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30-16: Vaccine Safety

Monica Fung; Peter V. Chin-Hong; B. Joseph Guglielmo; Katherine Gruenberg

Most vaccines are safe to administer. In general, it is recommended that the use of live vaccines be avoided in immunocompromised patients, including pregnant women. Vaccines are generally not contraindicated in the following situations: mild, acute illness with low-grade fevers (less than 40.5°C); concurrent antibiotic therapy; soreness or redness at the site; and family history of adverse reactions to vaccinations. Absolute contraindications to vaccines are rare (Table 30–8).

Table 30–8.Adverse effects and contraindications to commonly used vaccines in adults (listed in alphabetical order).
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Table 30–8. Adverse effects and contraindications to commonly used vaccines in adults (listed in alphabetical order).
Vaccine Adverse Effects Contraindications1

Haemophilus influenzae type b (Hib)

Minimal

Consist mainly of pain at the injection site

Any severe allergic reaction (eg, anaphylaxis) after a previous dose or to a vaccine component.

Hepatitis A

Minimal

Consist mainly of pain at the injection site

Any severe allergic reaction (eg, anaphylaxis) after a previous dose or to a vaccine component.

Hepatitis B

Minimal

Consist mainly of pain at the injection site

Any severe allergic reaction (eg, anaphylaxis) after a previous dose or to a vaccine component.

HPV

Minimal

Consist mainly of mild to moderate localized pain, erythema, swelling

Systemic reactions, mainly fever, seen in 4% of recipients

Any severe allergic reaction (eg, anaphylaxis) after a previous dose or to a vaccine component.

Influenza (intramuscular inactivated and intranasal live attenuated vaccines)

Intramuscular, inactivated vaccine: Local reactions (erythema and tenderness) at the site of injection are common, but fevers, chills, and malaise (which last in any case only 2–3 days) are rare.

Either inactivated or live attenuated vaccine: A potential association between Guillain-Barré syndrome (3000–6000 cases per year in the United States, usually following respiratory infections) and vaccination with intramuscular, inactivated influenza vaccine has been reported (possibly, 1–2 persons per million persons vaccinated), but this rate is lower than the risk of the syndrome developing after influenza itself (given that approximately 750 persons per million adults are hospitalized annually with influenza, and many more cases remain as outpatients). Influenza vaccination may be associated with multiple false-positive serologic tests to HIV, HTLV-1, and hepatitis C, but it is self-limited, lasting 2–5 months.

Contraindication to both inactivated and live attenuated vaccine:

History of Guillain-Barré syndrome, especially within 6 weeks of receiving a previous influenza vaccine.

Any severe allergic reaction (eg, anaphylaxis) after a previous dose or to a vaccine component, including egg protein.2

Intranasal, live attenuated vaccine (FluMist) should not be used in:

  • People 50 years of age and over

  • Immunosuppressed individuals and those on immunosuppressive therapy

  • Household members of immunosuppressed individuals

  • Health care workers, or others with close contact with immunosuppressed persons

  • Presence of reactive airway disease (eg, asthma) or chronic underlying metabolic (eg, kidney), pulmonary, or heart diseases (use intramuscular inactivated vaccine)

  • Pregnancy3

It is recommended that salicylates should be avoided for 6 weeks following vaccination (to prevent Reye syndrome).

Measles, mumps, and ...

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