Vaccination Documents

Vaccine Exemptions (Updated 9/10/19)

Due to the passing of the new vaccine exemption laws SB276 and SB714, we are regrettably unable to consider writing vaccine exemptions for any pediatric patients, unless it is a DOCUMENTED CDC Contraindication for the single vaccine meeting that criteria. 

Under the new laws, the only conditions that qualify for an exemption are the CDC/ACIP Contraindications:

SEC. 3. Section 120372

(3) (A) The department shall identify those medical exemption forms that do not meet applicable CDC, ACIP, or AAP criteria for appropriate medical exemptions.

 These are as follows (Copied from: https://www.cdc.gov/vaccines/hcp/acip-recs/general-recs/contraindications.html#t-01): 

VaccineCitationContraindicationsPrecautions
DT, Td(4)Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine componentGBS <6 weeks after previous dose of tetanus-toxoid–containing vaccine
History of Arthus-type hypersensitivity reactions after a previous dose of diphtheria-toxoid—containing or tetanus-toxoid–containing vaccine; defer vaccination until at least 10 years have elapsed since the last tetanus-toxoid-containing vaccine
Moderate or severe acute illness with or without fever
DTaP(38)Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component

Encephalopathy (e.g., coma, decreased level of consciousness,  prolonged seizures), not attributable to another identifiable cause, within 7 days of administration of previous dose of DTP or DTaP

Progressive neurologic disorder, including infantile spasms, uncontrolled epilepsy, progressive encephalopathy; defer DTaP until neurologic status clarified and stabilized
GBS <6 weeks after previous dose of tetanus-toxoid–containing vaccine
History of Arthus-type hypersensitivity reactions after a previous dose of diphtheria-toxoid–containing or tetanus-toxoid–containing vaccine; defer vaccination until at least 10 years have elapsed since the last tetanus-toxoid–containing vaccine
Moderate or severe acute illness with or without fever
Hepatitis A(39)Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine componentModerate or severe acute illness with or without fever
Hepatitis B(40)Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component

Hypersensitivity to yeast

Moderate or severe acute illness with or without fever
Hib(41)Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component

Age <6 weeks

Moderate or severe acute illness with or without fever
HPV(42)Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component, including yeast
Moderate or severe acute illness with or without fever
IIV(43)Severe allergic reaction (e.g., anaphylaxis) after previous dose of influenza vaccine or to vaccine component.
GBS <6 weeks after a previous dose of influenza vaccine
Moderate or severe acute illness with or without fever
Egg allergy other than hives, e.g., angioedema, respiratory distress, lightheadedness, recurrent emesis; or required epinephrine or another emergency medical intervention (IIV may be administered in an inpatient or outpatient medical setting and under the supervision of a health care provider who is able to recognize and manage severe allergic conditions).
IPV(44)Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component
Pregnancy
Moderate or severe acute illness with or without fever
LAIV(b)(43)Severe allergic reaction (e.g., anaphylaxis) after a vaccine component
Concomitant use of aspirin or aspirin-containing medication in children and adolescents
LAIV4 should not be administered to persons who have taken influenza antiviral medications within the previous 48 hours.
Pregnancy
GBS <6 weeks after a previous dose of influenza vaccine
Asthma in persons aged 5 years old or older
Medical conditions which might predispose to higher risk of complications attributable to influenza(c)
Moderate of severe acute illness with or without fever
MenACWY(45)Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine componentModerate or severe acute illness with or without fever
MenB(46, 47)Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine componentModerate or severe acute illness with or without fever
MMR(d),(e)(1)Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component

Pregnancy

Known severe immunodeficiency (e.g., from hematologic and solid tumors, receipt of chemotherapy, congenital immunodeficiency, long-term immunosuppressive therapy(f)or patients with HIV infection who are severely immunocompromised)

Family history of altered immunocompetence(g)

Recent (≤11 months) receipt of antibody-containing blood product (specific interval depends on product)

History of thrombocytopenia or thrombocytopenic purpuraNeed for tuberculin skin testing or interferon-gamma release assay (IGRA) testing(h)

Moderate or severe acute illness with or without fever

MPSV4(48)Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine componentModerate or severe acute illness with or without fever
PCV13(49)Severe allergic reaction (e.g., anaphylaxis) after a previous dose of PCV13 or any diphtheria-toxoid–containing vaccine or to a component of a vaccine (PCV13 or any diphtheria-toxoid–containing vaccine), including yeastModerate or severe acute illness with or without fever
PPSV23(50)Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine componentModerate or severe acute illness with or without fever
RIV(43)Severe allergic reaction (e.g., anaphylaxis) to any component of the vaccine
GBS <6 weeks after a previous dose of influenza vaccine
Moderate or severe acute illness with or without fever
Rotavirus(6)Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component

SCID

History of intussusception

Altered immunocompetence other than SCID

Chronic gastrointestinal disease(i)

Spina bifida or bladder exstrophy(i)

Moderate or severe acute illness with or without fever

Tdap(51)Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component

Encephalopathy (e.g., coma, decreased level of consciousness,  prolonged seizures), not attributable to another identifiable cause, within 7 days of administration of previous dose of DTP, DTaP, or Tdap

GBS <6 weeks after a previous dose of tetanus-toxoid–containing vaccine

Progressive or unstable neurological disorder, uncontrolled seizures, or progressive encephalopathy until a treatment regimen has been established and the condition has stabilized

History of Arthus-type hypersensitivity reactions after a previous dose of diphtheria-toxoid—containing or tetanus-toxoid–containing vaccine; defer vaccination until at least 10 years have elapsed since the last tetanus-toxoid–containing vaccine

Moderate or severe acute illness with or without fever

Varicella(d),(e)(52)Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component

Known severe immunodeficiency (e.g., from hematologic and solid tumors, receipt of chemotherapy, congenital immunodeficiency,  long-term immunosuppressive therapy(f)or patients with HIV infection who are severely immunocompromised)(e)

Pregnancy

Family history of altered immunocompetence(g)

Recent (≤11 months) receipt of antibody-containing blood product (specific interval depends on product)
Moderate or severe acute illness with or without fever
Receipt of specific antiviral drugs (acyclovir, famciclovir, or valacyclovir) 24 hours before vaccination (avoid use of these antiviral drugs for 14 days after vaccination)
Use of aspirin or aspirin-containing products(j)
Zoster(53)Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component

Known severe immunodeficiency (e.g., from hematologic and solid tumors, receipt of chemotherapy, congenital immunodeficiency,  long-term immunosuppressive therapy(f)or patients with HIV infection who are severely immunocompromised)(e)

Pregnancy

Moderate or severe acute illness with or without fever
Receipt of specific antiviral drugs (acyclovir, famciclovir, or valacyclovir) 24 hours before vaccination (avoid use of these antiviral drugs for 14 days after vaccination, for zoster vaccine live only)

Additionally, any physician that writes more than 5 vaccine exemptions per year will be automatically placed under investigation by the Medical Board of California for further investigation:

(2) A clinically trained immunization department staff member, who is either a physician and surgeon or a registered nurse, shall review all medical exemptions from any of the following:
(A) Schools or institutions subject to Section 120375 with an overall immunization rate of less than 95 percent.
(B) Physicians and surgeons who have submitted five or more medical exemptions in a calendar year.
(7) The department shall notify the Medical Board of California or the Osteopathic Medical Board of California, as appropriate, of any physician and surgeon who has five or more medical exemption forms in a calendar year that are revoked pursuant to this subdivision.
 

Due to the above reasons, unless there is documentation of the CDC contraindications, we can not legally write any medical exemptions to vaccines under these new laws. We are sorry for this. The state has not given us any other choice at this time. 

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CDC Vaccine Information Sheets (V.I.S.)

Please print and review the relevant PDF documents before your next vaccine related visit, where applicable. This way, any questions or doubts may be discussed openly at your next vaccine-related visit prior to the vaccination being given. (Well visits, vaccine only visit, etc). If you would prefer for us to give you a copy in the office instead, we will gladly do so. (In many pediatric practices, these sheets are given after the fact, which is rather curious and seems to defeat the purpose of the informed consent information included therein.)

Infants Under 1 Year Old

Toddlers/Kids

Late Childhood

Vaccine Package Inserts of the Vaccines We Use

For those of you are really curious or simply gluttons for punishment, these are the package inserts for the vaccine products we use here. For more inserts or other information, these are available on the FDA website (click for link).