Vaccine Rules

Most childhood vaccines require two or more doses for stimulation of an adequate and persisting
antibody response.
Interchangeability of vaccine products-in general, most vaccines from different manufacturers may be
interchangeable.
Simultaneous administration-Most can be safely and effectively given simultaneously.
Lapsed immunizations-A lapse in schedule does not require reinstitution of the entire series.

Unknown or uncertain immunization status
When in doubt, the child should be considered to be disease-susceptible, and appropriate
immunizations should be initiated without delay.
To be counted, the vaccine(s) must be documented on a formal immunization record) regardless
of country.

Active immunization of people who recently received gamma globulin
Live virus vaccine may have diminished imrnunogenicity when given shortly before or during the several
months after receipt of immunoglobulin (Ig).
Dose-No reduced dose or divided dose should be administered, including to babies born prematurely or
at low birth weight.


Institute of Medicine Immunization Safety Review Committee findings
Available evidence does not support the hypothesis that the MMR causes autism, associated disorders,
or inflammatory bowel disease. (Lancet report of Wakefield has been found to be fraudulent)
Based on epidemiologic evidence, there is no causal relationship between multiple immunizations and
increased risk of immune dysfunction and type 1 diabetes.
There is no causal relationship between hepatitis B vaccine administration and demy- elinating
neurologic disorders.
There is no causal relationship between meningococcal vaccination and Guillain- Barre.

Misconceptions
The following are not contraindications to immunizations:
A reaction to a previous DPT of temperature <105F, redness, soreness, and swelling A mild, acute
illness in an otherwise well child
Concurrent antimicrobial therapy
Prematurity-immunize at the chronological age
A family history of seizures
A family history of sudden infant death syndrome


Accepted Precautions and Contraindications
Minor illness. with or without a fever, does not contraindicate immunization.
Fever, per se, is not a contraindication.
o Guidelines for administration are based on the physician's assessment of illness and on
specific vaccines the child is scheduled to receive.
o If fever or other problems suggest moderate or serious illness, the child should not be
immunized until recovered.
Documented egg allergy is not a contraindication to the MMR. MMR is derived from chick embryo
fibroblast tissue cultures but does not contain significant amounts of egg cross-reacting proteins.
Influenza vaccine (and yellow fever) does contain egg protein and on rare occasions may induce a
significant immediate hypersensitivity reaction.


Hypersensitivity
o Egg hypersensitivity can occur with influenza and yellow fever vaccines.
o Neomycin is contained in IPV, measles, mumps, rubella, and MMR.
o Streptomycin is contained in lPV and MMR.
o Vaccines are now thimerosal free.


When you ask why he hasn't been immunized, his mother replies that she "hasn't gotten around to it yet," and
furthermore, that she "read on the Web and saw on TV that vaccines can hurt you." She then inquires of you,
"What shots does a kid actually need, what are vaccines actually made of, and how safe are those
immunizations, anyway?"

Vaccines are the single most cost-effective interventions performed to improve and maintain the health of
citizens of the United States, and have been cited as one of the most significant advancements in medical
practice occurring during the 20th century. Vaccines are not without risks, but the anxiety expressed by some
parents is almost always the result of misperceptions fueled by misinformation. When considered against the
risk of infection with concomitant associated morbidity and mortality, the benefits of universal childhood
immunization far outweigh all risks for each of the vaccine-preventable diseases. In those circumstances where
rare but potentially serious adverse reactions to immunization are demonstrated, such as the risk for
intussusception following administration of the oral tetravalent rotavirus vaccine (18), the national Vaccine
Adverse Event Reporting System (VAERS) provides identification of these rare complications and promotes
the appropriate corrective actions. Health care providers should strongly endorse routine childhood
immunization, and be capable and willing to adequately address any parental concerns.