Tag: contraindications

Precautions vs Contraindications When Vaccinating Your Kids

Believe it or not, there are some anti-vaccine folks who believe that all vaccines are dangerous and unnecessary. And they believe that pediatricians push vaccines on kids in all situations, using a one-size-fits-all kind of immunization schedule.

Of course, neither is true.

Vaccines are safe and necessary.

There are some true medical contraindications and precautions to getting vaccinated though. Still, it is important to remember that even more things are simply “conditions incorrectly perceived as contraindications to vaccination.”

Contraindications To Vaccinating Your Kids

There are actually some good reasons to delay or skip one or a few of your child’s vaccines, but only in some very specific situations.

These very specific situations are called contraindications and are what count as medical exemptions.

“A vaccine should not be administered when a contraindication is present; for example, MMR vaccine should not be administered to severely immunocompromised persons.”

CDC on Vaccine Contraindications and Precautions

Fortunately, there are not that many of these contraindications, they are usually specific to just one or a few vaccines, and they are usually, but not always, temporary.

That’s why it would be really unusual to get a true permanent medical exemption for all vaccines. Even if you had a severe allergy to a vaccine that contained yeast, latex, or gelatin, since vaccines contain different ingredients, you would very likely be able to safely get the others.

Remember, your doctor can’t, or at least shouldn’t, just make up contraindications and exemptions to help you avoid getting your kids vaccinated and help you keep them in school.

“I do not believe vaccines had anything to do with my child’s autism. I never noticed any change in his speech, behavior or development with vaccines. I believe the protection and benefits of vaccines far outweigh the risks!”

Michele Han, MD, FAAP

Autism, for example, has been shown to not be associated with vaccines, so it is not a contraindication to getting vaccinated. That’s why many parents vaccinate and protect their autistic kids!

Precautions To Vaccinating Your Kids

In addition to contraindications to getting vaccinated, there is an accompanying list of  precautions.

“A precaution is a condition in a recipient that might increase the risk for a serious adverse reaction, might cause diagnostic confusion, or might compromise the ability of the vaccine to produce immunity (e.g., administering measles vaccine to a person with passive immunity to measles from a blood transfusion administered up to 7 months prior). A person might experience a more severe reaction to the vaccine than would have otherwise been expected; however, the risk for this happening is less than the risk expected with a contraindication. In general, vaccinations should be deferred when a precaution is present. However, a vaccination might be indicated in the presence of a precaution if the benefit of protection from the vaccine outweighs the risk for an adverse reaction.”

CDC on Vaccine Contraindications and Precautions

Again, we are fortunate that most of the conditions that are listed as precautions are temporary.

The vaccine information sheet that you get with each vaccine will list contraindications and precautions on who should not get the vaccine.
The vaccine information sheet that you get with each vaccine will list contraindications and precautions on who should not get the vaccine.

In fact, the most common is having a “moderate or severe acute illness with or without fever.”

Don’t want to get your child vaccinated when he or she has a severe illness?

Don’t worry.

Your pediatrician usually doesn’t want to vaccinate your child in that situation either.

It is easy enough to wait a few days or a week to get vaccinated, when the illness has passed, keeping in mind that a “mild acute illness with or without fever” is neither a precaution nor a contraindication to getting vaccinated. So you can still get your child their recommended vaccines if they just have a cold, stomach bug, or ear infection, etc.

What to Know About Precautions and Contraindications to Vaccines

Although there are some true medical exemptions or contraindications and precautions to getting vaccinated, most are vaccine specific and many are temporary, so they shouldn’t keep you from getting your child at least mostly vaccinated and protected.

More on Precautions and Contraindications to Vaccines

Strategies for Increasing Childhood Vaccination Rates

How do we improve vaccination rates?

A very clever immunization reminder system for parents.
A very clever immunization reminder system for parents.

One way is to help parents get educated about vaccines, so that they understand that vaccines work, vaccines are safe, and that vaccines are necessary.

Strategies for Increasing Childhood Vaccination Rates

Vaccine-hesitant parents who might delay or skip some of their child’s vaccines aren’t the only reason vaccination rates aren’t where they should be though.

“Immunization levels in the United States are high, but gaps still exist, and providers can do much to maintain or increase immunization rates among patients in their practice.”

CDC on The Need for Strategies to Increase Immunization Levels

How do we fix these gaps in immunization rates?

Some easy things to do that can help increase vaccination rates might include:

  • regularly posting vaccine education material on your social media accounts
  • maintaining a good supply of vaccines
  • reminding parents to bring their immunization records with them to each appointment, especially if they are new patients
  • keeping accurate immunization records on each patient
  • carefully recording vaccines that have been given outside your office
  • using an immunization information system or immunization registry to make it easier to keep track of immunization records
  • generating lists of patients who’s vaccines are past due
  • using reminder and recall messages, either phone calls, text messages, or postcards, etc., so that parents are notified when vaccines are due soon or past due
  • using an electronic health record system to automatically generate prompts when vaccines are due at well visits and sick visits
  • manually reviewing your patient’s vaccination status at each visit, whether it is a sick visit, well visit, or just a nurse visit, to see if they need any immunizations. Remember, a mild illness is not usually a contraindication to getting vaccinated.
  • reducing missed opportunities to vaccinate kids by using standing orders and “nurse only” or “shots only” visits for vaccinations
  • having extended hours for some scheduled or walk-in vaccination clinics
  • enrolling in the Vaccines for Children program to provide free vaccine to families who are uninsured

And most importantly, office staff need to get educated about vaccines too, especially about the anti-vaccine talking points that might keep some kids from getting vaccinated on time. They should also understand the immunization schedule and catch-up immunization schedule, so they can easily recognize which vaccines are due.

“Pediatricians in the sample often provided parents with inconsistent, mixed messages and sometimes offered information about HPV or HPV vaccination that was inaccurate. Pediatricians used presumptive language in only 11 of 75 encounters; when used, presumptive language was associated with higher odds of accepting HPV vaccine.”

Sturm et al, on Pediatrician-Parent Conversations About Human Papillomavirus Vaccination: An Analysis of Audio Recordings

Pediatricians who are getting frustrated talking to parents who have been refusing vaccines might also learn a few new things, including how to use presumptive language.

What is presumptive language?

In the HPV vaccination study quoted above, it was defined as “a matter-of-fact statement that the child was due for or would receive HPV vaccine that day or at a future date, conveying a positive stance toward vaccination.” This is in contrast to a nonpresumptive style that “involved questions or uncertainty,” such as “do you want to get a shot today?”

“High-quality recommendations were strongly associated with HPV vaccination behavior, but only about one-third of parents received them.”

Gilkey et al, on Provider communication and HPV vaccination: The impact of recommendation quality

In addition to using presumptive language, another study has found that “By endorsing HPV vaccine highly, recommending same-day vaccination, and emphasizing cancer prevention, providers may be able to promote HPV vaccine initiation and completion while discouraging vaccine refusal and delay.”

Can these strategies work for your office?

What to Know About Increasing Childhood Vaccination Rates

From using reminder systems and standing orders to changing how you talk to parents, there are a lot of things that can be done to increase childhood vaccination rates.

More on Increasing Childhood Vaccination Rates

Vaccines for Premature Babies

Premature babies can usually get all vaccines on schedule - at their chronological age, not an adjusted age based on being a preemie.
Premature babies can usually get all vaccines on schedule, at their chronological age, not an adjusted age based on being a preemie. Photo by Vincent Iannelli, MD

It is easy for the parents of a premature baby in the NICU to get overwhelmed by all of the things that might be going on, especially if they are there long enough for their baby to get their two month vaccines.

Ventilators, TPN, jaundice lights, feeding tubes, oxygen, apnea monitors, etc. – is this really a time to be thinking about vaccines?

Since premature babies can have an immature immune system and are at greater risk for infectious diseases, including vaccine-preventable diseases, it is actually a great time to make sure that your baby gets vaccinated and protected.

Vaccine Recommendations for Preterm Babies

What vaccines do premature babies need?

Which ones should you delay or skip?

“In the majority of cases, infants born prematurely, regardless of birth weight, should be vaccinated at the same chronological age and according to the same schedule and precautions as full-term infants and children”

ACIP Vaccination of Premature Infants

Not surprisingly, it is recommended that you not delay or skip any vaccine just because your baby was born premature.

You also shouldn’t wait to vaccinate your preterm baby according to any corrected or age-adjusted schedule. Premature babies get vaccinated according to their chronological age, just like everyone else.

There is one exception.

If a preterm baby also has a birth weight less than 2,000g AND their mother is known to be negative for hepatitis B infection, then they can delay their first dose of hepatitis B vaccine until they are 1 month old or at hospital discharge (whichever is sooner). The hepatitis B vaccine can be safely given if the mother is hepB positive or her status isn’t known. That dose just isn’t counted and is later repeated, because of the concern that it might not work as well in low birth weight, premature newborns.

Vaccines Work for Premature Babies

Does that mean that other vaccines for premature babies might not work as well either?

Many studies have shown that vaccines work well in premature babies.

The World Health Organization does recommend that for Prevnar, “pre-term neonates who have received their 3 primary vaccine doses before reaching 12 months of age may benefit from a booster dose in the second year of life.” That doesn’t apply in the United States though, as we give a routine booster to all toddlers at 12 to 15 months and studies have shown this schedule works well for preterm babies. That’s good, because preterm babies are thought to be at much higher risk for invasive Streptococcus pneumoniae infections.

Otherwise, remember the advice of the AAP, including that “medically stable preterm babies weighing more than 4.4 lbs. at birth should be treated like full-term babies and receive the first dose of the hepatitis B immunization according to the recommended schedule.”

What To Know About Vaccines For Your Preterm Baby

Vaccines are safe, effective, and very necessary for premature babies.

More About Vaccines For Your Preterm Baby