Best guide to contradictions and precautions to commonly used vaccines in 2022

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Guide to contradictions and precautions to commonly used vaccines

Vaccine: Hepatitis B (HepB)

Contraindications:

  • After a previous vaccine component or dose, severe allergic reactions (e.g. anaphylaxis).
  • Hypersensitivity to yeast

Precautions:

  • Acute, moderate, or severe illness without or with fever
  • Infants weighing less than 2000g (4 lbs, 6.8 oz).

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Vaccine: Rotavirus (RV5 [RotaTeq], RV1 [Rotarix])

Contraindications:

  • After a previous vaccine component or dose, severe allergic reactions (e.g. anaphylaxis).
  • Severe combined immunodeficiency
  • History of intussusception

Precautions:

  • Acute, moderate, or severe illness without or with fever
  • Other than SCID, altered immunocompetence
  • Chronic gastrointestinal disease
  • Spina bifida, bladder exstrophy

Vaccine: Tetanus (DTaP), diphtheria and pertussis(Tdap), Tetanus (DT, Td), Tetanus (DT, Td).

Contraindications:

  • After a previous vaccine component or dose, severe allergic reactions (e.g. anaphylaxis).
  • Pertussis-containing vaccines: Encephalopathy (e.g. coma or decreased level of consciousness or prolonged seizures) that is not due to any other identifiable cause within 7 Days of administration of DTP or DTaP.

Precautions:

  • Acute, moderate, or severe illness without or with fever
  • Guillain Barre syndrome (GBS), occurs within six weeks of receiving a previous dose of tetanus-containing vaccine.
  • History of Arthus-type hypersensitivity reactions following a previous dose of tetanus-toxoid vaccine. Defer vaccination until at minimum 10 years have passed since the last dose.
  • Tdap and DTaP only: Uncontrolled seizures or progressive encephalopathy, uncontrolled seizures or progressive neurologic disorder (includes infantile spasms in DTaP). Defer until a treatment plan has been established and the condition stabilized.

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Vaccine: Haemophilus influenzae type b (Hib)

Contraindications:

  • After a previous vaccine component or dose, severe allergic reactions (e.g. anaphylaxis).
  • Age less than 6 weeks

Precautions:

  • Acute, moderate, or severe illness without or with fever

Vaccine: Inactivated poliovirus vaccine (IPV)

Contraindications:

  • After a previous vaccine component or dose, severe allergic reactions (e.g. anaphylaxis).

Precautions:

  • Acute, moderate, or severe illness without or with fever
  • Pregnancy

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Vaccine: Hepatitis A (HepA)

Contraindications:

  • After a previous vaccine component or dose, severe allergic reactions (e.g. anaphylaxis).

Precautions:

  • Acute, moderate, or severe illness without or with fever

Vaccine: Measles, mumps, rubella (MMR)

Contraindications:

  • After a previous vaccine component or dose, severe allergic reactions (e.g. anaphylaxis).
  • Severe immunodeficiency, such as hematologic and solid cancers, chemotherapy or long-term immunosuppressive treatment5 ), or people with HIV infection [HIV] who are severely immunocompromised6
  • If the potential vaccine recipient is not able to demonstrate their immune competence clinically or has been verified by a laboratory test, then there may be a family history of congenital and hereditary immunodeficiency in the first-degree relatives (e.g. parents and siblings).
  • Pregnancy

Precautions:

  • Acute, moderate, or severe illness without or with fever
  • Recent (within the last 11 months) receipt of antibody-containing blood products (specific interval dependent on product).
  • Only for MMRV: Family history of seizures
  • History of thrombocytopenia/thrombocytopenic purpura
  • Tuberculin skin testing is required or interferon-gamma released assay (IGRA).
  • Only for MMRV: Family history of seizures

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Vaccine: Varicella (Var)

Contraindications:

  • Severe allergic reaction (e.g. anaphylaxis), following a previous dose of vaccine components
  • Severe immunodeficiencies, such as hematologic or solid tumors, chemotherapy or long-term immunosuppressive treatment, or HIV-infected persons who are severely immunocompromised
  • If the potential vaccine recipient is not able to demonstrate their immune competence clinically or has had a laboratory test, it may be based on a family history of congenital or inherited immunodeficiency.
  • Pregnancy

Precautions:

  • Acute, moderate, or severe illness without or with fever
  • Recent (within the last 11 months) receipt of antibody-containing blood products (specific interval depends upon product).
  • You must receive antivirals within 24 hours of vaccination. Avoid using antivirals for 14 days following vaccination.
  • Aspirin and aspirin-containing products

Vaccine: Pneumococcal (PCV13, PPSV23).

Contraindications:

  • Anaphylaxis or severe allergic reaction to any vaccine component, including a previous dose, is possible after receiving a vaccine component.

Precautions:

  • Acute, moderate, or severe illness without or with fever

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Vaccine: Human papillomavirus (HPV)

Contraindications:

  • After a previous vaccine component or dose, severe allergic reactions (e.g. anaphylaxis).

Precautions:

  • Acute, moderate, or severe illness without or with fever

Vaccine: Influenza-inactivated injectable

Contraindications:

  • Severe allergic reaction (e.g. anaphylaxis), to any component of the vaccine (except egg) and to previous doses of influenza vaccine

Precautions:

  • Acute, moderate, or severe illness without or with fever
  • GBS history within 6 weeks of the previous influenza vaccination
  • Other than egg allergies, such as hives, angioedema or respiratory distress, lightheadedness or recurrent emesis, or required epinephrine (or another emergency medical intervention) (IIV can be administered in an outpatient or inpatient medical setting under the supervision of a healthcare professional who is capable of diagnosing and managing severe allergic conditions).

Vaccine: Influenza, recombinant (RIV)

Contraindications:

  • Severe allergic reaction (e.g. anaphylaxis), to any component of the vaccine (except egg), or to previous doses of influenza vaccine

Precautions:

  • Acute, moderate, or severe illness without or with fever
  • GBS history within 6 weeks of the previous influenza vaccination

Vaccine: Influenza, live attenuated (LAIV)

Contraindications:

  • Severe allergic reaction (e.g. anaphylaxis), to any component of the vaccine (except egg) and to previous doses of influenza vaccine
  • Concomitant use of aspirin or salicylate-containing therapy in children or adolescents
  • Per the healthcare provider’s statement, children aged 2 to 4 years old have had to wheeze for the past 12 months or have been diagnosed with asthma.
  • Children and adults who have been immunocompromised for any reason (including medication or HIV infection) are eligible for treatment.
  • Contacts and caregivers for severely immunosuppressed people who require a safe environment
  • Pregnancy
  • Receipt or receipt of influenza antivirals (amantadine/rimantadine/zanamivir, peramivir, oseltamivir, or peramivir) within 48 hours prior to vaccination. Avoid the use of these antivirals for 14 days following vaccination

Precautions:

  • Acute, moderate, or severe illness without or with fever
  • GBS within six weeks of prior influenza vaccination
  • Asthma in people aged 5 and over
  • Other chronic medical conditions, such as chronic lung disease, chronic cardiovascular disease [except isolated hypertension], diabetes, and chronic renal or liver disease.

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Vaccine: Meningococcal (MenACWY; MenB)

Contraindications:

  • After a previous vaccine component or dose, severe allergic reactions (e.g. anaphylaxis).

Precautions:

  • Acute, moderate, or severe illness without or with fever

Vaccine: Recombinant zoster vaccine (RZV) Zoster vaccine live (ZVL)

Contraindications:

  • After a previous vaccine component or dose, severe allergic reactions (e.g. anaphylaxis).
  • Only for ZVL: Severe immunodeficiency (e.g. from hematologic or solid tumors, receiving chemotherapy or long-term immunosuppression treatment7 ), or persons living with HIV infection who have severe immunocompromised
  • Only ZVL: Pregnancy

Precautions:

  • Acute, moderate, or severe illness without or with fever
  • Only for ZVL: Receive specific antivirals 24 hours prior to vaccination. Avoid using these antiviral medications for 14 days following vaccination
  • Only: Pregnancy, lactation, and RZV

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Points to be noted:

  1. The Advisory Committee on Immunization Practices (ACIP), recommendations, and Guide to contradictions and precautions to commonly used vaccines. Contraindications are conditions that can increase the risk of serious adverse reactions in vaccine recipients. The vaccine should not, therefore, be administered to anyone with a contraindication. Consider the potential benefits and risks to vaccine recipients when preparing for vaccination. If a person has severe allergies to latex (e.g. anaphylaxis), they should be aware that vaccines containing natural rubber latex are not recommended for them, and going through the Guide to contradictions and precautions to commonly used vaccines is important. If you have anaphylaxis of any kind, it is possible to administer vaccines in vials or through syringes containing dry, natural rubber, or natural rubber latex. Children with neurologic disorders that are suspected or proven should be assessed individually to determine if and when DTaP should be administered.
  2. Preterm infants and infants weighing less than 2000 g should not be vaccinated against hepatitis B. If the mother is HBsAg-negative, it should be delayed. The hospital discharge or chronological age can be used to start vaccination. Infants born to HBsAg-positive mothers should receive hepatitis B immunoglobulin or hepatitis B vaccination within 12 hours of their birth. This applies regardless of weight.
  3. For details, see CDC. “Prevention of Rotavirus Gastroenteritis in Infants and Children: Recommendations by the Advisory Committee on Immunization Practices. (ACIP),” MMWR 2009,58 (No. RR-2), available at CDC for Guide to contradictions and precautions to commonly used vaccines.
  4. You can administer age-appropriate parenteral vaccinations (LAIV/MMR, Var, ZVL) on the same day. These live vaccines must be administered separately if they are not given on the same day, and also go through the Guide to contradictions and precautions to commonly used vaccines for further details and information.
  5. The daily dose of immunosuppressive steroids is 20 mg of prednisone (or equivalent) for 2 weeks or more. After discontinuation of such therapy, vaccines should be delayed for at least one month. Or go through the Guide to contradictions and precautions to commonly used vaccines For more information about live vaccines for patients on immuno-suppressing medication or who have suffered from immune suppression, providers should consult ACIP recommendations.
  6. HIV-infected children aged 5 and younger must receive measles vaccination if their CDT+ T lymphocyte percentages are higher than or equal to 15% for more than or equal to 6 months. HIV-infected children over 5 years old must have CD4+ levels greater than or equal to 15 and CD4+ T lymphocyte counts greater than or equal to 200 lymphocytes/cubic millimeter for 6 months or more. If only counts or percentages are available for children aged over 5, use the data available. In cases where percentages are not available for children 5 years or younger, use counts based on the age-specific counts at the time the counts were measured (see www.cdc.gov/vaccines/hcp/acip-recs/index.html for detailed Guide to contradictions and precautions to commonly used vaccines). Varicella vaccine may be given to HIV-infected children under 8 years old if their CD4+ T lymphocyte percentage is greater than 15%. HIV-infected children aged 8 and older can receive the varicella vaccine if their CD4+ T lymphocyte count is higher than 200 cells/cubic millimeter.
  7. If replacement immunoglobulin products are being given by the Guide to contradictions and precautions to commonly used vaccines, vaccination should be delayed for the appropriate time. Recommended Intervals Between Administration of Antibody-Containing Products and Measles- or Varicella-Containing Vaccine, by Product and Indication for Vaccination” found in “Best Practices Guidance of the Advisory Committee on Immunization Practices (ACIP),” available at www.cdc.gov/vaccines/hcp/acip-recs/generalrecs/index.html for a guide to contradictions and precautions to commonly used vaccines)
  8. Measles vaccination may temporarily suppress tuberculin response. The measles-containing vaccine can be administered the same day as tuberculin Skin Testing or Interferon Gamma Release Assay (IGRA) or delayed for at least four weeks with the help of a Guide to contradictions and precautions to commonly used vaccines,
  9. Pregnant women should not receive the HPV vaccine. The series should be stopped if a woman becomes pregnant during the first vaccination. Before vaccination, pregnancy testing is not necessary.
  10. The CDC has additional information about influenza vaccines for people with egg allergies. “Prevention and Control of Seasonal Influenza with Vaccines – Recommendations of The Advisory Committee on Immunization Practices – United States. . .” Access links to influenza vaccine recommendations at www.cdc.gov/vaccines/hcp/acip-recs/vacc-specific/flu.html.
  11. People with anatomic or functional asplenia, complement deficiency, cochlear implant, or CSF leak should not use LAIV.

Note:

Adapted and modified from “Table 4-1.” Contraindications and precautions to commonly used vaccines, CDC. “Best Practices Guidance from the Advisory Committee on Immunization Practices (ACIP)” is available at www.cdc.gov/vaccines/hcp/acip-recs/general-recs/index.html

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