Guide to Contraindications and Precautions to Commonly ...

1 Guide to Contraindications and Precautions to Commonly Used Vaccines1,*. Vaccine Contraindications Precautions Hepatitis B (HepB) Severe allergic reaction ( , anaphylaxis) after Moderate or severe acute illness with or without fever a previous dose or to a vaccine component Infant weighing less than 2000 grams (4 lbs, oz)2. Hypersensitivity to yeast Rotavirus Severe allergic reaction ( , anaphylaxis) after Moderate or severe acute illness with or without fever (RV5 [RotaTeq], a previous dose or to a vaccine component Altered immunocompetence other than SCID. RV1 [Rotarix]) Severe combined immunodeficiency (SCID) Chronic gastrointestinal disease3. History of intussusception Spina bifida or bladder exstrophy3.

2 Diphtheria, tetanus, Severe allergic reaction ( , anaphylaxis) after Moderate or severe acute illness with or without fever pertussis (DTaP) a previous dose or to a vaccine component Guillain-Barr syndrome (GBS) within 6 weeks after a previous dose of tetanus For pertussis-containing vaccines: Encephalop- toxoid-containing vaccine Tetanus, diphtheria, athy ( , coma, decreased level of conscious- History of Arthus-type hypersensitivity reactions after a previous dose of pertussis (Tdap) ness, prolonged seizures) not attributable to diphtheria- or tetanus-toxoid-containing vaccine; defer vaccination until at another identifiable cause within 7 days of least 10 years have elapsed since the last tetanus-toxoid containing vaccine Tetanus, diphtheria administration of a previous dose of DTP or (DT, Td) For DTaP and Tdap only: Progressive or unstable neurologic disorder DTaP (for DTaP); or of previous dose of DTP, (including infantile spasms for DTaP), uncontrolled seizures, or progressive DTaP, or Tdap (for Tdap) encephalopathy; defer until a treatment regimen has been established and the condition has stabilized For DTaP only: Temperature of 105 F or higher ( C or higher) within 48 hours after vaccination with a previous dose of DTP/DTaP.

3 Collapse or shock-like state ( , hypotonic hyporesponsive episode) within 48 hours after receiving a previous dose of DTP/DTaP. Seizure within 3 days after receiving a previous dose of DTP/DTaP. Persistent, inconsolable crying lasting 3 or more hours within 48 hours after receiving a previous dose of DTP/DTaP. Haemophilus influenzae Severe allergic reaction ( , anaphylaxis) after Moderate or severe acute illness with or without fever type b (Hib) a previous dose or to a vaccine component Age younger than 6 weeks Inactivated poliovirus Severe allergic reaction ( , anaphylaxis) after Moderate or severe acute illness with or without fever vaccine (IPV) a previous dose or to a vaccine component Pregnancy Hepatitis A (HepA) Severe allergic reaction ( , anaphylaxis) after Moderate or severe acute illness with or without fever a previous dose or to a vaccine component Pneumococcal Severe allergic reaction ( , anaphylaxis) after Moderate or severe acute illness with or without fever (PCV13 or PPSV23)

4 A previous dose or to a vaccine component (including, for PCV13, to any diphtheria toxoid- containing vaccine). Measles, mumps, Severe allergic reaction ( , anaphylaxis) after Moderate or severe acute illness with or without fever rubella (MMR)4 a previous dose or to a vaccine component Recent (within 11 months) receipt of antibody-containing blood product Severe immunodeficiency ( , hematologic (specific interval depends on product)7. and solid tumors, chemotherapy, congenital For MMRV only: Family history of seizures immunodeficiency or long-term immuno- History of thrombocytopenia or thrombocytopenic purpura suppressive therapy5), or persons with human Need for tuberculin skin testing8. immunodeficiency virus [HIV] infection who are severely immunocompromised6.

5 Family history of congenital or hereditary immunodeficiency in first-degree relatives ( , parents and siblings), unless the immune competence of the potential vaccine recipient has been substantiated clinically or verified by a laboratory test Pregnancy continued on the next page . Technical content reviewed by the Centers for Disease Control and Prevention Saint Paul, Minnesota 651- 647- 9009 Item #P3072a (3/18). Guide to Contraindications and Precautions to Commonly Used Vaccines1,* (continued) PAGE 2 OF 2. Vaccine Contraindications Precautions Varicella (Var)4 Severe allergic reaction ( , anaphylaxis) after a previous Moderate or severe acute illness with or without fever dose or to a vaccine component Recent (within 11 months) receipt of antibody-containing blood Severe immunodeficiency ( , hematologic and solid product (specific interval depends on product)7.)

6 Tumors, chemotherapy, congenital immunodeficiency or Receipt of specific antivirals ( , acyclovir, famciclovir, or valacy- long-term immunosuppressive therapy5), or persons with clovir) 24 hours before vaccination; avoid use of these antiviral HIV infection who are severely immunocompromised6 drugs for 14 days after vaccination. Family history of congenital or hereditary immunodeficiency in first-degree relatives ( , parents and siblings), unless the immune competence of the potential vaccine recipient has been substantiated clinically or verified by a laboratory test Pregnancy Influenza, inactivated Severe allergic reaction ( , anaphylaxis) after a previous Moderate or severe acute illness with or without fever injectable (IIV)9,10 dose or to a vaccine component History of GBS within 6 weeks of previous influenza vaccination Egg allergy other than hives ( , angioedema, respiratory distress, lightheadedness, or recurrent emesis).

7 Or required epinephrine or another emergency medical intervention (IIV may be administered in an inpatient or outpatient medical setting, under the supervision of a healthcare provider who is able to recognize and manage severe allergic conditions)9. Influenza, recombinant Severe allergic reaction ( , anaphylaxis) after a previous Moderate or severe acute illness with or without fever (RIV)9,10 dose or to a vaccine component. RIV does not contain any History of GBS within 6 weeks of previous influenza vaccination egg Human papillomavirus Severe allergic reaction ( , anaphylaxis) after a previous Moderate or severe acute illness with or without fever (HPV) dose or to a vaccine component Pregnancy Meningococcal Severe allergic reaction ( , anaphylaxis) after a previous Moderate or severe acute illness with or without fever (MenACWY.)

8 MenB) dose or to a vaccine component Recombinant zoster Severe allergic reaction ( , anaphylaxis) to a vaccine Moderate or severe acute illness with or without fever vaccine (RZV) component For ZVL only: Receipt of specific antivirals ( , acyclovir, famci- Zoster vaccine live (ZVL)4 For ZVL only: Severe cellular immunodeficiency ( , clovir, or valacyclovir) 24 hours before vaccination; avoid use of hematologic and solid tumors, chemotherapy, or long-term these antiviral drugs for 14 days after vaccination. immunosuppressive therapy5) or persons with HIV infection For RZV only: Pregnancy and lactation. who are severely immunocompromised. For ZVL only: Pregnancy footnotes 1. The Advisory Committee on Immunization Practices (ACIP) recommendations and package tion on the use of specific live vaccines among persons on immune-suppressing medications or inserts for vaccines provide information on Contraindications and Precautions related to vac- with immune suppression because of other reasons.

9 Cines. Contraindications are conditions that increase chances of a serious adverse reaction in 6. HIV-infected children may receive varicella and measles vaccine if CD4+ T-lymphocyte count is vaccine recipients and the vaccine should not be administered when a contraindication is pres- >15%. (Source: Adapted from American Academy of Pediatrics. Immunization in Special Clini- ent. Precautions should be reviewed for potential risks and benefits for vaccine recipient. For a cal Circumstances. In: Pickering LK, ed. Red Book: 2015 Report of the Committee on Infectious person with a severe allergy to latex ( , anaphylaxis), vaccines supplied in vials or syringes Diseases. 30th ed. Elk Grove Village, IL: American Academy of Pediatrics: 2015.)

10 That contain natural rubber latex should not be administered unless the benefit of vaccination 7. Vaccine should be deferred for the appropriate interval if replacement immune globulin products clearly outweighs the risk for a potential allergic reaction. For latex allergies other than anaphy- are being administered (see Table 3-5. Recommended Intervals Between Administration of laxis, vaccines supplied in vials or syringes that contain dry, natural rubber or natural rubber Antibody-Containing Products and Measles- or Varicella-Containing Vaccine, by Product and latex may be administered. Whether and when to administer DTaP to children with proven or Indication for Vaccination found in Best Practices Guidance of the Advisory Committee on suspected underlying neurologic disorders should be decided on a case-by-case basis.)