Tuesday, March 28, 2023

Which Vaccines Cannot Be Given Together

Cdcs Recommended Childhood Vaccine Schedule Ensures Children Get The Best Protection During The Many Different Stages In Growth And Development

Could different COVID-19 vaccines be mixed together?

From the moment babies are born, they are exposed to numerous bacteria and viruses on a daily basis. Eating food introduces new bacteria into the body numerous bacteria live in the mouth and nose and an infant places his or her hands or other objects in his or her mouth hundreds of times every hour, exposing the immune system to still more germs. When a child has a cold, he or she is exposed to up to 10 antigens, and exposure to strep throat is about 25 to 50 antigens. Each vaccine in the childhood vaccination schedule has between 1-69 antigens. A child who receives all the recommended vaccines in the 2018 childhood immunization schedule may be exposed to up to 320 antigens through vaccination by the age of 2.

In fact, a 1994 report from the Institute of Medicine, Adverse Events Associated with Childhood Vaccinesexternal icon, states: In the face of these normal events, it seems unlikely that the number of separate antigens contained in childhood vaccines would represent an appreciable added burden on the immune system that would be immunosuppressive.

Reporting Adverse Events After Immunization

Modern vaccines are extremely safe and effective. Benefits and risks are associated with the use of all immunobiologicsno vaccine is completely effective or completely safe for all recipients. Adverse events after immunization have been reported with all vaccines, ranging from frequent, minor, local reactions to extremely rare, severe, systemic illness, such as that associated with yellow fever vaccine. Adverse events following specific vaccines and toxoids are discussed in detail in each ACIP statement. In the United States, clinicians are required by law to report selected adverse events occurring after vaccination with any vaccine in the recommended childhood series. In addition, CDC strongly recommends that all vaccine adverse events be reported to the Vaccine Adverse Event Reporting System , even if a causal relation to vaccination is not certain. VAERS reporting forms and information are available electronically at www.vaers.hhs.gov, or they may be requested by telephone: 800-822-7967 . Clinicians are encouraged to report electronically at .

Can You Give Rabies And Dhpp Vaccine Together

Dogs that are given the DHPP vaccination at the same time as their vaccination for rabies, will likely suffer discomfort during either shot. If your dog has a severe allergy to either, the vet recommends one of the two vaccinations every six months instead, so the treatment will be discontinued after six months

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Drug Interactions In Patients On Hiv Medications

Patients with HIV can be a challenge in the pretravel consultation . A study in Europe showed that as many as 29% of HIV-positive travelers do not disclose their disease and medication status when seeking pretravel advice. Antiretroviral medications have multiple drug interactions, especially through activation or inhibition of CYP3A4 and CYP2D6. There are several reports of antimalarial treatment failure and prophylaxis failure in patients on protease inhibitors and both nucleoside and nonnucleoside reverse transcriptase inhibitors, whereas entry and integrase inhibitors are not a common cause of drugdrug interactions with commonly administered travel-related medications. A number of the potential interactions are listed above, and 2 excellent resources for HIV medication interactions can be found at www.hiv-druginteractions.org and at www.aidsinfo.nih.gov. Preexposure prophylaxis with emtricitabine/tenofovir is not a contraindication for any of the commonly used travel-related medications.

Interactions Between Travel Vaccines Anddrugs

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Live Attenuated Oral Typhoid and Cholera Vaccines

Live attenuated vaccines generally should be avoided in immunocompromised travelers, including those taking immunomodulators, calcineurin inhibitors, cytotoxic agents, antimetabolites, and high-dose steroids .

Antimicrobial agents may be active against the vaccine strains in the oral typhoid and cholera vaccines and may prevent adequate immune response to these vaccines. Vaccination with oral typhoid vaccine should be delayed for > 72 hours and with oral cholera vaccine for > 14 days after administration of antimicrobial agents. Parenteral typhoid vaccine is an alternative to oral vaccine, but there is no parenteral cholera vaccine currently available, and no killed oral cholera vaccines are licensed in the United States.

Chloroquine and atovaquone-proguanil at doses used for malaria chemoprophylaxis may be given concurrently with oral typhoid vaccine. Data from an older formulation of the CVD 103-HgR oral cholera vaccine suggest that the immune response to the vaccine may be diminished when it is given concomitantly with chloroquine. Live attenuated oral cholera vaccine should be given at least 10 days before beginning antimalarial prophylaxis with chloroquine. A study in children using oral cholera vaccine suggested no decrease in immunogenicity when given with atovaquone-proguanil.

Rabies Vaccine

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Combination Vaccines And Multiple Vaccinations

Over the last 50 years there has been a big increase in the number of vaccines given to children. If all these vaccines were given separately, each child would have to receive a large number of injections. Combination vaccines such as the 6-in-1 and the MMR have been developed to help reduce the number of injections needed. Even so, babies and children often receive several vaccines at once. For example, in the UK a 2 month old baby will receive the 6-in-1, PCV, Rotavirus and MenB vaccines at the same time.

Parents sometimes worry that their childs immune system will not be able to cope with receiving several vaccines at once. In fact, even a tiny babys immune system can cope easily. From birth onwards, a baby comes into contact with millions of germs every day. Babies’ immune systems are working all the time to protect them against bacteria and viruses in the environment. Vaccines represent a very small challenge to the immune system when compared to this. Each millilitre of blood contains ten million B cells, the white blood cells that are associated with the immune response. It is estimated that this would be enough to cope with thousands of vaccines at a time, meaning that a babys immune system is not stretched at all by receiving several vaccines at once. It is not a good idea to delay vaccinations to spread the load, because it leaves the baby unprotected against dangerous diseases for longer.

How Do I Find Out If I’ve Had The Right Vaccinations

Ask a parent to contact your pediatrician or family doctor so he or she can check your health records.

If you’ve already had a disease like chickenpox, you won’t need the vaccine. And if it turns out you missed one or more of the required immunizations, you can still get them from your doctor it’s never too late. After getting a vaccination, it generally takes 10 days to 2 weeks for the body to build up immunity to a disease.

Once you have a certificate from your doctor that you’ve had all your shots, keep it filed away so you can find it easily later. If you plan to go to college, you will need to show proof that you’ve had a condition or been immunized. Some jobs also require proof of immunization for example, if you are working or volunteering in a hospital.

Because some teens may have missed getting certain shots, this is one of those times when you need to take charge of your health: Bring up the subject of immunization when you see your doctor and ask if you’ve had all the recommended vaccinations .

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Is The Vaccine Safe

The vaccine can be given to people with a previous history of shingles infection. It should not be given to anyone who currently has shingles. As stated above, the vaccine should not be given to people who are clinically immunosuppressed because the vaccine strain could replicate too much and cause a serious infection. For more information see the MHRA’s Drug Safety Update .

In clinical trials of the vaccine, there have been no reports of someone who was vaccinated passing the virus on to anyone else. However, because the shingles vaccine is a live vaccine, it is thought that this may be possible in rare cases.

There is thought to be a very small risk that someone who has been vaccinated could pass on the virus to someone who is not immune to chickenpox. This is only thought to be a risk if the person who has been vaccinated develops a shingles type rash at the injection site or elsewhere on the body.

The shingles vaccine is not recommended for pregnant women as a matter of caution. However, studies have been carried out on pregnant women who have accidentally received chickenpox or shingles vaccines. These have not shown any link between the weakened virus in the vaccine and any specific problems in babies born to these women. See this Public Health England statement for more information.

Spacing Of Multiple Doses Of The Same Antigen

While some still have no access to COVID vaccines, others are rejecting the jab | DW News

Vaccination providers should adhere to recommended vaccination schedules . Administration at recommended ages and in accordance with recommended intervals between doses of multidose antigens provides optimal protection.

Administration of doses of a multidose vaccine using intervals that are shorter than recommended might be necessary in certain circumstances, such as impending international travel or when a person is behind schedule on vaccinations but needs rapid protection. In these situations, an accelerated schedule can be implemented using intervals between doses that are shorter than intervals recommended for routine vaccination . The accelerated or minimum intervals and ages for scheduling catch-up vaccinations. Vaccine doses should not be administered at intervals less than these minimum intervals or at an age that is younger than the minimum age.*

Certain vaccines produce increased rates of local or systemic reactions in certain recipients when administered more frequently than recommended . Careful record keeping, maintenance of patient histories, use of immunization information systems , and adherence to recommended schedules can decrease the incidence of such reactions without adversely affecting immunity.

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Interactions With Drugs Used For Travel To High Altitudes


Acetazolamide produces alkaline urine that can increase the rate of excretion of barbiturates and salicylates and may potentiate salicylate toxicity, particularly if taking a high dose of aspirin. Decreased excretion of dextroamphetamine, anticholinergics, mecamylamine, ephedrine, mexiletine, or quinidine may also occur. Hypokalemia caused by corticosteroids may be potentiated by concurrent use of acetazolamide. Acetazolamide should not be given to patients taking the anticonvulsant topiramate, as concurrent use is associated with increased toxicity. Increased monitoring of cyclosporine, tacrolimus, and sirolimus is warranted if these drugs are given with acetazolamide. Concurrent administration of metformin and acetazolamide should be done with caution, as there may be an additive risk for lactic acidosis. Acetaminophen and diclofenac sodium form complex bonds with acetazolamide in the stomachs acidic environment, impairing absorption. These agents should not be taken within 30 minutes of acetazolamide.


Dexamethasone interacts with multiple classes of drugs. Using this drug to treat altitude illness may, however, be lifesaving. Interactions may occur with dexamethasone and the following drugs and drug classes: macrolide antibiotics, anticholinesterases, anticoagulants, hypoglycemic agents, isoniazid, digitalis preparations, oral contraceptives, and phenytoin.

Managing Fever After Immunisation

The following treatment options can reduce the effects of fever after immunisation:

  • Give extra fluids to drink and do not overdress children if they have a fever.
  • Although routine use of paracetamol after vaccination is not recommended, if fever is present, paracetamol can be given check the label for the correct dose or speak with your pharmacist, .

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Doctors Support The Change

Richard Watkins, MD, an infectious disease physician and a professor of internal medicine at the Northeast Ohio Medical University, tells Verywell that there was never any compelling evidence for the previous recommendation, adding, I am glad it has been changed.

Watkins says that the move may help more children get vaccinated, noting the convenience factor. Under the updated guidance, families only have to make one trip to get vaccinated instead of several under the previous recommendations, he says.

John Schreiber, MD, a pediatric infectious disease specialist at Connecticut Children’s Medical Center, tells Verywell that the changed guidance seems like a reasonable thing to do.

Schreiber anticipates that some parents may still be wary to give their children other vaccines at the same time as the COVID-19 vaccine, but say that new recommendations are sound.

I dont have any concerns with this, Schreiber says. But, he adds, the CDC and AAP will monitor children to see what happens next. If it turns out that children are complaining about more side effects after getting vaccinated, Im sure the recommendations can be modified.”

The information in this article is current as of the date listed, which means newer information may be available when you read this. For the most recent updates on COVID-19, visit our coronavirus news page.

Fever And Febrile Convulsions

Remember families that cannot come together and give ...

People who receive MMR vaccine may develop a fever 710 days after vaccination. This can last 23 days. The fever may be associated with malaise and/or a non-infectious rash. Up to 15% of MMR vaccine recipients develop a high fever .1,18

An increased risk of seizures of about 1 case per 30004000 doses occurs in the same time period.18

This time frame coincides with the period of peak measles vaccine virus replication.

Inform vaccine recipients, or their parents or carers, about:

  • possible symptoms occurring 512 days after vaccination
  • how to manage the symptoms, including using paracetamol for fever

In clinical trials, people who received MMRV vaccine had higher rates of fever than people who received MMR vaccine and monovalent varicella vaccine at the same time but at separate sites.34-37 Rates of fever were highest in people who received MMRV vaccine as their 1st dose.

Post-marketing studies in the United States identified an approximately 2-fold increased risk of fever and convulsions 710 days38 39 after vaccination in children who received MMRV vaccine as a 1st dose. MMRV recipients were compared with recipients of separate MMR vaccination resulted in 1 additional seizure for every 2300 doses compared with separate MMR and varicella vaccination.38 Children in the studies were mostly 1223 months of age.

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Getting Multiple Vaccines At The Same Time Has Been Shown To Be Safe

Scientific data show that getting several vaccines at the same time does not cause any chronic health problems. A number of studies have been done to look at the effects of giving various combinations of vaccines, and when every new vaccine is licensed, it has been tested along with the vaccines already recommended for a particular aged child. The recommended vaccines have been shown to be as effective in combination as they are individually. Sometimes, certain combinations of vaccines given together can cause fever, and occasionally febrile seizures these are temporary and do not cause any lasting damage. Based on this information, both the Advisory Committee on Immunization Practices and the American Academy of Pediatrics recommend getting all routine childhood vaccines on time.

Should I Have Any Other Vaccinations At The Same Time As The Teenage Booster

You’ll probably be offered the MenACWY vaccine at the same time as your 3-in-1 vaccine.

It’s also a good opportunity to check with the doctor or nurse that all your other vaccinations are up-to-date, such as MMR.

If not, you can have these other routine childhood vaccinations at the same time as the 3-in-1 teenage booster.

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Immunizing Agents Available For Use In Canada

Rotavirus vaccines

  • RotaTeq®: live, oral, pentavalent rotavirus vaccine, Merck Canada Inc.
  • ROTARIX®: live, oral, monovalent, attenuated human rotavirus vaccine, GlaxoSmithKline Inc.

For complete prescribing information, consult the product leaflet or information contained within the product monographs available through Health Canada’s Drug Product Database.

Refer to Contents of immunizing agents available for use in Canada in Part 1 for a list of vaccines available for use in Canada and their contents.

Can A Dog Have Too Many Vaccines

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Among Schulzs other opinions, he is in agreement with those who say more vaccination is needed. The problem is, he says, that veterinarians sometimes vaccinated pets for their own gain. While too many vaccines can destroy a persons immune system, it sometimes happens when youre giving Combo Shots.

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Vaccinating People With Acute Illnesses

Every opportunity should be taken to provide needed vaccinations. The decision to delay vaccination because of a current or recent acute illness depends on the severity of the symptoms and their cause. Although a moderate or severe acute illness is sufficient reason to postpone vaccination, minor illnesses are not contraindications to vaccination.

Antimicrobial therapy is not a contraindication to vaccination, with several exceptions:

  • Antibiotics may interfere with the response to oral typhoid vaccine and oral cholera vaccine.
  • Antiviral agents active against herpes viruses may interfere with the response to varicella-containing vaccines.
  • Antiviral agents active against influenza virus may interfere with the response to live attenuated influenza vaccine.

Pay Attention To Vaccine Placement

When administering the flu and COVID-19 vaccine together, they should be given in different sites on the arm separated by an inch or more if possible. If a local reaction does occur, the physician can identify which vaccine may have been responsible. But physicians should make sure to document the precise location in the patients chart for reference if they are unable to see the patient when they report the adverse reaction.

Additionally, if COVID-19 vaccines are administered at the same time as flu vaccines that might be more likely to cause a local reactionsuch as adjuvanted or high-dose inactivated influenza vaccinesthey should be administered in separate limbs if possible. The deltoid is the preferred site, but the anterolateral thigh may be used as an alternate site, according to the CDC COCA webinar. CDC has extensive guidance for health care providers on coadministration of vaccines.

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