Credit: A. Gamondes
NOTE: Can you make heads or tails of this missive on the AAP website about vaccine risks? Thanks to our Nancy Hokkanen for sharing the info. In short, AAP says, "Inject me," without regard for consequences. Tweedledumb and dumber.
"Vaccination should not be delayed because of the presence of mild upper respiratory tract illness, gastroenteritis, otitis media or other mild illness with or without fever."
"Conditions that may occur following DTaP vaccine, such as temperature of 105 degrees Fahrenheit or higher, collapse or shock-like state, persistent crying, or convulsions with or without fever are not contraindications or precautions to administration of Tdap to an adolescent or adult."
"Vaccinations usually should be deferred when a precaution is present, unless the provider determines the benefit of protection from the vaccine outweighs the risk for an adverse reaction."
From the AAP site:
Understanding Vaccine Contraindications, Precautions
The Centers for Disease Control and Prevention (CDC) defines a contraindication as a condition in an intended vaccinee that increases the risk for a serious adverse reaction. A vaccine should not be administered when a contraindication is present.
A precaution indicates that a more severe reaction to the vaccine may occur than would have otherwise been expected, although the risk is less than that associated with a contraindication. Also, a condition classified as a precaution may compromise the vaccine’s ability to produce immunity. Vaccinations usually should be deferred when a precaution is present, unless the provider determines the benefit of protection from the vaccine outweighs the risk for an adverse reaction.
Which of the following are correct?
a) The majority of contraindications and precautions are temporary, so the vaccine generally can be administered later.
b) A severe acute illness is defined as a temperature greater than 39 degrees Celsius.
c) A history of thrombocytopenia is not a precaution for measles-mumps-rubella (MMR) vaccine administration.
d) Persistent, inconsolable crying lasting more than three hours within 48 hours after administration of a previous diphtheria and tetanus toxoids and acellular pertussis (DTaP) or diphtheria toxoid, tetanus toxoid and pertussis (DTP) vaccine is a contraindication to tetanus toxoid, reduced diphtheria toxoid and acellular pertussis (Tdap) administration.
e) Spina bifida or bladder exstrophy is a precaution for rotavirus vaccine administration.
f) Both live-virus and inactivated vaccines may be administered to a mother who is breastfeeding without concern for the safety of the infant or mother.
Answer: a, e and f are correct
Measles vaccine is associated with a mild decrease in platelet count within a few days after the vaccine is administered. Rare cases of idiopathic thrombocytopenia purpura (ITP) have been associated with administration of a measles-containing vaccine. One Vaccine Safety Datalink review reported an attributable risk of one case of ITP per 40,000 doses of MMR.
People with a history of ITP may be at increased risk for developing clinically significant thrombocytopenia after MMR vaccination. The decision to vaccinate such a child with MMR depends on the benefits of immunity to measles, mumps and rubella and the risks for recurrence or exacerbation of thrombocytopenia after vaccination. The benefits of immunization usually are greater than the potential risks, and administration of MMR vaccine is justified because of the even greater risk for thrombocytopenia after measles or rubella disease.
The presence of a moderate or severe acute illness with or without a fever is a precaution to administration of all vaccines. This precaution avoids causing diagnostic confusion between manifestations of the underlying illness and possible adverse effects of vaccination or superimposing adverse effects of the vaccine on the underlying illness. No specific temperature defines a child with a severe acute illness. People with moderate or severe acute illness should be vaccinated as soon as the illness has resolved.
Vaccination should not be delayed because of the presence of mild upper respiratory tract illness, gastroenteritis, otitis media or other mild illness with or without fever.
Contraindications to DTaP administration include a history of Guillain-Barré syndrome occurring within six weeks after a previous dose of tetanus toxoid containing vaccine, a progressive or stable neurologic disorder, uncontrolled seizures or progressive encephalopathy. Tdap may be administered to a child with a history of persistent, inconsolable crying lasting more than three hours within 48 hours after administration of a previous DTaP or DTP vaccine.
Conditions that may occur following DTaP vaccine, such as temperature of 105 degrees Fahrenheit or higher, collapse or shock-like state, persistent crying, or convulsions with or without fever are not contraindications or precautions to administration of Tdap to an adolescent or adult. A history of extensive limb swelling following prior DTaP or a stable neurologic disorder (such as controlled seizures or cerebral palsy) are not contraindications or precautions to administration of Tdap.
Latex rubber is contained in the RV1 (Rotarix) oral applicator, whereas the RV5 (RotaTeq) dosing tube is latex free. Therefore, some experts prefer that infants with spina bifida or bladder exstrophy, who are at high risk for acquiring latex allergy, receive RV5 instead of RV1 to minimize latex exposure. However, if RV1 is the only rotavirus vaccine available, it should be administered because the benefit of vaccination is considered to be greater than the risk for sensitization.
Neither inactivated nor live attenuated virus vaccines administered to lactating women affect the safety of women or their infants. The attenuated live virus vaccine strain replicates in a vaccinated mother, but most live viruses in vaccines are not excreted in breast milk. Rubella virus vaccine may be excreted in human milk, but the virus usually does not infect the infant. If infection does occur, it is well-tolerated because the virus is attenuated.
Inactivated, recombinant, subunit, polysaccharide and conjugated vaccines, as well as toxoids, pose no risk for mothers who are breastfeeding or for their infants. Breastfeeding is a contraindication for smallpox vaccination of the mother because of the theoretical risk for contact transmission. Yellow fever vaccine should be avoided in breastfeeding women, unless a nursing mother cannot avoid or postpone travel to an endemic area.
There are no data to suggest that passive transfer of antibodies in human milk can affect the efficacy of a live virus vaccine administered to an infant. Breastfed infants should be vaccinated according to the recommended immunization schedule.
Dr. Meissner is professor of pediatrics at Floating Hospital for Children, Tufts Medical Center. He also is an ex officio member of the AAP Committee on Infectious Diseases and associate editor of the AAP Visual Red Book.