Basics
• Guide for parents: http://www.cdc.gov/vaccines/parents/index.html
• VISs are available at: http://www.cdc.gov/vaccines/pubs/vis/default.htm
• Up-to-date schedules available at http://www.cdc.gov/vaccines/schedules/index.html
Vaccine Safety
• Vaccine Adverse Event Reporting System (VAERS): http://www.vaers.hhs.gov
• Unexpected or clinically significant event after vaccine admin should be documented in medical record and VAERS form should be completed
• Reportable adverse events: Anaphylaxis, anaphylactic shock, brachial neuritis, encephalopathy or encephalitis, chronic arthritis, TTP, vaccine-strain measles viral infxn, paralytic polio, intussusception, death, or any adverse reaction that would be contraindication to future administration
• National Vaccine Injury Compensation Program: Provides compensation for people who have suffered injury 2/2 a covered vaccine: www.hrsa.gov/vaccinecompensation
Thimerosal (N Engl J Med 2007;357:1281; Pediatrics 2004;114:793)
• Mercury-containing preservative w/ antibacterial and antifungal properties
• All routinely recommended vaccines are thimerosal-free except some multi-dose vial flu vaccines and antivenoms
• IVIG and Rho immune globulin do not contain thimerosal
• Multi studies do not support assoc btw thimerosal exposure and neuro-psych deficits
Contraindications (J Allergy Clin Immunol 2004;114:1010)
• To any vaccine: Anaphylaxis after a previous vaccine dose or component
• Live attenuated vaccines should be administered together or at least 28 d apart
• DTap, Tdap: Encephalopathy w/i 7 d of admin of previous dose
• Defer vaccine in pts w/ progressive neurologic disorder (infantile spasms, uncontrolled epilepsy, encephalopathy) until neurologic status clarified
• Freq boosters may result in Arthus-like rxn; painful swelling shoulder to elbow
• Hepatitis B vaccine: Caution in pts w/ severe yeast allergy, allergic rxn rarely occur
• Influenza (live-attenuated): Pregnancy, known severe immunodeficiency, certain medical conditions, anaphylactic allergy to eggs
• Influenza (inactivated): Anaphylactic allergy to eggs
• IPV: Contains trace amounts of streptomycin, neomycin, and polymyxin-B
• MMR: Pregnancy, known severe immunodeficiency; contains trace amt neomycin
• Varicella: Pregnancy, known severe immunodeficiency; contains trace amt neomycin, precaution if received antibody-containing product w/i 11 mo
• Rotavirus: SCID
• Zoster: Suppression of cellular immunity, pregnancy
NOT Contraindications to Vaccinations
• Mild acute or convalescent illness with low-grade fever in an otherwise well child
• On antimicrobial therapy
• Nonspecific allergies or relatives with vaccine allergies
• Prior rxn to vaccine that included soreness, redness, or swelling at the injection site
• Prematurity – vaccines should be given according to birth age, not corrected age
• Immunosuppression of household contact (inactivated flu vaccine preferred)
• Pregnancy in a household contact or if breast-feeding
• FHx of seizures, SIDS, or of an adverse event following vaccination