Saar Kuzi
Alessandra Coutinho Fernandes
William Cope
Richard Tapping
Kashif Ahmad
Reda Sadki
Shubhra Kanti Karmaker Santu
Adam P Rusch
Elle Meisner
Nereyda Ochoa
Landon J. Kunzelman
James DotimasFA16 Immunization Module’s Updates
Contraindications for Vaccines
There are several common misconceptions when it comes to vaccinations, one of which is contraindications. For example, many pregnant women are fearful of receiving vaccinations in fear of harming their child, and many people refuse to get their annual influenza vaccination because they may have developed a minor fever or cough after receiving it before.
The CDC has tried to alleviate these concerns by posting numerous helpful articles, such as which vaccinations are safe during pregnancy, times vaccinations are contraindicated, and times vaccinations should be administered, but "with caution."
I found it most interesting that the CDC rarely ever does not recommend a vaccination, e.g. there really are no contraindications, aside from "severe allergic reactions (anaphylaxis)." They also do not recommend live attenuated vaccinations for pregnant women. Otherwise, reasons people commonly think they cannot get a vaccine, such as current minor illness, recent illness, or having developed mild symptoms after receiving the vaccination before, are essentially void. People with those conditions can and should still receive the vaccine.
I also found it interesting that the CDC has accepted that physicians frequently do not recommend a vaccine if a patient is convinced that he/she had an allergic reaction to it before. Yet again, the CDC states that aside from anaphylaxis (and a few other minor exceptions) people should still be vaccinated. As future physicians, I think we should be aware of valid and invalid contraindications and attempt to educate our patients as such.
http://www.cdc.gov/vaccines/hcp/admin/contraindications-adults.html
http://www.cdc.gov/vaccines/hcp/admin/contraindications-misconceptions.html
http://www.cdc.gov/vaccines/pregnancy/hcp/guidelines.html
@Amanda Johnson, thanks for the insightful update. I think that there is an interesting dynamic when it comes to vaccines. On the one hand, the vaccine is probably completely safe and will benefit both the direct patient and the general population through herd immunity. However, I believe it is important for a patient to be autonomous over their own health so if a patient does not want a vaccine, while I think it is an unwise decision, it is hard to force someone to do it. I think that @Cory has a good point that better patient education could allow a patient to autonomously desire a vaccine.
If a patient is convinced that their previous allergic reaction disqualifies for reviving a vaccine, it might be helpful to talk to that patient about what a sever severe allergic reaction actually means. Severe is a very subjective sounding term that in this case has a very specific meaning.
@Amanda Johnson, you have made a very important point here. The best evidence shows that it is perfectly safe to vaccinate even if your patient has a minor illness. This is especially relevant for pediatric patients for whom full compliance to a frequent vaccination schedule is difficult.