Reasons to delay vaccination
- Acute illness: if a child is suffering from any acute febrile illness, postpone immunization until the child has fully recovered. Minor infections without fever or systemic upset are not reasons to postpone immunization.
- Adverse reaction to vaccine: vaccines should not be given to those who have had: a confirmed anaphylactic reaction to a previous dose of the same vaccine. Diphtheria containing vaccines should not be given if there is a confirmed anaphylactic reaction to neomycin, streptomycin or polymyxin B (which may be present in trace amounts).
- Untreated malignant disease or altered immunity: those receiving immunosuppressive or X-ray therapy or high-dose corticosteroids. Malignant conditions of the reticulo-endothelial system such as lymphoma, leukaemia, or Hodgkin’s disease, and where the normal immunological mechanism may be impaired.
- Children who have received another live vaccine, including Bacillus Calmette-Guérin vaccine (BCG), within 3 weeks: do not give measles, mumps, and rubella (MMR) vaccine within 3 months of an injection of immunoglobulin.
- Pregnancy should be avoided for 1 month after MMR vaccine, as for rubella vaccine. Although there is no information to suggest that tetanus, diphtheria, or meningococcal C vaccination is unsafe during pregnancy, do not use unless there is a high risk of the individual developing the disease. Do not offer BCG to women who are pregnant or who are breastfeeding, unless it is thought that they are at high risk of catching TB.
- Tuberculin positive: BCG vaccine should not be administered to individuals who are tuberculin-positive (that is, an induration of 5 mm or greater in diameter in the Mantoux test, or a Heaf grade 2 to 4).
Where there is doubt, seek appropriate advice from a consultant paediatrician, District Immunization Coordinator or Consultant in Communicable Disease Control, rather than withholding vaccine.
NOT contraindications to vaccination
The following are not reasons to delay or avoid vaccination:
- A personal or family history of allergy not related to one of the vaccine components.
- A family history of any adverse reactions following immunizations.
- A stable neurological condition such as cerebral palsy, Down’s syndrome, or spina bifida.
- Previous history of pertussis, measles, rubella or mumps infection.
- Prematurity: immunization should not be postponed.
- Contact with an infectious disease.
- Asthma, eczema, hay fever, or ‘snuffles’.
- Treatment with antibiotics or locally acting (e.g. topical or inhaled) corticosteroids.
- Child’s mother is pregnant.
- Child being breastfed.
- History of jaundice after birth.
- Under a certain weight for child’s age.
- Over the age recommended in the immunization schedule. (There is currently no pertussis-containing vaccine licensed for immunization in children age 7 years or older.)
- Family history of convulsions. Immunization should be carried out after advice on the prevention of pyrexia has been given.
- Surgery is not a contraindication to immunization, nor is recent immunization a contraindication to anaesthesia or surgery.
- HIV-positive: most vaccines in the childhood vaccination programme are suitable for people who are HIV-positive. In areas where the risk of contracting tuberculosis and HIV is high, the World Health Organization states that it may be appropriate to vaccinate asymptomatic HIV-positive people. However, the Joint Committee on Vaccination and Immunization advises that BCG should not be administered to individuals infected with HIV.