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Morbil dity aqd Morta,llty Weqkiy RJaport
Recommendations and,Reports’February 8* 2002 / Vuf. 51/ No. RR-2
RecommendcHionq of the Advisory ~,~mrni~~eeon Im,~unizcHion PructicqslPi-and the American Academy of Fclmil$ ,~~~~~~~~ns (AAFP)
 
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MhUWR
TheMMWR series f pubticationsspublished
y the
iEpidemiology
rogram ffice,
Centers or DiseaseControlandPreventionCDC), U.S. Department f Health ndHu.man ervices,tlanta,
GA 30333.
/,
SUGGESTED CZTATrOJUCentersor Diseaseontrol nd ever&on. eneralrecommendations n immunization: recom-mendations f the Advisory Committee 05ImmunizationracticesndheAmericancademy of FamlyPhysicians.MWR 20023 WO.m-2): [inclusiveage umbers].Centers or Disease ontrol and PreventionJeffher? Kaplan, .D., M.P.H.Diwti
IDavidW.
Fleming, .D.D&y Dimwrfor Scimcr d Put% Heakb:DixieE. Snider, r,, M.D., M&H.Associakircctwfir St&me_Epide&logy Program OfficeStephen; Thacker, .D., M.Sc.. .I. . :.DimctorjCONTEN,lS
Timing nd Spacing f lmmunabiologics.............................GeneralPrinciplesor Vaccine cheduling........................ i:Spa&g of MultipleRoses f the Same Antigen................ 2SimLilfaneausdm~nisfratjan...........................................Nansimuifoneous~~~~sf~~on ......................................5Spacing f Anfibody-Coniriining roductsand Vaccines.... 6Cntcrchangeobilityf Vacci~s rom ‘DifferentMonufacfurersLapsed accinafian chedule...........................................8Unknownor Unceriairi accination.Status........................ 8Contraindicationsnd Precautions......................................8Vacci& Administration.....................................................11Infection Qnfraf~and Sterile Technique..........................Recammended&fes of Injectianand NeedleLength ... ::&ttiple Vaccinations.....................................................12Jet injection...................................................................13Mefhbds or Aik&afin~ Discomfort and PainAssociatedwith Voccinafion..........................................................13Nan&and&d. Vaccinaiion ractices.................................13Prevenfing,Adverse eactions.........................................14Managing cute Vaccine wcfiont .................................14Qccupationol afefy
Regulations....................................15
Storage and
Handling
df Immunabiol;ogics....................... 15Special ituations.............................................................16Concurrently dminisfering ntimicrobialAgentsand Vaccines..............................................................16fubercolasis.Screeningnd SkinTest
Reacfivify
............... 16SeverbAilergy o Vaccine omponents........................... 16LatexAllergy ..................................................................17Voccinafion f Premature nfants.. ...................................18Breasf-Feedingnd Vaccincifion.....................................18VaccinationDuringPregnancy........................................ 18Voccinofionef Jnfernafio~alty dopted Children............. ?Altered lmmun~com~fe~c~ -. ........................................22Vaccinofion f Hernafopoiefic tem CellTransplantRecipients...................................................................23Vaccinofing ersans ith
Bbeding
isordersand Pemns Receiving nficoagu.lant herapy............. 23Vaccination &ords ...........................................................
Consent
o Vac&afe......................................................f fProviderRecords............................................................24Pafienfs’Pitrsontil~Kec~s..............................................Registries.......................................................................4:ReporfingAdverseEve& After Vaccination....................... 24VaccinenjuryCompensation rogram........................... 25Benefitand R&k Commuriicotion....................................25VacBnoiiori rograms.......................................................Vaccine nformationSources.............................................itNatia,nal mtiunizafion. nformotionHofiine.................... 28CDC’s National mmunizaiian ogram ..........................Morbidify ndMa~a~~~‘~eek~yep& ..............................2Am&con-Academy of Pediafrics AAP) ............................Am&on Acadbmy FamifyPhysiciansAAFP} ............. ftImmuniz;ation’Actionoalition.......................................National N&work far immvirizafionnformation............. ;:Vaccine. ducafion enter ...............................................28lnstiiite far Vaccine aEefy... . .......................................28Notion4 Partnershipor tmmunization........................... 28State and Local ealflhDeportments ...............................28References........................................................................29AbbrehotionsUsed
n
hisPublication..............................34DefinitionsUsed-in hisRepoti..........................................34Continuing
Education
xamitiotiim ................................CE-1
 
Vol. 51 I RR.2Wxommandations and 33qwts 1
Recommendafions of: the Advbry Commiftee an ~mm~~izufion Practices(ACIP) and the American Academy of ~FggiEpr Fhy&ians (AAFP)
Prepared byWilliam L. Arkinson. M.D.’larry K. Pickering, M.D.2Benjamin Schwara, M.D.1Bruce G. Wtniger, M.D.’Jdhn K. &u&r, M.DPJohn C. Watson, M.D.’
fImmmieation
mrierr DivirionaOfice
ofhe
Director‘&pi&mialb and Sn~*Uance DittirianNutxa
Immm~tion
PwgramJ‘DiviJion ofRar&ic Dizcam
NuXio?udCtnter&rhxjhiwDire~
This
report iz a ret&m of Gencrd Rccommm&d~~ ot2 mmunizahbn and, up&es the .lP94 statement by the AdvimryComkttee otf Immun;p;at;on Pructic~ (ACIPj &DC. General recommendations on immunization: recommendations ofthe Advhory Committee on Immunization Pracrices [ACIP]. MMWR 1994;43mo. RR-S&1-38). Tbeprinc$~J &ngesin&h cxp~.~~&nof tbr disczusionaf vacchtitm spkng and timing rec~mmcn&titmr flir wuccizu~ths rrdmnistered by anincorrect route, inform&m regarding need&he injectiion t&ho&~ u~ccir~tion of chitirex adaptedfrom count&s outside heUnited States,iming of live-vina vaccination and tubercr+s screeningq&ion sfthe d&cl&m a*rd t&s
of
antruindiaativns
and precautions “garding va&tatzhs, and &titnz of a directory of immunikatiun WOWC%F hese ecommendations re ?wtcomprebensheh ea& vckne. The most rrrmt AC.@ rrcommenh&ms
fur
drh spe~$%vrlcrinc should be consulted ir ad&-tional a&z&. This report, ACIP ~~mme&&cm.s fir each vaccine, czn4other
isfomtion
gardipg itimutition CSPI eacessedat CZXX Ntionai Immunivrtiort Prognzm wtbsxte dt http://wwwcdkguuh~ (access#d t&r
1 I, 2001).
Inf
roducfion
This report provides technical guidance regarding commonimmunization concerns for health-care providers who admin-ister vaccines o children, adolescents, and adults. Vaccine rec-ommen.dations are based on characteristics of theimmunobiologic product, scientific knowledge regarding theprinciples of active and passive mmunization, the epidemiol-ogy and burden of diseases i.e., morbidity, mortality, costs oftreatment, and loss of productivity), the safety of vaccines,and the cost analysis of preventive measures as udged by pub-lic health officials and specialists in clinical and preventivemedicine.Benefits and risks are associated with using al!immunobiologics. ‘No vaccine is completely safe or 100% ef-fective. Benefits of vaccination include partial or completeprotection against the consequencesof infection for the vacci-nated person, as welI as overall benefits to society as a whole.Beneftts include protection from symptomatic illness, im-
Immunization ServicesDiiision, Lance E. Rodewald,M.D., Dictctor.
proved quality of life and~productivity, and prevention of death.SocieJ benefa inch& cre+ion and maintenance of herd im-munity against communicable diseases,prevention of diseaseoutbreaks, and reduction in health-care-related costs. Vacci-nation risks range from common, minor, and local adversee&us
to
rare, sew&e, and life-ehreacenitrg conditions. Thus,recommendations for iminunization practices balance scien-tific evidence.ofbenefits for eacfi person and to society againstthe potential postsand risksof vaccination programs.Standards for child and adolescent immunization practicesand standards foradult immunization practices (1,2) have beenpublished to assist with implementing vaccination programsand maximizing their benefits. Any person or institution thatprovides vaccination servic@ should adopr these standards toimprove immunization delive,ry and protect children, adoks-cents, and adults from vaccine-preventable diseases.To maxim& the benefits of vaccination, this tepoct,pro-vides general information regarding immunobiologics andprovides.practic;rl guidelines concerning vaccine administra-tion and technique. Ta minimize risk from vaccine adminis-tration, this report dekeates situations that warrantprecautions or contraindication to using a vaccine. These rec-ommerxlations are intended for use in the United States be-
of 00

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