Screening for Contraindications and Precautions to Vaccination
The key to preventing serious adverse reactions is screening. Every person who administers vaccines should screen every patient for contraindications and precautions before giving the vaccine dose. Effective screening is not difficult or complicated and can be accomplished with just a few questions.
Is the child (or are you) sick today?
There is no evidence that acute illness reduces vaccine efficacy or increases vaccine adverse events. However, as a precaution, with moderate or severe acute illness, all vaccines should be delayed until the illness has improved. Mild illnesses (such as otitis media, upper respiratory infections, and diarrhea) are NOT contraindications to vaccination. Do not withhold vaccination if a person is taking antibiotics.
Does the child have allergies to medications, food, or any vaccine?
A history of anaphylactic reaction such as hives (urticaria), wheezing or difficulty breathing, or circulatory collapse or shock (not fainting) from a previous dose of vaccine or vaccine component is a contraindication for further doses. It may be more efficient to inquire about allergies in a generic way (i.e., any food or medication) rather than to inquire about specific vaccine components. Most parents will not be familiar with minor components of vaccine, but they should know if the child has had an allergic reaction to a food or medication that was severe enough to require medical attention. If a person reports anaphylaxis after eating eggs, a specific protocol should be followed that includes ascertaining the symptoms experienced. For specific information, see Influenza chapter.
Has the child had a serious reaction to a vaccine in the past?
A history of anaphylactic reaction to a previous dose of vaccine or vaccine component is a contraindication for subsequent doses. A history of encephalopathy within 7 days following DTP/DTaP is a contraindication for further doses of pertussis-containing vaccine. Precautions to DTaP (not Tdap) include (a) seizure within 3 days of a dose, (b) pale or limp episode or collapse within 48 hours of a dose, (c) continuous crying for 3 hours within 48 hours of a dose, and (d) fever of 105°F (40°C) or higher within 48 hours of a previous dose. There are other adverse events that might have occurred following vaccination that constitute contraindications or precautions to future doses. Usually vaccines are deferred when a precaution is present. However, situations may arise when the benefit outweighs the risk (e.g., during a community pertussis outbreak). A local reaction (redness or swelling at the site of injection) is not a contraindication to subsequent doses.
Has the child had a seizure, or brain or nerve problem?
DTaP and Tdap are contraindicated for children who have a history of encephalopathy not attributed to an identifiable cause within 7 days following DTP/DTaP. An unstable progressive neurologic problem is a precaution to the use of DTaP and Tdap. Children with stable neurologic disorders (including seizures) unrelated to vaccination may be vaccinated as usual.
A history of Guillain-Barré syndrome is a precaution for tetanus-containing and influenza vaccines.
Patients with a personal or family history of febrile or afebrile seizures have a precaution for MMRV vaccine. Simultaneous MMR and varicella vaccine administration (the single component vaccines) is not associated with an increased risk of fever or seizures and is therefore the acceptable alternative to MMRV.
Has the child had a health problem with asthma, lung disease, heart disease, kidney disease, metabolic disease such as diabetes, or a blood disorder?
Children with any of these conditions should not receive LAIV. Children with these conditions should receive inactivated influenza vaccine only.
Does the child have cancer, leukemia, AIDS, or any other immune system problem?
Live-virus vaccines (e.g., MMR, varicella, rotavirus, and the intranasal live attenuated influenza vaccine [LAIV]) are usually contraindicated in severely immunocompromised children. Persons with severe immunosuppression should not receive MMR, varicella, rotavirus, or LAIV vaccines. However, there are exceptions. For example, MMR and varicella vaccines are recommended for HIV-infected children who do not have evidence of severe immunosuppression. For details, consult the ACIP recommendations for each vaccine.
Has the child taken cortisone, prednisone, other steroids, or anticancer drugs, or had x-ray treatments in the past 3 months?
Live-virus vaccines (e.g., MMR, varicella, zoster, LAIV) should be postponed until after chemotherapy or long-term, high-dose steroid therapy has ended. Details and the length of time to postpone vaccination are described elsewhere in this chapter and in the General Recommendations on Immunization.
Has the child received a transfusion of blood or blood products, or been given a medicine called immune (gamma) globulin in the past year?
Certain live virus vaccines (e.g., MMR and varicella) may need to be deferred, depending on the type of blood product and the interval since the blood product was administered. Information on recommended intervals between immune globulin or blood product administration and MMR or varicella vaccination is in Appendix A and in the General Recommendations on Immunization.
Is the person pregnant or is there a chance she could become pregnant during the next month?
Live-virus vaccines (e.g., MMR, varicella, zoster, LAIV) are contraindicated during pregnancy because of the theoretical risk of virus transmission to the fetus. Sexually active young women who receive MMR or varicella vaccination should be instructed to practice careful contraception for 1 month following receipt of either vaccine. On theoretical grounds, inactivated poliovirus vaccine should not be given during pregnancy; however, it may be given if the risk of exposure is imminent (e.g., travel to endemic-disease areas) and immediate protection is needed.
Has the child received vaccinations in the past 4 weeks?
If the child was given either live attenuated influenza vaccine or an injectable live-virus vaccine (e.g., MMR. varicella, yellow fever) in the past 4 weeks, he or she should wait 28 days before receiving another live vaccine. Inactivated vaccines may be given at the same time or at any time before or after a live vaccine.
Every person should be screened for contraindications and precautions before vaccination. Standardized screening forms for both children and adults have been developed by the Immunization Action Coalition and are available at http://www.immunize.org.
0 comments:
Post a Comment