Guide to Contraindications and Precautions1 to Commonly Used Vaccines

Vaccine True Contraindications and Precautions1 Not True (vaccines may be given)
Diphtheria, Contraindications: Temperature of <105F or <40.5 C, fussiness or
tetanus, Severe allergic reaction (e.g., anaphylaxis) after a previous dose or mild drowsiness after a previous dose of DTP/
pertussis to a vaccine component DTaP
(DTaP)2 Encephalopathy (e.g., coma, decreased level of consciousness; Family history of seizures3
prolonged seizures) without an identied cause within 7 days of Family history of sudden infant death syndrome
administration of prior dose of DTP or DTaP Family history of an adverse event after DTP or
Progressive neurological disorder, including infantile spasms, DTaP administration
uncontrolled epilepsy, progressive encephalopathy: defer DTaP until Stable neurological conditions (e.g., cerebral
neurologic status claried and stabilized palsy, well controlled convulsions, developmental
Precautions: delay)
Fever of 105F or 40.5C within 48 hours after vaccination with a
previous dose of DTP or DTaP
Collapse or shock-like state (hypotonic hypo-responsive episode)
within 48 hours of receiving a previous dose of DTP/DTaP
Seizure within 3 days of receiving a previous dose of DTP/DTaP
(see footnote #3 regarding management of children with a personal
history of seizures not related to vaccination)
Persistent, inconsolable crying lasting 3 hours within 48 hours after
receiving a previous dose of DTP/DTaP
Guillain-Barr syndrome (GBS) within 6 weeks after a previous
dose of tetanus toxoid-containing vaccine.
Moderate or severe acute illness with or without fever
Tetanus, Contraindications:
diphtheria Severe allergic reaction (e.g., anaphylaxis) after a previous dose or
(DT, Td) to a vaccine component
Precautions:
Guillain-Barr syndrome within 6 weeks after a previous dose of
tetanus toxoid-containing vaccine
Moderate or severe acute illness with or without fever
Tetanus, Contraindications:
diphtheria, Severe allergic reaction (e.g., anaphylaxis) to a vaccine component
pertussis Encephalopathy (e.g., coma, decreased level of consciousness,
(Tdap) prolonged seizures) without an identied cause within 7 days of
administration of prior dose of DTP or DTaP
Moderate or severe illness with or without fever
Precautions:
Guillain-Barr syndrome within 6 weeks after previous dose of
tetanus toxoid-containing vaccine
Progressive or unstable neurologic disorder, uncontrolled seizures
or progressive neuropathy until stabilized
History of Arthus-type reaction following a previous dose of
tetanus-toxoid containing vaccine. Defer until at least 10 years from
previous dose
Inactivated Contraindications:
polio vaccine Severe allergic reaction (e.g., anaphylaxis) to previous dose or to a
(IPV) vaccine component
Precautions:
Pregnancy
Moderate or severe acute illness with or without fever
Haemophilus Contraindications:
inuenzae Severe allergic reaction (e.g., anaphylaxis) after a previous dose or
type B to a vaccine
(Hib) component
Age <6 weeks
Precautions:
Moderate or severe acute illness with or without fever

Immunization Program
P.O. Box 64975
St. Paul, MN 55164-0975
651-201-5503, 1-800-657-3970
www.health.state.mn.us/immunize IC#141-0649 (MDH, 7/2008) Page1 of 4
 Vaccine True Contraindications and Precautions1 Not True (vaccines may be given)
Hepatitis A Contraindications:
(Hep A) Severe allergic reaction (e.g., anaphylaxis) after a previous dose or
to a vaccine component
Precautions:
Pregnancy
Moderate or severe acute illness with or without fever
Hepatitis B Contraindications: Pregnancy
(Hep B) Severe allergic reaction (e.g., anaphylaxis) after a previous dose or Autoimmune disease (e.g., systemic lupus
to a vaccine component erythematosis, rheumatoid arthristis)
Precautions:
Infant weighing <2000 grams4
Moderate or severe acute illness with or without fever
Pneumococcal, Contraindications:
conjugate Severe allergic reaction (e.g., anaphylaxis) after a previous dose or
(PCV7) to a vaccine component
Precautions:
Moderate or severe acute illness with or without fever
Pneumococcal, Contraindications: History of pneumonia or previous invasive
polysaccharide Severe allergic reaction (e.g., anaphylaxis) after a previous dose or pneumococcal disease
(PPV23) to a vaccine component
Precautions:
Moderate or severe acute illness with or without fever
Rotavirus Contraindications: Mild diarrheal disease
(Rota) Severe allergic reaction (e.g., anaphylaxis) after a previous dose or Prematurity
to a vaccine component Pregnant family member or household contact
Precautions: Receipt of RSV monoclonal antibody (Synagis)
Moderate or severe acute illness with or without fever
Altered immunocompetence
Moderate to severe acute gastroenteritis or pre-existing intestinal
disease
History of intussusception
Receipt of antibody-containing blood product within 6 weeks5
Measles, Contraindications: Positive tuberculin skin test
mumps, Severe allergic reaction (e.g., anaphylaxis) after a previous dose or Simultaneous TB skin testing8
rubella to a vaccine component Breastfeeding
(MMR)6 Pregnancy Pregnancy of recipients mother or other close or
Known severe immunodeciency (e.g., hematologic and solid household contact
tumors, congenital immunodeciency, long term immunosuppressive Recipient is childbearing-age female
therapy7 including chemotherapy, severely symptomatic HIV infection) Immunodecient family member or household
contact
Precautions:
Asymptomatic or mildly symptomatic HIV infection
Recent (within 11 months) receipt of antibody-containing blood
Allergy to eggs
product (specic interval depends on product)5
Receipt of RSV monoclonal antibody (Synagis)
History of thrombocytopenia or thrombocytopenic purpura
Moderate or severe acute illness with or without fever
Varicella Contraindications: Pregnancy of recipients mother or other close or
(Var)6 Severe allergic reaction (e.g., anaphylaxis) after a previous dose or household contact
to a vaccine component Immunodecient family member or household
Substantial suppression of cellular immunity contact9
Pregnancy Asymptomatic or mildly symptomatic HIV infection
Precautions: Humoral immunodeciency (e.g.,agammaglobulinemia)
Receipt of antibody-containing blood product within 11 months Receipt of RSV monoclonal antibody (Synagis)
(specic interval depends on product)5
Moderate or severe acute illness with or without fever

MDH Immunization Program IC#141-0649 (7/2008) Page 2 of 4

 Vaccine True Contraindications and Precautions1 Not True (vaccines may be given)
Measles, Contraindications: Positive tuberculin skin test
mumps, Severe allergic reaction (e.g., anaphylaxis) after a previous dose or Simultaneous TB skin testing8
rubella, to a vaccine component Breast-feeding
varicella Pregnancy Pregnancy of recipients mother or other close or
(MMRV)6 Known severe immunodeciency (e.g., hematologic and solid household contact
tumors, congenital immunodeciency, long term immunosuppressive Recipient is child-bearing-age female
therapy7 including chemotherapy, severely symptomatic HIV infection) Immunodecient family member or household
Precautions: contact9
Recent (within 11 months) receipt of antibody-containing blood Asymptomatic or mildly symptomatic HIV infection
product (specic interval depends on product)5 Allergy to eggs
History of thrombocytopenia or thrombocytopenic purpura Receipt of RSV monoclonal antibody (Synagis)
Moderate or severe acute illness with or without fever
Inuenza, Contraindications: Non-systemic allergy to latex or thimerosal
injected Severe allergic reaction (e.g., anaphylaxis) to previous dose or to a
trivalent vaccine component, including egg protein
(TIV) Precautions:
Moderate or severe acute illness with or without fever
Guillain-Barr syndrome within 6 weeks after a previous dose of
inuenza vaccine
Inuenza, Contraindications: Immunodecient family member or household
live attenuated Severe allergic reaction (e.g., anaphylaxis) to previous dose or to a contact
(LAIV)6 vaccine component, including egg protein Pregnant or breastfeeding family member or
Aspirin therapy in children and adolescents household contact
Precaution: Breastfeeding
Children with recurrent wheezing or asthma
Moderate or severe acute illness with or without fever
Pregnancy
Known severe immunodeciency (e.g., hematologic and solid
tumors, congenital immunodeciency, long term immunosuppressive
therapy7 including chemotherapy, severely symptomatic HIV infection)
History of Guillain-Barr syndrome
Certain medical conditions
Receipt of inuenza antiviral medication within past 2 weeks
Human Contraindications: Previous HPV infection10
Papillomavirus Severe allergic reaction (e.g., anaphylaxis) after a previous dose or
(HPV) to a vaccine component
Precautions:
Moderate or severe acute illness with or without fever
Pregnancy
Meningococcal, Contraindications:
conjugate Severe allergic reaction (e.g., anaphylaxis) after a previous dose or
(MCV4) to a vaccine component
History of Guillain-Barr syndrome if not at high risk for meningococcal
disease
Precautions:
Moderate or severe acute illness with or without fever
Meningococcal, Contraindications:
polysaccharide Severe allergic reaction (e.g., anaphylaxis) after a previous dose or
(MPSV4) to a vaccine component
Precautions:
Moderate or severe acute illness with or without fever
Zoster Contraindications: Short-term, low-dose, or local (e.g., topical or
(Zos)6 Severe allergic reaction (e.g., anaphylaxis) after a previous dose or non-systemic administration) corticosteroid
to a vaccine component therapy7
Primary or acquired immunodeciency (e.g., leukemia, lymphoma, Receipt of blood products
AIDS or symptomatic HIV, long term immunosuppressive therapy7,
receiving chemotherapy for malignancy, undergoing stem-cell trans
plantation, receiving immune mediators or modulators)
Pregnancy
Precautions:
Moderate or severe acute illness with or without fever

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 The following are not a contraindication to administration of any vaccine. Vaccines may be given
even if these conditions exist:
Mild acute illness with or without fever
Mild to moderate local reaction (swelling, redness, soreness); low-grade or moderate fever after prior

dose

Lack of prior physical examination in well-appearing person

Current antimicrobial therapy
Convalescent phase of illness
Premature birth (hepatitis B vaccine is an exception in certain circumstances)4
Recent exposure to an infectious disease
History of penicillin allergy, other non-vaccine allergies, relatives with allergies, receiving allergen

extract immunotherapy

Footnotes
1. Carefully review events or conditions listed as precautions. Consider the benets and risks of
administering a specic vaccine to a person under these circumstances. If the risk from the vaccine
seems to outweigh the benet, do not administer the vaccine.
2. Whether and when to administer DTaP to children with proven or suspected underlying neurological
disorders should be decided on a case-by-case basis.
3. Children with a personal or family history of seizures can recieve acetaminophen or other appropriate
antipyretic at the time of DTaP vaccination and every 4-6 hours for 24 hours thereafter to reduce the
possibility of post-vaccination fever. (Source: American Academy of Pediatrics. 2006 Red Book; Report
of the Committee on Infectious Diseases.)
4. Defer hepatitis B vaccination for infants weighing <2,000 grams if the mother is documented to be
HBsAg negative at the time of the infants birth. Start vaccinating these infants at age 1 month (28 days).
For infants born to HBsAg-positive women, administer HBIG and hepatitis B vaccine within 12 hours of
birth regardless of weight.
5. For details on receipt of anitbody-containing blood product see pages 6-7 of ACIPs General
Recommendations on Immunization found in the December 1, 2006 MMWR and on the web at
www.cdc.gov/vaccines/pubs/ACIP-List.htm.
6. Live virus vaccines, can be administered on the same day. However, if not administered on the same
day, these vaccines should be separated by at least 28 days.
7. Immunosuppressive steroid dose is dened as 2 weeks of 20 mg per day or 2 mg/kg body weight
of prednisone or equivalent. Non-immunosuppressive steroid dose is dened as either short-term,
<2 weeks or low-to-moderate dose dened as <20 mg per day or <2 mg/kg/day of prednisone or
equivalent.
8. Vaccination with measles-containing vaccine can temporarily suppress tuberculin reactivity. However,
measles-containing vaccine can be administered on the same day as tuberculin skin testing. If not done
on the same day postpone the skin test for 4 weeks after the vaccination. If the skin test is urgent do it
with the understanding that the vaccine might reduce reactivity.
9. If a patient develops a presumed vaccine-related rash 7-25 days after receiving varicella-containing
vaccine, they should avoid direct contact with immunocompromised persons for the duration of the
rash.
10. Sexually active women and those with a previous HPV infection may not receive the full benet of the
vaccine if they were already infected with an HPV type found in the vaccine.
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