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                                 Vaccination section -Autoimmune diseases

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Update: Vaccine Side Effects, Adverse Reactions, Contraindications, and Precautions Recommendations of the Advisory Committee on Immunization Practices (ACIP) part-2

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  Return to page-2 of vaccination practises

Altered Immunocompetence

Management of Patients with Contraindications to Measles Vaccine

If immediate protection against measles is required for persons with contraindications to measles vaccination, passive immunization with IG, 0.25 mL/kg (0.11 mL/lb) of body weight (maximum dose=15 mL), should be given as soon as possible after known exposure. Exposed symptomatic HIV-infected and other immunocompromised persons should receive IG regardless of their previous vaccination status; however, IG in usual doses may not be effective in such patients. For immunocompromised persons, the recommended dose is 0.5 mL/kg of body weight if IG is administered intramuscularly (maximum dose=15 mL). This corresponds to a dose of protein of approximately 82.5 mg/kg (maximum dose=2,475 mg). Intramuscular IG may not be needed if a patient with HIV infection is receiving 100-400 mg/kg IGIV at regular intervals and the last dose was given within 3 weeks of exposure to measles. Because the amounts of protein administered are similar, high-dose IGIV may be as effective as IG given intramuscularly. However, no data are available concerning the effectiveness of IGIV in preventing measles.

Simultaneous Administration of Vaccines

In general, simultaneous administration of the most widely used live and inactivated vaccines does not impair antibody responses or increase rates of adverse reactions (53). The administration of MMR vaccine yields results similar to the administration of individual measles, mumps, and rubella vaccines at different sites or at different times.

Vaccines recommended for administration at 12-15 months of age can be administered at either one or two visits. There are equivalent antibody responses and no clinically significant increases in the frequency of adverse events when DTP, MMR, and OPV (or IPV) vaccines and H. influenzae type b conjugate vaccine (HbCV) are administered either simultaneously at different sites or at separate times. If a child might not be brought back for future vaccinations, all vaccines (including DTP {or DTaP}, OPV {or IPV}, MMR, varicella, HbCV, and hepatitis B vaccines) may be administered simultaneously, as appropriate to the child's age and previous vaccination status.


The following recommendations concerning adverse events associated with mumps vaccination update those applicable sections in "Mumps Prevention" (MMWR 1989;38:388-92,397-400), and they apply regardless of whether the vaccine is administered as a single antigen or as a component of MR or MMR vaccine. Information concerning adverse events associated with the measles component of MMR vaccine is reviewed earlier in this document (see Measles Prevention), and information concerning the rubella component is located in the previously published ACIP statement for rubella (18).

Adverse Effects of Vaccine Use

Contraindications to Vaccine Use Pregnancy

Although mumps vaccine virus has been shown to infect the placenta and fetus (56), there is no evidence that it causes congenital malformations in humans. However, because of the theoretical risk of fetal damage, it is prudent to avoid giving live virus vaccine to pregnant women. Live mumps vaccine, when combined with rubella vaccine, should not be administered to women known to be pregnant or who are considering becoming pregnant within the next 3 months. Women vaccinated with monovalent mumps vaccine should avoid becoming pregnant for 30 days after the vaccination. Routine precautions for vaccinating postpubertal women include asking if they are or may be pregnant, excluding those who say they are, and explaining the theoretical risk to those who plan to receive the vaccine. Vaccination during pregnancy should not be considered an indication for termination of pregnancy. However, the final decision about interruption of pregnancy must rest with the individual patient and her physician.

Severe Febrile Illness

Vaccine administration should not be postponed because of minor or intercurrent febrile illnesses, such as mild upper respiratory infections. However, vaccination of persons with severe febrile illnesses should generally be deferred until they have recovered from the acute phase of the illness.

Allergic Reactions

Hypersensitivity reactions rarely occur after the administration of MMR or any of its component vaccines. Most of these reactions are minor and consist of a wheal and flare or urticaria at the injection site. Immediate, anaphylactic reactions to MMR or its component vaccines are extremely rare. Although greater than 70 million doses of MMR vaccine have been distributed in the United States since VAERS was implemented in 1990, only 33 cases of anaphylactic reactions that occurred after MMR vaccination have been reported. Furthermore, only 11 of these cases a) occurred immediately after vaccination and b) occurred in persons who had symptoms consistent with anaphylaxis (CDC, unpublished data).

In the past, persons who had a history of anaphylactic reactions (i.e., hives, swelling of the mouth or throat, difficulty breathing, hypotension, and shock) following egg ingestion were considered to be at increased risk for serious reactions after receipt of mumps-containing vaccines, which are produced in chick embryo fibroblasts. Protocols requiring caution were developed for skin testing and vaccinating persons who had had anaphylactic reactions after egg ingestion (30-34). However, the predictive value of such skin testing and the need for special protocols when vaccinating egg-allergic persons with mumps-containing vaccines is uncertain. The results of recent studies suggest that anaphylactic reactions to mumps-containing vaccines are not associated with hypersensitivity to egg antigens but with some other component of the vaccines. The risk for serious allergic reaction to these vaccines in egg-allergic patients is extremely low, and skin testing is not necessarily predictive of vaccine hypersensitivity (35-37). Therefore, ACIP is re-evaluating whether skin testing and the use of special protocols are routinely necessary when administering mumps-containing vaccines to persons who have a history of anaphylactic-like reactions after egg ingestion.

Recent Injection of Immune Globulin

The effect of immune globulin preparations on the response to mumps vaccine is unknown, but commercial immune globulin preparations contain mumps antibodies. Therefore, monovalent mumps or rubella-mumps vaccine should be given at least 2 weeks before the administration of an immune globulin preparation or deferred until approximately 3 months after the administration of an immune globulin preparation. For suggested time intervals between administration of immune globulin preparations and vaccines containing live measles virus, refer to (Table_5).

Altered Immunocompetence

In theory, replication of the mumps vaccine virus may be potentiated in patients with immune deficiency diseases and by the suppressed immune responses that occur with leukemia, lymphoma, or generalized malignancy or with therapy with corticosteroids, alkylating drugs, antimetabolites, or radiation. In general, patients with such conditions should not be given live mumps virus vaccine. Because vaccinated persons do not transmit mumps vaccine virus, the risk of mumps exposure for those patients may be reduced by vaccinating their close susceptible contacts.


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