Contraindications and Precautions to Vaccination : Allergy and Pregnancy

Contraindications and Precautions to Vaccination : Allergy and Pregnancy

Contraindications and precautions to vaccination generally dictate circumstances when vaccines will not be given. Many contraindications and precautions are temporary, and the vaccine can be given at a later time.

A contraindication is a condition that increases the likelihood of a serious adverse reaction to a vaccine for a patient with that condition. If the vaccine were given in the presence of that condition, the resulting adverse reaction could seriously harm the recipient. For instance, adminis­tering MMR vaccine to a person with a true anaphylactic allergy to gelatin could cause serious illness or death in the recipient. In general, vaccines should not be administered when a contraindication condition is present.

A precaution is a condition in a recipient that might increase the chance or severity of a serious adverse reaction, or that might compromise the ability of the vaccine to produce immunity (such as administering measles vaccine to a person with passive immunity to measles from a blood transfusion). Injury could result, but the chance of this happening is less than with a contraindication. In general, vaccines are deferred when a precaution condition is present. However, situations may arise when the benefit of protection from the vaccine outweighs the risk of an adverse reaction, and a provider may decide to give the vaccine.

There are very few true contraindication and precaution conditions. Only four of these conditions are generally considered to be permanent contraindications: severe (anaphylactic) allergic reaction to a vaccine component or following a prior dose of a vaccine; encephalopathy not due to another identifiable cause occurring within 7 days of pertussis vaccination; severe combined immunodeficiency (SCID) and a history of intussusception as contraindications to rotavirus vaccine.

Conditions considered permanent precautions to further doses of pediatric DTaP are temperature of 105ºF or higher within 48 hours of a dose, collapse or shock-like state (hypotonic hyporesponsive episode) within 48 hours of a dose, persistent inconsolable crying lasting 3 or more hours occurring within 48 hours of a dose, or a seizure, with or without fever, occurring within 3 days of a dose. The occurrence of one of these events in a child following DTaP vaccine is not a precaution to later vaccination with the adolescent/adult formulation of pertussis vaccine (Tdap).

Two conditions are temporary precautions to vaccination: moderate or severe acute illness (all vaccines), and recent receipt of an antibody-containing blood product. The latter precaution applies only to MMR and varicella-containing (except zoster) vaccines. Two conditions are temporary contraindications to vaccination with live vaccines: pregnancy and immunosuppression.

Allergy

A severe (anaphylactic) allergic reaction following a dose of vaccine will almost always contraindicate a subsequent dose of that vaccine. Anaphylactic reactions are those that are mediated by IgE, occur within minutes or hours of receiving the vaccine, and require medical attention. Examples of symptoms and signs typical of anaphylactic reactions are generalized urticaria (hives), swelling of the mouth and throat, difficulty breathing, wheezing, hypotension, or shock. These reactions are very rare following vaccination and can be further minimized with appropriate screening.

A table listing vaccine contents is included in Appendix B. Persons may be allergic to the vaccine antigen or to a vaccine component such as animal protein, antibiotic, preservative, or stabilizer. The most common animal protein allergen is egg protein found in vaccines prepared using embryonated chicken eggs (e.g., yellow fever and influenza vaccines). Ordinarily, a person who can eat eggs or egg products can receive vaccines that contain egg; persons with histories of anaphylactic or anaphylactic-like allergy to eggs or egg proteins should be referred for further evaluation. Asking persons whether they can eat eggs without adverse effects is a reasonable way to screen for those who might be at risk from receiving yellow fever and egg-containing influenza vaccines.

Studies have shown that children who have a history of severe allergy to eggs rarely have reactions to MMR vaccine. This is probably because measles and mumps vaccine viruses are both grown in chick embryo fibroblasts, not actually in eggs. It appears that gelatin, not egg, might be the cause of allergic reactions to MMR. As a result, in 1998, the ACIP removed severe egg allergy as a contraindication to measles and mumps vaccines. Egg-allergic children may be vaccinated with MMR without prior skin testing.

Certain vaccines contain trace amounts of neomycin. Persons who have experienced an anaphylactic reaction to neomycin should not receive these vaccines. Most often, neomycin allergy presents as contact dermatitis, a manifes­tation of a delayed-type (cell-mediated) immune response, rather than anaphylaxis. A history of delayed-type reactions to neomycin is not a contraindication for administration of vaccines that contain neomycin.

Latex is sap from the commercial rubber tree. Latex contains naturally occurring impurities (e.g., plant proteins and peptides), which are believed to be responsible for allergic reactions. Latex is processed to form natural rubber latex and dry natural rubber. Dry natural rubber and natural rubber latex might contain the same plant impurities as latex but in lesser amounts. Natural rubber latex is used to produce medical gloves, catheters, and other products. Dry natural rubber is used in syringe plungers, vial stoppers, and injection ports on intravascular tubing. Synthetic rubber and synthetic latex also are used in medical gloves, syringe plungers, and vial stoppers. Synthetic rubber and synthetic latex do not contain natural rubber or natural latex, and therefore, do not contain the impurities linked to allergic reactions.

The most common type of latex sensitivity is contact-type (type 4) allergy, usually as a result of prolonged contact with latex-containing gloves. However, injection-procedure-associated latex allergies among diabetic patients have been described. Allergic reactions (including anaphylaxis) after vaccination procedures are rare. Only one report of an allergic reaction after administration of hepatitis B vaccine in a patient with known severe allergy (anaphylaxis) to latex has been published.

If a person reports a severe (anaphylactic) allergy to latex, vaccines supplied in vials or syringes that contain natural rubber should not be administered unless the benefit of vaccination clearly outweighs the risk of an allergic reaction to the vaccine. For latex allergies other than anaphylactic allergies (e.g., a history of contact allergy to latex gloves), vaccines supplied in vials or syringes that contain dry natural rubber or natural rubber latex can be administered.

Pregnancy

The concern with vaccination of a pregnant woman is infection of the fetus and is theoretical. Only smallpox (vaccinia) vaccine has been shown to cause fetal injury. However, since the theoretical possibility exists, live vaccines should not be administered to women known to be pregnant.

Since inactivated vaccines cannot replicate, they cannot cause fetal infection. In general, inactivated vaccines may be administered to pregnant women for whom they are indicated. An exception is human papillomavirus vaccine, which should be deferred during pregnancy because of a lack of safety and efficacy data for this vaccine in pregnant women.

Pregnant women are at increased risk of complications of influenza. Any woman who will be pregnant during influenza season (generally December through March) should receive inactivated influenza vaccine. Pregnant women should not receive live attenuated influenza vaccine.
ACIP recommends that providers of prenatal care implement a Tdap immunization program for all pregnant women. Healthcare personnel should administer a dose of Tdap during each pregnancy, irrespective of the patient’s prior history of receiving Tdap. To maximize the maternal antibody response and passive antibody transfer to the infant, optimal timing for Tdap administration is between 27 and 36 weeks gestation although Tdap may be given at any time during pregnancy. For women not previously vaccinated with Tdap, if Tdap is not administered during pregnancy, Tdap should be administered immediately postpartum.

Studies on the persistence of antipertussis antibodies following a dose of Tdap show antibody levels in healthy, nonpregnant adults peak during the first month after vaccination, with subsequent antibody waning after 1 year. Antibody levels in pregnant women likely would be similar. Because antibody levels wane substantially during the first year after vaccination, ACIP concluded a single dose of Tdap at one pregnancy would be insufficient to provide protection for subsequent pregnancies.

Susceptible household contacts of pregnant women should receive MMR and varicella vaccines, and may receive LAIV, zoster and rotavirus vaccines if they are otherwise eligible.

Contraindications and Precautions to Vaccination : Allergy and Pregnancy 2019-01-06T07:21:00-08:00 Rating: 4.5 Diposkan Oleh: David Maharoni