Lane et al identified reasons for when a child can and should not be vaccinated. These can help safely maximize protection of a child. The authors are from the Health Protection Agency and Department of Health in London.



(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.


To read more or access our algorithms and calculators, please log in or register.