• 15
    Jan
  • A guide to contraindications to childhood vaccinations

A guide to contraindications to childhood vaccinations

The infant and childhood immunization program in Can­ada has led to extraordinary decreases in serious infec­tions with diphtheria, tetanus, pertussis, polio, Haemophilus influenzae type b, hepatitis B, measles, mumps and rubella. There is a danger that this successful immunization program may lead to complacency about vaccine preventable illnesses such that parents, and sometimes physicians, may become too focused on potential adverse events of vaccination and lose sight of the serious and sometimes even fatal consequences of the disease being prevented. Physicians and parents need reli­able accurate information on true contraindications so that opportunities to immunize an infant or child are not missed. In fact, there are very few true contraindications. Deferral or delay of immunization based on misconceptions about contra­indications puts an infant or child at risk. The following tables summarize the answers to the most frequently raised ques­tions about contraindications. Tables 1 to 3 are based upon recommendations from the National Advisory Committee on Immunization and the American Advisory Committee on Immunization. Additional information written for par­ents is available in the publication entitled, Your Child’s Best Shot.
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TABLE 1: Contraindications to childhood vaccinations as recommended by the National Advisory Committee on Immunization and the American Advisory Committee on Immunization

Symptom or
condition

Contraindication

Allergy

Anaphylactic (life-threatening) allergy to:

a) Previous dose of vaccine

That vaccine

b) Neomycin

Inactivated polio vaccine (IPV),
DtaP-IPV-Haemophilus influenzae
type b (Pentacel, Aventis

Pasteur, Toronto, Ontario), measles-mumps-rubella (MMR) vaccine and
varicella vaccine

c) Gelatin

Varicella vaccine and MMR vaccine

d) Baker’s yeast

Hepatitis B vaccine

e) Egg ingestion

Influenza vaccine

f) Streptomycin

IPV

Immunodeficient state

a) Recipient

• congenital immunodeficiency, eg, severe

MMR vaccine, varicella vaccine, oral polio vaccine (OPV)* and
bacille Calmette-Guerin (BCG)

combined immunodeficiency

vaccine

• acquired immunodeficiency, eg, HIV

OPV*, BCG vaccine and varicella vaccine; precaution with MMR

• immunosuppression, eg, acute lymphoblastic

MMR vaccine, varicella vaccine, BCG vaccine and OPV*

leukemia on chemotherapy

b) Household contacts

• congenital immunodeficiency

OPV*

• HIV

OPV*

c) Systemic steroids, high dose

Defer MMR, varicella vaccine, BCG vaccine and OPV*

Pregnancy

MMR and varicella vaccine

TABLE 2: Precautions to childhood vaccinations as recommended by National Advisory Committee on Immunization and the American Advisory Committee on Immunization

Symptom or
condition

Precaution or
action

Moderate or severe illness with or without fever Recent
immunoglobulin administration

Pregnancy

Defer only if the child is NOT in immediate danger of exposure to
the disease or the child is

likely to return to continue immunization in a timely fashion
Intravenous and intramuscular gammaglobulin can interfere with
measles-mumps-rubella

(MMR) vaccine and varicella vaccine Delay MMR three to 10 months;
time depends upon immunoglobulin amount Delay varicella vaccine for
five months if intravenous immune globulin (IVIG) and varicella

immune globulin (VZIG) given Defer MMR and varicella vaccine until
immediate postpartum

TABLE 3: Noncontraindications to childhood vaccination as recommended by National Advisory Committee on Immunization and the American Advisory Committee on Immunization

Symptom or
condition

Action

Mild to moderate local reaction to previous injection of vaccine

Immunize

Mild acute illness with or without fever

Immunize

Currently taking antibiotics

Immunize

Recovering from an acute illness

Immunize

Premature infant

Immunize on time – do NOT delay

Recent exposure to an infectious disease

Immunize

Personal or family history of allergy to

Penicillin

Immunize

Duck meat, duck feathers

Immunize

Molds, grasses, pollens, etc

Immunize

Eggs

Immunize except for influenza vaccine; NO contraindication to

measles-mumps-rubella (MMR) vaccine

Tuberculosis (TB) or positive TB skin test

Immunize even with MMR and varicella vaccine

Simultaneous TB skin test

Immunize even with MMR and varicella vaccine

Fever 40.5°C or higher after first dose of DTP or DtaP

Immunize, give acetaminophen

Family history of sudden infant death syndrome

Immunize

Seizure within 48 h of the prior dose of DTP or DtaP

Immunize; give acetaminophen if seizure accompanied by fevers

Family history of seizures

Immunize

Persistent inconsolable crying 3 h or more within 48 h after prior
dose of

Immunize

DTA or DtaP

Pregnancy

Immunize with tetanus, hepatitis B, influenza and inactivated polio

vaccines as required

History of Haemophilus influenzae type b
disease

Immunize Haemophilus influenzae type b
vaccine

Hypotonic-hyporesponsive state within 48 h after prior dose of DtaP

Not necessary to defer because episodes may occur with both DT,
DTaP;

containing vaccine

continued immunization with all antigens is recommended

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