cInfants weighing less than 2 kg at birth and born to hepatitis B surface antigen (HBsAg)-negative mothers should receive the first dose of HepB vaccine series starting at 1 month of chronologic age or at hospital discharge if before 1 month of chronologic age. All infants weighing less than 2 kg born to HBsAg- positive mothers should receive immunoprophylaxis (Hepatitis B Immune Globulin and vaccine) beginning as soon as possible after birth, and always within 12 hours after birth, followed by appropriate postimmunization testing and receipt of 3 doses of hepatitis B vaccine. All infants weighing less than 2 kg at birth and born to mothers with unknown HBsAg status should receive hepatitis B vaccine within 12 hours of birth if status remains unknown by 12 hours of life or if maternal HBsAg is positive, Hepatitis B Immune Globulin should be given. dAcetaminophen given before administering DTaP and thereafter every 4 hours for 24 hours may be considered for children with a personal or family (ie, siblings or parents) history of seizures. eThe decision to give additional doses of DTaP should be made on the basis of consideration of the benefit of further immunization versus the risk of recur- rence of GBS. For example, completion of the primary series in children is justified. fEgg allergy is not considered a contraindication or precaution. gRefer to Influenza chapter (p 476). hThe administration of multiple live-virus vaccines within 28 days (4 weeks) of one another if not given on the same day may result in suboptimal immune response. Data substantiate this risk for MMR and possibly varicella vaccine, which should, therefore, be given on the same day or more than 4 weeks apart. iImmunosuppressive steroid dose is considered to be 2 or more weeks of daily receipt of 20 mg prednisone or the equivalent. Vaccination should be deferred for at least 1 month after discontinuation of such therapy. jRefer to Biologic Response Modifiers Used to Decrease Inflammation (p 85). kEvidence of severe immunosuppression in HIV-infected children is CD4+ T-lymphocyte percentage less than 15% in children of any age, and CD4+ T- lymphocyte percentage less than 200 lymphocytes/mm3 in children 6 years and older. Severely immunocompromised HIV-infected infants, children, adoles- cents, and young adults should not receive measles virus-containing vaccine, because vaccine-related pneumonia has been reported. The quadrivalent mea- sles-mumps-rubella-varicella (MMRV) vaccine should not be administered to any HIV-infected infant, regardless of degree of immunosuppression, because of lack of safety data in this population. lA theoretical basis exists for concern that measles vaccine might exacerbate tuberculosis. Consequently, before administering MMR to people with untreated active tuberculosis, initiating antituberculosis therapy is advisable. mMeasles immunization may suppress tuberculin reactivity temporarily. MMR vaccine may be given after, or on the same day as, tuberculin skin testing. If MMR has been given recently, postpone the tuberculin skin test until 4 to 6 weeks after administration of MMR. The effect of MMR on IGRA test results is unknown. nVaricella vaccine should not be administered to a person who has a family history of congenital or hereditary immunodeficiency (such as parents or siblings) until the potential vaccinee’s immune competence has been substantiated clinically or verified by a laboratory. APPENDIX V GUIDE TO CONTRAINDIC ATIONS 1081
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