# Presentation: 593901

## General Recommendations on Immunization

**Epidemiology and Prevention of Vaccine-Preventable Diseases**
**National Immunization Program**
**Centers for Disease Control and Prevention**

**Revised January 2007**

## Principles of Vaccination

- General Rule

**Inactivated vaccines are generally not affected by circulating antibody to the antigen. **
**Live attenuated vaccines may be affected by circulating antibody to the antigen. **

## Antibody and Measles- andVaricella-Containing Vaccines

**Vaccine**
**Antibody**

_**Action**_
**	**** ****Wait 2 weeks before****	**** giving antibody**
**	**** ****Wait 3 months or**
**    ****longer* before giving**
**    ****vaccine**
**	**** ****(See Table, Appendix A)****  **

- Antibody and Measles- andVaricella-Containing Vaccines

***except rotavirus vaccine, which should be delayed for**
** ****6 weeks, if possible**

## Products Containing Type-Specific or Negligible Antibody

**Palivizumab (Synagis)**
**contains only monoclonal RSV antibody**
**does not interfere with live virus vaccination**
**Red blood cells (RBCs), washed**
**negligible antibody content**

## Principles of Vaccination

- General Rule

**All vaccines can be administered at the same visit as all other vaccines.**

## Spacing of Vaccine Combinations Not Given Simultaneously

**Two live injected ****or intranasal influenza vaccine**
**All other**

_**Minimum Interval**_
**4 weeks**
** **
**None**

## Nonsimultaneous Administration of Two Live Parenteral Vaccines

**Interference can occur between  two live vaccines given less than 28 days apart**
**If two live parenteral vaccines, or live intranasal influenza vaccine, are given less than 28 days apart the vaccine given second should be repeated**
**Exception is yellow fever vaccine given less than 4 weeks after measles vaccine**

## Principles of Vaccination

- General Rule

**Increasing the interval between doses of a multidose vaccine does not diminish the effectiveness of the vaccine***
**Decreasing the interval between doses of a multidose vaccine may interfere with antibody response and protection**

***after the series has been completed**

## Minimum Intervals and Ages

**Vaccine doses should not be administered at intervals less than the minimum intervals or earlier than the minimum age**

## Violation of Minimum Intervals or Minimum Age

**ACIP recommends that vaccine doses given up to four days before the minimum interval or age be counted as valid**
**Immunization programs and/or school entry requirements may not accept all doses given earlier than the minimum age or interval**

## Extended Interval Between Doses

**Not all permutations of all schedules for all vaccines have been studied**
**Available studies of extended intervals have shown no significant difference in final titer**
**It is not necessary to restart the series or add doses because of an extended interval between doses**

## Vaccine Adverse Reactions

**Adverse reaction**
** ****extraneous effect *****caused by ****** vaccine***
** ****side effect**
**Adverse event**
** *****any***** event following vaccination**
** ****may be true adverse reaction**
** ****may be only coincidental**

## Vaccine Adverse Reactions

**Local**
** ****pain, swelling, redness at****  site of injection**
** ****common with inactivated****  vaccines**
** ****usually mild and self-limited**

## Vaccine Adverse Reactions

**Systemic**
** ****fever, malaise, headache**
** ****nonspecific**
** ****may be unrelated to vaccine**

## Live Attenuated Vaccines

**Must replicate to produce immunity**
**Symptoms usually mild**
**Occur after an incubation period****(usually 7-21 days)**

## Vaccine Adverse Reactions

**Allergic**
** ****due to vaccine or vaccine**** component**
** ****rare**
** ****risk minimized by screening**

## Vaccine Adverse Event Reporting System (VAERS)www.vaers.hhs.gov

## Contraindication

**A condition in a recipient that greatly increases the chance of a serious adverse reaction**

## Precaution

**A condition in a recipient that might increase the chance or severity of an adverse reaction, or**** **
**Might compromise the ability of the vaccine to produce immunity**

## Contraindications and Precautions

**severe allergic reaction to a vaccine component or following a prior dose **** **
**encephalopathy not due to another identifiable cause occurring within 7 days of pertussis vaccination**

**Permanent contraindications to vaccination:**

## Contraindications and Precautions

_**Condition**_
**Allergy to component**
**Encephalopathy**
**Pregnancy**
**Immunosuppression**
**Severe illness**
**Recent blood product**

_**Live**_
- C
- ---
- C
- C
- P
-    P**

_**Inactivated**_
- C
- C
-  V*
- V
- P
- V

- C**=contraindication   **P**=precaution  **V**=vaccinate if indicated**
***except HPV vaccine. **MMR and varicella-containing (except zoster vaccine), and rotavirus vaccines only**

## Vaccination of Pregnant Women

**Live vaccines should not be administered to women known to be pregnant**
**In general inactivated vaccines may be administered to pregnant women for whom they are indicated**
**HPV vaccine should be deferred during pregnancy**

## Use of Tdap Among Pregnant Women*

**Any woman who might become pregnant is encouraged to receive a single dose of Tdap**
**Women who have not received Tdap should receive a dose in the immediate postpartum period**
**ACIP recommends Td when tetanus and diphtheria protection is required during pregnancy**
**Pregnancy is not a contraindication for Tdap **
**Clinician may choose to administer Tdap to a pregnant woman in certain circumstances (such as during a community pertussis outbreak)**

***Provisional recommendations approved by ACIP June 28, 2006**

## Immunosuppression

**Disease**
**congenital immunodeficiency**
**leukemia or lymphoma**
**generalized malignancy**
**Chemotherapy**
**alkylating agents**
**antimetabolites**
**radiation**

## Immunosuppression

**Corticosteroids**
**20 mg or more per day****of prednisone***
**2 mg/kg or more per day of prednisone***
**NOT aerosols, alternate day, short courses, topical**

***for 14 days or longer**

## Vaccination of Immunosuppressed Persons

**Live vaccines should not be administered to severely immunosuppressed persons**
**Persons with isolated B-cell deficiency may receive varicella vaccine**
**Inactivated vaccines are safe to use in immunosuppressed persons but the response to the vaccine may be decreased **

## Live Attenuated Vaccines for Persons with HIV/AIDS*

**Varicella**
**Zoster**
**MMR**
**MMRV**
**LAIV**
**Rotavirus**
**Yellow fever**

_**Asymptomatic**_
**Yes****+**
**No**
**Yes**
**No**
**No**
**No**
**Consider**

_**Symptomatic**_
**No**
**No**
**No**
**No**
**No**
**No**
**No**

**Yes=vaccinate   No=do not vaccinate**

***see specific ACIP recommendations for details.**
**+children only.**** **

## Vaccination of Hematopoietic Stem Cell Transplant Recipients

**Antibody titers to VPDs decline during the 1-4 years after allogeneic or autologous HSCT if the recipient is not revaccinated**
**HSCT recipients are at increased risk of some VPDs, particularly pneumococcal disease**
**Revaccination recommended beginning 6-12 months post-transplant**

***MMWR***** 2000;49(RR-10)**

## Vaccination of Hematopoietic Stem Cell Transplant Recipients

**Inactivated influenza vaccine at least 6 months following transplant and annual thereafter**
**Inactivated vaccines (DTaP/Td, IPV,  hepatitis B, Hib, PCV, PPV) at 12 months**
**MMR and varicella vaccines at 24 months if immunocompetent**
**Meningococcal and Tdap vaccines not recommended (insufficient data)**

***MMWR***** 2000;49(RR-10) and *****MMWR***** 2006;55(RR-15)**

## Vaccination of Household Contacts of Immunosuppressed Persons

**Healthy household contacts of immunosuppressed persons  should receive MMR and varicella vaccines and annual influenza vaccination**

## Invalid Contraindications to Vaccination

**Mild illness**
**Antimicrobial therapy**
**Disease exposure or convalescence**
**Pregnant or immunosuppressed person in the household**
**Breastfeeding**
**Preterm birth**
**Allergy to products not present in vaccine or allergy that is not anaphylactic**
**Family history of adverse events**
**Tuberculin skin testing**
**Multiple vaccines**

## Screening Questions

**Is the child (or are you) sick today? **
**Does the child have an allergy to any medications, food, or any vaccine?**
**Has the child had a serious reaction to a vaccine in the past?**
**Has the child had a seizure, brain or nerve problem?**
**Does the child have cancer, leukemia, AIDS, or any other immune system problem?**

## Vaccination During Acute Illness

**No evidence that acute illness reduces vaccine efficacy or increases vaccine adverse reactions**
**Vaccines should be delayed until the illness has improved**
**Mild illness, such as otitis media or an upper respiratory infection, is NOT a contraindication to vaccination **

## Screening Questions

**Has the child taken cortisone, prednisone, other steroids, or anticancer drugs, or had  x-ray treatments in the past 3 months?**
**Has the child received a transfusion of blood or blood products, or been given a medicine called immune (gamma) globulin in the past year?**
**Is the child/teen pregnant or is there a chance she could become pregnant during the next month?**
**Has the child received vaccinations in the past 4 weeks?**

## National Immunization ProgramContact Information

**Telephone****	****800.CDC.INFO**** **
**Email****	****	****	****nipinfo@cdc.gov**** **
**Website****	****	****www.cdc.gov/nip**