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Ask the Experts: Contraindications & Precautions

Results (37)

An excellent resource for vaccine contraindications and precautions is the ACIP “General Best Practice Guidelines for Immunization”, available at www.cdc.gov/vaccines/hcp/acip-recs/general-recs/contraindications.html. A table in the Contraindications and Precautions chapter has a listing for all routine vaccines available in the United States. Immunize.org also has summary tables of contraindications and precautions for people of all ages (www.immunize.org/catg.d/p3072a.pdf) and a summary for vaccines given to adults (www.immunize.org/catg.d/p3072.pdf).

Contraindications and precautions to non-routine vaccines of special interest are not listed in the “General Best Practice Guidelines for Immunization” but may be accessed directly on the CDC website:

Last reviewed: August 29, 2022

A contraindication is a condition in a recipient that increases the risk for a serious adverse reaction to vaccination and is a condition under which vaccines should not be administered. In addition to contraindications found in prescribing information, ACIP may recommend against the use of a vaccine under certain conditions (e.g., a lack of data).

A precaution is a condition in a recipient that might increase the risk for a serious adverse reaction, might cause diagnostic confusion, or might compromise the ability of the vaccine to produce immunity. For example, not vaccinating a person who is moderately or severely acutely ill avoids diagnostic confusion between the underlying illness and side effects of vaccination. Vaccination may be deferred if a precaution is present, although a vaccination might be indicated in the presence of a precaution if the benefit of protection from the vaccine outweighs the risk for an adverse reaction.

Last reviewed: August 29, 2022

No. Hospitalization should be used as an opportunity to provide recommended vaccinations. Hospitalized patients who are not moderately or severely acutely ill may be vaccinated during hospitalization or at discharge. Current, recent or upcoming anesthesia, surgery or hospitalization are not contraindications to vaccination, although certain factors may lead a healthcare provider to consider these situations a precaution to vaccination for a specific patient.

Last reviewed: August 29, 2022

This is not true. Pregnant healthcare personnel may administer any vaccine except the live, replication-competent smallpox vaccine (ACAM2000, Emergent Biosolutions).

Last reviewed: August 29, 2022

No. ACIP does not recommend routinely checking a patient’s temperature or other vital signs before vaccination. Requiring these extra steps can be a barrier to immunization.

Last reviewed: August 29, 2022

A “moderate or severe acute illness” is a precaution for administering any vaccine. A mild acute illness (e.g., diarrhea or mild upper-respiratory tract infection) with or without fever is not a precaution, and vaccines may be given. The concern in vaccinating someone with moderate or severe illness is that a fever following the vaccine could complicate management of the concurrent illness – it could be difficult to determine if the fever was from the vaccine or due to the concurrent illness. In deciding whether to vaccinate a patient with moderate or severe illness, the clinician needs to determine if deferring vaccination will increase the patient’s risk of vaccine-preventable diseases, as is the case if the patient is unlikely to return for vaccination or to seek vaccination elsewhere.

Last reviewed: August 29, 2022

Treatment with antibiotics is not a valid reason to defer vaccination. If the child or adult is otherwise well, or has only a minor illness, vaccines should be administered. But if the person has a moderate or severe acute illness (regardless of antibiotic use) vaccination may be deferred until the person’s condition has improved.

Last reviewed: August 29, 2022

In general, neither exposure to or recovery from an infectious disease is a contraindication or precaution to vaccination. In particular, recovery from varicella (chickenpox) is not a reason to withhold a live vaccine, such as MMR.

COVID-19 is the exception to this general rule. CDC recommends that routine vaccination should be deferred for persons with suspected or confirmed COVID-19, regardless of symptoms, until criteria have been met for them to discontinue isolation. The reason for this exception is that vaccination visits for these individuals should be postponed to avoid exposing healthcare personnel and other patients to the virus that causes COVID-19.

Last reviewed: August 29, 2022

No. Pregnancy tests prior to vaccination are not routinely recommended. However, patients of childbearing age should be asked about the possibility of their being pregnant prior to being given any vaccine for which pregnancy is a contraindication or precaution. The patient’s answer should be documented in the medical record. If the patient responds that they believe they may be pregnant, a test should be performed before administering vaccines not recommended or contraindicated in pregnancy.

Last reviewed: August 29, 2022

The following vaccines are recommended for new mothers before they leave the hospital: (1) mothers without documentation of previous Tdap vaccination need a dose to protect themselves; (2) mothers who did not receive influenza vaccination during pregnancy need to be vaccinated if it is still influenza vaccination season (October through March); (3) mothers who tested susceptible to rubella on prenatal testing need MMR vaccine even if they have 1 or 2 documented doses of MMR in their medical record; (4) mothers who are not immune to chickenpox need 2 doses of varicella vaccine – the first dose before hospital discharge and the second dose 4 to 8 weeks after the first dose.

Last reviewed: August 29, 2022

Yes. Receipt of RhoGam is not a reason to delay vaccination. See the ACIP “General Best Practices Guidelines for Immunization” at www.cdc.gov/vaccines/hcp/acip-recs/general-recs/timing.html.

Last reviewed: August 29, 2022

Due to theoretical risk to the developing fetus, ACIP recommends that pregnancy be avoided for four weeks after receiving a live attenuated vaccine (MMR, varicella, live attenuated influenza, yellow fever). This interval may be shorter than that recommended by the manufacturer.

Last reviewed: August 29, 2022

Having a pregnant person in a household, including the child’s mother, is not a contraindication to administration of any routinely recommended vaccine. Pregnant people should not have close contact with anyone who has recently (within the last 28 days) received the live, replication-competent smallpox vaccine (ACAM2000, Emergent Biosolutions).

Last reviewed: August 29, 2022

All vaccines except the live, replication-competent smallpox vaccine (ACAM2000, Emergent Biosolutions) and yellow fever vaccine may be given to people who are breastfeeding.

ACAM2000 is contraindicated due to the theoretical risk of contact transmission of the vaccine virus from mother to child.

The only yellow fever (YF) vaccine licensed in the United States (YF-Vax, Sanofi) is contraindicated in people who are breastfeeding infants younger than 9 months of age. There have been three case reports of YF vaccine-associated encephalitis in infants under one month of age who were being exclusively breastfed at the time the mother received YF vaccine. ACIP currently recommends that people who are breastfeeding should be advised to postpone travel to YF endemic or epidemic regions; however, if travel cannot be avoided or postponed, the breastfeeding parent should receive YF vaccine. Although there are no data, some experts recommend that breastfeeding people who receive YF vaccine should temporarily suspend breastfeeding, pump, and discard pumped milk for at least 2 weeks after vaccination before resuming breastfeeding.

Last reviewed: August 29, 2022

A pregnant person may administer any vaccine except live, replication-competent smallpox vaccine (ACAM2000, Emergent Biosolutions).

Last reviewed: August 29, 2022

It is estimated that for every million doses administered, about one (~0.0001%) will result in an anaphylactic reaction following vaccination. The estimate for mRNA COVID-19 vaccines is slightly higher, at 2 to 5 anaphylactic reactions per million vaccinations given. With proper screening, most providers who administer thousands of vaccines in their lifetimes will never see an anaphylactic reaction.

Last reviewed: August 29, 2022

The antibiotics, of which there are trace amounts in some influenza vaccines, are neomycin, gentamicin, and polymyxin B. You should check each product’s package insert information to see which, if any, antibiotics are listed.  Links to all current vaccine package inserts for vaccines are available at www.immunize.org/fda/.

Last reviewed: October 4, 2022

Yellow fever is contraindicated for people who have a history of a severe (anaphylactic) allergy to eggs.

ACIP and CDC no longer consider egg allergy of any severity to be a contraindication or precaution to egg-based influenza vaccines. A person with egg allergy of any severity may receive any influenza vaccine that is appropriate for the person’s age and health status. When administering an egg-based influenza vaccine to a person with egg allergy of any severity, no additional safety precautions are needed, beyond those recommended when administering any vaccine to any recipient.

For more details about giving influenza vaccine to people with a history of egg allergy, go to www.cdc.gov/vaccines/hcp/acip-recs/vacc-specific/flu.html for a link to the current ACIP recommendations for influenza vaccination.

Last reviewed: September 19, 2022

Allergy to egg is not a contraindication for MMR vaccine. Although measles and mumps vaccines are grown in chick embryo tissue culture, several studies have documented the safety of these vaccines in children with severe egg allergy.

Last reviewed: August 29, 2022

Begin by asking a general question about whether the person has an allergy to any food, medication, or vaccine. If they report an allergy to gelatin or foods that contain gelatin, you could follow up by asking if they can eat Jell-O™ and gelatin-type products. Gelatin allergies are extremely rare. Only severe, life-threatening (anaphylactic) allergy is a contraindication to vaccination.

Last reviewed: August 29, 2022

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