Saar Kuzi
Alessandra Coutinho Fernandes
William Cope
Richard Tapping
Kashif Ahmad
Reda Sadki
Shubhra Kanti Karmaker Santu
Adam P Rusch
Elle Meisner
Nereyda Ochoa
Landon J. Kunzelman
James DotimasFA16 Immunization Module’s Updates
Contraindications to vaccination
Although vaccines are an effective method for preventing disease infection, there are certain situations in which vaccines should not be administered to patients. Vaccines are safe for most patients because the FDA regulates both vaccine safety testing in the prelicensure stage and vaccine safety monitoring in the postlicensure stage of vaccine development. However, certain clinical scenarios may present contraindications and precautions to vaccination that dictate when vaccines should not be given.
As defined by the Center for Disease Control (CDC), a contraindication is a condition that increases the likelihood of a serious adverse reaction to a vaccine for a patient with that condition. In contrast, a precaution is a condition in a patient that might increase the chance or severity of a serious adverse reaction. Precautions may also compromise the ability of the vaccine to produce immunity (e.g. immunosuppression, so the immune system can't mount an adaptive immunity response). Many contraindications and precautions are temporary, allowing vaccines to be administered a later time after the condition has subsided (e.g. acute illness, pregnancy). Generally, vaccines should not be administered when a contraindication or precaution is present, although providers may decide under their discretion to administer vaccines when precautions are present (not allowed for contraindications) if the benefits of the vaccine outweigh the risk of an adverse reaction.
The CDC indicates that there are only four permanent contraindications for vaccines:
1) Allergy to vaccine component or previous dose of a vaccine
2) Encephalopathy (broad term for neurological disorders)
3) Severe combined immunodeficiency (SCID)*
4) History of intussusception (medical condition in which a part of the intestine into another section of intestine like a teloscope)*
*3 and 4 are contraindications to rotavirus vaccine.
In order to summarize the most common conditions that present as contraindications and precautions for vaccines, the following is a table adapted from the CDC's General Recommendations on Vaccinations:
| Condition | Live Vaccine | Inactivated Vaccine |
| Allergy to Component | C | C |
| Encephalopathy | -- | C |
| Pregnancy | C | V* |
| Immunosuppression | C | V |
| Severe illness | P | P |
|
Recent antibody-containing blood product |
P** | V |
C=contraindication
P=precaution
V=vaccinate if indicated (no contraindication or precaution)
*except HPV
**MMR and varicella containing (except zoster vaccine) only
References:
1. "General Recommendations on Vaccination." Epidemiology and Prevention of Vaccine-Preventable Diseases: Chapter 2. (CDC)
2. The CDC Contraindication and Vaccine Guide (CDC)
@Carly Gridley. I was also surprised to learn that the list of contraindications was very short. Vaccines are generally safe unless a patient is allergic or has a compromised immune system. The list of precautions appears to be slightly broader, as it includes conditions such as asthma and other chronic conditions.
In case you are interested, the CDC has a list of contraindications and precautions for the most commonly used vaccines, which you can view here: http://www.cdc.gov/vaccines/schedules/hcp/imz/adult-contraindications.html.
@James Dotimas This is great information. I agree with Nelson that these scenarios illustrate the importance of Herd immunity. I also had the same question as Madeline about how we would know if someone is allergic to a vaccine prior to an adverse reaction upon administration. The response you provided was very interesting. One thing that did surprise me, was that there weren't more contraindications.
@James Dotimas, you've found some really good information and the Table above is an especially useful starting point. The follow up on dermal testing is great!
@Madeline Bell, I think you just did but a like button might be a nice feature.
@James Dotimas I wish we could like or upvote comments. Thanks!
@Madeline Bell: Researchers have demonstrated that intradermal tests using 1:10 dilutions of vaccines are effective for predicting allergic reactions for some vaccines. They recommend that patients who test positive for allergic reactions may be able to receive the vaccination using a stepwise methods (from low to high concentrations of vaccine occurring over multiple visits). As you mention, though, this method of testing may be too time consuming to be considered worthwhile by healthcare providers.
Link to the study (titled Dermal testing of vaccines for children at high risk of allergies.): https://www.ncbi.nlm.nih.gov/pubmed/17276555
Do you know if there is a way to test for allergies to vaccine components? I feel like a lot of people use that as an excuse to not get vaccines when it isn't really the case. I'm sure there's a way, but is it too expensive/time consuming to do on a regular basis, so it's easier to just take the patient's word for it?
@NelsonNwumeh That's why herd immunity is so important!
The CDC recommendations also state, The presence of a moderate or severe acute illness with or without a fever is a precaution to administration of all vaccines. A personal or family history of seizures is a precaution for MMRV vaccination. A family history of seizures is quite vague. I'm sure clinicians would be able to use their judgement in deciding what is relevant or not, but that seems like something that should be included in guidelines/recommendations. If anyone finds more specifics on this, please post!
This is very interesting. Begs the question of how people who have contraindications to certain vaccinations could alternatively be protected from infection, especially if there is a epidemic where they live.