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In terms of vaccine administration, you’ll see terms such as contraindication and precaution. A contraindication is a strong recommendation against giving the vaccine and it’s very strong because harm may occur to the person you are vaccinating. Whereas the precaution; you need to consider the circumstances and in some cases you may want to give the vaccine, even though there is a precaution against giving it because the benefits of vaccination may outweigh the risks of the vaccine itself. You need to sort of individualize this. There are a few vaccines where this is very important and I will talk about those issues when that comes up for the specific vaccine.
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These are general contraindications for vaccination, and again we are talking generalities now. We’ll talk about the specific vaccines in a moment. But in general, anybody with an acute febrile illness should not be vaccinated. It may interfere with your evaluation of their acute illness in an immunosuppressed individual, or if somebody in the household has an immunodeficiency disorder. We’ll talk about specific vaccines that are indicated just in that circumstance and others that you would want to avoid. Pregnancy; live vaccines in general are contraindicated due to theoretical concerns. Recent passive antibody administration will interfere with parenteral live vaccine take, such as MMR and varicellar vaccine. And anybody with a prior allergic reaction or serious adverse reaction to the same or related vaccine, obviously you’d want to think about giving them the same vaccine again.
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But it’s important not to over-call contraindications. If you over-call them and don’t give a vaccine when it’s indicated, a missed opportunity for vaccination and you shouldn’t do that. You should be aware that these are not vaccine contraindications, but these are common misconceptions. Anybody with a previous mild local reaction or a fever. You give a DTaP vaccine and they have a fever of 101 afterwards, that’s no big deal. Anybody with a mild acute illness, a low grade fever, a kid with a cold, a kid with otitis media, a kid taking antibiotics for otitis media, that’s not a contraindication to vaccination. Recent exposure to an infectious disease such as chicken pox, a penicillin allergy or non-specific allergies are not contraindications. Family history of seizures, SIDS or whatever, it’s not a contraindication. Mother pregnant or breast feeding, a kid with diarrhea, TB, positive PPD or simultaneous PPD – there’s some confusion there – and we’ll talk about that more with MMR vaccine. But those aren’t contraindications. Prematurity in general isn’t a contraindications. We’ll talk about some caveats in relationship to hepatitis B vaccine and malnutrition. So these are not contraindications to vaccination.
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In terms of scheduling immunization, as a general rule, simultaneous immunization is beneficial. You can give as many as you want at one visit. If a lapse in a series occurs, there is no need to restart the series. The body remembers. The immune system remembers that first dose. In general the minimal interval between the first two doses in a series is four weeks, and in general vaccine brands are interchangeable. So although your syllabus, to be complete, contains a lot of trademark vaccine names and a lot of the slides will show that too, don’t pay too much attention to those for Board review purposes. Those are important sometimes for practical purposes, but on a test in general – and I’ll point out some exceptions – in general you don’t have to know the vaccine brands.