Screening Checklist For Contraindications To Vaccines For Adults (Page 2 of 2) in pdf

Information for Healthcare Professionals about the Screening Checklist

for Contraindications to Vaccines for Adults

Are you interested in knowing why we included a certain question on the screening checklist? If so, read

the information below. If you want to find out even more, consult the references listed at the end.

1. Are you sick today? [all vaccines]

note: Live attenuated influenza vaccine (LAIV4; FluMist), is not recommended by

There is no evidence that acute illness reduces vaccine efficacy or increases vaccine

CDC’s Advisory Committee on Immunization Practices for use in the U.S. during

adverse events.

However, as a precaution with moderate or severe acute illness, all

the 2016–17 influenza season. Because LAIV4 is still a licensed vaccine that might

vaccines should be delayed until the illness has improved. Mild illnesses (such as

be available and that some providers might elect to use, for informational purposes,

upper respiratory infections or diarrhea) are NOT contraindications to vaccination.

reference is made to previous recommendations for its use.

Do not withhold vaccination if a person is taking antibiotics.

2. Do you have allergies to medications, food, a vaccine component, or latex?

7. Have you had a seizure or a brain or other nervous system problem?

[all vaccines]

[influenza, Td/Tdap]

An anaphylactic reaction to latex is a contraindication to vaccines that contain

Tdap is contraindicated in people who have a history of encephalopathy within

latex as a component or as part of the packaging (e.g., vial stoppers, prefilled syringe

7 days following DTP/DTaP given before age 7 years. An unstable progressive neuro-

plungers, prefilled syringe caps). If a person has anaphylaxis after eating gelatin, do

logic problem is a precaution to the use of Tdap. For people with stable neurologic

not administer vaccines containing gelatin. A local reaction to a prior vaccine dose or

disorders (including seizures) unrelated to vaccination, or for people with a family

vaccine component, including latex, is not a contraindication to a subsequent dose

history of seizure, vaccinate as usual. A history of Guillain-Barré syndrome (GBS) is

or vaccine containing that component. For information on vaccines supplied in vials

a consideration with the following: 1) Td/Tdap: if GBS has occurred within 6 weeks

or syringes containing latex, see reference 2; for an extensive list of vaccine compo-

of a tetanus-containing vaccine and decision is made to continue vaccination, give

nents, see reference 3.

Tdap instead of Td if no history of prior Tdap; 2) Influenza vaccine (IIV/LAIV): if GBS

People with egg allergy of any severity can receive any recommended influenza vac-

has occurred within 6 weeks of a prior influenza vaccine, vaccinate with IIV if at

cine (i.e., any IIV or RIV) that is otherwise appropriate for the patient’s age. For people

increased risk for severe influenza complications.

with a history of severe allergic reaction to egg involving any symptom other than

hives (e.g., angioedema, respiratory distress), or who required epinephrine or another

8. During the past year, have you received a transfusion of blood or blood

emergency medical intervention, the vaccine should be administered in a medical

products, or been given immune (gamma) globulin or an antiviral drug?

setting, such as a clinic, health department, or physician office. Vaccine administration

[LAIV, MMR, VAR, ZOS]

should be supervised by a healthcare provider who is able to recognize and manage

Certain live virus vaccines (e.g., LAIV, MMR, VAR, ZOS) may need to be deferred,

severe allergic conditions.

depending on several variables. Consult the most current ACIP recommendations for

current information on intervals between antiviral drugs, immune globulin or blood

3. Have you ever had a serious reaction after receiving a vaccination?

product administration and live virus vaccines.

[all vaccines]

History of anaphylactic reaction (see question 2) to a previous dose of vaccine or vaccine

9. For women: Are you pregnant or is there a chance you could become

component is a contraindication for subsequent doses.

Under normal circumstances,

pregnant during the next month? [HPV, IIV, MMR, LAIV, VAR, ZOS]

vaccines are deferred when a precaution is present. However, situations may arise

Live virus vaccines (e.g., MMR, VAR, ZOS, LAIV) are contraindicated one month

when the benefit outweighs the risk (e.g., during a community pertussis outbreak).

before and during pregnancy because of the theoretical risk of virus transmission to

the fetus. Sexually active women in their childbearing years who receive live virus

4. Do you have a long-term health problem with heart disease, lung disease,

vaccines should be instructed to practice careful contraception for one month follow-

asthma, kidney disease, metabolic disease (e.g., diabetes), anemia, or other

ing receipt of the vaccine. On theoretical grounds, inactivated poliovirus vaccine

blood disorder? [LAIV]

should not be given during pregnancy; however, it may be given if risk of exposure is

The safety of intranasal live attenuated influenza vaccine (LAIV) in people with

imminent and immediate protection is needed (e.g., travel to endemic areas). Inacti-

these conditions has not been established. These conditions, including asthma in

vated influenza vaccine and Tdap are both recommended during pregnancy. Both

adults, should be considered precautions for the use of LAIV.

vaccines may be given at any time during pregnancy but the preferred time for Tdap

administration is at 27–36 weeks’ gestation. HPV vaccine is not recommended during

1,4,5,6,8,9

pregnancy.

5. Do you have cancer, leukemia, HIV/AIDS, or any other immune system

problem? [LAIV, MMR, VAR, ZOS]

10. Have you received any vaccinations in the past 4 weeks? [LAIV, MMR, VAR,

Live virus vaccines (e.g., LAIV, measles-mumps-rubella [MMR], varicella [VAR], zoster

yellow fever, ZOS]

[ZOS]) are usually contraindicated in immunocompromised people. However, there

are exceptions. For example, MMR vaccine is recommended and varicella vaccine

People who were given either LAIV or an injectable live virus vaccine (e.g., MMR,

should be considered for adults with CD4+ T-lymphocyte counts of greater than or

VAR, ZOS, yellow fever) should wait 28 days before receiving another vaccination of

equal to 200 cells/µL. Immunosuppressed people should not receive LAIV. For details,

this type. Inactivated vaccines may be given at any spacing interval if they are not

4,5,6

consult the ACIP recommendations.

administered simultaneously.

references

6. I n the past 3 months, have you taken medications that affect your immune

system, such as cortisone, prednisone, other steroids, or anticancer drugs;

1. CDC. General recommendations on immuniza-

6. CDC. Prevention of varicella: Recommendations

drugs for the treatment of rheumatoid arthritis, Crohn’s disease, or psoriasis;

of the Advisory Committee on Immunization

tion, at

Practices. MMWR 2007; 56 (RR-4).

or have you had radiation treatments? [LAIV, MMR, VAR, ZOS]

2. Latex in Vaccine Packaging:

pubs/pinkbook/downloads/appendices/B/latex-

7. Tomblyn M, Einsele H, et al. Guidelines for prevent-

Live virus vaccines (e.g., LAIV, MMR, VAR, ZOS) should be postponed until after

table.pdf.

ing infectious complications among hematopoietic

chemotherapy or long-term high-dose steroid therapy has ended. For details and length

stem cell transplant recipients: a global perspec-

3. Table of Vaccine Components:

1,5

of time to postpone, consult the ACIP statement.

Some immune mediator and

tive. Biol Blood Marrow Transplant 15:1143–1238;

vaccines/pubs/pinkbook/downloads/appendices/

2009 at pubs/hemato-cell-

immune modulator drugs (especially the antitumor-necrosis factor agents adalimumab,

B/excipient-table-2.pdf.

transplts.htm.

infliximab, and etanercept) may be immunosuppressive. The use of live vaccines

4. CDC. Prevention and control of seasonal influenza

8. CDC. Notice to readers: Revised ACIP recommen-

with vaccines: Recommendations of the Advisory

should be avoided in persons taking these drugs (MMWR 2011;60 [RR-2]:23). To

dation for avoiding pregnancy after receiving a

Committee on Immunization Practices – United

find specific vaccination schedules for stem cell transplant (bone marrow transplant)

rubella-containing vaccine. MMWR 2001; 50 (49).

States, 2016–17 influenza season at

patients, see reference 7. LAIV can be given only to healthy non-pregnant people

gov/mmwr/volumes/pdf/65/rr/pdfs/rr6505.pdf,

9. CDC. Updated recommendations for use of tetanus

ages 2 through 49 years.

toxoid, reduced diphtheria toxoid, and acellular

pages 1–56.

pertussis vaccine (Tdap) in pregnant women:

5. CDC. Measles, mumps, and rubella – vaccine use

Recommendations of the ACIP. MMWR 2012; 62

and strategies for elimination of measles, rubella,

(7):131–4.

and congenital rubella syndrome and control of

mumps. MMWR 1998; 47 (RR-8).

651 - 647 - 9009

Immunization Action Coalition

Saint Paul, Minnesota

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/catg.d/p4065.pdf

Item #P4065 – page 2 (10/16)

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Screening Checklist For Contraindications To Vaccines For Adults Page 2

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