Very special cases in which it is not advisable to vaccinate children

There is a long list of vaccine-preventable diseases, and as science and technology advance, this list continues to grow; Therefore, every child must strictly comply with the vaccination schedule, and although there are variations according to the epidemiology of each country, in general, these vaccination differences are minimal. Still, there are some very special cases in which it is not advisable to vaccinate children.

Vaccines are biological drugs made from infectious agents, either live, attenuated, or inactivated. Once they penetrate the body, they trigger a response in the immune system (defense system), generating substances known as antibodies, which protect the individual from developing a certain disease when it comes into contact with the germ involved by which got vaccinated.

Vaccination is the best tool to prevent some infectious diseases and it is one of the public health measures that has saved the most lives throughout history, although unfortunately they are not always accessible.

The Spanish Association of Vaccination establishes: "Vaccines are the safest drugs that exist, because for their authorization studies and controls have to be carried out than with any other drug, mainly because they are mainly intended for healthy people."

Vaccines are not exempt from adverse reactions (extremely rare), although in general, the reactions they can cause are mild, and well tolerated by the individual and, in rare cases, more serious effects can occur.

It is important to emphasize that vaccine preparations are made up not only of antigens (substances derived from bacteria or viruses) responsible for stimulating the immune response (defense), but also have other components (antibiotics, preservatives, stabilizers or adjuvants), whose purpose is to enhance the response of the vaccine, avoid contamination or extend the expiration date, so when a vaccine reaction occurs, it may be due to the vaccine itself (antigen) or to some component of it.

When you talk about precaution, you mean that the administration of a vaccine may condition a greater risk of presenting an adverse reactionEither because some unwanted effect attributed to the vaccine has already been presented before or because of some clinical condition present in the person that prevents them from obtaining an adequate and / or expected post-vaccination response.

When speaking of contraindication, it refers to a specific situation in which a drug should not be used, in this case a vaccine, since it can cause an adverse reaction, even be lethal for the person, so it should not be administered.

However, there are cases in which vaccination is not recommended, in this sense, the objective of this article is to explain in detail what these situations are, based on the Recommendations of the Vaccine Advisory Committee of the Spanish Association of Pediatrics. In which cases is vaccination not recommended?

- Absolute or permanent contraindications
Here we refer to an anaphylactic reaction (severe allergic reaction) to previous doses of the same vaccine, to a severe anaphylactic reaction to any of the components of the vaccine (the most allergenic products are antibiotics, egg proteins, gelatins and , less often, yeast) or if an acute encephalopathy occurs within 7 days of vaccination with the pertussis vaccine (the component of the vaccine cannot be administered, even if it is an acellular vaccine).

- Relative or temporary contraindications
1. Age is an important factor to take into account, since if a vaccine is completed before the recommended age, the immune response would not be as expected, therefore, it can be taken as a contraindication, such is the case of:

- The MMR vaccine is not recommended to be administered before 12 months of age (except in epidemic situations that can occur after 6 months of age).

- The vaccine against hepatitis A is administered from 12 months of age.

- The flu from 6 months.

2. In the case of premature babies, they must be fulfilled according to their chronological age and not according to corrected age, regardless of weight and gestational age at birth.

3. During pregnancy, live virus vaccines are contraindicated due to the potential risk of harm to the fetus. Exceptions are the polio, typhoid and yellow fever vaccines, which in cases where the risk is high, could be complied with, taking into account the prior evaluation by health personnel.

4. In patients with immunodeficiencies, vaccines with live germs such as Triplevirus (measles, rubella, mumps, varicella and yellow fever mainly) are contraindicated, since they can cause the disease in a serious way.

5. When there is any moderate and severe acute infection, severe diarrhea, vomiting, fever, asthma attack, heart disease, nephropathy, decompensated diabetes or neurological infections, vaccines should NOT be administered, but when recovering, the schedule must be followed; If, on the other hand, there is a non-serious or trivial disease, such as the common cold, mild diarrhea or some viral infectious disease with or without fever, vaccination should not be postponed.

6. In the case of diseases such as HIV, AIDS, cancer and immunosuppression therapy (metabolites, chemotherapy), each case must be evaluated in a particular and individualized way.

7. Caution should be taken for subsequent doses in the case of pertussis vaccine: seizures within 3 days after the vaccine, crying with screaming lasting more than 3 hours, and hypotonia and hyporesponsiveness syndrome in the first 48 hours after vaccination.

8. In the breastfeeding mother, the child can receive the vaccines according to age, the exception would be the vaccine against yellow fever.

9. If the child had the disease they are currently vaccinating for, there is no risk.

10. Patients with a stable diagnosis of epilepsy and those with febrile seizures can be safely vaccinated.

11. History of Guillain-Barré syndrome within 6 weeks after administration of a vaccine. In this case, the convenience or not of administering a subsequent dose of said vaccine should be carefully assessed.

12. Antibiotics are not a contraindication to vaccinations, except for oral typhoid vaccine.

13. It is not possible to predict which person might react to a vaccine, although there are a few contraindications for some vaccines. Observance of contraindications can minimize the risk of serious adverse effects.

14. There are several vaccines on the market in whose synthesis process the egg intervenes, such as the influenza vaccine, the yellow fever vaccine and the MMR. Children with an anaphylactic allergy to eggs can receive these vaccines by waiting 15-30 minutes later in the waiting room and under medical supervision at the health center, and they can also receive inactivated vaccines against influenza and the vaccine against yellow fever. at the health center.

If the vaccine-preventable diseases were not mostly fatal, it would simply not be insistent on complying with the vaccination schedules, so it is important that both the mother and the health personnel recognize the true contraindications, so as not to miss a vaccination opportunity.

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