136 Vaccines

Contraindications to vaccination with live attenuated vaccine are (Medimmune 2005):

!age < 5 or > 65 years.

!immunocompromised patients – the use of the live-attenuated vaccine is contraindicated, and inactivated vaccines should be used instead. Caution should be used when giving the vaccine to those who may come into contact with immunocompromised patients, as this caused controversy in 2004 when vaccine supplies were limited (Manion 2005). HIV-infected individuals may not have significant immune suppression in the early years of their HIV infection, and it is accepted that certain live attenuated vaccines, such as those for measles and varicella, can be used in these patients. Little information is available on the use of live attenuated influenza vaccine in HIV-infected people, but what is available suggests that this vaccine is safe in adults who are in the CDC class A1-2, and in children who are in the CDC class N1-2 or A1-2, i.e. asymptomatic or mildly symptomatic, with CD4 counts higher than 200/µl in adults (King 2000, King 2001). Both studies conclude that inadvertent vaccination or exposure to the attenuated virus is unlikely to result in significant adverse effects. However, it should be noted that small numbers of patients were involved, and until sufficient data are obtained, extreme caution should be exercised.

!previous Guillain-Barré syndrome.

!children under the age of 18 years who are receiving aspirin therapy should not receive live vaccine, as it is a risk for Reye’s syndrome. They should receive inactivated vaccine instead.

!In addition,

osafety in asthma sufferers and patients with underlying medical conditions that put them at risk for wild type influenza infections has not been established.

osafety regarding teratogenicity and breast milk excretion has not been established in pregnant women, who should receive inactivated vaccine instead.

oparenteral administration is contraindicated – mucosal administration via nasal spray is the correct usage.

oadministration with other vaccines should be avoided – within 4 weeks before or after a live vaccine, and within 2 weeks before or after an inactivated vaccine.

Dosage / use

Inactivated vaccine

Children

!6-35 months – 0.25 ml in anterolateral thigh (deltoid only if adequate muscle is present)

!3-8 years – 0.5 ml in anterolateral thigh (deltoid as above)