Guide to vaccine contraindications and precautions

Contraindications
and Precautions
Guide to Vaccine Contraindications and
Precautions
This guide summarizes CDC's recommendations regarding common symptoms and conditions that do and do not contraindicate vaccines licensed in the United States: Human Papillomavirus (HPV)
Rotavirus
Inﬂuenza (TIV & LAIV)
Japanese Encephalitis (JE)
Hepatitis A (HA)
Meningococcal Vaccines (MPSV & MCV) Vaccinia (non-emergency)
Hepatitis B (HB)
Pneumococcal Vaccines (PPV &PCV)
Varicella
Haemophilus inﬂuenzae type b
Polio (IPV)
Yellow Fever (YF)
The guide is arranged alphabetically according to symptoms and conditions which may, correctly or not, be perceived as contraindications to vaccination. e ﬁrst column states the
•The second column lists
•The third column states whether
symptom or condition.
individual vaccines, when
or not a person with that
recommendations diﬀ er by
symptom or condition should be
vaccine.
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. If there is a contraindication to any component of a combination vaccine, do not use that combination. Contents:

Appendix A: Summary of Contents of Vaccines Licensed in the United States . . . . . . . . 15
Appendix B: Latex in Vaccine Packaging . . . . . . . . . . . . . . . . . . . . . . 20
Appendix C: Reaction After a Previous Dose of Diphtheria-, Tetanus-, or Appendix D: Suggested Intervals Between Administration of Immune Globulin Preparations and Measles- or Varicella-Containing Vaccine . . . . . . . . . . . . . . . . .24 Appendix E: Vaccinia (Smallpox) Vaccine (Routine, Non-Emergency Use) . . . . . . . . . 26
Appendix F: Quick Reference - Contraindications and Precautions to Routine Childhood and Adolescent Vaccinations, By Vaccine . . . . . . . . . . . . . . . . . . .29 Symptom or Condition
Vaccine(s)
Vaccinate?
to any vaccine component (See Appendix A) HA (HAVRIX only) to 2-phenoxyethanol TIONS & PRECAUTIONS to duck meat or duck to gelatin Allergy (anaphylactic) to neomycin to penicillin to polymyxin B to proteins of rodent or neural origin to streptomycin nonspeciﬁ c or nonanaphylactic in relatives Flu (Inactivated) to thimerosal Anaphylactic (life-threatening) reaction to previous dose of vaccine Symptom or Condition
Vaccine(s)
Vaccinate?
Anthrax, prior infection Yes (See Note 5) Yes (See Note 6) Antimicrobial therapy (current) Yes (See Note 7) Yes (See Note 8) Asplenia (anatomic or functional) Aspirin or salicylate therapy (children or Bleeding Disorders Yes (See Note 9) Vaccinate nursing Vaccinate lactating TIONS & PRECAUTIONS Convalescing from illness Convulsions (ﬁts, seizures), family history Yes (See Note 10) (including epilepsy) Diarrhea (See Illness: Concurrent) Encephalopathy (See "Reaction after a previous dose of DTaP," Appendix C) Exposure to infectious disease (recent) Low-grade fever with or without mild illness Fever with moderate to severe illness Flu (Inactivated) Guillain Barré Syndrome (GBS) (history of ) No (See Note 14) Heart Conditions Hematopoietic Stem Cell Transplant (HSCT) Symptom or Condition
Vaccine(s)
Vaccinate?
in recipient (asymptomatic) Typhoid (Ty21a only) TIONS & PRECAUTIONS in recipient Typhoid (Ty21a only) (symptomatic) in household contact IG (Immune Globulin) administration, recent (Either intramuscular or intravenous) Acute: mild (with or without low-grade Acute: moderate to Illness: Concurrent severe (with or without in recipient (hematologic and solid Yes (See Note 29) tumors, congenital Immunodeﬁ ciency immunodeﬁ ciency, long-term Typhoid (Ty21a only) therapy, including "Hematopoietic Stem Cell Transplant" steroids) family history in household contact Symptom or Condition
Vaccine(s)
Vaccinate?
Intussusception, history of Neurologic disorders, underlying (including seizure disorders, cerebral palsy, and developmental delay) mild (with or without low-grade fever) moderate or severe (with or without fever) resolving No (See Note 38) No (See Note 40) TIONS & PRECAUTIONS No (See Note 43) in recipient No (See Note 43) No (See Note 43) in mother or household contact of recipient Yes (See Note 47) Yes (See Note 48) Yes (See Note 49) No (See Note 50) threatening) Reaction to a previous dose of vaccine local (mild-to-moderate soreness, redness, swelling) Reaction after a previous dose of diphtheria-, tetanus-, or pertussis-containing vaccine (See Appendix C) Sudden infant death syndrome (SIDS), family history Steroids (See "Immunodeﬁciency," p. 4) Thrombocytopenia, or history of thrombocytopenic purpura Symptom or Condition
Vaccine(s)
Vaccinate?
Yes (See Note 52) Tuberculin skin testing, performed Yes (See Note 53) simultaneously with vaccination Yes (See Note 53) Tuberculosis (TB) or positive PPD Unvaccinated household contact TIONS & PRECAUTIONS mild (with or without low-grade fever) moderate or severe (with or without fever) Wheezing (recurrent) Zoster (history of ) Note 1: Protocols have been published for safely administering inﬂuenza vaccine to persons with
egg allergies. See "Prevention and Control of Inﬂuenza," MMWR 2008;57 (No. RR-7) References 222-224. 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. Note 3: Some brands or formulations still contain thimerosal as a preservative, or may contain
trace amounts of thimerosal that are a remnant of the manufacturing process. Check the appropriate manufacturer's package insert for more information. Note 4: Contraindicates vaccination only with vaccine to which reaction occurred.
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 inﬂ uenza antiviral medications should not be administered for 2 weeks following receipt of LAIV. Note 6: The vaccine manufacturer advises that Ty21a should not be administered to persons
receiving sulfonamides 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. Note 7: 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 8: "Persons taking chronic acyclovir, famciclovir, or valacyclovir should discontinue these
medications at least 24 hours before administration of zoster vaccine, if possible. Th medications should not be used for at least 14 days after vaccination, by which time the immunologic eﬀect should be established." 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 ﬁ rm 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. 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 5.) Note 11:Persons with moderate or severe illnesses, with or without fever, can be vaccinated as soon as
they are recovering and no longer acutely ill. NOTES Note 12: The decision to give additional doses of DTaP to children who developed GBS within 6
weeks of a prior dose should be based on consideration of the beneﬁts of further vaccination vs. the risk of recurrence of GBS. For example, completion of the primary series in children is justiﬁ ed. Note 13: Whether inﬂuenza vaccination speciﬁcally might increase the risk for recurrence of GBS
is not known; therefore, avoiding vaccinating persons who are not at high risk for severe inﬂuenza complications and who are known to have developed GBS within 6 weeks after a previous inﬂuenza vaccination is prudent. Although data are limited, for the majority of persons who have a history of GBS and who are at high risk for severe complications from inﬂuenza, the established beneﬁts of inﬂuenza vaccination justify yearly vaccination. Note 14:CDC recommends that persons with a history of GBS not receive MCV, although persons
with a history of GBS at especially high risk for meningococcal disease (i.e., microbiologists routinely exposed to isolates of Neisseria meningitidis) might consider vaccination. Note 15:Not a contraindication, but providers should evaluate the risks and beneﬁts of administering
Tdap or Td. If a decision is made to continue vaccination with tetanus toxoid, Tdap is preferred to Td if otherwise indicated. Note 16:Persons with chronic disorders of the cardiovascular system should not get live attenuated
inﬂ uenza vaccine. Note 17: Speciﬁc vaccines are recommended, or may be given, at varying times after transplant and
under certain circumstances. For some vaccines, no data exist. Use of live vaccines is
indicated only among immunocompetent persons and is contraindicated for recipients
after HSCT who are not presumed immunocompetent. HSCT recipients are presumed
immunocompetent at >24 months after HSCT if they are not on immunosuppressive
therapy and do not have graft-versus-host disease. For more information, see "Guidelines
for Preventing Opportunistic Infections Among Hematopoietic Stem Cell Transplant
Recipients" (MMWR 2000; 49 [No RR-10]), especially Tables 4 and 6; and ACIP's "General
Recommendations on Immunization" (MMWR 2006; [No RR-15]:28).
Note 18:MMR vaccination is recommended for all asymptomatic HIV-infected persons who do not
have evidence of severe immunosuppression and for whom measles vaccination would otherwise be indicated. [For deﬁnition of severe immunosuppression, see 2006 AAP Red Book, Table 3.25, p. 382.] Note 19:Consider the potential risks and beneﬁts of administering rotavirus vaccine to infants
with known or suspected altered immunocompetence. Children and adults who are immunocompromised because of congenital immunodeﬁ ciency, hematopoietic transplantation, or solid organ transplantation sometimes experience severe, prolonged, and even fatal rotavirus gastroenteritis. However, no safety or eﬃcacy data are available for the administration of rotavirus vaccine to infants who are potentially immunocompromised, including . . infants with primary and acquired immunodeﬁciency states, including HIV/ AIDS or other clinical manifestations of infection with HIV. Data are insuﬃ clinical trials to support administration of rotavirus vaccine to infants with indeterminant HIV status who are born to mothers with HIV/AIDS. Note 20:Children aged 1-8: HIV-infected children with CD4+ T-lymphocyte percentage >15%
should be considered for vaccination with the single-antigen varicella vaccine (2 doses
administered 3 months apart). Adolescents and adults: Data are lacking; however,
weighing the risk for severe disease from wild VZV and potential beneﬁt of vaccination, vaccination may be considered (2 doses, administered 3 months apart) for HIV-infected persons with CD4+T-lymphocyte count >200 cells/μL in these age groups. Because data are not available on safety, immunogenicity or eﬃcacy of MMRV vaccine in HIV infected children, MMRV should not be used when vaccinating these children. Note 21:MMR vaccination should be considered for all symptomatic HIV-infected persons who do
not have evidence of severe immunosuppression or of measles immunity. [For deﬁ nition of severe immunosuppression, see 2006 AAP Red Book, Table 3.25, p. 382.] Note 22:Zoster vaccine should not be administered to persons with primary or acquired
immunodeﬁciency including persons with AIDS or other clinical manifestations of HIV, including persons with CD4+ T-lymphocyte values <200 per mm3 or <15% of total lymphocytes. Note 23:Do not give immune globulin products and MMR simultaneously. If unavoidable, give
at diﬀerent sites and revaccinate or test for seroconversion in 3 months. If MMR is given ﬁrst, do not give IG for 2 weeks. If IG is given ﬁrst, the interval between IG and measles vaccination depends on the product, the dose, and the indication (see Appendix D). Because of the importance of rubella immunity among childbearing-age women, the postpartum vaccination of rubella-susceptible women with rubella or MMR vaccine should not be delayed because of receipt of anti-Rho(D) globulin or any other blood product during the last trimester of pregnancy or at delivery. These women should be vaccinated immediately after delivery and, if possible, tested >3 months later to ensure immunity to rubella and, if necessary, to measles. Note 24:Do not give varicella vaccine for 3-11 months (see Appendix D) after administration of
blood (except washed red blood cells) or after plasma tranfusions or IG. Do not give antibody-containing products for 2 weeks after vaccination unless the beneﬁts exceed those of vaccination. In such instances, either revaccinate or test for immunity at the appropriate intervals, and revaccinate if seronegative. Note 25:If nasal congestion is present that might impede delivery of the vaccine to the
nasopharyngeal mucosa, deferral of administration should be considered until resolution of the illness, or TIV should be administered instead. Note 26:Persons with asthma, reactive airways disease or other chronic disorders of the pulmonary
or cardiovascular systems and persons with other underlying medical conditions, including metabolic diseases such as diabetes, renal dysfunction, and hemoglobinopathies should not receive LAIV. NOTES Note 27:Consider the potential risks and beneﬁts of administering rotavirus vaccine to infants with
preexisting chronic gastrointestinal disease (e.g., congenital malabsorption syndromes, Hirschsprung's disease, short-gut syndrome, persistent vomiting of unknown cause). Infants with chronic gastrointestinal conditions who are not undergoing immunosuppressive therapy should beneﬁt from rotavirus vaccine, and the beneﬁts outweigh the theoretical risks. However, the safety and eﬃcacy of rotavirus vaccine have not been established for infants with these conditions. Note 28: The great majority of persons with chronic illnesses should be appropriately vaccinated. Th
decision whether or not to vaccinate these persons, and what vaccines to give, should be made on an individual basis. Note 29:When cancer chemotherapy or other immunosuppressive therapy is being considered
(e.g., for patients with Hodgkins disease or those who undergo organ or bone marrow transplantation), the interval between vaccination and initiation of immunosuppressive therapy should be at least 2 weeks. Vaccination during chemotherapy or radiation therapy should be avoided. Note 30:Preexposure: Patients who are immunosuppressed by disease or medications should
postpone preexposure vaccinations and consider avoiding activities for which rabies
preexposure prophylaxis is indicated. When this course is not possible, immunosuppressed
persons who are at risk for rabies should be vaccinated by the IM route and their antibody
titers checked. Failure to seroconvert after the third dose should be managed in consultation
with appropriate public health oﬃcials. Postexposure: Immunosuppressive agents should
not be administered during postexposure therapy unless essential for treatment of other
conditions. When postexposure prophylaxis is administered to an immunosuppressed
person, it is especially important that a serum sample be tested for rabies antibody to ensure
that an acceptable antibody response has developed.
Note 31:Varicella vaccine should not be administered to persons who have cellular
immunodeﬁciencies, but persons with impaired humoral immunity may be vaccinated. Vaccination of leukemic children who are in remission and who do not have evidence of immunity to varicella should be undertaken only with expert guidance and with the availability of antiviral therapy should complications ensue. Persons without evidence of immunity who are receiving systemic steroids for certain conditions (e.g., asthma) and who are not otherwise immunocompromised may be vaccinated if they are receiving <2 mg/kg of body weight or a total of <20 mg/day of prednisone or its equivalent. Note 32: Zoster vaccine should not be administered to:
• Persons with leukemia, lymphomas, or other malignant neoplasms affecting the bone marrow or lymphatic system. • Persons on immunosuppressive therapy, including high-dose corticosteroids (>20 mg/day of prednisone or equivalent) lasting two or more weeks. Defer vaccination for at least 1 months after discontinuation of such therapy. • Persons with clinical or laboratory evidence of other unspecified cellular immunodeficiency. • Persons receiving recombinant human immune mediators and immune modulators, especially the antitumor necrosis factor agents adalimumab, infliximab, and etanercept. If it is not possible to administer zoster vaccine to patients before initiation of therapy, assess the immune status of the recipient on a case-by-case basis to determine the relevant risks and benefits. Otherwise, defer vaccination for at least 1 month after discontinuation of such therapy. Zoster vaccine may be administered to:
• Patients whose leukemia is in remission and who have not received chemotherapy or radiation for at least 3 months. • Persons on short-term corticosteroid therapy (<14 days); low to moderate dose (<20 mg/ day of prednisone or equivalent); topical; intra-articular, bursal, or tendon injections; or long-term alternate-day treatments with low to moderate doses of short-acting systemic corticosteroids. • Persons on therapy with low doses of methotrexate (<0.4 mg/Kg/week), azathioprine (<3.0 mg/Kg/day), or 6-mercaptopurine (<1.5 mg/Kg/day) for treatment of rheumatoid arthritis, psoriasis, polymyositis, sarcoidosis, inflammatory bowel disease, and other conditions. • Persons with impaired humoral immunity (e.g., hypogammaglobulinemia or
dysgammaglobulinemia). Note 33:Varicella vaccine should not be administered to a person with a family history of congenital
or hereditary immunoceﬁdiency in parents or siblings unless that person's immune competence has been clinically substantiated or veriﬁed by a laboratory. Note 34:TIV is preferred for vaccinating household members, healthcare personnel, and others who
have close contact with severely immunosuppressed persons during those periods in which the immunosuppressed person requires care in a protective environment. No preference is indicated for TIV use by those who have close contact with persons with lesser degrees of immunosuppression. Note 35:Data suggest that infants with a history of intussusception might be at higher risk for a
repeat episode than other infants. Therefore, until postlicensure data on safety of rotavirus vaccine is available, the risks and beneﬁts of vaccination should be considered when vaccinating infants with a previous episode of intussusception. Note 36:Whether and when to administer DTaP to children with proven or suspected underlying
neurologic disorders should be decided individually. Generally, infants and children with stable neurologic conditions, including well-controlled seizures, may be vaccinated. Note 37:ACIP recommends that children with progressive neurologic conditions not be vaccinated
with Tdap until the condition stabilizes. Chronic progressive neurologic conditions that are stable in adults do not constitute a reason to delay Tdap; this is in contrast to unstable or evolving neurologic conditions (e.g., cerebrovascular events and acute encephalopathic conditions). Note 38:Pregnant women should be vaccinated against anthrax only if the potential beneﬁ ts of
vaccination outweigh the potential risks to the fetus. Note 39: The theoretical risk to the developing fetus is expected to be low. The risk associated with
vaccination should be weighed against the risk for hepatitis A in women who may be at high risk for exposure to hepatitis A virus. NOTES Note 40:HPV vaccine is not recommended for use in pregnancy. It has not been causally associated
with adverse outcomes of pregnancy or adverse events in the developing fetus. However, until additional information is available, initiation of the vaccine series should be delayed until after completion of the pregnancy. If a woman is found to be pregnant after initiating the vaccination series, the remainder of the 3-dose regimen should be delayed until after completion of the pregnancy. A vaccine in pregnancy registry has been established; report any exposure to HPV vaccine during pregnancy to 800-986-8999. No intervention is needed. Note 41:If a pregnant woman is at increased risk for infection and requires immediate protection
against polio, IPV can be administered in accordance with the recommended schedules for adults. Note 42:Pregnant women who must travel to an area where risk of JE is high should be vaccinated
when the theoretical risks of immunization are outweighed by the risk of infection to the mother and developing fetus. Note 43:Women should avoid becoming pregnant for 4 weeks following vaccination.
Note 44:Vaccine is not contraindicated, but no data exist on its use among pregnant women.
Note 45:ACIP recommends Td when tetanus and diphtheria protection is required during pregnancy.
In some situations, health-care providers can choose to administer Tdap instead of Td to add protection against pertussis. When Td or Tdap is administered during pregnancy, the second or third trimester is preferred. Data on safety, immunogenicity and the outcomes of pregnancy are not available for pregnant women who receive Tdap. Providers who choose to administer Tdap to pregnant women should discuss the lack of data with the pregnant women and are encouraged to report Tdap administration, regardless of the trimester, to the appropriate manufacturer's pregnancy registry (Boostrix to GlaxoSmithKline at 1-888-8255349; Adacel to sanoﬁ pasteur at 1-800-822-2463). Note 46:Pregnant women should not be routinely vaccinated on theoretical grounds, and travel to
areas where yellow fever is present should be postponed until after delivery. If international travel requirements constitute the only reason to vaccinate a pregnant woman, rather than an increased risk of infection, eﬀorts should be made to obtain a waiver letter from the traveler's physician. Pregnant women who must travel to areas where the risk of yellow fever is high should be vaccinated. Note 47:HBsAg-Negative Mother: Preterm infants weighing <2,000 g and born to HBsAg-negative
mothers should have their ﬁrst vaccine dose delayed until 1 month after birth or hospital discharge. For these infants, a copy of the original laboratory report indicating that the mother was HBsAg negative during this pregnancy should be placed in the infant's medical record.
HBsAg-Positive
Mother: For preterm infants weighing <2,000 g, the initial vaccine dose
(birth dose) should not be counted as part of the vaccine series because of the potentially reduced immunogenicity of hepatitis B vaccine in these infants; 3 additional doses of vaccine (for a total of 4 doses) should be administered beginning at age 1 or 2 months. Mother's HBsAg Status Unknown: Preterm infants weighing <2,000 g should receive both
single-antigen hepatitis B vaccine and HBIG (0.5 mL) if the mother's HBsAg status cannot be determined within 12 hours of birth. The birth dose of vaccine should not be counted as part of the 3 doses required to complete the vaccine series; 3 additional doses of vaccine (for a total of 4 doses) should be administered according to a recommended schedule on the basis of the mother's HBsAg test result. Note 48:ACIP supports vaccination of prematurely born infants with rotavirus vaccine if they are at
least 6 weeks of age, are being or have been discharged from the hospital nursery, and are clinically stable. Note 49: The appropriate age for initiating vaccinations in the prematurely born infant is the usual
chronological age (same dosage and indications as for normal, full-term infants). Note 50:Contraindicates vaccination only with vaccine to which reaction occurred. If tetanus toxoid
is contraindicated for someone who has not completed a primary tetanus series and that person has a wound that is neither clean nor minor, give only passive vaccination, using tetanus immune globulin (TIG). Note 51:Consider the beneﬁts of immunity to measles, mumps, and rubella vs. the risk of recurrence
or exacerbation of thrombocytopenia after vaccination, or risk from natural infections of measles or rubella. In most instances, the beneﬁts of vaccination will be much greater than the potential risks and will justify giving MMR, particularly in view of the even greater risk of thrombocytopenia following measles or rubella disease. However, if a prior episode of thrombocytopenia occurred near the time of vaccination, it might be prudent to avoid a subsequent dose. (Also applies to MMRV.) Note 52:Measles vaccination may temporarily suppress tuberculin reactivity. MMR vaccine may be
given after, or on the same day as, TB testing. If MMR has been given recently, postpone the TB test until 4-6 weeks after administration of MMR. If giving MMR simultaneously with tuberculin skin test, use the Mantoux test, not multiple puncture tests, because the latter, if results are positive, require conﬁrmation (and conﬁrmation would then have to be postponed 4-6 weeks). Note 53:No data exist for the potential degree of PPD suppression that might be associated with
other parenteral live attenuated virus vaccines. Nevertheless, in the absence of data, following guidelines for measles-containing vaccine when scheduling PPD screening and administering other parenteral live attenuated virus vaccines is prudent. Note 54:A theoretical basis exists for concern that measles vaccine might exacerbate tuberculosis.
Consequently, before administering MMR to persons with untreated active tuberculosis, initiating antituberculosis therapy is advisable. Note 55:Although no data exist regarding whether either varicella or live varicella virus vaccine
exacerbates tuberculosis, vaccination is not recommended for persons who have untreated, active tuberculosis. Note 56:LAIV should not be administered to children younger than 5 years of age with recurrent
APPENDICES Appendices:
Appendix A: Summary of Contents of Vaccines Licensed in the United States . . . . . . . . 15
Appendix B: Latex in Vaccine Packaging . . . . . . . . . . . . . . . . . . . . . . 20
Appendix C: Reaction After a Previous Dose of Diphtheria-, Tetanus-, or Appendix D: Suggested Intervals Between Administration of Immune Globulin Preparations and Measles- or Varicella-Containing Vaccine . . . . . . . . . . . . . . . . .24 Appendix E: Vaccinia (Smallpox) Vaccine (Routine, Non-Emergency Use) . . . . . . . . . 26
Appendix F: Quick Reference - Contraindications and Precautions to Routine Childhood and Adolescent Vaccinations, By Vaccine . . . . . . . . . . . . . . . . . . .29 Summary of Contents of Vaccines Licensed in
the United States
The ACIP speciﬁes that severe allergies to certain substances contraindicate speciﬁc vaccines (see "Allergies," pages 1 & 2). But ACIP also makes the general statement that a "serious allergic reaction [e.g., anaphylaxis] to a vaccine component" is a contraindication to any vaccine containing that component. This table lists vaccine components (e.g., adjuvants and preservatives) found in all U.S. vaccines, as well as substances used during the manufacturing process, including vaccine-production media, that are removed from the ﬁnal product and present only in trace quantities. If in doubt about the contents of a particular vaccine, check the current package insert. In addition to the substances listed, most vaccines contain Sodium Chloride (table salt). Contains
Aluminum Hydroxide, Amino Acids, Benzethonium Chloride, Formaldehyde or Formalin, Inorganic Salts and Sugars, Vitamins Asparagine, Citric Acid, Lactose, Glycerin, Iron Ammonium Citrate, Magnesium Sulfate, Potassium Phosphate Aluminum Phosphate, Ammonium Sulfate, Casamino Acid, Dimethyl-beta-cyclodextrin, Formaldehyde or Formalin, Glutaraldehyde, 2-Phenoxyethanol Aluminum Hydroxide, Bovine Extract, Formaldehyde or Formalin, Glutaraldhyde, 2-Phenoxyethanol, Polysorbate 80 Aluminum Potassium Sulfate, Ammonium Sulfate, Bovine Extract, Formaldehyde or Formalin, Gelatin, Polysorbate 80, Sodium Phosphate, Th Aluminum Potassium Sulfate, Ammonium Sulfate, Bovine Extract, Formaldehyde or DTaP/Hib (TriHIBit) Formalin, Gelatin, Polysorbate 80, Sucrose, Th Aluminum Hydroxide, Bovine Extract, DTaP/IPV (Kinrix) Formaldehyde, Gluteraldehyde, Monkey Kidney Cells, Neomycin, Polymyxin B, Polysorbate 80 Contains
Aluminum Hydroxide, Aluminum Phosphate, Bovine Protein, Lactalbumin Hydrolysate, Formaldehyde or Formalin, Glutaraldhyde, DTaP/HepB/IPV (Pediarix) Monkey Kidney Tissue, Neomycin, 2-Phenoxyethanol, Polymyxin B, Polysorbate 80, Th imerosal*, Yeast Protein 2-phenoxyethanol, Aluminum Phosphate, Bovine Serum Albumin, Casamino Acid, Formaldehyde, DTaP/Hib/IPV (Pentacel) Gluteraldehyde, MRC-5 Cellular Protein, Neomycin, Polymyxin B, Polysorbate 80 Aluminum Potassium Sulfate, Bovine Extract, Formaldehyde or Formalin, Th imerosal (multi imerosal* (single-dose) DT (Massachusetts) Aluminum Hydroxide, Formaldehyde or Formalin Ammonium Sulfate, Formaldehyde or Formalin, Aluminum Hydroxyphosphate Sulfate Amino Acids, Aluminum Hydroxyphosphate Sulfate, Dextrose, Formaldehyde or Formalin, Hib/Hep B (Comvax) Mineral Salts, Sodium Borate, Soy Peptone, Yeast Protein Aluminum Hydroxide, Amino Acids, Formaldehyde or Formalin, MRC-5 Cellular Protein, Neomycin Sulfate, 2-Phenoxyethanol, Phosphate Buﬀ ers, Polysorbate Aluminum Hydroxyphosphate Sulfate, Bovine Albumin or Serum, DNA, Formaldehyde or Formalin, MRC-5 Cellular Protein, Sodium Borate Aluminum Hydroxide, Phosphate Buﬀ ers, Hep B (Engerix-B) imerosal*, Yeast Protein Aluminum Hydroxyphosphate Sulfate, Amino Acids, Dextrose, Formaldehyde or Formalin, Hep B (Recombivax) Mineral Salts, Potassium Aluminum Sulfate, Soy Peptone, Yeast Protein Aluminum Hydroxide, Aluminum Phosphate, Amino Acids, Dextrose, Formaldehyde or Formalin, Inorganic Salts, MRC-5 Cellular HepA/HepB (Twinrix) Protein, Neomycin Sulfate, 2-Phenoxyethanol, Phosphate Buﬀers, Polysorbate 20, Th Vitamins, Yeast Protein Contains
Amino Acids, Amorphous Aluminum Hydroxyphosphate Sulfate, Carbohydrates, Human Papillomavirus (HPV) (Gardasil) L-histidine, Mineral Salts, Polysorbate 80, Sodium Borate, Vitamins Beta-propiolactone, Calcium Chloride, Ovalbumin, Neomycin Sulfate, Polymyxin B, Inﬂ uenza (Aﬂ uria) Potassium Chloride, Potassium Phosphate, Sodium Phosphate, Sodium Taurodeoxycholate, Thimerosal (multidose containers) Egg Albumin (Ovalbumin), Egg Protein, Formaldehyde or Formalin, Gentamicin, Inﬂ uenza (Fluarix) Hydrocortisone, Octoxynol-10, α-Tocopheryl Hydrogen Succinate, Polysorbate 80, Sodium Deoxycholate, Sodium Phosphate, Th Egg Albumin (Ovalbumin), Egg Protein, Inﬂ uenza (Flulaval) Formaldehyde or Formalin, Sodium Deoxycholate, Phosphate Buﬀ ers, Th Beta-Propiolactone , Egg Protein, Neomycin, Polymyxin B, Polyoxyethylene 9-10 Nonyl Inﬂ uenza (Fluvirin) Phenol (Triton N-101, Octoxynol 9), Th (multidose containers), Th imerosal* (single-dose Egg Protein, Formaldehyde or Formalin, Inﬂ uenza (Fluzone) Gelatin, Octoxinol-9 (Triton X-100), Th (multidose containers) Chick Kidney Cells, Egg Protein, Gentamicin Inﬂ uenza (FluMist) Sulfate, Monosodium Glutamate, Sucrose Phosphate Glutamate Buﬀ er Calf Serum Protein, Formaldehyde or Formalin, Monkey Kidney Tissue, Neomycin, 2-Phenoxyethanol, Polymyxin B, Streptomycin Formaldehyde or Formalin, Gelatin, Mouse Serum Japanese Encephalitis (JE-Vax) Protein, Polysorbate 80, Th Amino Acid, Bovine Albumin or Serum, Chick Embryo Fibroblasts, Gelatin, Glutamate, Human Measles (Attenuvax) Albumin, Neomycin, Phosphate, Sodium Phosphate, Sorbitol, Sucrose, Vitamins Meningococcal (Menactra) Formaldehyde or Formalin, Phosphate Buﬀ ers Meningococcal (Menomune) Lactose, Thimerosal (10-dose vials only) Contains
Amino Acid, Bovine Albumin or Serum, Chick Embryo Fibroblasts, Human Serum Albumin, Mumps (Mumpsvax) Gelatin, Glutamate, Neomycin, Phosphate Buﬀers, Sorbitol, Sucrose, Vitamins Amino Acid, Bovine Albumin or Serum, Chick Embryo Fibroblasts, Human Serum Albumin, Gelatin, Glutamate, Neomycin, Phosphate Buﬀers, Sorbitol, Sucrose, Vitamins Bovine Albumin or Serum, Gelatin, Human Serum Albumin, Monosodium L-glutamate, MRC-5 Cellular Protein, Neomycin, Sodium Phosphate Dibasic, Sodium Bicarbonate, Sorbitol, Sucrose, Potassium Phosphate Monobasic, Potassium Chloride, Potassium Phosphate Dibasic Pneumococcal (Pneumovax) Bovine Protein, Phenol Aluminum Phosphate, Amino Acid, Soy Peptone, Pneumococcal (Prevnar) Human Serum Albumin, Beta-Propiolactone, MRC-5 Cellular Protein, Neomycin, Phenol Red (Phenolsulfonphthalein), Vitamins Amphotericin B, Beta-Propiolactone , Bovine Albumin or Serum, Chicken Protein, Rabies (RabAvert) Chlortetracycline, Egg Albumin (Ovalbumin), Ethylenediamine-Tetraacetic Acid Sodium (EDTA), Neomycin, Potassium Glutamate Cell Culture Media, Fetal Bovine Serum, Sodium Citrate, Sodium Phosphate Monobasic Rotavirus (RotaTeq) Monohydrate, Sodium Hydroxide Sucrose, Polysorbate 80 Amino Acids, Calcium Carbonate, Dextran, Rotavirus (Rotarix) Dulbecco's Modiﬁed Eagle Medium (DMEM), Sorbitol, Sucrose, Xanthan Bovine Albumin or Serum, Gelatin, Human Rubella (Meruvax II) Serum Albumin, Neomycin, Phosphate Buﬀ ers, Sodium Phosphate, Sorbitol Aluminum Potassium Sulfate, Bovine Extract, Formaldehyde or Formalin, 2-Phenoxyethanol, Peptone, Th Contains
Aluminum Hydroxide, Aluminum Phosphate, Td (Massachusetts) Formaldehyde or Formalin, Th multidose containers) Aluminum Phosphate, Formaldehyde or Formalin, Glutaraldehyde, 2-Phenoxyethanol Aluminum Hydroxide, Bovine Extract, Formaldehyde or Formalin, Glutaraldehyde, Polysorbate 80 Disodium Phosphate, Monosodium Typhoid (inactivated – Typhim Vi) Phosphate, Phenol, Polydimethylsilozone, Hexadecyltrimethylammonium Bromide Amino Acids, Ascorbic Acid, Bovine Protein, Typhoid (oral – Ty21a) Casein, Dextrose, Galactose, Gelatin, Lactose, Magnesium Stearate, Sucrose, Yeast Extract Glycerin, Human Serum Albumin, Neomycin, Vaccinia (ACAM2000) Phenol, Polymyxin B Bovine Albumin or Serum, Ethylenediamine-Tetraacetic Acid Sodium (EDTA), Gelatin, Monosodium L-Glutamate, MRC-5 DNA and Varicella (Varivax) Cellular Protein, Neomycin, Potassium Chloride, Potassium Phosphate Monobasic, Sodium Phosphate Monobasic, Sucrose Yellow Fever (YF Vax) Egg Protein, Gelatin, Sorbitol Bovine Calf Serum, Hydrolyzed Porcine Gelatin, Monosodium L-glutamate, MRC-5 DNA and Zoster (Zostavax) Cellular Protein, Neomycin, Potassium Phosphate Monobasic, Potassium Chloride, Sodium Phosphate Dibasic, Sucrose *Where "thimerosal" is marked with an asterisk (*) it indicates that the product should be considered equivalent to thimerosal-free products. This vaccine may contain trace amounts (<3 mcg) of mercury left after post-production thimerosal removal, but these amounts have no biological eﬀ ect. JAMA 1999;282(18) and JAMA 2000;283(16) Adapted from Grabenstein JD. ImmunoFacts: Vaccines & Immunologic Drugs. St. Louis, MO: Wolters Kluwer Health Inc.; 2006 and individual products' package inserts. All reasonable eﬀorts have been made to ensure the accuracy of this information, but manufacturers may change product contents before that information is reﬂ ected here. APPENDIX Latex in Vaccine Packaging
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 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. The following table is accurate, to the best of our knowledge, as of July 2008. If in doubt, check the package insert for the vaccine in question. YES – Diluent vial NO – Lyophilized vaccine vial YES – Syringe YES – Syringe Japanese Encephalitis (JE-Vax) Measles (Attenuvax) Mumps (Mumpsvax) Rubella (Meruvax II) YES – Applicator NO– Vial & Transfer Adapter Varicella (Varivax) Yellow Fever (YF-Vax) Zoster (Shingles) (Zostavax) APPENDIX Reaction After a Previous Dose of Diphtheria-,
Tetanus- or Pertussis-Containing Vaccine
Symptom or Condition
Vaccinate?
Arthus reaction, following tetanus- and/ or diphtheria toxoid-containing vaccine Collapse or shock-like state within 48 hours of Encephalopathy within 7 days after dose, not Tdap attributable to an identiﬁ able cause Extensive limb swelling that was not an Arthus Yes (See Note C3) Family history of any adverse event after a Yes (See Note C3) Fever of <40.5°C (105°F) within 48 hours See Notes C2 & C3 Fever of >40.5°C (105°F) within 48 hours after a dose, not attributable to another cause Guillain-Barré syndrome (GBS) within 6 weeks after a dose Persistent, inconsolable crying lasting for 3 or more hours, occurring within 48 hours of a See Notes C2 & C3 Seizures within 3 days after a dose Note C1: Providers should carefully review the medical history to verify the diagnosis of an Arthus
reaction, and can consult with an allergist or immunologist. If an Arthus reaction was likely, consider deferring DTaP, Tdap or Td vaccination until at least 10 years have elapsed since the last tetanus toxoid-containing and/or diphtheria toxoid-containing vaccine was received. If the Arthus reaction was associated with a vaccine that contained diphtheria toxoid without tetanus toxoid (e.g., MCV), deferring Tdap or Td might leave the patient inadequately protected against tetanus. In this situation, if the last tetanus toxoid-containing vaccine was >10 years earlier, providers can obtain a serum antitetanus level to evaluate the need for tetanus vaccination (antitetanus levels >0.1 IU/mL are considered protective) or administer TT. Note C2: Not a contraindication, but a precaution. Consider carefully the beneﬁts and risks of
this vaccine under these circumstances. If the risks are believed to outweigh the beneﬁ ts, withhold the vaccination; if the beneﬁts are believed to outweigh the risks (for example, during an out-break or foreign travel), give the vaccine. Note C3: Consider giving acetaminophen before DTaP and every 4 hours thereafter for 24 hours.
Note C4: The decision to give additional doses of DTaP should be based on consideration of the
beneﬁts of further vaccination vs. the risk of recurrence of GBS. For example, completion of the primary series in children is justiﬁ ed. Note C5: Not a contraindication, but providers should evaluate the risks and beneﬁ ts of
administering Tdap or Td. If a decision is made to continue vaccination with tetanus toxoid, Tdap is preferred to Td if otherwise indicated. APPENDIX Suggested Intervals Between Administration of
Immune Globulin Preparations and Measles- or
Varicella-Containing Vaccine (Does not include zoster
vaccine [Zostavax])
Recommended
interval before
Dose, including mg
measles- or
Product / Indication
immunoglobulin G
(IgG)/kg body weight
containing
RSV monoclonal antibody (SynagisTM)1 15 mg/kg intramuscularly (IM) Tetanus IG (TIG) 250 units (10 mg IgG/kg) IM Hepatitis A IG Contact 0.02 mL/kg (3.3 mg IgG/kg) IM 0.06 mL/kg (10 mg IgG/kg) IM Hepatitis B IG (HBIG) 0.06 mL/kg (10 mg IgG/kg) IM Rabies IG (HRIG) 20 IU/kg (22 mg IgG/kg) IM Measles prophylaxis IG Standard (i.e., non- 0.25 mL/kg (40 mg IgG/kg) IM immunocompromised) contact Immunocompromised contact 0.50 mL/kg (80 mg IgG/kg) IM Blood tranfusion Red blood cells (RBCs), washed 10 mL/kg negligible IgG/kg intravenously (IV) RBCs, adenine-saline added 10 mL/kg (10 mg IgG/kg) IV Packed RBCs (Hct 65%)2 10 mL/kg (60 mg IgG/kg) IV Whole blood (Hct 35%-50%)2 10 mL/kg (80-100 mg IgG/kg) IV 6 months Plasma/platelet 10 mL/kg (160 mg IgG/kg) IV Cytomegalovirus intravenous immune 150 mg/kg maximum Replacement therapy for immune deﬁ ciencies3 300-400 mg/kg IV3 Immune thrombocytopenic purpura 400 mg/kg IV Immune thrombocytopenic purpura 1000 mg/kg IV Postexposure varicella prophylaxis4 This table is not intended for determining the correct indications and dosages for using antibody- containing products. Unvaccinated persons might not be fully protected against measles during the entire recommended interval, and additional doses of immune globulin or measles vaccine might be indicated after measles exposure. Concentrations of measles antibody in an immune globulin preparation can vary by manufacturer's lot. Rates of antibody clearance after receipt of an immune globulin preparation also might vary. Recommended intervals are extrapolated from an estimated half-life of 30 days for passively acquired antibody and an observed interference with the immune response to measles vaccine for 5 months after a dose of 80 mg IgG/kg. Note 1: Contains antibody only to respiratory syncytial virus. Note 2: Assumes a serum IgG concentration of 16 mg/mL. Note 3: Measles and varicella vaccinations are recommended for children with asymptomatic or mildly symptomatic human immunodeﬁciency virus (HIV) infection but are contraindicated for persons with severe immunosuppression from HIV or any other immunosuppressive disorder. Note 4: The investigational product VariZIG, similar to licensed VZIG, is a puriﬁ ed human immune globulin preparation made from plasma containing high levels of anti-varicella antibodies (immunoglobulin class G [IgG]). When indicated, health-care providers should make every eﬀort to obtain and administer VariZIG. In situations in which administration of VariZIG does not appear possible within 96 hours of exposure, administration of immune globulin intravenous (IGIV) should be considered as an alternative. IGIV also should be administered within 96 hours of exposure. Although licensed IGIV preparations are known to contain anti-varicella antibody titers, the titer of any speciﬁc lot of IGIV that might be available is uncertain because IGIV is not routinely tested for antivaricella antibodies. The recommended IGIV dose for postexposure prophylaxis of varicella is 400 mg/kg, administered once. For a pregnant woman who cannot receive VariZIG within 96 hours of exposure, clinicians can choose either to administer IGIV or closely monitor the woman for signs and symptoms of varicella and institute treatment with acyclovir if illness occurs. (CDC. A new product for postexposure prophylaxis available under an investigational new drug application expanded access protocol. MMWR 2006;55:209-10.) Adapted from ACIP General Recommendations on Immunization, December 1, 2006 APPENDIX Vaccinia (Smallpox) Vaccine (Routine, non-emergency use*) Symptom or Condition
Vaccinate with Smallpox?
Anaphylactic allergy to : E Antimicrobial therapy (current) Breastfeeding (vaccinate lactating mother) Convulsions (ﬁts, seizures) in recipient, or Eczema or atopic dermatitis (presence or history of ) Eye disease (inﬂammatory, requiring steroid treatment) Guillain Barré syndrome (GBS), history of Heart conditions HIV infection (symptomatic or asymptomatic) IG administration, recent or simultaneous Mild acute (with or without low-grade fever) Moderate or severe acute (with or without fever) Reaction to previous dose of smallpox vaccine Anaphylactic (life-threatening) Local (mild-to-moderate soreness, redness, swelling Simultaneous administration with other vaccines With varicella vaccine No (See Note E4) With all other vaccines Yes (See Note E5) Skin condition (acute, chronic or exfoliative) in recipient or No (See Note E6) household contact Sudden infant death syndrome (SIDS), family history * 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. Symptom or Condition
Vaccinate with Smallpox?
Steroid eye drops Thrombocytopenia, or history of thrombocytopenic purpura Tuberculin skin testing, performed simultaneously with Yes (See Note E7) Household contact (i.e., can a person be vaccinated who has a household contact who): - is allergic to a vaccine component? - is breastfeeding? - is a child or adolescent? Yes (See Note E8) - has (or has a history of ) eczema or atopic dermatitis? - has HIV infection? - has altered immunocompetence? - has an acute, chronic or exfoliative skin condition? No (See Note E6) - has a heart condition? Note E1: Persons with inﬂammatory eye disease can be at increased risk for inadvertent inoculation
as a result of touching or rubbing the eye. Therefore, deferring vaccination of persons with inﬂammatory eye diseases requiring steroid treatment is prudent until the condition resolves and the course of therapy is complete. Note E2: As a precaution, a patient who has been diagnosed by a doctor as having a heart condition
with or without symptom should not get the smallpox vaccine at this time while experts continue their investigations. These conditions include known coronary disease including previous myocardial infarction or angina, congestive heart failure, cardiomyopathy, stroke or transient ischemic attack, chest pain or shortness of breath with activity, or other heart conditions under the care of a doctor. In addition, a patient should not get smallpox vaccine who has 3 or more of the following factors: - has been diagnosed with high blood pressure - has been diagnosed with high blood cholesterol - has been diagnosed with diabetes or high blood sugar - has a ﬁrst degree relative who had a heart condition before the age of 50 - smokes cigarettes Note E3: Persons with moderate or severe illnesses, with or without fever, can be vaccinated as soon as
they are recovering and no longer acutely ill. Note E4: Varicella vaccine and smallpox vaccine should be administered >4 weeks apart.
APPENDIX Note E5: There is a theoretical risk that the administration of multiple live virus vaccines within 4
weeks of one another, if not given on the same day, will result in a suboptimal immune response. Parenterally administered live vaccines, and live attenuated inﬂ uenza vaccine, when not administered on the same day, should be administered >4 weeks apart whenever possible. If these live vaccines are separated by <4 weeks, the vaccine administered second should not be counted as a valid dose and should be repeated >4 weeks after the last, invalid, dose. Note E6: Vaccination may be administered after condition resolves. (Recommendations diﬀ er for
eczema and atopic dermatitis. See page 23) Note E7: No data exist for the potential degree of PPD suppression that might be associated with
parenteral live attenuated virus vaccines (other than measles). Nevertheless, in the absence of data, following guidelines for measles-containing vaccine when scheduling PPD screening and administering other parenteral live attenuated virus vaccines is prudent. Note E8: Not a contraindication, but ACIP recognizes that programs might defer vaccination of
household contacts of infants <1 year of age because of data indicating a higher risk for adverse events among primary vacinees in this age group, compared with that among older children. Quick Reference
Contraindications and Precautions to Routine Childhood & A
Vaccinations BY VACCINE
For more complete and detailed information, see pages 2 through 6, or read the ACIP's recommendations for the indivdual vaccines (www.cdc.gov/vaccines/pubs/acip-list.htm). Contraindications and Precautions to Routine Childhood & Adolescent
Vaccinations BY VACCINE
Contraindications • Anaphylactic reaction to a prior dose of the • Moderate or severe acute illness vaccine or any of its components • Underlying unstable, evolving neurologic • Encephalopathy within 7 days of a previous dose of DTaP or DTP (use DT instead of • Any of these conditions within the speciﬁ ed time after a previous dose of DTaP or DTP - Fever of > 40.5°C (105°F) unexplained by another cause (within 48 hours) - Collapse or shock-like state (within 48 - Persistent, inconsolable crying lasting >3 hours (within 48 hours) - Seizure or convulsion (within 72 hours) - Guillain-Barré syndrome (within 6 weeks) Contraindications • Anaphylactic reaction to a prior dose of the • Moderate or severe acute illness vaccine or any of its components • History of an Arthus reaction following a • Encephalopathy within 7 days of a previous previous dose of a tetanus-containing and/ dose of DTaP or DTP (use Td instead of or diphtheria toxoid-containing vaccine, including meningococcal conjugate vaccine. Contraindications • Anaphylactic reaction to a prior dose of • Moderate or severe acute illness the vaccine or any of its components (e.g., 2-phenoxyethanol, alum) Contraindications • Anaphylactic reaction to a prior dose of the • Moderate or severe acute illness vaccine or any of its components (e.g., baker's yeast) APPENDIX Contraindications and Precautions to Routine Childhood & Adolescent
Vaccinations BY VACCINE
Contraindications • Anaphylactic reaction to a prior dose of the • Moderate or severe acute illness vaccine or any of its components Contraindications F • Anaphylactic reaction to a prior dose of the • Moderate or severe acute illness vaccine or any of its components (e.g., yeast). Inﬂ uenza (inactivated) Contraindications • Anaphylactic reaction to a prior dose of the • Moderate or severe acute illness vaccine or any of its components (e.g., eggs) Inﬂ uenza (LAIV) Contraindications • Anaphylactic reaction to a prior dose of the • Moderate or severe acute illness vaccine or any of its components (e.g., eggs) • Chronic illness of pulmonary system (including asthma or Reactive Airway Disease), or cardiovascular system; metabolic disorder (e.g., diabetes); hemoglobinopathies (e.g., sickle cell disease) • Immunodeﬁ ciency • Aspirin or salicylate therapy (children & • Pregnancy • History of Guillian-Barré syndrome Contraindications • Anaphylactic reaction to a prior dose of • Moderate or severe acute illness the vaccine or any of its components (e.g., neomycin, streptomycin, polymyxin B) Contraindications • Anaphylactic reaction to a prior dose of the • Moderate or severe acute illness vaccine or any of its components Contraindications and Precautions to Routine Childhood & Adolescent
Vaccinations BY VACCINE
Contraindications • Anaphylactic reaction to a prior dose of • Moderate or severe acute illness the vaccine or any of its components (e.g., • Recent administration of antibody- gelatin, neomycin) containing blood products rombocytopenia/ thrombocytopenic • Immunodeﬁ ciency purpura (now or by history) • Untreated active tuberculosis Contraindications • Anaphylactic reaction to a prior dose of the • Moderate or severe acute illness vaccine or any of its components (e.g., yeast) Contraindications • Anaphylactic reaction to a prior dose of the • Moderate or severe acute illness, including vaccine or any of its components • Immune deﬁciency for any reason • Administration of antibody-containing blood products within the past 42 days • Preexisting chronic GI disease • History of intussusception Contraindications • Anaphylactic reaction to a prior dose of • Moderate or severe acute illness the vaccine or any of its components (e.g., • Recent administration of antibody- gelatin, neomycin) containing blood products • Pregnancy • Immunodeﬁ ciency • Untreated active tuberculosis Contraindications • History of anaphylactic reaction to any • Moderate or severe acute illness vaccine component (e.g., gelatin, neomycin) • Immunodeﬁ ciency • Pregnancy
Source: http://www.bhsj.org/Clinic/immz/contraindications-guide-508.pdf
St mary's school

Medicines and Illness Policy (Boarders) 2016-2017 The following protocol has been written using the guidelines from the Handbook of School Health, Boarding Schools National Minimum Standards (April 2015), Supporting students with medical conditions (DfES Sept 2014) We aim to provide guidelines for boarding & teaching staff who find themselves in a position of responsibility regarding the storage and administration of drugs. The aim of this policy is to protect the boarding & teaching staff against any unforeseen liability. Despite the fact that many medicines are available over the counter, the boarding staff are advised by the medical centre staff only to use those which have been prescribed by a doctor or those that have been sanctioned by the school doctor or nursing staff at the medical centre (List below). This is stressed in order to protect not only the students from any errors but to protect the staff. No child under the age of sixteen should be given medicines without their parents' consent. Each child must have a completed medical form prior to starting the school which includes a declaration giving permission for nursing staff, boarding staff or teaching staff to give appropriate treatment for minor problems using non-prescription medicines. This is also authorisation for housemistress or a member of staff to approve such medical treatment as is deemed necessary in an emergency. Parents have a clear responsibility to provide the school with written details of the medicines and medical needs of their daughters. They are also expected to inform the school of any changes as they arise. Please note that if a girl has been accepted into the school without prior notification of health problems that could significantly affect the management of their daughter in the school then the school has the right to review the continuation of the student in the school. When students start or return to school, all drugs and medicines must be given to the housemistress or nurse who will dispense them as prescribed. These medications should be patient named & listed in the British National Formulary and any foreign language must be translated into English. The school medical officer will treat and prescribe for students as necessary whilst the student is in their care as a boarder Sixth Form students (i.e. those over the age of 16) may give their own consent for medical treatment. Gillick competence is used in medical law to decide whether a child (16 years or younger) is able to consent to his or her own medical treatment, without the need for parental permission or knowledge. A child will be Gillick competent if he or she has sufficient understanding and intelligence to understand fully what is proposed. The Medical Centre St. Mary's Medical Centre is staffed by registered nurses (or qualified first aider in their absence) who are available to assist student, provide first aid and advice between the hours of 08.15 – 16.00 Monday to Friday term time only. Should you wish to contact the nurses directly please telephone 01223 224169 between these hours or email

Microsoft word - hepatitis c guidance_final july

NZ SOCIETY OF GASTROENTEROLOGY HCV TREATMENT GUIDELINES Initial assessment Hepatitis C Virus virology Anti-HCV (serology) • Indicates HCV exposure HCV RNA level (viral load) • Confirms HCV infection • Determines treatment regimen Liver staging Liver Elastography Scan Excludes cirrhosis if: