Contraindications to immunization dictate circumstances when vaccines should not be given because the condition in an individual increases the risk for a serious adverse reaction following immunization. The majority of con traindications are temporary, and the vaccine can be given later. However, in many cases immunization is delayed or denied because of conditions falsely believed by the physician or the health worker to constitute a contraindication. The World Health Organization and the majority of countries have established and periodically updated lists of contraindications (and often also false contraindications) to offer expert advice for physicians and health workers involved in immunization for individual cases where doubt occurs.
Genuine contraindications are few and the numbers of individuals to whom they apply are fewer still. The various lists of contraindications include mainly:
- acute illness
- altered immunity
- severe adverse events after a previous dose
- children with neurological disorders
- anaphylaxis and allergy to vaccines and vaccine constituents.
Depending on the individual vaccines, contraindications are provided specifically.
Conditions that are NOT contraindications to immunization are called 'false contraindications'. Examples are the following conditions:
- minor illness, such as upper respiratory infection or diarrhea, with temperature < 38.5 °C
- asthma or other atopic manifestations
- family history of convulsions
- treatment with antibiotics, low-dose or locally acting corticosteroids
- dermatoses, localized skin infection
- chronic diseases of heart, lung, kidney and liver
- stable neurological conditions, such as Down's syndrome
- history of jaundice after birth
- mother pregnant
- in incubation period of illness.
Some of these conditions increase the risk from infectious diseases and such individuals should be immunized as a matter of priority [17, 26].
1 Dittmann S (2006) Elimination der Poliomyelitis. Polio-Nachrichten 2: 11-12
2 Dittmann S (2001) Vaccine safety: risk communication - a global perspective. Vaccine 19: 2446-2456
3 Campbell H, Ramsay M, Gungabissoon U, Miller E, Andrews N, Mistry A, Mallard R, Borrow R (2004) Impact of the meningococcal C conjugate vaccination programme in England. Summary Surveillance Report from the Health Protection Agency, Centre for Infections Immunisation Department to end December 2004.
4 Centers for Disease Control and Prevention (2002) Epidemiology and prevention of vaccine-preventable diseases. In: Atkinson W, Hamborsky J, McIntyre L, Wolfe S (eds): The Pink Book, 9th edn, Appendix G: Reported cases and deaths for vaccine-preventable diseases. Public Health Foundation, Washington, D.C.
5 Six common misconceptions about vaccination and how to respond to them. htpp://www.cdc/nip/publications/6mishome.htm (accessed August 14, 2006)
6 Offit PA, Quarles J, Gerber MA, Hackett CJ, Marcuse EK, Kollman TR, Gellin BG, Landry S (2002) Addressing parents' concerns: do multiple vaccines overwhelm or weaken the infant's immune system? Pediatrics 109:124-129
7 Public Health Agency of Canada (2002) Talking with patients about immunization. In : Canadian Immunization Guide 2002, Public Health Agency of Canada, Ottawa, 42-54.
8 Responding to questions and concerns about immunization. In: Australian Immunization Handbook, 8th edn 2003, online. htpp://www9.health.gov.au/ immhandbook (accessed August 14, 2006)
9 Global Advisory Committee on Vaccine Safety (2003) MMR and autism. Weekly Epidemiol Rec 78: 18
10 Global Advisory Committee on Vaccine Safety (2005) Thiomersal: neurobe-havioural studies in animal models. Wkly Epidemiol Rec 80: 3-4
11 Institute of Medicine Immunization Safety Reviews: Measles-mumps-rubella vaccine and autism. National Academy Press, Washington DC 2001. http://www. cdc.gov/nip/news/iom-04-24.htm (accessed August 14, 2006)
12 US Centers for Disease Control. Vaccines and autism - references. http:// www.cdc.gov/nip/vacsafe/concerns/autism/autism-ref.htm (accessed August 14, 2006)
13 Davis RL, Kramarz P, Bohlke K, Benson P, Thompson RS, Mullooly J, Black S, Shinefield H, Lewis E, Ward J et al (2001) Measles-mumps-rubella and other measles-containing vaccines do not increase the risk for inflammatory bowel disease. Arch Pediatr Adolesc Med 155: 354-359
14 US Centers for Disease Control. Measles vaccine and inflammatory bowel disease - references. http://www.cdc.gov/nip/vacsafe/concerns/autism/ibd. htm#references (accessed August 14, 2006)
15 (2002) Immunization Safety Review: Hepatitis B Vaccine and Demyelinating Neurological Disorders. National Academy Press, Washington, D.C.
16 (2003) Immunization Safety Review: Vaccinations and Sudden Unexpected Death in Infancy. National Academy Press, Washington, D.C.
17 (2002) Recommendations of the Advisory Committee on Immunization
Practices (ACIP). General recommendations on immunization. Morb Mortal Wkly Rep 51: No RR-2.
18 American Academy of Pediatrics (2003) Immunocompromised children. In: LK Pickering (ed): 2003 Red Book: Report of the Committee on Infectious Diseases. 26th ed. Elk Grove Village, IL, 69
19 Moss WJ, Clements CJ, Halsey NA (2003) Immunization of children at risk of infection with human immunodeficiency virus. Bull World Health Organ 81: 61-70
20 EPI Vaccines in HIV-infected Individuals. htpp://www.who.int/vaccines-dis-eases/diseases/HIV.shtml (accessed August 14, 2006)
21 Contraindications for childhood vaccinations. htpp://www.cdc.gov/nip/recs/con-traindications.htm (accessed August 14, 2006)
22 (2000) Guidelines for preventing opportunistic infections among hematopoi-etic stem cell transplant recipients. Recommendations of CDC, the Infectious Disease Society of America, and the American Society of Blood and Marrow Transplantation. MMWR 49: RR-10
23 Avery RK, Ljungman P (2001) Prophylactic measures in the solid-organ recipient before transplantation. Clin Infect Dis 33 (Suppl 1): 15-21
24 Stark K, Günther M, Schönfeld C, Tullius SG, Bienzle U (2002) Immunisations in solid-organ transplant recipients. Lancet 359: 957-965
25 Ljungman P (2004) Immunization in the immunocompromised host. In: SA Plotkin, WA Orenstein (eds): Vaccines, 4th edn. Saunders, Philadelphia, 155168
26 (1998) Contraindications for vaccines used in EPI. Wkly Epidemiol Rec 63: 279-281
Pediatric Infectious Diseases Revisited ed. by Horst Schroten and Stefan Wirth © 2007 Birkhäuser Verlag Basel/Switzerland
Was this article helpful?