The Australian Immunisation Handbook 10th Edition 2013

whether the AEFI is likely to recur with subsequent doses. Persons who have
experienced a serious adverse event following immunisation (other than a
contraindication, such as anaphylaxis confirmed as triggered by a vaccine or one
of its components) can usually subsequently be vaccinated under close medical
supervision. However, further advice should be sought where appropriate,
by referral to a specialist clinic for the management of persons with special
vaccination requirements (including persons who have had a previous AEFI).
Information about specialist immunisation clinics, or the contact details for
paediatricians or medical specialists with experience in management of persons
with AEFI, are usually available from state and territory health authorities (see
Appendix 1 Contact details for Australian, state and territory government health
authorities and communicable disease control) and from the Immunise Australia
website (www.immunise.health.gov.au).
Allergies
Vaccines rarely produce allergy or anaphylaxis (a rapid and life-threatening
form of allergic reaction). Overall, the risk of anaphylaxis after a single vaccine
dose has been estimated as less than 1 case per 1 million; however, this risk
varies depending on the vaccine type. 2 Antibiotics, gelatin and egg proteins
are the components most often implicated in allergic reactions. Yeast has only
rarely been associated with vaccine-related allergic reaction. Persons allergic to
latex may be at risk from some vaccines. This is usually not from the vaccine
formulation itself, but from the presence of latex in the equipment used to
hold the vaccine, such as vaccine vial stoppers (bungs) and syringe plungers.
However, very few vaccine bungs contain natural latex. Before administering
the vaccine, consult the product information (PI) of each vaccine to check for the
presence of latex or, where not listed on the PI, contact the vaccine manufacturer
for specific details.
It is important that immunisation service providers assess each individual
for a history of allergies and previous reactions to vaccines prior to giving
any dose of vaccine. Depending on the allergy identified, there often may
not be a contraindication to vaccination. For example, a history of allergy to
antibiotics most commonly relates to β-lactam or related antibiotics and is not a
contraindication to vaccines that contain neomycin, polymyxin B or gentamicin.
Previous reactions to neomycin that only involved the skin are not considered a
risk factor for a severe allergic reaction or anaphylaxis to vaccines manufactured
with neomycin because there are only trace amounts of this antibiotic in the final
product. 3 Similarly, the measles and mumps components of measles-mumpsrubella
(MMR) vaccine contain only a negligible quantity of egg ovalbumin
and do not contraindicate MMR vaccination of persons with egg allergy (even
anaphylaxis) (see ‘Vaccination of persons with a known egg allergy’ below). 4-7
It is important that persons who experience an allergic reaction associated with a
vaccine dose are fully investigated appropriately to ascertain the possible causal
PART 3 VACCINATION FOR SPECIAL RISK GROUPS 131
3.3 GROUPS WITH SPECIAL
VACCINATION REQUIREMENTS