Ask the Experts: Influenza: Contraindications & Precautions

Results (8)

Contraindications to egg-based inactivated influenza vaccines (IIV) are a severe allergic reaction to a prior dose of any influenza vaccine (any egg-based IIV, ccIIV, RIV, or LAIV of any valency) or a severe allergy to an influenza vaccine component (except egg). ACIP recommends that people with egg allergy of any severity may receive any influenza vaccine appropriate for their age and health status.

Precautions to egg-based IIV include moderate or severe acute illness, and history of Guillain-Barré syndrome within 6 weeks after a dose of influenza vaccine.

Contraindications to ccIIV4 are a history of a severe allergic reaction or any component of ccIIV4.

Precautions to ccIIV4 are moderate or severe acute illness, a history of Guillain-Barré syndrome within 6 weeks after a dose of influenza vaccine, and a history of a severe allergic reaction to a previous dose of any other influenza vaccine (e.g., any egg-based IIV, RIV, or LAIV).

Contraindications to RIV4 are a history of a severe allergic reaction or any component of RIV4.

Precautions to RIV4 are moderate or severe acute illness, a history of Guillain-Barré syndrome within 6 weeks after a dose of influenza vaccine, and a history of a severe allergic reaction to a previous dose of any other influenza vaccine (e.g., any egg-based IIV, ccIIV, or LAIV).

Last reviewed: September 10, 2023

A severe allergic reaction to any influenza vaccine is a contraindication to receiving additional doses of the same vaccine or receiving any egg-based influenza vaccines. The following table summarizes the contraindications and precautions for different types of influenza vaccine and is adapted from table 3 of the 2022–23 influenza ACIP recommendations at www.cdc.gov/mmwr/volumes/71/rr/pdfs/rr7101a1-H.pdf:

Vaccine (of any valency) associated with previous serious or anaphylactic reaction Available 2022–23 influenza vaccines
Egg-based IIV4s
and LAIV4		 Cell-culture- based IIV4: ccIIV4 (Flucelvax) Recombinant IIV4: RIV4 (Flublok)
Any egg-based IIV or LAIV Contraindication Precaution † Precaution †
Any ccIIV Contraindication Contraindication Precaution †
Any RIV Contraindication Precaution † Contraindication
Unknown influenza vaccine Allergist consultation recommended

† Note regarding patients having either of the above precautions for either ccIIV or IIV: use of ccIIV4 and RIV4 in such instances should occur in an inpatient or outpatient medical setting under the supervision of a healthcare provider (HCP) who can recognize and manage severe allergic reaction; HCPs can also consider consulting with an allergist to help identify the vaccine component responsible for the reaction.

Last reviewed: September 10, 2023

Contraindications are:
• a history of severe allergic reaction to a vaccine component (except egg) or after a previous dose of any influenza vaccine (people with egg allergy of any severity may receive LAIV if it is otherwise appropriate for their age and health status)
• concomitant aspirin or salicylate-containing therapy in children and adolescents because of the risk of Reye syndrome
• children age 2 through 4 years who have received a diagnosis of asthma or whose parents or caregivers report that a healthcare provider has told them during the preceding 12 months that their child had wheezing or asthma or whose medical record indicates a wheezing episode during the preceding 12 months
• immunosuppression due to any cause including medications or HIV infection
• cerebral spinal fluid (CSF) leak, cochlear implant, or anatomic asplenia or functional asplenia (e.g., due to sickle cell anemia)
• close contacts and caregivers of severely immunosuppressed people who require a protected environment (e.g., reverse isolation in a hospital)
• pregnancy
• receipt of influenza antiviral medication within the previous 48 hours (oseltamivir or zanamivir), previous 5 days (peramivir), or previous 17 days (baloxavir)

Precautions are:
• moderate or severe acute illness with or without fever (defer)
• history of Guillain-Barré syndrome within 6 weeks after a dose of influenza vaccine
• asthma in a person age 5 years or older
• underlying medical conditions that might predispose to complications after influenza virus infection, such as chronic pulmonary, cardiovascular (except isolated hypertension), renal, hepatic, neurologic, hematologic, or metabolic disorders including diabetes mellitus

Last reviewed: September 10, 2023

The 2023 influenza ACIP recommendations state that everyone 6 months of age or older with egg allergy should receive an influenza vaccine. Any influenza vaccine (egg based or non-egg based) appropriate for the person’s age and health status can be used.

Egg allergy alone does not require any additional safety measures for influenza vaccination beyond those recommended for any recipient of any vaccine. All vaccines should be administered in settings in which personnel and equipment needed for rapid recognition and treatment of acute hypersensitivity reactions are available.

A person who has had a previous severe allergic reaction to an influenza vaccine has a contraindication to future receipt of that vaccine. For a complete list of vaccine components (i.e., excipients and culture media) used in the production of the vaccine, check the package insert (available at www.immunize.org/fda) or go to www.cdc.gov/vaccines/pubs/pinkbook/downloads/appendices/B/excipient-table-2.pdf.

For more on the evidence and rationale supporting the change in recommendations regarding influenza vaccination and egg allergy, see pages 12 and 13 of the published ACIP recommendations for the 2023–24 season at www.cdc.gov/mmwr/volumes/72/rr/pdfs/rr7202a1-H.pdf.

Last reviewed: September 10, 2023

No.

Last reviewed: September 10, 2023

Yes, you can. Some, but not all, studies have reported increased rates of febrile seizures among children, especially those age 12 through 23 months, who received simultaneous vaccination with IIV and pneumococcal conjugate vaccine (PCV13, Pfizer) or DTaP vaccine (Daptacel, Infanrix, Pediarix, Pentacel), when compared with children who received these vaccines separately. However, because of the risks associated with delaying either of these vaccines, ACIP does not recommend administering them at separate visits or deviating from the recommended vaccine schedule in any way. The risk of febrile seizure following coadministration of influenza vaccine with the newer PCV15 or PCV20 pneumococcal conjugate vaccines has not been evaluated.

Febrile seizures may be triggered by any cause of fever and occur in up to 5% of all children, and they are generally benign. Healthcare providers should be prepared to answer parents’ questions about febrile seizures and fever when discussing vaccinations. Here is a CDC resource that addresses these concerns: www.cdc.gov/vaccinesafety/concerns/febrile-seizures.html.

Last reviewed: September 10, 2023

The probability of a serious allergic reaction following any vaccine is extremely low if the person is properly screened. ACIP has not issued a recommendation that desensitization injections and vaccines be separated by any specific time period; consequently, we feel that you should take the opportunity to vaccinate.

Last reviewed: September 10, 2023

Yes. A history of GBS unrelated to influenza vaccine is not a contraindication or precaution to influenza vaccination. GBS within 6 weeks following a previous dose of influenza vaccine is considered a precaution for use of influenza vaccines.

Last reviewed: September 10, 2023

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