Update: Vaccine Side Effects, Adverse Reactions,
Immunosuppressive therapies -- including irradiation, antimetabolites, alkylating agents, cytotoxic drugs, and corticosteroids (used in greater than physiologic doses) -- may reduce the immune response to vaccines. Short-term (less than 2-week) corticosteroid therapy or intra-articular, bursal, or tendon injections with corticosteroids should not be immunosuppressive. Although no specific studies with pertussis vaccine are available, if immunosuppressive therapy will be discontinued shortly, it is reasonable to defer vaccination until the patient has been off therapy for 1 month; otherwise, the patient should be vaccinated while still on therapy (85).
Special Considerations for Preparations Containing Pertussis Vaccine
Contraindications
If any of the following events occur in temporal relationship to the administration of DTP, further vaccination with DTP is contraindicated (Table_7):
- An immediate anaphylactic reaction.
- Encephalopathy (not due to another identifiable cause). This is defined as an acute, severe CNS disorder occurring within 7 days following vaccination and generally consisting of major alterations in consciousness, unresponsiveness, generalized or focal seizures that persist more than a few hours, with failure to recover within 24 hours. No subsequent doses of pertussis vaccine should be given.
Precautions
If any of the following events occur in relation to receipt of DTP, the decision to give subsequent doses of vaccine containing the pertussis component should be carefully considered . Although these events were considered absolute contraindications . The following events were previously considered contraindications and are now considered precautions:
- Temperature of greater than or equal to 40.5 C (greater than or equal to 105 F) within 48 hours not due to another identifiable cause. Such a temperature is considered a precaution because of the likelihood that fever following a subsequent dose of DTP also will be high. Because such febrile reactions are usually attributed to the pertussis component, vaccination with DT should not be discontinued.
- Collapse or shock-like state (hypotonic-hyporesponsive episode) within 48 hours. Although these uncommon events have not been recognized to cause death nor to induce permanent neurological sequelae, it is prudent to continue vaccination with DT, omitting the pertussis component (58,89).
- Persistent, inconsolable crying lasting greater than or equal to 3 hours, occurring within 48 hours.
- Convulsions with or without fever occurring within 3 days. Short-lived convulsions, with or without fever, have not been shown to cause permanent sequelae (57,90). . Accordingly, although a convulsion following DTP vaccination has previously been considered a contraindication to further doses, under certain circumstances subsequent doses may be indicated, particularly if the risk of pertussis in the community is high. If a child has a seizure following the first or second dose of DTP, it is desirable to delay subsequent doses until the child's neurologic status is better defined. By the end of the first year of life, the presence of an underlying neurologic disorder has usually been determined and appropriate treatment instituted. DT vaccine should not be administered before a decision has been made about whether to restart the DTP series. Regardless of which vaccine is given, it is prudent also to administer acetaminophen, 15 mg/kg of body weight, at the time of vaccination and every 4 hours subsequently for 24 hours (92,93).
Please proceed to page -4 vaccination in Infants