Diagnosis and Assessment
ÎIf the intradermal skin test result is negative, the chance that the patient has IgE antibody to any vaccine constituent is negligible, and the vaccine can be administered in the usual manner. It is prudent, nonetheless, in a patient with a history suggestive of an anaphylactic reaction to administer the vaccine under observation with epinephrine and other treatment available. (B)
ÎIn patients with histories and skin tests results consistent with an IgE- mediated reaction to a vaccine, who require additional doses of the suspect vaccine or other vaccines with common ingredients, consideration can be given to administering the vaccine in graded doses under observation. (C)
ÎSome more serious, and less common, reactions to vaccines require evaluation, but only a few are absolute contraindications to future doses. (B)
ÎPregnant women should not be vaccinated with live vaccines. However, pregnant women should be given inactivated influenza vaccine as well as tetanus and hepatitis B vaccine if otherwise indicated. (B)
ÎIn general, live vaccines should not be given to persons who are immune- compromised because of a risk of generalized infection with the immunizing agent. (B)
ÎSpecific vaccines or vaccination in general has been purported to have long-term consequences, including atopy, autism, and multiple sclerosis. Epidemiologic studies have not supported such associations. (B)
ÎLive Vaccines
> Bacille Calmette-Guerin (BCG) > Influenza (intranasal) > Measles-mumps-rubella (MMR) > Oral poliovirus (OPV) > Rotavirus > Typhoid (oral) > Vaccinia (smallpox) > Varicella > Yellow fever > Zoster
ÎKilled Vaccines
> Diphtheria, tetanus and acellular pertussis (DTaP, Tdap)
> Diphtheria-tetanus (DT, Td) > Hepatitis A > Hepatitis B > Hib conjugates > Human papillomavirus (HPV) > Inactivated poliovirus (IPV) > Influenza (injectable) > Japanese encephalitis > Meningococcal > Meningococcal conjugate > Pneumococcal > Pneumococcal conjugate > Rabies > Typhoid (injectable)
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