Pertussis vaccination contraindications

The primary course of DTP protection consists of three doses of a combined vaccine, each dose separated by at least 1 month and commencing not earlier than 2 months of age. In such combinations the pertussis component ofthe vaccine acts as an additional adjuvant for the toxoid components. Monovalent pertussis and tetanus vaccines, and combined vaccines lacking the pertussis component (DT) are available. If pertussis vaccination is contraindicated or refused then DT vaccine alone should be offered. The primary course of pertussis vaccination is considered sufficient to confer life-long protection, especially since the mortality associated with disease declines markedly after infancy. The risks associated with tetanus and diphtheria infection persist... 

General contraindications to vaccine administration include a history of anaphylactic reaction to a previous dose or an unexplained encephalopathy occurring within 7 days of a dose of pertussis vaccine. Immunosuppression and pregnancy are temporary contraindications to live vaccines. Whenever possible, transplant patients should be immunized before transplantation. Live vaccines generally are not given after transplantation. 

Following hematopoietic stem cell transplantation the patient will need virtually all routine vaccines to be administered again however, the patient will not be able to mount an adequate response for 6 to 12 months post-transplant. Diphtheria, tetanus, acellular pertussis, Haemophilus influenzae type b, hepatitis B, pneumococcal, and inactivated poliovirus should be given at 12,14, and 24 months post-hematopoietic stem cell transplantation. Inactivated influenza vaccine should be given yearly, starting 6 months after transplant. Measles, mumps and rubella can be given 2 years after transplant and varicella vaccine is contraindicated.16... 

Systemic reactions, such as moderate fever, occur in 3% to 5% of those receiving vaccines. Very rarely, high fever, febrile seizures, persistent crying spells, and hypotonic hyporesponsive episodes occur after vaccination. There are only two absolute contraindications to pertussis administration an immediate anaphylactic reaction to a previous dose or encephalopathy within 7 days of a previous dose, with no evidence of other cause. 

The reports of the Institute of Medicine, National Academy of Sciences, Washington (on adverse events after pertussis and mbeUa immnnization (SED-12, 817) (SED-12, 825) and on adverse events after immunization against tetanus, diphtheria, measles, mumps, poliomyelitis, H. influenzae type b, and hepatitis B (SEDA-18,325) have provided useful reviews (13,14). The 1996 Update on vaccine side effects, adverse reactions, contraindications,... 

---