2025 – PAGE 346 – VACCINES, IMMUNIZATIONS AND CONTRAINDICATIONS
VACCINE CONTRAINDICATIONS
ILLNESS
You may be asked if a vaccine is contraindicated in a child with a moderate to severe illness with or without fever. In such a child, all vaccines are relatively contraindicated, and the physician is supposed to weigh risks and benefits.
CHICKEN OR EGG ALLERGY
Children with severe (life-threatening) allergic reactions to eggs, chicken, or gelatin should not receive the Yellow Fever vaccine.
PEARL: Both inactivated influenza vaccine and live attenuated influenza vaccine may be given to patients with a CHICKEN or EGG allergy (including history of anaphylaxis) without any additional safety precautions.
PEARL: Giving the MMR is fine!
DTaP CONTRAINDICATIONS
The DTaP contraindications are worth being familiar with for the pediatric boards.
- ENCEPHALOPATHY or “PROLONGED” SEIZURE: If a child has encephalopathy or a “prolonged” seizure within 1 week of getting DTaP, the PERTUSSIS (aP) component is contraindicated in future vaccinations. Instead, give DT. Please remember that this is possibly a reaction to the PERTUSSIS component and not the Tetanus component. Also, DO NOT order allergy testing because you may induce a seizure!
- PROGRESSIVE NEUROLOGIC DISORDER: If a child has a neurologic disorder that is considered progressive, or has a seizure disorder that is not yet under control, then DTaP is relatively If the neurologic disorder has been stabilized or is no longer progressive, you MAY give DTaP.
- OTHER RELATIVE CONTRAINDICATIONS: Having a brief seizure within 3 days or a high fever (>105°F) or shock-like state within 48 hours of previous administration.
- PEARL/MNEMONIC: If tested on one of these three relative contraindications, you are more likely to be given a case in which the child had an issue 4–7 days from the date of previous vaccination. This would make the answer clear: give DTaP! Therefore, keeping the FOURTH day in mind as the day when the child is in the clear might help with these three relative contraindications.
LIVE VACCINE CONTRAINDICATIONS
Severely immunocompromised patients should not receive live vaccines. Some conditions include ataxia telangiectasia, Wiskott Aldrich, DiGeorge, Chediak Higashi, Leukocyte adhesion deficiency, Brutons, SCID, complement deficiency, uncontrolled HIV, activeTB, those on immunosuppressive therapy, and pregnancy. Also, once a patient has been administered a live virus vaccine, there needs to be at least a 28-day interval until another live vaccine is given.
GELATIN ALLERGY
The MMR, varicella, influenza, and yellow fever vaccines may contain gelatin. If the patient has a true gelatin allergy, these vaccines should not be given until cleared by an allergist.
NEOMYCIN, POLYMYXIN, AND STREPTOMYCIN ALLERGIES
The varicella (VZV), polio (IPV), and MMR vaccines all contain traces of NEOmycin and POLYmyxin. Polio vaccine (IPV) also contains traces of streptomycin. So, if a patient has had an anaphylactic allergic reaction to any of these components, the patient must be evaluated by an allergist before being given these vaccines.