KNOW Contraindications / Precautions

The CDC recognizes there are risks associated with vaccines. Anaphylaxis, severe allergic reactions, Guillian Barre Syndrome (a severe paralytic illness), seizures and other neurological conditions are known side effects from vaccinations. The CDC advises that persons with allergies to specific vaccine ingredients not be vaccinated with those vaccines and lists the following precautionary guidelines with regards thimerosal, pregnancy, DTaP, live flu vaccine, MCV (meningococcal), MMR, rotavirus, and vaccinating those with chronic illnesses:

Anaphylactic reactions:

If you or your child has experienced anaphylaxis to a previous dose of any vaccine – do not vaccinate.

Allergic reactions:

  • to any vaccine component (all vaccines) – do not vaccinate.
  • to eggs (flu, yellow fever) – do not vaccinate.
  • to yeast (hepatitis B, HPV) – do not vaccinate. Anyone with a life-threatening allergy to baker’s yeast or to any other component of this vaccine should not get the hepatitis B vaccine. (How does a parent know if their one-day old baby has an allergy to yeast?)
  • to gelatin (MMR, Varicella Zoster) – do not vaccinate. If vaccinating persons with a history of an anaphylaxis reaction to gelatin or gelatin-containing products with MMR or its component vaccines, or with varicella vaccine, extreme caution should be exercised.
  • to neomycin (IPV Polio, MMR, Varicella, Zoster) – do not vaccinate.
  • to polymyxin (IPV Polio) – do not vaccinate.
  • to streptomycin (IPV Polio) – do not vaccinate.

Guillian Barre Syndrome (GBS):

  • GBS is a known side effect to DTaP. The decision to give additional doses of DTaP to children who developed GBS within 6 weeks of a prior dose should be based on consideration of the benefits of further vaccination vs. the risk of recurrence of GBS.
  • It is not known whether influenza vaccination increases the risk for recurrence of GBS, however avoiding vaccinating persons who are known to have developed GBS within 6 weeks after a previous influenza vaccination is prudent.
  • Persons with a history of GBS should not receive the meningococcal vaccine (MCV).
  • Persons with a history of GBS should not receive the live flu vaccine (LAIV).

Neurologic conditions (seizures):

Administration of DTaP to children with proven or suspected underlying neurologic disorders should be decided individually.

The CDC’s Advisory Committee on Immunization Practices (ACIP) recommends that children with progressive neurologic conditions not be vaccinated with Tdap until the condition stabilizes.

Regarding Thimerosal:

Some brands or formulations still contain thimerosal as a preservative, or may contain trace amounts of thimerosal that are a remnant of the manufacturing process. Check the appropriate manufacturer’s package insert for more information. Vaccines listed with thimerosal in trace amounts or more include DTaP, Td/DT, Inactivated Flu vaccine, Hepatitis B. (See KNOW Contents of Vaccines)

Regarding Pregnancy:

  • Women should avoid becoming pregnant for 4 weeks following vaccination.
  • Pregnant women should not be routinely vaccinated on theoretical grounds and should not travel to areas where yellow fever is present should be postponed until after delivery.
  • The following vaccines are listed as DO NOT VACCINATE pregnant women: Live Intranasal Flu Vaccine (LAIV), MMR, Varicella, Zoster and Human Papillomavirus (HPV)
  • The HPV vaccine is not recommended for use in pregnancy. It has not been causally associated with adverse outcomes of pregnancy or adverse events in the developing fetus. However, until additional information is available, initiation of the vaccine series should be delayed until after completion of the pregnancy. If a woman is found to be pregnant after initiating the vaccination series, the remainder of the 3-dose regimen should be delayed until after completion of the pregnancy. Any exposure to HPV vaccine during pregnancy should be reported to pregnancy vaccine registry 800-986-8999.

Regarding DPaT:

  • Any child who suffered a brain or nervous system disease within 7 days after a dose of DTaP should NOT get another dose.
  • Tell your doctor if your child had a seizure or collapsed after a dose of DTaP.
  • Tell your doctor if your child cried non-stop for 3 hours or more and/or had a fever over 105 degrees after a dose of DTaP.
  • DTaP should not be given to anyone 7 years of age or older.

Regarding Live Virus Influenza (LAIV):

  • The Live Intranasal Flu Vaccine (LAIV) should NOT be administered to children younger than 5 years of age with asthma or recurrent wheezing.
  • Persons with asthma, reactive airways disease or other chronic disorders of the pulmonary should not receive this vaccine.
  • Children between 6 months and 2 years of age should not get this vaccine. Children younger than 6 months should not get either influenza vaccine.
  • Children or adolescents on long-term aspirin treatment should not receive this vaccine.
  • Persons with seizure disorders, cerebral palsy or other muscle/nerve disorders with breathing or swallowing problems should not get this vaccine.
  • People who have long-term chronic health problems with cardiovascular, heart, kidney, lung or liver disease should not receive this vaccine.
  • Persons with underlying medical conditions including metabolic diseases such as diabetes, renal dysfunction and hemoglobinopathies (anemia) should not receive this vaccine.
  • Anyone with a weakened immune system should not receive this vaccine. (Most old people have chronic diseases and weakened immune systems.)
  • Adults 50 years of age or older should not get this vaccine.
  • Pregnant women should not receive this vaccine.
  • Tell your doctor if you ever had Guillain-Barré syndrome.

Regarding Meningococcal (MCV)

Persons with a history of GBS should not receive the meningococcal vaccine (MCV).

Regarding MMR and Thrombocytopenia or history of thrombocytopenic purpura:

There is risk of recurrence or exacerbation of thrombocytopenia after vaccination.

If a prior episode of thrombocytopenia occurred near the time of vaccination, it might be prudent to avoid a subsequent dose.

Regarding Rotavirus:

The safety and efficacy of rotavirus vaccine have not been established for infants with preexisting chronic gastrointestinal disease.

Data suggest that infants with a history of intussusception might be at higher risk for a repeat episode after rotavirus vaccine than other infants. Therefore, until postlicensure data on safety of rotavirus vaccine is available, the risks and benefits of vaccination should be considered when vaccinating infants with a previous episode of intussusception.

Regarding Chronic Illnesses:

The CDC states that the great majority of persons with chronic illnesses should be appropriately vaccinated, however, the CDC emphasizes that the decision whether or not to vaccinate persons with chronic illnesses, and what vaccines to give, should be made on an individual basis.

Multiple symptoms of illness:

When assessing a patient with multiple symptoms, if any one of them is a contraindication, do not vaccinate. If there is a contraindication to any component of a combination vaccine, do not use that combination.

For complete guide, see: CDC Guide to Contraindications & Precautions: http://www.cdc.gov/vaccines/recs/vac-admin/downloads/contraindications-guide-508.pdf

For additional warnings, see: CDC Who Should NOT be Vaccinated: http://www.cdc.gov/vaccines/vpd-vac/should-not-vacc.htm