Premises:
(1) A child will have maximal protection from infection if as many vaccines are given as possible (i.e., vaccines are good).
(2) The precise cause of a previous problem should be identified whenever possible.
(3) A vaccine should be given unless there is a good reason not to give it.
(4) Several conditions thought previously to be contraindications to vaccination have been found safe after careful investigation.
Absolute contraindications to immunization:
(1) history of an anaphylactic reaction to a vaccine component that is still present in the vaccine formulation
Reasons to delay vaccination:
(1) live virus vaccine in a patient during a period of severe immunosuppression (vaccine can be given before a period of immunosuppression or during a period of relative immunity)
(2) moderate to severe acute illness - reasons: (a) not to expose a child to an additional burden if a reaction did occur; (b) not to create a situation where the vaccine could be blamed for the illness
(3) deteriorating neurologic condition (until the patient has stabilized and the cause has been found)
Invalid reasons to defer vaccination:
(1) minor injection reaction
(2) local reaction caused by administrator technique
(3) reaction to a vaccine component or contaminant that has been removed from the formulation
(4) reaction to a different vaccine with different formulation
(5) presence of a minor illness
(6) nonlive virus in a patient with immunosuppression (may reduce level of immunization)
(7) stable pre-existing neurological condition (if vaccinating against pertussis use an acellular vaccine to reduce the risk of a febrile convulsion)
Additional recommendations:
(1) If a child cannot be vaccinated because of immunosuppression, close contacts should be vaccinated to reduce the chance of exposure. If the contact received a live vaccine, then that contact should be kept away while there is a risk of shedding live virus.
