Humana Quality Improvement Guidelines - Preventive Services Guidelines











	1. Contraindications and Precautions for Childhood Immunizations 2. Birth to 24 Months 3. Ages 2-6 4. Ages 7-12 5. Ages 13-18 6. Ages 19-39 7. Ages 40-64 8. Ages 65 and Over 9. Pregnant Women

Contraindications and Precautions for Childhood Immunizations^¹
True Contraindications and Precautions	NOT Contraindications (vaccine may be given)
Anaphylactic reaction to a vaccine contraindicates further doses of that vaccine	Mild to moderate local reaction (soreness, redness, swelling) following a dose of an injectable antigen
Anaphylactic reaction to a vaccine constituent contraindicates the use of vaccines containing that substance	Mild acute illness with or without low-grade fever
Moderate or severe illness with ot without fever	Current antimicrobial therapy
	Convalescent phase of illness
	Prematurity (same dosage and indications as for normal, full term infants)
	Recent exposure to an infectious disease
	History of penicillin or other nonspecific allergies or fact that relatives have such allergies

Contraindications and Precautions for MMR Vaccinations
True Contraindications and Precautions	NOT Contraindications (vaccine may be given)
Anaphylactic reaction to egg ingestion and to neomycin	Tuberculosis or positive PPD
Pregnancy	Simultaneous Tb skin testing^²
Known altered immunodeficiency (hematologic and solid tumors, congenital immunodeficiency, and long term immunosuppressive therapy)	Breast feeding
Recent IG administration (within 3-11 months)	Pregnancy of mother of recipient
	Immunodeficient family member of household contact
	Infection with HIV
	Non-anaphylactic reactions to eggs of neomycin

Contraindications and Precautions for DTP/DTaP Vaccination
True Contraindications and Precautions	NOT Contraindications (vaccine may be given)
Encephalopathy within 7 days of administration of previous dose of DTP/DTaP	Temperature <40.5ºC (104.9ºF) following a previous dose of DTP/DTaP
Fever>40.5ºC (104.9ºF) within 48 hours after vaccination with a previous dose of DTP/DTaP3	Family history of convulsions
Collapse or shock-like state (hypotonic- hyporesponsive episode) within 48 hours of receiving a previous dose of DTP/DTaP3	Family history of sudden infant death syndrome
Seizures within 3 days of receiving a previous dose of DTP/DTaP3	Family history of adverse event following DTP administration
Persistent, inconsolable crying lasting over hours within 48 hours of receiving a previous dose of DTP/DTaP3

1 Source: Clinicians Handbook of Preventive Services, US Department of Health & Humana Services, Public Health Service 1994

2 Measles vaccination may temporarily suppress tuberculin reactivity. If testing cannot be done the day of MMR vaccination, the test should be postponed for 4-6 weeks.

3 This is a precaution, not a contraindication, and should be carefully reviewed. The benefits and risks of administering a specific vaccine to an individual under the circumstances should be considered. If the risks are believed to outweigh the benefits, the immunization should be withheld; if the benefits are believed to outweigh the risks (for example, during an outbreak or foreign travel), it should be given. Whether and when to administer DTP/DTaP to children with proven or suspected underlying neurologic disorders should be decided on an individual basis. Children in the first year of life with a neurologic disorder that prevents the use of the pertussis vaccine also should not receive diphtheria or tetanus vaccine. After the first birthday, the child may receive DT vaccine if the contraindications to pertussis vaccine persists.