Precautions and Contraindication before vaccination

Precautions and Contraindication before vaccination
There are many reasons to avoid or postpone vaccines.Sometimes people may have unreasonable concerns that lead to indecision to get vaccination even when there is no risk.  It is critical for vaccine providers and relevant healthcare workers to distinguish among these different reasons. In this article we try to make rough idea about this facts. Before that lets refresh the terms "Contraindication " and "Precaution ".

A contraindication is a situation in which a drug, such as a vaccine, should not be used because the risk outweighs any potential therapeutic benefit.

A precaution is a condition that may increase the risk of an adverse reaction following immunization or that may compromise the ability of the vaccine to produce immunity. In general, vaccines are deferred when a precaution is present. However, there may be circumstances when the benefits of giving the vaccine outweigh the potential harm, or when reduced vaccine immunogenicity may still result in significant benefit to a susceptible, immuno-compromised host.

1. Vaccines should not be administered
if there was a severe reaction such as anaphylaxis following administration of that particular vaccine or a component of that vaccine.

2. Live vaccines should not be administered
• to a person having a malignancy of the reticulo-endothelial system
• during pregnancy
• if a live vaccine had been administered within one month
• if the person has had blood or blood products including immunoglobulin within three months
• for two weeks after stopping long term oral steroids ( >= 2mg/kg /day prednisolone or equivalent or 20 mg / day for > 2 weeks in children or 40 mg/day > 2 weeks in adults)
• for three months after stopping immunosuppressive therapy varicella vaccine can be administered to leukaemic children in remission.

3. Postpone vaccination
• if the vaccine is suffering from an acute infection or fever (temperature > 38.5°C)

4. Be cautious if there is,
• a bleeding disorder
• a history of Guillain Barre Syndrome
• a progressive neurological disorder

5. Postpone pregnancy
• for three months after varicella vaccination
• for one month after MMR

6. Vaccination should be given in a hospital if there is history of severe allergy.

7. Vaccination should be given only in clinics where the following minimum facilities are available.
Adrenaline, Syringes, Canula, Saline and a Bed. It is preferable to have a complete emergency tray.

Dr Maxie Fernandopulle MBBS, MRCP
Consultant Paediatrician, Colombo.
SLMA guidelines information on vaccines

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