Immunisation (vaccinations) side effects/contraindications

Contraindications 

absolute contraindications apply to all vaccines:

• anaphylaxis following a previous dose of the relevant vaccine
• anaphylaxis following any component of the relevant vaccine 

contraindications apply to live vaccines (both parenteral and oral):

• People who are significantly immunocompromised should not receive live vaccines.
  • This is regardless of whether the immunocompromising condition is caused by disease or treatment.
    • Active leukaemia or lymphoma, or other generalised malignancy 
    • Received recent chemotherapy or radiotherapy
    • HIV (certain people only)
    • Had a solid organ transplant or haematopoietic stem cell transplant less than 2 years ago, or are still immunocompromised or taking immunosuppressive drugs, or  graft-versus-host disease 
    • Are taking highly immunosuppressive therapy, 
    • including
      • bdmards (biological disease-modifying anti-rheumatic drugs
      • tsdmards (targeted synthetic disease-modifying anti-rheumatic drugs)
      • high-dose corticosteroids
      • low-dose csDMARD(conventional synthetic DMARDs )
        • methotrexate ≤0.4 mg per kg per week
        • azathioprine ≤3.0 mg per kg per day 
        • mercaptopurine ≤1.5 mg per kg per day
    • Certain autoimmune diseases, particularly if they are on highly immunosuppressive therapy
    • Aplastic anaemia
    • Congenital immunodeficiency
• Pregnant women should not receive live vaccines, in general
  • women should be advised not to become pregnant within 28 days of receiving a live vaccine

Live vaccines

• BCG (bacille Calmette–Guérin) vaccine
• Some Japanese encephalitis virus vaccines
• MMR (measles-mumps-rubella) vaccine
• rotavirus vaccine
• oral typhoid vaccine
• varicella vaccine
• yellow fever vaccine
• zoster vaccine (Zostavax)

Inactivated vaccines

•  that are routinely recommended in people who are immunocompromised
• People who are immunocompromised are routinely recommended to receive:

• influenza vaccine
• pneumococcal vaccine
• meningococcal vaccine
• HPV vaccine
• hepatitis B vaccine
• recombinant zoster vaccine (Shingrix)

Valid consent

the voluntary agreement by an individual to a proposed procedure, given after sufficient, appropriate and reliable information about the procedure, including the potential risks and benefits, has been conveyed to that individual

Recommended injection sites

Infants less than 12 months of age : The vastus lateralis muscle in the angerolateral thigh is the recommended site for IM vaccination in infants <12 months of age, due to its larger muscle size 

Children aged 12 months or older : The deltoid muscle is the recommended site for IM or SC vaccination in children ≥12 months of age

Vaccine side effects

• The most common adverse events following immunisation are; local reactions (such as pain, redness or swelling at the injection site), fever, irritability and injection site nodules.  These responses are usually mild and self-limiting and generally, do not require specific treatment.
• Routine use of paracetamol at the time of, or immediately after, vaccination is not recommended, unless Bexsero® is being administered (see MVEC).

Diphtheria-tetanus-pertussis (acellular), DTPa-containing vaccines and dTpa (reduced antigen) vaccines	Pain, redness and swelling at injection site Occasionally, an injection-site nodule; may last many weeks; no treatment needed Low-grade fever Children may be irritable, crying, drowsy, tired, unsettled and generally unhappy
Haemophilus influenzae type b vaccine (Hib)	Pain, redness and swelling at injection site Occasionally, an injection-site nodule; may last many weeks; no treatment needed Low-grade fever
Hepatitis A vaccine	Pain, redness and swelling at injection siteLow-grade fever
Hepatitis B vaccine	Pain, redness and swelling at injection site Occasionally, an injection-site nodule; may last many weeks; no treatment needed Low-grade fever
Human papillomavirus (HPV) vaccine	Pain, redness and swelling at injection site Low-grade fever Mild headache Mild nausea
Influenza vaccine	Drowsiness or tiredness Muscle aches Pain, redness and swelling at injection site Occasionally, an injection-site nodule; may last many weeks; no treatment needed Low-grade fever
Measles-mumps-rubella vaccine (MMR, MMRV – see also varicella)	Occasionally, an injection-site nodule; may last many weeks; no treatment needed Seen 7–10 days after vaccination:  – Fever (can be >39.4˚C), lasting 2–3 days, faint red rash (not infectious), head cold and/or runny nose, cough and/or puffy eyes – Drowsiness or tiredness – Swelling of salivary glands
Meningococcal vaccine	Irritable, crying, unsettled and generally unhappyLoss of appetiteHeadache (usually in adolescents and adults)P ain, redness and swelling at injection site Occasionally, an injection-site nodule; may last many weeks; no treatment needed Low-grade fever
Pneumococcal vaccines (13vPCV and 23vPPV)	Pain, redness and swelling at injection site Occasionally, an injection-site nodule; may last many weeks; no treatment needed Low-grade fever
Inactivated polio vaccine (IPV) and IPV-containing vaccines	Muscle aches Pain, redness and swelling at injection site Occasionally, an injection-site nodule; may last many weeks; no treatment needed Low-grade fever
Rotavirus vaccine	Vomiting and diarrhoea can occur up to 7 days following vaccination
Varicella vaccine	Pain, redness and swelling at injection site Occasionally, an injection-site nodule; may last many weeks; no treatment needed Fever (can be >39˚C)5–26 days after vaccination: pustular rash (2–5 lesions), usually at injection site, occasionally elsewhere