In general, simply taking an antibiotic would not usually be a reason to not get vaccinated.
“Contraindications and precautions to vaccination generally dictate circumstances when vaccines will not be given. Many contraindications and precautions are temporary, and the vaccine can be given at a later time.”
General Recommendations on Immunization
The reason your child is taking the antibiotic could make you want to think about delaying the vaccine though.
Can Your Kids Get a Vaccine While They Are Taking Antibiotics?
Kids are prescribed antibiotics for a lot of different reasons, from treating ear infections and acne to pneumonia and meningitis.
Since a mild acute illness with or without fever isn’t considered a contraindication or precaution to getting vaccinated, in most cases, being on an antibiotic would not cause you to want to skip or delay your child’s vaccines.
The vaccine information sheet that you get with each vaccine will list contraindications and precautions on who should not get the vaccine.
In fact, current antimicrobial therapy is listed by the CDC as one of the conditions commonly misperceived as a contraindication or precaution!
There are some exceptions though, including:
taking the antibiotic for a moderate or severe acute illness with or without fever (a general precaution to getting a vaccine)
antimalarial agents and antibiotics might interfere with the Ty21a oral typhoid vaccine
antiviral drugs (acyclovir, famciclovir, or valacyclovir) might interfere with varicella-containing vaccines (Varivax)
antiviral drugs (Tamiflu, Relenza) might interfere with LAIV4 (FluMist, the nasal spray flu vaccine)
Is your child taking the antibiotic for a mild illness or a more moderate or severe illness for which they are now recovering? Then the fact that they are still taking an antibiotic likely isn’t a contraindication or a precaution to getting vaccinated.
There are some situations in which it is very important to think about vaccines before your child has surgery.
“Pneumococcal conjugate vaccine (PCV13, Prevnar 13, Pfizer), Haemophilus influenzae type b vaccine (Hib), meningococcal conjugate vaccine (MenACWY), and meningococcal B vaccine should be given 14 days before splenectomy, if possible.”
Ask the Experts about Scheduling Vaccines
A splenectomy leaves your child at extra risk for many vaccine-preventable diseases, so it is a good idea to get vaccinated and protected well in advance of a planned splenectomy, if possible.
This doesn’t mean that these vaccines won’t work after the surgery, but just that you don’t want your child to be unprotected while he remains unvaccinated.
Is Surgery a Contraindication to Getting Vaccinated?
What about other surgeries?
Some kids are put on an aspirin regimen after cardiac surgery and it should be noted that taking aspirin is a contraindication for getting FluMist, the nasal spray flu vaccine, and is considered a precaution for getting the chicken pox vaccine.
“(j)No adverse events associated with the use of aspirin or aspirin-containing products after varicella vaccination have been reported; however, the vaccine manufacturer recommends that vaccine recipients avoid using aspirin or aspirin-containing products for 6 weeks after receiving varicella vaccines because of the association between aspirin use and Reye syndrome after varicella. Vaccination with subsequent close monitoring should be considered for children who have rheumatoid arthritis or other conditions requiring therapeutic aspirin. The risk for serious complications associated with aspirin is likely to be greater in children in whom natural varicella develops than it is in children who receive the vaccine containing attenuated VZV. No association has been documented between Reye syndrome and analgesics or antipyretics that do not contain aspirin.”
Vaccine Recommendations and Guidelines of the ACIP
In most other situations, not only is surgery not considered a contraindication to getting vaccinated, but “hospitalization should be used as an opportunity to provide recommended vaccinations.”
“Most studies that have explored the effect of surgery or anesthesia on the immune system were observational, included only infants and children, and were small and indirect, in that they did not look at the immune effect on the response to vaccination specifically. They do not provide convincing evidence that recent anesthesia or surgery significantly affect response to vaccines. Current, recent, or upcoming anesthesia/surgery/hospitalization is not a contraindication to vaccination. Efforts should be made to ensure vaccine administration during the hospitalization or at discharge.”
Vaccine Recommendations and Guidelines of the ACIP
The one possible argument that makes sense to delay a vaccine in few days or weeks before a planned surgery is that if your child has a reaction to the vaccine, even if it is a mild reaction, like a fever or irritability, then it might cause them to delay the surgery.
And you could make the same argument about delaying vaccines in the days or weeks after having surgery. Could mild reactions to a vaccine be confused with complications from the surgery?
Otherwise, your anesthesiologist’s preferences aside, a recent or upcoming surgery is not a true contraindication to getting vaccinated, especially if it is a vaccine that your child is already past due for or needs because of a local outbreak, etc.
Unless they are giving these kids the oral polio vaccine or plan on them sharing a room with a bone marrow transplant patient, they don’t need to worry about shedding. But that’s only one of the reasons that this hospital’s recommendations don’t follow ACIP guidelines.
What happens if you delay getting your child vaccinated because of a planned surgery and they get exposed to someone with measles or chicken pox?
Fortunately, this isn’t usually an issue unless your child is already behind on their vaccines and needs to catch up. After all, there is a lot of flexibility built into the immunization schedule, so that your child could get all of their vaccines on time, even with a planned or unexpected surgery.
We sometimes hear that folks are going to skip their yearly flu vaccine because they don’t believe in flu shots, they never get sick, or they think that flu shots don’t work or are dangerous.
Some nurses and doctors are refusing to get a flu shot and have to wear masks at work.
Flu vaccines are safe and have many benefits, even if they aren’t any where near 100% effective.
So are there any legitimate reasons to skip a flu shot?
Of course.
In fact, three very good reasons to skip a flu shot include:
being younger than 6 months of age
having a severe allergic reaction (e.g., anaphylaxis) after a previous dose of flu vaccine or to any component of the flu vaccine
and, uh…
Actually, although folks might have many of bad excuses, there are only two good reasons to skip a flu shot…
So, infants who aren’t old enough to be vaccinated yet, and anyone who has had a life-threatening reaction to a previous dose.
Additional precautions, but not true contraindications, do including having had Guillain-Barré syndrome <6 weeks after a previous dose of influenza vaccine and having a moderate or severe acute illness with or without fever when you are planning to get vaccinated.
Even if you have had a severe reaction to eggs, you can still get a flu shot. Just get it get it in an inpatient or outpatient medical setting (such as a hospital, clinic, health department, or physician’s office), so that you can be supervised by a health care provider who is able to recognize and manage severe allergic reactions.
Are you skipping the flu shot because you never get sick? How lucky do you feel this year? Don’t continue to gamble that you won’t get the flu. Increase your chances of staying well by getting a flu shot, the best way to avoid the flu.
The way that these laws and exemptions are set up leaves a lot of room for abuse though.
Abuse of Religious Exemptions
How many religions are actually against kids getting vaccinated?
That’s right, almost none.
So why are there so many religious vaccine exemptions in most states, especially in states that don’t have a personal belief exemption?
Right again.
Folks who don’t want to vaccinate their kids, and can’t use a personal belief exemption, just say that vaccinating them would be against their religion.
Abuse of Medical Exemptions
There are some children who shouldn’t be vaccinated.
These children can get a true medical exemption to one or more vaccines because they have a real contraindication or precaution to getting vaccinated.
“If a child has a medical exemption to immunization, a physician licensed to practice medicine in New York State must certify that the immunization is detrimental to the child’s health. The medical exemption should specify which immunization is detrimental to the child’s health, provide information as to why the immunization is contraindicated based on current accepted medical practice, and specify the length of time the immunization is medically contraindicated, if known.”
Dear Colleague letter regarding guidelines for use of immunization exemptions
a moderate or severe acute illness with or without fever (precaution)
a progressive neurologic disorder (precaution)
Although it will get you a medical exemption for just $120 in California, a family history of these conditions would not be a reason to skip or delay any vaccines.
Most other things are “incorrectly perceived as contraindications to vaccination” and should not be a medical exemptions, including having :
a mild acute illness with or without fever
a mild to moderate local reaction
relatives with allergies
a family history of seizures
a stable neurologic condition
an autoimmune disease
a family history of an adverse event after DTP or DTaP administration
A medical exemption can also exist if your child already had the disease and so has natural immunity. In most cases, except for chicken pox disease, titers will likely need to be done to prove that your child already has immunity.
Stopping the Abuse of Vaccine Exemptions
We know that vaccine exemptions are being abused.
How do you stop it?
“Permitting personal belief exemptions and easily granting exemptions are associated with higher and increasing nonmedical US exemption rates. State policies granting personal belief exemptions and states that easily grant exemptions are associated with increased pertussis incidence.”
Omer et al on Nonmedical exemptions to school immunization requirements: secular trends and association of state policies with pertussis incidence.
You likely have to make it harder to get a vaccine exemption.
Strong exemption laws, which are needed in many states, make it clear that:
many exemptions are temporary
medical exemptions are based on ACIP guidelines, current accepted medical practice, and evidence based medicine – not anecdotes
religious exemptions specifically exclude philosophical exemptions and must reflect a sincere religious belief
exempted students will be excluded from school during outbreaks
exemptions should include a signed affidavit that is notarized
exemptions should be recertified each year
a separate exemption application will be needed for each vaccine
Getting an exemption shouldn’t be easier than getting vaccinated! And it should include some degree of education against the myths and misinformation that scares parents away from vaccinating their kids.
“Because rare medically recognized contraindications for specific individuals to receive specific vaccines exist, legitimate medical exemptions to immunization requirements are important to observe. However, nonmedical exemptions to immunization requirements are problematic because of medical, public health, and ethical reasons and create unnecessary risk to both individual people and communities.”
AAP on Medical Versus Nonmedical Immunization Exemptions for Child Care and School Attendance
You could also get rid of nonmedical vaccine exemptions.
Of course, for that to work, you can’t allow just anything to count as a medical exemption.
“Review of all medical exemption requests will be conducted at the Mississippi State Department of Health by the State Epidemiologist or Deputy State Epidemiologist.”
Mississippi Medical Exemption Policy
In Mississippi, for example, where medical exemptions are reviewed and approved by the State Epidemiologist or Deputy State Epidemiologist, there were just 208 medical exemptions in the whole state during the 2016-17 school year.
In some states, rates of medical exemptions might be six or seven times higher. This is mostly seen in states that don’t allow personal belief exemptions and make it difficult to get a religious exemption.
That seems to be the case in Nebraska, where there are no personal belief exemptions and you have to submit a notarized statement to get a religious exemptions. Their high rates of medical exemptions likely reflect some abuse and the fact that medical exemptions aren’t reviewed or approved by anyone, they just reflect “that, in the health care provider’s opinion, the specified immunization(s) required would be injurious to the health and well – being of the student or any member of the student’s family or household.”
As we are seeing, that simply invites vaccine exemption abuse.
Very few states currently require that exemption applications go to the health department for review. Those that do include Alabama, Arkansas, Michigan, Minnesota, Mississippi, and West Virginia.
California is notably absent. I guess they didn’t see the potential for abuse when they passed their latest vaccine law. I mean, who could have guessed that doctors would actually be selling medical exemptions to parents based on unrelated conditions, like a family history of diabetes, celiac disease, or autism?
The non-medical vaccine exemption form in Colorado includes information on the risks of each vaccine-preventable disease.
At the very least, until we have stronger exemption laws, parents who want to get a nonmedical exemption should acknowledge that they understand the risks they are taking when they skip or delay their child’s vaccines.
What to Know About Abuse of Vaccine Exemptions
While medical exemptions are necessary for kids who have true contraindications to getting vaccinated, stronger laws can help decrease the abuse we see in medical, religious, and personal belief vaccine exemptions.
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.
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.
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
