2025 – PAGE 341 – VACCINES, IMMUNIZATIONS AND CONTRAINDICATIONS
MEASLES, MUMPS, RUBELLA (MMR) AND VARICELLA (VZV) PEARLS
- MMRand VARICELLA are both prohibited in patients with an immunocompromised state (SCID or AIDS) and in PREGNANCY. These are NOT contraindicated in family members.
- MMR and VARICELLA are both okay for children with HIV who are doing well.
- MMR and PPD: A PPD can be placed on the same day the MMR is given. However, if the MMR was already given LESS THAN 4 WEEKS ago, do not place the PPD yet.
- MMR contains some ingredients that can cause joint pain of the hands and knees for up to one month after administration.
ROTAVIRUS VACCINE
The first rotavirus vaccine dose should NOT be given prior to 6 weeks of age OR ONCE the child turns 15 weeks. That means that children who miss the 2-month visit and present for the 4-month visit can no longer be immunized for rotavirus. The series is a 2–3 dose series, depending on which formulation is used. The 2-dose series is given at 2 and 4 months. The 3-dose series is given at months 2, 4, and 6 (maximum age for the 3rd dose is 8 months of age).
PEARLS: Do NOT give the rotavirus vaccine to patients in the hospital. You CAN give it to children who have an immunocompromised FAMILY MEMBER in the home. Yes, it IS shed in the stool.
INFLUENZA VACCINATION
The CDC has made the influenza vaccination recommendations very easy. Give the flu vaccine to everyone over 6 months of age, every year. High-risk patients (i.e., respiratory disease, asthmatics) should get priority. The LIVE NASAL SPRAY INFLUENZA (FLU) VACCINE version can be given to anyone over the age of TWO who is healthy, NOT PREGNANT, not IMMUNOCOMPROMISED, not an ASTHMATIC, and not the close contact of someone who is severely immunocompromised. Children 6 months through 8 years of age who are getting vaccinated for the first time require 2 doses of influenza vaccine.
PEARL: If you have a question about injectable flu vaccination, the answer will likely be to VACCINATE. For the nasal spray vaccination, you will need to look at the age and comorbidities.
PEARL: Remember, influenzA is the virus. H. flu is the gram-negative organism and is spelled influenzAE (HIB vaccine).