32 INFECTIOUS DISEASE, DISASTER PLANNING & WOUND CARE | 2019 | www.elitecme.com (CDC, 2016). Nursing Consideration: In order to take advantage of the most current vaccination guidelines, it is critical that nurses and ANPs are aware of and understand the most cur- rently issued vaccination guidelines issued by the Centers for Disease Control and Prevention. Further, it is important to under- stand any changes that may have been imple- mented since the issuance of the previous schedules. This knowledge will equip nurses and ANPs to provide other clinicians with changes that they must be aware of. CONTRAINDICATIONS AND PRECAUTIONS TO THE MMR VACCINATION The use of the MMR vaccine is contrain- dicated in patients who have experienced a severe allergic reaction to the vaccine or a vaccine component, which includes gelatin (Merck, 2017-1). Despite previous beliefs that severe egg allergies increased the risk of adverse reactions to the MMR vaccine, data suggest that anaphylactic reactions to the MMR vaccine are not associated with hypersensitivity to eggs; rather, reactions are likely explained by the gelatin or neomycin contained in the vaccine than rather than the ovalbumin. The risk of severe aller- gic reactions to the MMR vaccine when administered to patients with egg allergies (non-anaphylactic) is extremely low; its use is recommended in patients with egg allergies without special protocols (Khakoo & Latch, 2000). Pregnant women should not receive the MMR vaccine: Pregnancy should be avoided for three months after receiving it since the possible impacts of the vaccine on fetal devel- opment is not known. Available data suggest that lactating women administered live vac- cine may transmit it to their baby in breast milk. As a result, caution must be exercised if MMR vaccine is administered to nursing women. MMR vaccination is contradicted in the following populations: • Patients who suffer from febrile illness or infections. Nonetheless, vaccination is appro- priate in patients with minor illnesses, such as diarrhea, mild infections or low-grade febrile illnesses; • Patients currently administered immuno- suppressive therapy (prednisone equivalent of more than 2 mg/kg per day or more than 20 mg per day for 14 days or more). This does not apply to patients receiving replacement corti- costeroid therapy, such as Addison’s Disease patients; • People with blood dyscrasias, leukemia, lymphoma, or malignancies of the bone mar- row or lymphatics; • Persons who have experienced anaphy- lactic reactions to topically or systemically administered neomycin. (This is not to be confused with the more common cell-me- diated, or delayed reactions such as contact dermatitis.); • Patients in immunodeficient states (Merck, 2017-1). Patients with a history of a low platelet count (i.e., thrombocytopenia) may be at a higher risk of developing thrombocytopenia after receiving an MMR vaccination, although no deaths have been reported due to vac- cine-induced thrombocytopenia. Benefits and risks should be considered in these patients in order to determine if vaccination is appropriate (Merck, 2017-1). MMR vaccination in patients with a per- sonal or family history of cerebral injury, febrile seizures, epilepsy, or any condition which includes fever-related stress should pro- ceed with caution (Merck, 2017-1). Persons with a history of anaphylaxis or other immediate reactions to eggs may be at an enhanced level of risk of immediate-type hypersensitivities to vaccines containing chick embryo antigens, such as MMR. In these cases, the risk/benefits profile must be individual- ized on a case-by-case basis. If the vaccination is indicated in these populations, extreme cau- tion must be exercised (Merck, 2017-1). SELF-ASSESSMENT QUESTION Answers are listed on the last page of the course. 9. Patients receiving high doses of cortico- steroids are considered immunocompromised and should avoid MMR vaccination for at least _________ after cessation of corticosteroid therapy. a) 7 days. b) 1 month. c) 3 months. d) 45 days. ADVERSE REACTIONS TO MMR VACCINATION The MMR vaccine is generally safe and well tolerated. As with all medications, some adverse events (AE) are associated with this product. The most common AE linked to MMR immunization include skin rash, low-grade fevers, itching, hives, and weak- ness. Serious AE are unusual. However, an occurrence of seizures, double vision, severe headache, joint pain, abdominal pain, and vomiting have been reported after MMR administration. Rare post marketing serious complications that have been reported by the manufacturer include: • Encephalitis; • Encephalopathy; • Panniculitis; • Atypical measles; • Syncope; • Vasculitis; • Pancreatitis, • Thrombocytopenia purpura; • Leukocytosis; • Anaphylaxis; • Bronchial spasms; • Arthritis; • Arthalgia; • Myalgia; • Polyneuritis (NVIC). According to a search engine designed to search the federal Vaccine Adverse Reporting System (VAERS) database, as of spring 2016 there were approximately 7,700 serious adverse events (SAE) associated with the administration of vaccines containing a measles component since 1990. The majority of these SAEs were reported to have occurred in children = three years of age; additionally, these SAEs were associated with 397 fatali- ties, again, with most occurring in children = three years of age (NVIC). A number of people have voiced concerns that the use of vaccines, including MMR, is associated with occurrences of autism. However, according to the Centers for Disease Control and Prevention, a number of stud- ies have demonstrated that there is no link between immunizations and the development of autism (CDC, 2015). Nursing Consideration: Unfortunately, the fear of autism’s linkage to vaccine is still prev- alent in our communities. Nurses and ANPs should familiarize themselves with this con- CONTINUING EDUCATION  |