Rapid Review II: Immunizations, Contraindications, and the Rashes
A horizontal immunization rail with ticks at birth, 2, 4, 6, 12 to 15 months, 4 to 6 years, and 11 to 12 years; live vaccines drawn with a dashed outline so live status reads by shape, not color.
Verify before you rely on this. crit The childhood and adolescent immunization schedule is revised annually. Antigens move, age windows shift, and new products are added. Learn the shape below, then confirm every specific against the current CDC schedule.
The shape of the schedule
| Visit | What clusters there |
|---|---|
| Birth | Hepatitis B, first dose |
| 2 months | Diphtheria, tetanus, acellular pertussis; inactivated polio; Haemophilus influenzae type b; pneumococcal conjugate; rotavirus (oral, live); hepatitis B second dose |
| 4 months | The same injection cluster repeats |
| 6 months | The cluster repeats again; influenza becomes due annually from six months |
| 12 to 15 months | Measles, mumps, rubella; varicella; hepatitis A; the Hib and pneumococcal boosters |
| 4 to 6 years | School-entry boosters: diphtheria, tetanus, acellular pertussis; polio; measles, mumps, rubella; varicella |
| 11 to 12 years | Adolescent cluster: tetanus, diphtheria, acellular pertussis booster; human papillomavirus; meningococcal conjugate |
The live ones. Measles-mumps-rubella, varicella, the combined measles-mumps-rubella-varicella product, rotavirus, and the intranasal influenza vaccine. Live vaccines are what drive the contraindication questions. Two live injectable vaccines are given the same day or separated by at least four weeks.
True contraindications crit
- Anaphylaxis to a previous dose or to a vaccine component.
- Encephalopathy within seven days of a pertussis-containing vaccine, which contraindicates further pertussis-containing doses.
- Severe immunocompromise, for live vaccines.
- Pregnancy, for live vaccines.
- A history of intussusception or severe combined immunodeficiency, for rotavirus vaccine.
Not contraindications. The distractor is almost always one of these.
- Mild illness with or without low-grade fever.
- Current antibiotic therapy.
- Breastfeeding, by mother or infant.
- Prematurity; premature infants are immunized by chronological age.
- A mild local reaction, including redness or soreness, to a previous dose.
- A family history of a vaccine reaction or of seizures.
Airborne rashes. Measles and varicella. Airborne precautions and a negative-pressure room. Measles brings cough, coryza, conjunctivitis, Koplik spots inside the cheek, then a rash spreading from the face downward. Varicella is contagious until every lesion has crusted, and lesions appear in successive crops, so a child with both blisters and crusts is still infectious. → BOOK 04 · P7
Droplet rashes and coughs. Pertussis, mumps, rubella, scarlet fever. Pertussis gives paroxysmal coughing with an inspiratory whoop and post-cough vomiting. Mumps gives parotid swelling. Rubella is mild in the child and dangerous to a pregnant contact. Scarlet fever, from group A streptococcus, gives a sandpaper rash and strawberry tongue, and the full antibiotic course must be finished to prevent rheumatic fever and glomerulonephritis.
Alarming but not. Fifth disease, from parvovirus B19, gives a slapped-cheek appearance and is no longer contagious once the rash appears, so the well child does not need exclusion. It is dangerous to a pregnant contact and to a child with sickle cell disease, in whom it can cause aplastic crisis. Roseola gives three to five days of high fever followed by a rash that appears as the fever breaks, and the fever spike is a common trigger for a first febrile seizure.
Margin notea mild cold means you still vaccinate.
Takeawayhold a vaccine for a true contraindication, never for a runny nose.