![]() ![]() A late dose should be administered at the next visit. In some cases, a scheduled dose of vaccine may be administered late. An example is an infant age 6 through 11 months receiving 1 dose of MMR vaccine prior to international travel (not to be considered valid as part of the routinely recommended series) or administering the second dose of measles vaccine before age 4 years during a measles outbreak (considered valid as long as a minimum interval of at least 4 weeks from the prior dose was heeded and the child was age 12 months or older). In these cases, an accelerated schedule using the minimum age or minimum interval criteria can be used. Other exceptions are administering doses in a vaccine series at shorter intervals than recommended when a person is behind schedule and needs to be brought up to date quickly or when international travel is pending. Doses administered 5 days or more before the minimum age or interval should not be counted as valid and should be repeated as age-appropriate. In certain situations, state or local requirements might mandate doses of selected vaccines be administered on or after specific ages, superseding this 4-day grace period. These early doses administered within 4 days of the minimum age or interval are considered valid. If the patient is new to the provider or habitually misses appointments, it may be preferable to administer the vaccine early. However, if the provider has confidence that the patient will return for a later visit, it is preferable to reschedule vaccination on or after the recommended minimum age or interval. In these situations, the provider can consider administering the vaccine earlier than the minimum age or interval. The patient may have come to the office early or for an appointment not specifically for vaccination. One exception involves administering a dose up to 4 days before the minimum age or interval to avoid missing an opportunity to vaccinate. However, exceptions may occasionally be necessary. As a general rule, decreasing the interval between doses in a multiple-dose vaccine series may interfere with antibody response and protection.įor routine vaccination, vaccine doses should not be administered earlier than the minimum ages or at less than the minimum intervals. Studies have demonstrated that following the recommended ages and intervals between doses of the same antigen(s) provides optimal protection. Vaccinations are recommended beginning with the youngest age group at risk for a disease for whom vaccine efficacy and safety have been demonstrated. Most vaccines in the immunization schedule require two or more doses for development of an adequate and persistent antibody response. Interval Between Doses of the Same Vaccine Specific circumstances commonly encountered in immunization practice are the intervals between doses of the same vaccine, simultaneous and nonsimultaneous administration of different vaccines, and the intervals between antibody-containing blood products and live attenuated vaccines (particularly measles- and varicella-containing vaccines). Timing and spacing of vaccine doses are two of the most important considerations for the appropriate use of vaccines. Information about recommended travel vaccines (e.g., yellow fever, typhoid) can be found in CDC’s Yellow Book. A more thorough discussion of issues common to the use of multiple vaccines and non-routinely recommended vaccines (e.g., rabies, smallpox) can be found in the General Best Practice Guidelines for Immunization: Best Practices Guidance of the Advisory Committee on Immunization Practices. This chapter discusses best practices related to vaccine timing and spacing, dosing, adverse reactions, and contraindications and precautions for routinely recommended vaccines in the United States. Contraindications and Precautions to Vaccination.Adverse Reactions Following Vaccination.
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