DOCSLIB.ORG

Guide to Contraindications to Vaccinations

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Guide to Contraindications to Vaccinations GUIDE TO CONTRAINDICATIONS TO VACCINATIONS Department of Health & Human Services Centers for Disease Control and Prevention National Immunization Program INTRODUCTION Guide to Contraindications to Vaccination This guide is designed to help immunization providers determine what common symptoms and conditions should contraindicate vaccination and which ones should not. It supersedes the 2000 Guide to Contraindications to Childhood Vaccination and, unlike that and previous Guides, contains information on all licensed U.S. vaccines, not just pediatric vaccines: Anthrax Hepatitis B (HB) Rabies BCG Japanese Encephalitis (JE) Td DTaP MMR Typhoid DT Pneumococcal Conjugate (PCV) Vaccinia (routine, non-emergency use)* Influenza (Flu) Pneumococcal Polysaccharide (PPV) Varicella Hepatitis A (HA) Polio (IPV) Yellow Fever (YF) Using this Guide The Guide is arranged alphabetically according to symptoms and conditons that may, correctly or not, be perceived as contraindications to vaccination. The first column states the symptom or condition. The second column lists individual vaccines, when recommendations differ by vaccine. The third column states whether or not a person with that symptom or condition should be vaccinated. Notes describe exceptions and special situations, or provide additional information. When assessing a patient with multiple symptoms, if any one of them is a contraindication, do not vaccinate. When using a combination vaccine, if there is a contraindication to any of the components, do not vaccinate. *Vaccinia Vaccination During a Smallpox Emergency: No absolute contraindications exist regarding vaccination of a person with a high-risk exposure to smallpox. Persons at greatest risk for experiencing serious vaccination complications are also at greatest risk for death from smallpox. If a relative contraindication to vaccination exists, the risk for experiencing serious vaccination complications must be weighed against the risk for experiencing a potentially fatal smallpox infection. When the level of exposure risk is undetermined, the decision to vaccinate should be made after prudent assessment by the clinician and the patient of the potential risks versus the benefits of smallpox vaccination. The Guide to Contraindications to Vaccinations was developed by the National Immunization Program, Centers for Disease Control and Prevention, using information derived from the Standards for Pediatric Immunization Practices, recommendations of the Advisory Committee on Immunization Practices (ACIP), and those of the Committee on Infectious Diseases (Red Book Committee) of the American Academy of Pediatrics (AAP). Some of these recommendations may differ from those stated in manufacturers’ package inserts. For more details, consult the published recommendations of the ACIP, the AAP, and the American Academy of Family Physicians (AAFP), and manufacturers’ package inserts. September 2003 CHECKLIST (Selected Conditions) CHECK FOR REASON SEE PAGE(S) Anaphylactic allergies Contraindicates some vaccines 1-2 Anaphylactic reaction to previous Contraindicates that vaccine 2 dose of any vaccine Anthrax (prior infection) Contraindicates anthrax vaccine 2 Antimicrobial therapy (current) Precaution for several vaccines 2 Eczema or atopic dermatitis in Contraindicates vaccinia vaccine 3 patient or household contact Guillian-Barré Syndrome, history of Precaution for DTaP and influenza vaccines 4 Hematopoietic stem cell transplant Contraindicates varicella vaccine, 4 precaution for several other vaccines HIV (in recipient) Contraindication or precaution for several 5 vaccines Immune globulin (IG) Precaution for MMR and varicella vaccines 5 administration, recent Illness (moderate to severe acute Deferral of vaccination until recovery may 3, 6, 7, 11 illness, fever, otitis, diarrhea, be prudent vomiting) Immunodeficiency: -Family history -Precaution for varicella vaccine 6 -In household contact -Contraindicates vaccinia and live flu vaccines 6 -In recipient -Contraindication or precaution for several 6 vaccines Neurologic disorder Precaution for DTaP 7 Pregnancy: -In mother or household contact -Contraindicates vaccinia vaccine 7 of recipient -In recipient -Contraindication or precaution for several 8 vaccines Reaction to pevious vaccine dose May be contraindication or precaution for 9 that vaccine Skin condition (acute, chronic or Contraindication for vaccinia vaccine 10 exfoliative) Thrombocytopenic purpura Precaution for MMR vaccine 10 (history) Symptom or Condition Vaccine(s) Vaccinate? Allergies (anaphylactic) to any vaccine component (See Appendix A) All No to 2-phenoxyethanol HA (HAVRIX only) No All Others Yes to alum HA No All Others Yes to baker’s yeast HB No All Others Yes to chlortetracycline hydrochloride Vaccinia No All Others Yes to duck meat or duck feathers All Yes to eggs Flu No (See Note 1) YF No All others Yes Note 1: Protocols have been published for safely administering influenza vaccine to persons with egg allergies. See “Prevention and Control of Influenza,” MMWR 2003;52 (No. RR-8) p. 13. to gelatin Varicella See Note 2 MMR See Note 2 All Others Yes Note 2: If vaccinating persons with a history of an anaphylactic reaction to gelatin or gelatin-containing products with MMR or its component vaccines, or with varicella vaccine, extreme caution should be exercised. Before administering these vaccines to such persons, skin testing for sensitivity to gelatin can be considered. However, no specific protocols for this purpose have been published. to latex All See Note 3 Note 3: If a person reports a severe (anaphylactic) allergy to latex, vaccines supplied in vials or syringes that con- tain natural rubber should not be administered, unless the benefit of vaccination 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 rubber latex can be administered. to neomycin MMR No IPV No Vaccinia No Varicella No All Others Yes to penicillin All Yes 1 Symptom or Condition Vaccine(s) Vaccinate? Allergies, continued to polymyxin B IPV No Vaccinia No All Others Yes to proteins of rodent or neural origin JE No All Others Yes to streptomycin IPV No Vaccinia No All Others Yes nonspecific or nonanaphylactic All Yes in relatives All Yes to thimerosal JE No All Others Yes Anaphylactic (life-threatening) reaction to All No (See Note 4) previous dose of vaccine Note 4: Contraindicates vaccination only with vaccine to which reaction occurred. (Also, see “Allergies,” pp 1 - 2). Anthrax, prior infection Anthrax No All Others Yes Antimicrobial therapy (current) Flu (LAIV only) Yes (See Note 5) Varicella Yes (See Note 6) Typhoid Yes (See Note 7) All Others Yes Note 5: It is not known whether administering influenza antiviral medications affects the safety or efficacy of live, attenuated influenza vaccine (LAIV); LAIV should not be administered until 48 hours following cessation of influenza antiviral therapy, and influenza antiviral medications should not be administered for two weeks following receipt of LAIV. Note 6: Antiviral drugs active against herpesviruses (e.g., acyclovir or valacyclovir) might reduce the efficacy of live attenuated varicella vaccine. These drugs should be discontinued >24 hours before the administration of varicella vaccine, if possible. Note 7: The vaccine manufacturer advises that Ty21a should not be administered to persons receiving sulfon- amides or other antimicrobial agents. Ty21a should be administered >24 hours after an antimicrobial dose. Mefloquine can inhibit the growth of the live Ty21a strain in vitro; if this antimalarial is administered, vaccination with Ty21a should be delayed for 24 hours. Aspirin or salicylate therapy (children or Flu (LAIV only) No adolescents) All Others Yes 2 Symptom or Condition Vaccine(s) Vaccinate? Blood Disorders Flu (LAIV only) See Note 8 (Also see Thrombocytopenia, p. 10) All Others Yes (See Note 9) Note 8: Persons with hemoglobinopathies should not get LAIV. Note 9: When [any] intramuscular vaccine is indicated for a patient with a bleeding disorder or a person receiving anticoagulant therapy, the vaccine should be administered intramuscularly if, in the opinion of a physician familiar with the patient's bleeding risk, the vaccine can be administered with reasonable safety by this route. If the patient receives antihemophilia or similar therapy, intramuscular vaccinations can be scheduled shortly after such therapy is administered. A fine needle (<23 gauge) should be used for the vaccination and firm pressure applied to the site, without rubbing, for >2 minutes. The patient or family should be instructed concerning the risk for hematoma from the injection. Breastfeeding (vaccinate nursing infant) All Yes Breastfeeding (vaccinate lactating mother) Vaccinia No All Others Yes Convalescing from illness All Yes Convulsions (fits, seizures), family history All Yes (See Note 10) (including epilepsy) Note 10: Consider giving acetaminophen before DTaP and every 4 hours thereafter for 24 hours to children who have a personal or a family history of convulsions. (If an underlying neurologic disorder is involved, also see page 7.) Convulsions (fits, seizures) within 3 days of DTaP See Note 11 previous dose of DTaP All Others Yes Note 11: Not a contraindication, but a precaution. Consider carefully the benefits and risks of this vaccine in these circumstances. If the risks are believed to outweigh the benefits,
Load more

Recommended publications
  • Healthcare Personnel Vaccination Recommendations1 Vaccine ­ Recommendations in Brief ­
    Healthcare Personnel Vaccination Recommendations1 Vaccine Recommendations in brief Hepatitis B Give 3-dose series (dose #1 now, #2 in 1 month, #3 approximately 5 months after #2). Give IM. Obtain anti-HBs serologic testing 1–2 months after dose #3. Influenza Give 1 dose of influenza vaccine annually. Give inactivated injectable influenza vaccine intramuscularly or live attenuated influenza vaccine (LAIV) intranasally. MMR For healthcare personnel (HCP) born in 1957 or later without serologic evidence of immunity or prior vaccination, give 2 doses of MMR, 4 weeks apart. For HCP born prior to 1957, see below. Give SC. Varicella For HCP who have no serologic proof of immunity, prior vaccination, or history of varicella disease, (chickenpox) give 2 doses of varicella vaccine, 4 weeks apart. Give SC. Tetanus, diphtheria, Give a one-time dose of Tdap as soon as feasible to all HCP who have not received Tdap previously. pertussis Give Td boosters every 10 years thereafter. Give IM. Meningococcal Give 1 dose to microbiologists who are routinely exposed to isolates of N. meningitidis. Give IM or SC. Hepatitis A, typhoid, and polio vaccines are not routinely recommended for HCP who may have on-the-job exposure to fecal material. Hepatitis B Healthcare personnel (HCP) who perform tasks that may involve exposure to of live rubella vaccine). HCP with 2 documented doses of MMR are not blood or body fluids should receive a 3-dose series of hepatitis B vaccine at recommended to be serologically tested for immunity; but if they are tested 0-, 1-, and 6-month intervals. Test for hepatitis B surface antibody (anti-HBs) and results are negative or equivocal for measles, mumps, and/or rubella, to document immunity 1–2 months after dose #3.
    [Show full text]
  • Mmrv Vaccine
    VACCINE INFORMATION STATEMENT (Measles, Mumps, Many Vaccine Information Statements are available in Spanish and other languages. MMRV Vaccine Rubella and See www.immunize.org/vis Varicella) Hojas de información sobre vacunas están disponibles en español y en muchos otros What You Need to Know idiomas. Visite www.immunize.org/vis These are recommended ages. But children can get the Measles, Mumps, Rubella and second dose up through 12 years as long as it is at least 1 Varicella 3 months after the first dose. Measles, Mumps, Rubella, and Varicella (chickenpox) can be serious diseases: Children may also get these vaccines as 2 separate shots: MMR (measles, mumps and rubella) and Measles varicella vaccines. • Causes rash, cough, runny nose, eye irritation, fever. • Can lead to ear infection, pneumonia, seizures, brain 1 Shot (MMRV) or 2 Shots (MMR & Varicella)? damage, and death. • Both options give the same protection. Mumps • One less shot with MMRV. • Causes fever, headache, swollen glands. • Children who got the first dose as MMRV have • Can lead to deafness, meningitis (infection of the brain had more fevers and fever-related seizures (about and spinal cord covering), infection of the pancreas, 1 in 1,250) than children who got the first dose as painful swelling of the testicles or ovaries, and, rarely, separate shots of MMR and varicella vaccines on death. the same day (about 1 in 2,500). Rubella (German Measles) Your doctor can give you more information, • Causes rash and mild fever; and can cause arthritis, including the Vaccine Information Statements for (mostly in women). MMR and Varicella vaccines.
    [Show full text]
  • (ACIP) General Best Guidance for Immunization
    8. Altered Immunocompetence Updates This section incorporates general content from the Infectious Diseases Society of America policy statement, 2013 IDSA Clinical Practice Guideline for Vaccination of the Immunocompromised Host (1), to which CDC provided input in November 2011. The evidence supporting this guidance is based on expert opinion and arrived at by consensus. General Principles Altered immunocompetence, a term often used synonymously with immunosuppression, immunodeficiency, and immunocompromise, can be classified as primary or secondary. Primary immunodeficiencies generally are inherited and include conditions defined by an inherent absence or quantitative deficiency of cellular, humoral, or both components that provide immunity. Examples include congenital immunodeficiency diseases such as X- linked agammaglobulinemia, SCID, and chronic granulomatous disease. Secondary immunodeficiency is acquired and is defined by loss or qualitative deficiency in cellular or humoral immune components that occurs as a result of a disease process or its therapy. Examples of secondary immunodeficiency include HIV infection, hematopoietic malignancies, treatment with radiation, and treatment with immunosuppressive drugs. The degree to which immunosuppressive drugs cause clinically significant immunodeficiency generally is dose related and varies by drug. Primary and secondary immunodeficiencies might include a combination of deficits in both cellular and humoral immunity. Certain conditions like asplenia and chronic renal disease also can cause altered immunocompetence. Determination of altered immunocompetence is important to the vaccine provider because incidence or severity of some vaccine-preventable diseases is higher in persons with altered immunocompetence; therefore, certain vaccines (e.g., inactivated influenza vaccine, pneumococcal vaccines) are recommended specifically for persons with these diseases (2,3). Administration of live vaccines might need to be deferred until immune function has improved.
    [Show full text]
  • The Safety of Influenza Vaccines in Children
    Vaccine 33 (2015) F1–F67 Contents lists available at ScienceDirect Vaccine j ournal homepage: www.elsevier.com/locate/vaccine Review The safety of influenza vaccines in children: An Institute for Vaccine ଝ,ଝଝ Safety white paper a,b,∗ b,c d a Neal A. Halsey , Kawsar R. Talaat , Adena Greenbaum , Eric Mensah , a,b a,b a,b Matthew Z. Dudley , Tina Proveaux , Daniel A. Salmon a Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States b Institute for Vaccine Safety, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States c Center for Immunization Research, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States d Division of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, MD, United States a r t i c l e i n f o a b s t r a c t Keywords: Most influenza vaccines are generally safe, but influenza vaccines can cause rare serious adverse events. Influenza Some adverse events, such as fever and febrile seizures, are more common in children than adults. There Influenza vaccine can be differences in the safety of vaccines in different populations due to underlying differences in Vaccine safety genetic predisposition to the adverse event. Live attenuated vaccines have not been studied adequately Local reactions following IIV in children under 2 years of age to determine the risks of adverse events; more studies are needed to Cellulitis-like reactions address this and several other priority safety issues with all influenza vaccines in children.
    [Show full text]
  • Recommended Adult Immunization Schedule
    Recommended Adult Immunization Schedule UNITED STATES for ages 19 years or older 2021 Recommended by the Advisory Committee on Immunization Practices How to use the adult immunization schedule (www.cdc.gov/vaccines/acip) and approved by the Centers for Disease Determine recommended Assess need for additional Review vaccine types, Control and Prevention (www.cdc.gov), American College of Physicians 1 vaccinations by age 2 recommended vaccinations 3 frequencies, and intervals (www.acponline.org), American Academy of Family Physicians (www.aafp. (Table 1) by medical condition and and considerations for org), American College of Obstetricians and Gynecologists (www.acog.org), other indications (Table 2) special situations (Notes) American College of Nurse-Midwives (www.midwife.org), and American Academy of Physician Assistants (www.aapa.org). Vaccines in the Adult Immunization Schedule* Report y Vaccines Abbreviations Trade names Suspected cases of reportable vaccine-preventable diseases or outbreaks to the local or state health department Haemophilus influenzae type b vaccine Hib ActHIB® y Clinically significant postvaccination reactions to the Vaccine Adverse Event Hiberix® Reporting System at www.vaers.hhs.gov or 800-822-7967 PedvaxHIB® Hepatitis A vaccine HepA Havrix® Injury claims Vaqta® All vaccines included in the adult immunization schedule except pneumococcal 23-valent polysaccharide (PPSV23) and zoster (RZV) vaccines are covered by the Hepatitis A and hepatitis B vaccine HepA-HepB Twinrix® Vaccine Injury Compensation Program. Information on how to file a vaccine injury Hepatitis B vaccine HepB Engerix-B® claim is available at www.hrsa.gov/vaccinecompensation. Recombivax HB® Heplisav-B® Questions or comments Contact www.cdc.gov/cdc-info or 800-CDC-INFO (800-232-4636), in English or Human papillomavirus vaccine HPV Gardasil 9® Spanish, 8 a.m.–8 p.m.
    [Show full text]
  • Varicella (Chickenpox): Questions and Answers Q&A Information About the Disease and Vaccines
    Varicella (Chickenpox): Questions and Answers Q&A information about the disease and vaccines What causes chickenpox? more common in infants, adults, and people with Chickenpox is caused by a virus, the varicella-zoster weakened immune systems. virus. How do I know if my child has chickenpox? How does chickenpox spread? Usually chickenpox can be diagnosed by disease his- Chickenpox spreads from person to person by direct tory and appearance alone. Adults who need to contact or through the air by coughing or sneezing. know if they’ve had chickenpox in the past can have It is highly contagious. It can also be spread through this determined by a laboratory test. Chickenpox is direct contact with the fluid from a blister of a per- much less common now than it was before a vaccine son infected with chickenpox, or from direct contact became available, so parents, doctors, and nurses with a sore from a person with shingles. are less familiar with it. It may be necessary to perform laboratory testing for children to confirm chickenpox. How long does it take to show signs of chickenpox after being exposed? How long is a person with chickenpox contagious? It takes from 10 to 21 days to develop symptoms after Patients with chickenpox are contagious for 1–2 days being exposed to a person infected with chickenpox. before the rash appears and continue to be conta- The usual time period is 14–16 days. gious through the first 4–5 days or until all the blisters are crusted over. What are the symptoms of chickenpox? Is there a treatment for chickenpox? The most common symptoms of chickenpox are rash, fever, coughing, fussiness, headache, and loss of appe- Most cases of chickenpox in otherwise healthy children tite.
    [Show full text]
  • 2021 Medicare Vaccine Coverage Part B Vs Part D
    CDPHP® Medicare Advantage Vaccine Coverage Guide Part B (Medical) vs. Part D (Pharmacy) Medicare Part B (Medical): Medicare Part D (Pharmacy): Vaccinations or inoculations Vaccinations or inoculations are included when the administration is (except influenza, pneumococcal, reasonable and necessary for the prevention of illness. and hepatitis B for members at risk) are excluded unless they are directly related to the treatment of an injury or direct exposure to a disease or condition. • Influenza Vaccine (Flu) • BCG Vaccine • Pneumococcal Vaccine • Diphtheria/Tetanus/Acellular Pertussis Vaccine (ADACEL, (Pneumovax, Prevnar 13) BOOSTRIX, DAPTACEL, INFANRIX) • Hepatitis B Vaccine • Diphtheria/Tetanus/Acellular Pertussis/Inactivated Poliovirus (Recombivax, Engerix-B) Vaccine (KINRIX, QUADRACEL) for members at moderate • Diphtheria/Tetanus Vaccine (DT, Td, TDVAX, TENIVAC) to high risk • Diphtheria/Tetanus/Acellular Pertussis/Inactivated Poliovirus Vac­ • Other vaccines when directly cine/ Haemophilus Influenzae Type B Conjugate Vaccine (PENTACEL) related to the treatment of an • Diphtheria/Tetanus/Acellular Pertussis/Inactivated Poliovirus injury or direct exposure to a Vaccine/Hepatitis B Vaccine (PEDIARIX) disease or condition, such as: • Haemophilus Influenzae Type B Conjugate Vaccine (ActHIB, PedvaxHIB, • Antivenom Sera Hiberix) • Diphtheria/Tetanus Vaccine • Hepatitis A Vaccine, Inactivated (VAQTA) (DT, Td, TDVAX, TENIVAC) • Hepatitis B Vaccine, Recombinant (ENGERIX-B, RECOMBIVAX HB) • Rabies Virus Vaccine for members at low risk (RabAvert,
    [Show full text]
  • Varicella/Chickenpox (VAR)
    Vaccine Fact Sheet Varicella/Chickenpox (VAR) Brand Name and Manufacturer Varivax® Merck Protects Against Varicella Zoster Virus (chickenpox) Routine Schedule Two (2) dose series: First dose at 12-15 months and second dose at 4-6 years Minimum Intervals Younger than 13 years of age: 3 month minimum interval between doses 13 years of age and older: 4 week minimum interval between doses Approved for use in Persons aged 12 months and older Administration Subcutaneous (SC) injection Packaging Vaccine is packaged as 10 single-dose vials of lyophilized vaccine and a separate box of 10 single-dose 0.7mL vials of sterile diluent Storage Freeze between -58ºF and +5ºF (-50ºC to -15ºC) STORE IN FREEZER PROTECT VACCINE FROM LIGHT Full ACIP Recommendations https://www.cdc.gov/vaccines/hcp/acip-recs/vacc-specific/varicella.html VFC Letter Not available on EZIZ Billing Codes CHDP code: 46 CPT code for vaccine: 90716 CPT code for administration: 90460 Medi-Cal Fee-For-Service (FFS) administration: 90716 with modifiers –SK (high-risk) and –SL (VFC) ICD-10-CM code (encounter for immunization): Z23 *http://www.aafp.org/practice-management/payment/coding/admin.html Comments • Licensed in 1995 • Use only the Merck sterile diluent to reconstitute lyophilized varicella vaccine • Varicella vaccine must be used within 30 minutes of reconstitution • Store sterile diluent separately at room temperature (68ºF to 77ºF) or in the refrigerator • If varicella, MMR, and/or LAIV are not administered at the same visit, they should be separated by at least 28 days. • Persons who are immunocompromised due to certain conditions or treatments or who are pregnant should not be vaccinated with varicella vaccine California Department of Public Health, Immunization Branch IMM-1078 VFCvaccinefactsheet_Varicella (4-17) EZIZ.ORG.
    [Show full text]
  • Vaccinations for Pregnant Women the Table Below Shows Which Vaccinations You May Or May Not Need During Your Pregnancy
    Vaccinations for Pregnant Women The table below shows which vaccinations you may or may not need during your pregnancy. Vaccine Do you need it during your pregnancy? Influenza Yes! You need a flu shot every fall (or even as late as winter or spring) for your protection and for the protection of your baby and others around you. It’s safe to get the vaccine at any time during your pregnancy. Tetanus, diphtheria, Yes! Women who are pregnant need a dose of Tdap vaccine (the adult whooping cough vaccine) during each pregnancy, prefer- whooping cough ably in the early part of the third trimester. It’s safe to be given during pregnancy and will help protect your baby from whooping (pertussis) cough in the first few months after birth when he or she is most vulnerable. After Tdap, you need a Tdap or Td booster dose every Tdap, Td 10 years. Consult your healthcare provider if you haven’t had at least 3 tetanus- and diphtheria-toxoid containing shots some- time in your life or if you have a deep or dirty wound. Human No. This vaccine is not recommended to be given during pregnancy, but if you inadvertently receive it, this is not a cause for papillomavirus concern. HPV vaccine is recommended for all people age 26 or younger, so if you are in this age group, make sure you are HPV vaccinated before or after your pregnancy. People age 27 through 45 may also be vaccinated against HPV after discussion with their healthcare provider. The vaccine is given in 2 or 3 doses (depending on the age at which the first dose is given) over a 6-month period.
    [Show full text]
  • Adult Immunizations
    Guidelines for Clinical Care Ambulatory Immunizations Guideline Team Adult Immunizations Team Leads Susan F Engert, MD, MPH Population: Adults, >18 years old Pediatrics and Communi- cable Diseases Objectives: Implement an evidence-based strategy for routine adult immunizations. Candia B Laughlin, RN, Key Points MS Routine immunizations for adults are: hepatitis A, hepatitis B, herpes zoster, human papilloma virus, Ambulatory Care Nursing Administration influenza, measles, mumps, rubella, meningococcal, pneumococcal, tetanus, diphtheria, pertussis and Team Members varicella. Below is a summary on priority populations, initial vaccination, and revaccination. Margie C Andreae, MD Use combination vaccines whenever possible to increase the coverage rates for vaccine-preventable Pediatrics and Communi- diseases: Tetanus-diphtheria (Td), Tetanus-diphtheria-acellular pertussis (Tdap), Measles-Mumps- cable Diseases Rubella (MMR), hepatitis A-hepatitis B (Twinrix®). Single antigen vaccines have no safety advantage. Mary K.Barry-Bodine, Live virus vaccines (Herpes Zoster, Measles-Mumps-Rubella, Varicella and Live Attenuated Influenza RN, BSN Vaccine) are contraindicated in persons who are pregnant or may become pregnant in the next four Nursing, Health Centers weeks, or who have immunocompromising conditions. If administering multiple live vaccines, give Susan G Blitz, MD, MPH simultaneously or separate them by 4 weeks. Tuberculosis (PPD) skin test should be administered General Medicine before or on the same day as a live virus vaccine or they need to be spaced 4-6 weeks apart. Katie Barwig, RN, MS This guideline follows recommendations of the federal Advisory Committee on Immunization Practices: Nursing Administration These vaccinations should be performed [strength of recommendation] for indicated populations at risk. Sherry L DeLoach, Evidence for each vaccine is based on randomized controlled trials [level of evidence] in general PharmD population and some subgroups, with findings extrapolated to some subgroups.
    [Show full text]
  • Varicella Vaccine Update
    AMERICAN ACADEMY OF PEDIATRICS Committee on Infectious Diseases Varicella Vaccine Update ABSTRACT. Recommendations for routine varicella vaccine coverage are more than 90% for children 19 vaccination were published by the American Academy of to 35 months of age and more than 95% at school Pediatrics in May 1995, but many eligible children re- entry.6 Varicella deaths and severe morbidity, as well main unimmunized. This update provides additional in- as the societal disruption of children missing 5 to 7 formation on the varicella disease burden before the days of school or child care, have prompted states to availability of varicella vaccine, potential barriers to im- consider requirements for varicella immunization for munization, efforts to increase the level of coverage, new safety data, and new recommendations for use of the school and child care center entry. Several states and varicella vaccine after exposure and in children with the District of Columbia already have such require- human immunodeficiency virus infections. Pediatricians ments, and a number of other states have begun the are strongly encouraged to support public health officials implementation process. Children 12 months of age in the development and implementation of varicella im- or older without documentation of varicella immu- munization requirements for child care and school entry. nization or infection who do not have a contraindi- cation should receive a dose of varicella vaccine im- ABBREVIATIONS. AAP, American Academy of Pediatrics; ACIP, mediately. In addition, special emphasis should be Advisory Committee on Immunization Practices; CDC, Centers placed on immunization of susceptible older chil- for Disease Control and Prevention; CI, confidence interval; VZV, dren and adults, because the likelihood of severe varicella-zoster virus; VZIG, varicella-zoster immune globulin.
    [Show full text]
  • Global Advisory Committee on Vaccine Safety (GACVS)
    Global Advisory Committee on Vaccine Safety (GACVS) Report on GACVS meeting June 2013 1 | GACVS June 2013 report Topics Discussed ! Pentavalent vaccine in 4 Asian Countries ! Zoster vaccine safety and varicella vaccine safety in immunocompromised populations ! Immunization during pregnancy ! Yellow fever vaccine safety during mass immunization campaigns in sub-Saharan Africa ! Safety profile: Japanese encephalitis vaccines ! Update: human papillomavirus vaccines ! Update: pandemic influenza vaccine (Pandemrix®) and narcolepsy 2 | GACVS June 2013 report Progressive pentavalent vaccine introduction in 4 Asian Countries ! Sri Lanka (Crucell, Jan 2008): – Within 3 months, 4 deaths and 24 suspected HHE: precautionary suspension of initial lot. – 1 death following immunization April 2009: vaccine suspended, DTwP and Hep B resumed. ! Bhutan (Panacea, Sep 2009) – 5 cases of encephalopathy and/or meningoencephalitis lead to suspended vaccination 23 Oct 2009. (Subsequently, 4 serious AEFI were identified and investigated). ! India (Serum Institute of India, Tamil Nadu and Kerala, Dec 2011; Goa, Pondicherry, Karnataka, Haryana, Jammu and Kashmir, Gujarat and Delhi from Q3 2012 – Q1 2013) – To date, 83 AEFI cases reported, some associated with mortality. ! Vietnam (Crucell, Jun 2010 - May 2013) – 43 serious AEFI investigated, including 27 with fatal outcome. – Following 9 deaths following vaccination reported Dec 2012 - March 2013: vaccine suspended. 3 | GACVS June 2013 report GACVS analysis of common features among countries experiencing significant vaccine safety concerns ! Vaccination programmes are well established and achieves high coverage ! Vaccine introduction was accompanied by thorough training of health-care staff on benefits and risks of vaccine ! Sri Lanka and Bhutan: discontinuation and resumption of pentavalent vaccine did not significantly modify pattern of serious AEFI with previously utilized vaccines ! Limitations in all 4 countries: – Incomplete clinical information complicated causality assessment.
    [Show full text]