Delay elective surgery 48hrs post-vaccine to avoid post-vaccination symptoms causing diagnostic concern peri-operatively
20% will develop a fever, but it has often resolved within 48hrs
Live attenuated vaccines
E.g. MMR
No reason to delay if child well immediately pre-operatively
6% will develop fever but usually occurs 5 - 10 days (and up to 21 days) post-operatively
The risk of developing fever following live attenuated vaccines is similar to the risk of fever from common febrile illnesses of childhood
Therefore should not delay either vaccination or surgery
Vaccination after surgery
No contraindication to vaccination immediately after surgery, once the child is well and has recovered
Pre-operative assessment
Continue normal vaccination schedule if it complies with the above
Take into account the risk of vaccine side-effects occurring if a prolonged post-operative recovery period is expected after major surgery
No evidence that recent vaccination increases risk of complications from surgery and anaesthesia
No evidence that the immunity acquired from vaccination is reduced by vaccination before, during or after surgery
Urgent or emergency surgery should never be delayed as a result of recent vaccination
Sequelae of vaccination (fever, irritability) may complicate assessment of a child with these symptoms peri-operatively
It is only likely to be an issue in the first 48hrs after administration of an inactivated vaccine
A routine vaccine can be delayed until after surgery, so long as there is a mechanism to ensure no undue delay post-surgery
Delaying vaccination increases the risk of infection in the affected child, and has been shown to result in non-completion of the vaccination schedule in some children
The importance of completing the vaccination schedule both for the child and the community outweighs any concerns about the impact of vaccination upon surgery
No absolute contra-indication to this practice
In children who would otherwise miss their vaccine, or are having non-surgical procedures (e.g. MRI) under GA, the benefit of giving it may outweigh the risk
In children having surgery, giving the vaccine may complicate the post-operative period by increasing the risk of fever and irritability
In general, however, should avoid giving vaccines under GA such that paracetamol/NSAIDs can be used freely as part of the anaesthetic technique
This is because there are some concerns that said drugs may reduce the efficacy/antibody response to vaccines
Therefore if a vaccine is given under GA, one should not administer empirical paracetamol