What are the contraindications and precautions for FluMist Quadrivalent (LAIV4)?

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