Myth Versus Fact in Vaccine Contraindications

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Another pro-vaccine article.

From

Pediatric News

Myth Versus Fact in Vaccine Contraindications

Mike Bykowski, Senior Writer

[Pediatric News 33(3):9, 1999. © 1999 International Medical News Group.]

burg, Va. -- Withholding or postponing vaccines because of false

contraindications is a big contributor to unsatisfactory immunization rates,

Dr.

R. reminded the audience at a pediatric update sponsored by the

American

Academy of Pediatrics.

The three general contraindications for all vaccines or subsequent doses of

a vaccine

are anaphylactic reaction to a vaccine, anaphylactic reaction to a vaccine

constituent, and moderate or severe illnesses with or without fever, he

said.

And as a rule, avoid giving live, attenuated vaccines to immunocompromised

patients and pregnant women (these include the oral poliovirus, MMR,

varicella, and

rotavirus vaccines), said Dr. , an infectious disease specialist and

chair of the

department of pediatrics at Children's Hospital Medical Center of Akron

(Ohio),

Killed preparations, like the inactivated poliovirus and hepatitis A

vaccines can be

given to immunocompromised patients.

Even though they are often cited as reasons for not giving a vaccine, the

following

are not contraindications: mild to moderate local reaction following the

injection,

mild acute illness with or without low-grade fever, current antimicrobial

therapy,

prematurity, recent exposure to an infectious disease, and a history of

penicillin or

nonspecific allergies or a family history of such allergies.

Dr. gave these examples of some common misconceptions associated with

childhood immunizations:

Hepatitis B Vaccine.

Myth: The hepatitis B vaccine is contraindicated in pregnant women.

Fact: The vaccine is made via recombinant DNA technology from baker's

yeast, so an anaphylactic reaction to baker's yeast is the only true

contraindication to the hepatitis B vaccine.

DTP/DTaP Vaccine.

Myth: Contraindications to this vaccine include a fever of less than

105[infinity]F following a previous dose of DTP or a family history of

convulsions, sudden infant death syndrome, or an adverse event

following

DTP.

Fact: The only true contraindication to the DTP/DTaP vaccine is a

history of

encephalopathy within 7 days of receiving a previous dose of the

vaccine.

Although not contraindications, a temperature of greater than

105[infinity] F

after vaccination and collapse or shocklike state within 24 hours of

receiving

a dose of DTP/DTaP are situations in which pediatricians " need to make

a

decision whether or not to vaccinate a patient based on the risk of the

disease, the risk to the child, and the benefit of the vaccine.

" As a parent, if my child had one of these spells after a DTP vaccine,

there is

no way I'd let them get another dose. I'd be too frightened, " he said.

Hib Vaccine.

Myth: A history of H. influenzae type b disease is a contraindication

to this

vaccine.

Fact: There are no contraindications to the Hib vaccine.

Inactivated Polio Vaccine.

Myth: The inactivated polio vaccine is contraindicated in pregnant

women.

Fact: An anaphylactic reaction to neomycin or streptomycin are the

contraindications to this vaccine.

Oral Polio Vaccine.

Myth: Breast-feeding, current antimicrobial therapy, and diarrhea are

contraindications to the oral polio vaccine.

Fact: The true contraindications are HIV infection, a household contact

with

HIV, known altered immune state, or an immunodeficient household

contact.

" If a child has severe diarrhea, the conventional thinking is to repeat

that

vaccine dose sometime in the future but not to cut down or withhold the

dose, " Dr. noted.

Rotavirus Vaccine.

Myth: The rotavirus vaccine is contraindicated if household members are

immunodeficient.

Fact: Hypersensitivity to aminoglycosides, amphotericin B, or

monosodium

glutamate are contraindications; so is a known or suspected

immunodeficiency state in the child.

MMR Vaccine.

Myth: Tuberculosis, a positive purified protein derivative skin test,

simultaneous TB testing, and breast-feeding are contraindications to

this

vaccine.

Fact: An anaphylactic reaction to eggs and to neomycin are

contraindications,

as is pregnancy and immunodeficiency.

Varicella Vaccine.

Myth: Pregnancy is not a contraindication to the varicella vaccine.

Fact: Pregnancy and an altered immune status are the contraindications

to this

vaccine.

Women should avoid getting pregnant for 3 months after vaccination, he

said.

" Following the immunization, try to avoid giving immunoglobulin for 2

months,

and be careful with salicylates following varicella vaccination because

of the

association with varicella and Reye's syndrome in the presence of

salicylates, "

Dr. cautioned.