3 Immunization Pearls You Need to Know

Updated 07/26/2022

August is National Immunization Awareness Month, a perfect time to talk to your patients about vaccines! These important dates are also a great reminder for you to brush up on your knowledge and stay current in your practice.

This month, tackle immunizations with the high-yield pearls you must know from the Preventative Pediatrics section of our 10th Edition Pediatrics Core. When it comes to immunizations, there are several topics you must know very well! Some of these include:

• • Routine and “catch-up” immunization schedules
  • Differentiating live vs. inactivated vaccines
  • Vaccine adverse effects and contraindications

Routine and “Catch-Up” Immunization Schedules

Both routine and “catch-up” schedules are updated yearly by the CDC and the AAP. "Catch-up" schedules and minimal intervals between vaccinations vary depending on the age of the child and the specific vaccine.

The majority of childhood immunizations are administered by IM injection; exceptions include:

• Subcutaneous: measles, mumps, and rubella (MMR); varicella; and measles, mumps, rubella, and varicella (MMRV)
• Subcutaneous or IM: inactivated polio vaccine (IPV) and pneumococcal polysaccharide vaccine (PPSV23)
• Nasal spray: live attenuated influenza vaccine (LAIV)
• Oral: rotavirus vaccines

Differentiating Live vs. Inactivated Vaccines

• MMR (or MMRV) 
• Varicella
• Rotavirus
• LAIV

Oral typhoid and yellow fever vaccines are also live, but rarely given—except when traveling to affected areas.

Live vaccines are typically contraindicated in patients who are immunocompromised. The exceptions to this rule are:

• Give MMR and varicella vaccine (not MMRV) to:
  • Asymptomatic children with HIV
  • Those with more advanced HIV disease but with CD4+ T-lymphocyte percentages > 15% normal
• Give rotavirus vaccine to HIV infected children irrespective of CD4+ T-lymphocyte percentages. Severely immunocompromised individuals should avoid changing or handling diapers of infants who have been vaccinated with rotavirus vaccine for 4 weeks after vaccination.

Live attenuated influenza vaccine (LAIV) special note: Due to its low effectiveness against H1N1 strains in previous years (2013–2016), the AAP recommended against the use of LAIV in the 2016–17 and 2017–18 seasons. For the 2018–19 influenza season, the AAP recommends inactivated trivalent or quadrivalent influenza vaccines for all children, reserving LAIV for children who would otherwise not receive a vaccine, such as in cases of vaccine refusal.

Vaccine Adverse Effects and Contraindications

Most live vaccines (MMR, varicella, MMRV, and rotavirus) are not contraindicated in a child who lives with an immunocompromised person or whose mother is pregnant. The exception is LAIV, which is contraindicated both in immunocompromised individuals and in those who live with a severely immunocompromised person.

Side effects: Local tenderness, mild warmth, erythema, and low-grade fever are very common after administration of most vaccines.

Allergic reaction: If a patient has an allergic reaction to one of the following, refer them to an allergist for evaluation and possible skin testing to determine the risks and benefits of immunization with the noted vaccine:

1. 1. Egg antigens: yellow fever
   2. Gelatin: MMR, varicella, yellow fever, MMRV, influenza, oral typhoid, and rabies
   3. Streptomycin, neomycin, polymyxin B (referral indicated only with anaphylaxis to these antibiotics): IPV
   4. Neomycin (referral indicated only with anaphylaxis to these antibiotics): MMR; varicella; some diphtheria, tetanus, and acellular pertussis (DTaP); hepatitis A vaccine (HepA vaccine); influenza; and rabies

Know these other key points:

• Do not give vaccine to a person with:
  • A previous anaphylactic reaction to the vaccine or one of its components
• Give vaccine to those who have:
  • Previous mild-to-moderate local reaction to a vaccine (soreness, redness, or swelling)
  • Concurrent mild, acute illness with or without lowgrade fever
  • Current antibiotic/antiviral treatment
  • Recent exposure to an infectious disease
  • Family history of seizures
  • Family history of previous adverse reaction to a vaccine (particularly DTaP)
  • Active tuberculosis or PPD-positive (Give vaccine after starting tuberculosis [TB] medications.)
  • TB skin testing on day of vaccine

Note: Measles vaccine can suppress tuberculin reactivity. If the PPD test is not given on the same day as the MMR, wait 4–6 weeks after the MMR vaccination before placing the PPD.

Give all pregnant women (including pregnant adolescents) the tetanus, diphtheria, and pertussis (Tdap) vaccination during each pregnancy, ideally between 27 and 36 weeks of gestation, for optimum protection for the newborn.

Pregnancy is a contraindication to administration of all live-virus vaccines; however, no vaccine is contraindicated in children living in households that include a pregnant family member. All routine vaccines are considered safe for breastfeeding mothers.

Keep in mind, these are just the high-yield pearls from the Preventative Pediatrics topic in the Peds Core. Get all this information, plus every other topic from the ABP content outline when you buy the 10th Edition Pediatrics Core!