First AD

Second AD

Have another look at this list of scenarios.

A. DTaP administration to a 4-month-old who spiked a temperature to 105.5 with a previous DTaP

B. DTaP administration to a 5y-old on anticonvulsants for a well-controlled seizure disorder associated w/ spastic quadriplegia

C. MMR administration to a child whose mother is significantly immune-suppressed

D. HPV administration to a pregnant mother in her third trimester

E. PPSV23 to a 66y-old with a 101°F fever and a positive influenza B rapid test

F. Flu shot to a 21y-old with egg allergy that causes generalized urticaria that resolves with oral antihistamines

G. LAIV (Flumist) administration to a nurse working in a newborn intensive care unit

 ( DTaP administration to a 4-month-old who spiked a temperature to 105.5 with a previous DTaP) 

 (PPSV23 to a 66y-old with a 101°F fever and a positive influenza B rapid test) 

are the only two that would be considered precautions

Fever over 105°F with a previous DTP shot used to be a contraindication before the approval of DTaP. While Flumist (which may or may not be on the market next year) has been shown to cause some low level shedding of vaccine virus from some vaccine recipients, the only contraindication would be to give it to a person who will be around a patient in a reverse isolation unit. A common misconception is that a vaccine should not be given to anyone with an acute illness or fever. This falls into the precaution section since some confusion may arise the day after a vaccine is given should the fever get higher: is it from the vaccine or is the individual's underlying illness taking a turn for the worse?

While minding your “P's and Q's” is important for everyone, healthcare providers also need to mind their “P's and C's” (precautions and contraindications) before ordering a vaccine.

https://www.cdc.gov/vaccines/hcp/acip-recs/general-recs/contraindications.html

https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6430a3.htm

Which of These Scenarios Warrants Precaution before Vaccination?