000 g; moderate

or severe
acute illness with
or without fever

Severe allergic
reaction to a previous dose
or a vaccine component
Hepatitis A
Precaution:
Pregnancy; moderate or
severe acute illness with or
without fever

Severe allergic
reaction to a previous do
se
or a vaccine component
Pregnancy of
recipient's mother or another
close or household contact
Substantial
suppression of cellular
immunity
Immunodeficient
family member or household
contact; asymptomatic or
mildly symptomatic HIV
infection
Pregnancy
Varicella

Precaution:
Recent
(
≤11 months) receipt of
antibody-
containing blood
products (specific interval
depends on product)

Pneumococcal
Severe allergic
reaction to a previous dose

or a vaccine component
Precaution:
Moderate
or sev
ere acute illness with
or without fever

Severe allergic
reaction to a previous dose
or a vaccine component,
including egg protein
Nonsevere (e.g.,
contact) allergy to latex or
thimerosal; concurrent
administration of warfarin or
aminophylline
Influenza

Precaution:
Moderate
or severe acute illness with
or without fever

Severe allergic
reaction to a previous dose
or a vaccine component
Pneumococcal
polysaccharide
vaccines
Precaution:
Moderate

or severe acute illness with
or without fever

a
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, th
e vaccine should not be administered. If the benefit of
vaccination is believed to outweigh the risk, the vaccine should be administered.
b
Whether and when to administer DTaP to children with proven or
suspected underlying neurologic disorders should be decided on a case-by-
case
basis.
Note: DTP, diphtheria and tetanus toxoids and whole-

cell pertussis vaccine;
DTaP, diphtheria and tetanus toxoids and acellular pertussis vaccine; DT,
diphtheria and tetanus toxoids; Td, tetanus and reduced-dose diphtheria tox
oids,
adsorbed; IPV, inactivated polio vaccine; MMR, measles, mumps, and rubella
vaccine; Hib, Haemophilus influenzae type b vaccine.
Source:
General Recommendations on Immunization. MMWR
51(RR02):1, 2002.