Assessing Vaccine Contraindications Through the Use of the Immunization Action Coalition Screening Checklist

Abstract

Immunization action coalition (IAC) provides a checklist that occupational health nurses use to screen for vaccine contraindications to identify and prevent possible adverse effects.

In the United States, vaccines have reduced or eliminated many infectious diseases that once killed or harmed infants, children, and adults (Centers for Disease Control and Prevention, 2016). Occupational health nurses often administer immunizations to workers that require them to assess vaccine contraindications. The immunization action coalition (IAC) has established a screening checklist for contraindications to vaccines for adults to evaluate whether a vaccine can be safely administered (link to checklist: http://www.immunize.org/catg.d/p4065.pdf). Based on data from 25 million administered vaccines, 33 were found to have contraindications (American Academy of Allergy, Asthma & Immunology [AAAAI], 2015). Live attenuated influenza vaccine (LAIV), measles–mumps–rubella (MMR), varicella (VAR), and zoster vaccine live (ZVL) vaccines are contraindicated among immunocompromised (e.g., HIV/AIDS, cancer, or leukemia) individuals as these vaccines may be potentially pathogenic (IAC, 2018).

The IAC checklist consists of 10 questions. The first three questions evaluate (1) an individual’s current health and possible illnesses; (b) allergies to medications, food, latex, or vaccine component; and (c) prior serious vaccine reactions. In case of a moderate or severe acute illness (e.g., HIV/AIDS individuals with a CD4+ T-lymphocyte count of less than 200 cells/µL), all vaccines should be delayed until the individual has fully recovered. If an individual previously had an anaphylactic reaction to gelatin, latex, or any vaccine that contain these substances, it is recommended to withhold the vaccination. An anaphylactic response often includes generalized uticaria, hives, decreased blood pressure, constriction of the airways such as wheezing, and/or shock (IAC, 2018). Because anaphylactic reactions can be fatal, they should be accurately assessed before administering any vaccine and require prompt intervention. For example, MMR or VAR vaccines are contraindicated for individuals who had serious reactions after consuming gelatin.

Questions 4 and 5 focus on long-term, chronic health problems such as heart disease, lung disorders, kidney diseases, anemia, HIV/AIDS, and metabolic diseases. For example, LAIV, MMR, or VAR vaccine should not be administered to HIV/AIDS individuals with a CD4+ T-lymphocyte count of less than 200 cells/µL (IAC, 2018). These cells are crucial to regulate effective immune response to pathogens. A level less than 200 cells/µL indicates that an individual is immunocompromised.

Question 6 focuses on medications that may affect the immune system such as steroids or anticancer drugs. If an individual is taking these medications, LAIV, MMR, VAR, and ZVL vaccines should be withheld, as they are immunosuppressive therapies. Occupational health nurses should ask individuals if they have taken these therapies within the past 3 months as they can suppress their immune system if vaccinated with live vaccines.

Question 7 ascertains details about neurological problems. For example, Tdap (tetanus, diphtheria, and pertussis) is contraindicated in individuals with a history of encephalopathy within 7 days following DTaP/DTP (diphtheria, tetanus, and pertussis) vaccination. Question 8 asks about the receipt of blood transfusions, blood products, immune (gamma) globulin, or antiviral drugs. Consideration should be given to deferring these products during vaccine administration to prevent adverse reactions (IAC, 2018).

Question 9 focuses pregnancy. Vaccines MMR, VAR, ZVL, and LAIV are teratogenic to the fetus and contraindicated for pregnant women (IAC, 2018). Occupational health nurses should advise women against becoming pregnant within the 30 days post vaccination. A sexually active female in childbearing years should practice contraception following the administration of these live vaccines. Also, inactivated poliovirus vaccine should not be given during pregnancy due to the possibility of health-related consequences to the fetus (IAC, 2018).

The last question (#10) asks if the individual received any vaccinations in the past 4 weeks. Individuals who received LAIV, MMR, VAR, ZVL, or yellow fever vaccines should wait 28 days before receiving another live vaccination (30 days for yellow fever).

Occupational health nurses should follow the screening checklist, and its supplementary document, to assess for and document vaccine contraindications, and prevent any serious adverse effects of vaccines. In addition, occupational health nurses should educate workers about the benefits and risks of immunizations and ensure that they do not miss any necessary vaccines.