Paeds · preventive-and-community-paediatrics
Vaccine contraindications, precautions and adverse events
Also known as Vaccine contraindications · Vaccine precautions · AEFI · Adverse events following immunisation · Vaccine anaphylaxis · False contraindications vaccination
A fellowship approach to paediatric vaccine safety: true contraindications versus precautions and false contraindications; live-vaccine rules in immunocompromise and pregnancy; AEFI recognition including anaphylaxis, intussusception and ITP; bedside screening; resuscitation; reporting; and regional guidance across ANZ, UK, US and Canada.
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Target exams
Red flags
- Anaphylaxis to a previous dose or vaccine component — withhold that vaccine and keep IM adrenaline ready
- Live vaccines in severe immunocompromise (SCID, chemotherapy, recent HSCT, high-dose steroids) or pregnancy
- Encephalopathy within 7 days of a pertussis-containing vaccine with no other identifiable cause
- SCID or suspected severe IEI — no rotavirus and no BCG
- Suspected vaccine anaphylaxis now — IM adrenaline first, never antihistamine alone
- Cluster of AEFIs in one session — treat patients and investigate programme error
Life stages
Care settings
Clinical exam formats
Board mappings
- General and Community Paediatrics
- Infectious Diseases and Immunisation
- Current 2026 PREP curriculum — Learning Objective area: immunisation and preventive care safety
- Renewed curriculum for first-year trainees from 2027 — Learning goal 5: Clinical assessment – essential general paediatrics
- Renewed curriculum for first-year trainees from 2027 — Learning goal 6: Clinical management – essential general paediatrics
- Renewed curriculum for first-year trainees from 2027 — Learning goal 12: Communication with patients, families, and health professionals
- Renewed curriculum for first-year trainees from 2027 — Learning goal 15: Essential general paediatrics
- Infectious Diseases
- Clinical Applications
- Long Cases
- Short Cases
- 2. Professional skills and knowledge: Communication
- 4. Professional skills and knowledge: Patient management
- 7. Patient safety, including safe prescribing
- General Paediatrics: preventive care and immunisation safety
- Foundation of Practice (FOP)
- Applied Knowledge in Practice (AKP)
- History
- Communication
- Clinical
- General Pediatrics Content Outline — Domain 1: Preventive Pediatrics/Well-Child Care
- General Pediatrics Content Outline — Domain 9: Infectious Diseases
- General Pediatrics Content Outline — Domain 24: Patient Safety, Quality Improvement, and Research Methods
- General Pediatrics EPA related to providing preventive care including immunisations
- Patient Care 5: Patient Management
- Medical Knowledge 1: Clinical Reasoning
- Systems-Based Practice 1: Patient Safety and Quality Improvement
- Interpersonal and Communication Skills 1: Patient- and Family-Centered Communication
- Medical Expert
- Communicator
- Health Advocate
- Pediatrics: Foundations EPA — Providing preventive care including immunisation counselling and safety assessment
- Pediatrics: Core EPA — Managing acute allergic emergencies including anaphylaxis
Overview & Definition
A six-week-old arrives with a runny nose and a temperature of 37.8°C. The nurse asks whether to cancel the primary schedule. The fellowship answer is almost always vaccinate if the child is otherwise well, because mild illness is not a true contraindication. Under-vaccination is driven more by missed opportunities than by genuine safety stops. [1] [27]
A contraindication is a condition that markedly increases the risk of a serious adverse reaction. The vaccine should not be given. A precaution is a condition that might increase risk, might impair immune response, or might confuse interpretation of a later illness. You usually defer or seek specialist advice rather than permanently withhold. A false contraindication is a commonly believed barrier that does not justify delay. [1]
An adverse event following immunisation (AEFI) is any untoward medical occurrence after a vaccine. Temporal association is not automatic causation. Passive systems such as VAERS detect signals; they do not, alone, prove product-related harm. [15] [25]
Safe immunisation encounter
- 1
Identify and check due vaccines
Confirm identity, age and record — not parental recall alone.
- 2
Screen for true stops
Prior anaphylaxis, severe immunocompromise, pregnancy for live vaccines, vaccine-specific rules.
- 3
Decide give, defer or withhold
Separate false barriers from precautions and absolute contraindications.
- 4
Administer and observe
Correct product, route and site; observe; keep adrenaline available.
- 5
Safety-net and document
Expected reactions, when to return, batch/lot, and any AEFI report.
References33ShowHide
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- [2]McNeil MM Risk of anaphylaxis after vaccination in children and adults. J Allergy Clin Immunol, 2016.PMID 26452420
- [3]Shearer WT, Fleisher TA, Buckley RH, et al. Recommendations for live viral and bacterial vaccines in immunodeficient patients and their close contacts. J Allergy Clin Immunol, 2014.PMID 24582311
- [4]France EK Risk of immune thrombocytopenic purpura after measles-mumps-rubella immunization in children. Pediatrics, 2008.PMID 18310189
- [5]Miller E Idiopathic thrombocytopenic purpura and MMR vaccine. Arch Dis Child, 2001.PMID 11207170
- [6]Haber P Postlicensure monitoring of intussusception after RotaTeq vaccination in the United States, February 1, 2006, to September 25, 2007. Pediatrics, 2008.PMID 18519491
- [7]Murphy TV The first rotavirus vaccine and intussusception: epidemiological studies and policy decisions. J Infect Dis, 2003.PMID 12696011
- [8]Vesikari T Safety and efficacy of a pentavalent human-bovine (WC3) reassortant rotavirus vaccine. N Engl J Med, 2006.PMID 16394299
- [9]Hviid A Measles, Mumps, Rubella Vaccination and Autism: A Nationwide Cohort Study. Ann Intern Med, 2019.PMID 30831578
- [10]Di Pietrantonj C Vaccines for measles, mumps, rubella, and varicella in children. Cochrane Database Syst Rev, 2021.PMID 34806766
- [11]Gerber JS Vaccines and autism: a tale of shifting hypotheses. Clin Infect Dis, 2009.PMID 19128068
- [12]Madsen KM A population-based study of measles, mumps, and rubella vaccination and autism. N Engl J Med, 2002.PMID 12421889
- [13]Taylor B Autism and measles, mumps, and rubella vaccine: no epidemiological evidence for a causal association. Lancet, 1999.PMID 10376617
- [14]Smeeth L MMR vaccination and pervasive developmental disorders: a case-control study. Lancet, 2004.PMID 15364187
- [15]Varricchio F Understanding vaccine safety information from the Vaccine Adverse Event Reporting System. Pediatr Infect Dis J, 2004.PMID 15071280
- [16]Pulendran B Immunological mechanisms of vaccination. Nat Immunol, 2011.PMID 21739679
- [17]Greenhawt MJ Establishing the safety of influenza vaccine in egg-allergic individuals. Pediatr Ann, 2013.PMID 23805959
- [18]Howe LE Safe administration of seasonal influenza vaccine to children with egg allergy of all severities. Ann Allergy Asthma Immunol, 2011.PMID 21530882
- [19]Greenhawt M Physician compliance with updated practice parameters for influenza vaccination in individuals with egg allergies. J Allergy Clin Immunol Pract, 2013.PMID 24565707
- [20]Cordonnier C Vaccination of haemopoietic stem cell transplant recipients: guidelines of the 2017 European Conference on Infections in Leukaemia (ECIL 7). Lancet Infect Dis, 2019.PMID 30744963
- [21]Pinto MV Immunisation of the immunocompromised child. J Infect, 2016.PMID 27233121
- [22]Hartley C Live-Attenuated Vaccines in Pediatric Solid Organ Transplant. Vaccines (Basel), 2024.PMID 38675758
- [23]Laberko A BCG Infection in Patients With Inborn Errors of Immunity Receiving the Russian BCG Strain. J Allergy Clin Immunol Pract, 2022.PMID 35470098
- [24]Pariyaprasert W Successful treatment of disseminated BCG infection in a SCID patient with granulocyte colony stimulating factor. Asian Pac J Allergy Immunol, 2008.PMID 18595532
- [25]Klein NP Surveillance for Adverse Events After COVID-19 mRNA Vaccination. JAMA, 2021.PMID 34477808
- [26]Lafnitzegger A Vaccine Hesitancy in Pediatrics. Adv Pediatr, 2022.PMID 35985708
- [27]Wodi AP Advisory Committee on Immunization Practices Recommended Immunization Schedule for Children and Adolescents Aged 18 Years or Younger - United States, 2024. MMWR Morb Mortal Wkly Rep, 2024.PMID 38206855
- [28]Schillie S Prevention of Hepatitis B Virus Infection in the United States: Recommendations of the Advisory Committee on Immunization Practices. MMWR Recomm Rep, 2018.PMID 29939980
- [29]Mbaeyi SA Meningococcal Vaccination: Recommendations of the Advisory Committee on Immunization Practices, United States, 2020. MMWR Recomm Rep, 2020.PMID 33417592
- [30]Meites E Human Papillomavirus Vaccination for Adults: Updated Recommendations of the Advisory Committee on Immunization Practices. MMWR Morb Mortal Wkly Rep, 2019.PMID 31415491
- [31]Broder KR Preventing tetanus, diphtheria, and pertussis among adolescents: use of tetanus toxoid, reduced diphtheria toxoid and acellular pertussis vaccines. MMWR Recomm Rep, 2006.PMID 16557217
- [32]Colditz GA Efficacy of BCG vaccine in the prevention of tuberculosis. Meta-analysis of the published literature. JAMA, 1994.PMID 8309034
- [33]Huh WK Final efficacy, immunogenicity, and safety analyses of a nine-valent human papillomavirus vaccine in women aged 16-26 years: a randomised, double-blind trial. Lancet, 2017.PMID 28886907