II. Health Supervision

Immunizations: Vaccine Precautions, Exceptions, and Contraindications

Before administering any vaccine, consider the following information based on recommendations of ACIP and AAP:

• Refer to package inserts and statements from ACIP and AAP for additional details.
• Follow the manufacturers' recommendations regarding dosage, route of
  administration, and storage of vaccines.
• Decide to administer or delay DTaP vaccine because of a current or recent
  febrile illness based largely on the severity of the symptoms and their etiology.
• Be aware that mild acute illnesses with or without low-grade fever and current use of antibiotics or other medicine (except immunosuppressive medicine or radiation therapy) are not contraindications for any vaccine.
• Delay immunization if the patient has a moderate or severe illness with or without a fever and appears to be very sick.
• Recognize that anaphylactic reaction to a vaccine contraindicates further doses of that vaccine.
• Also recognize that anaphylactic reaction to a vaccine constituent contraindicates the use of vaccines containing that substance.
• Refrain from giving all live virus vaccines to females known to be pregnant or
  considering becoming pregnant within a three-month time period.
• Be aware that:
  • MMR vaccine is contraindicated for those who have experienced an anaphylactic reaction to egg ingestion or to neomycin.
  • IPV is contraindicated for children who have experienced an anaphylactic reaction to neomycin or streptomycin.
  • Anaphylactic reaction to common baker’s yeast contraindicates the use of hepatitis B vaccine.

Adverse Events

Report all adverse events following immunizations to (1) the Federal Vaccine Adverse Event Reporting System (VAERS) at 1-800-822-7967, and (2) the DC Immunization Program at (202) 576-7130.

National Childhood Vaccine Injury Act

According to the National Childhood Vaccine Injury Act of 1986, PCPs must:

• Provide a copy of the most current Vaccine Information Statement (VIS) to the child’s parent/legal guardian and to adolescents aged 18 years of age or younger who are covered under the VFC program
• Maintain documentation of when and what vaccines were administered
• Document in the patient’s medical record the date that the VIS was given (along with the statement’s publication date)

Vaccine Information Statements (VISs)

VISs are required and available for:

• All vaccines routinely recommended for infants and children covered by the National Childhood Vaccine Injury Act

VISs are also recommended and available, but not required for the following vaccines:

• Influenza,
• Pneumococcal
• Hepatitis A

School Exemptions

Exemptions from the required immunizations are granted for the following reasons:

• Religious: exemptions may be granted to students who in good faith believe that immunizations would violate their religious beliefs.
• Medical: exemptions may be granted by PCPs who determine that immunizations would be medically inadvisable because of health reasons or a time-limited condition.

Submit all exemption requests in writing to:

Chief, Bureau of Epidemiology and Disease Control
825 North Capitol St., NE, Washington, DC 20002
Phone (202) 442-9366; fax (202) 442-4834.