Immunisation - contraindications and when to defer
Contraindications (absolute)
● Anaphylaxis following a previous dose of the relevant vaccine
● Anaphylaxis following any component of the relevant vaccine
When to defer vaccination
● Acute febrile illness (temp >38.5)
● Acute systemic illness
Note: Defer until afebrile. Can vaccinate those with mild illness with no systemic symptoms
8 month old, BIB mother, for the first time. No previous immunisations as father is against it. Mother wants the patient to be vaccinated despite the biological father’s wishes.
- What are the two key features in managing this situation?
- What are the 2 medical contraindications for childhood immunisation?
What are the two key features in managing this situation?
● Do not vaccinate the child at this stage/ Explain the reason why you cannot vaccinate the child
● Explore the reasons behind father’s vaccination hesitancy with Nora’s consent
● Obtain medico-legal advice
What are the 2 medical contraindications for childhood immunisation?
● Anaphylactic reaction to any vaccine or vaccine components
● Immunodeficiency for vaccines with live viruses
Note: Courts have authorised the vaccination of a child against the wishes of at least one of the parents, in all cases
acting in the best interest of the child
Immunisations - egg allergy
● All routine vaccinations including MMR and influenza can be safely given in children with an egg allergy
● Yellow fever and Q fever vaccines contain egg protein
○ Hx of anaphylaxis: should be given cautiously in split doses under medical supervision
○ Hx of allergy but no anaphylaxis: can receive single dose under medical supervision
Immunisation - influenza
Key point:
- Can give for 6 months and above.
- Children under <9 yrs receiving for first time need two doses 1 month apart
Vaccine timing
Pregnant women: any stage during pregnancy.
Travellers: should be offered for any travel where influenza is circulating.
Children: those who are less than 9 years old should have 2 doses of the influenza vaccine 4 weeks apart for the first
year that they receive the vaccine.
2F with asthma presenting for influenza vaccine. Has atopic eczema and is allergic to eggs. Reaction: lip swelling and urticaria. Father is also anaphylactic to egg.
- How are you going to give the influenza vaccine?
Give it now and give the booster in 4 weeks.
Immunisations - expiration dates and windows
Key point ● If given inadvertently then should not be counted as a valid dose and should be repeated Time frame of readministration: ● Inactivated: immediately ● Live: 28 days after
Immunisation - pregnancy
Key point
● Should not receive live vaccines in general
● If planning for pregnancy, should avoid becoming pregnant within 28 days of receiving a live vaccine
Pertussis vaccine
● Recommended for each pregnancy (even ones that are closely spaced)
● Optimal time is 20-32 weeks gestation (no safety concerns if given earlier)
● If not given during optimal window, should be given ASAP at any time up to delivery
Birth (Non-Indigenous and Indigenous)
Engerix B Paediatric (hepatitis B)
2 months (Non-Indigenous)
Infanrix hexa
- DTP
- Polio
- Hepatitis B
- Haemophilus influenza B
Prevenar 13
- Pneumococcal
Rotarix
- Rotavirus
- can be given from 6 weeks
4 months (Non-Indigenous)
Infanrix hexa
- DTP
- Polio
- Hepatitis B
- Haemophilus influenza B
Prevenar 13
- Pneumococcal
Rotarix
- Rotavirus
6 months (Non-Indigenous)
Infanrix hexa
- DTP
- Polio
- Hepatitis B
- Haemophilus influenza b
+/- Prevenar 13
(* <32 weeks or <2000g)
12 months (Non-Indigenous)
Nimenrix
- Meningococcal ACWY
Prevenar 13
- Pneumococcal
Priorix
- Mumps, measles, rubella
18 months (Non-Indigenous)
ActHIB
- Haemophilus influenza B
Priorix-Tetra
- Measles, mumps, rubella
- Varicella
Infanrix
- DTP
4 years (Non-Indigenous)
Infanrix IPV
- DTP
- Polio
+/- Pneumovax 23
- Pneumococcal
12-13 years
14-16 years
All
12-13
Gardasil
Boostrix
14-16
Nimenrix
2 months (Indigenous)
Infanrix hexa
- DTP
- Polio
- Hepatitis B
- Haemophilus influenza B
Prevenar 13
- Pneumococcal
Rotarix
- Rotavirus
Bexsero
- Meningococcal B
4 months (Indigenous)
Infanrix hexa
- DTP
- Polio
- Hepatitis B
- Haemophilus influenza B
Prevenar 13
- Pneumococcal
Rotarix
- Rotavirus
Bexsero
- Meningococcal B
6 months (Indigenous)
Infanrix hexa
- DTP
- Polio
- Hepatitis B
- Haemophilus influenza b
+/- Prevenar 13
+/- Bexsero
(* <32 weeks or <2000g)
12 months (Indigenous)
Nimenrix
- Meningococcal ACWY
Prevenar 13
- Pneumococcal
Priorix
- Mumps, measles, rubella
Bexsero
- Meningococcal B
18 months (Indigenous)
ActHIB
- Haemophilus influenza B
Priorix-Tetra
- Measles, mumps, rubella
- Varicella
Infanrix
- DTP
+/- Vaqta Paediatric
- Hepatitis A
4 years (Indigenous)
Infanrix IPV
- DTP
- Polio
+/- Pneumovax 23
+/- Vaqta Paediatric
> 50 yrs (Indigenous)
Prevenar 13
+ Pneumovax 23 1 year after
+ 2nd Pneumovax 23 at least 5 years after
> 70 years (Non-Indigenous)
Prevenar 13
70-79 years (All)
Zostavax
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