Ask the Experts: Influenza: Contraindications & Precautions

Results (9)

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 cell culture-based IIV (ccIIV) are a history of a severe allergic reaction to a previous dose of ccIIV or any component of ccIIV.

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

Contraindications to RIV are a history of a severe allergic reaction to a previous dose of RIV or any component of RIV.

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

Last reviewed: August 11, 2024

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 has been adapted from table 3 of the 2022-23 influenza ACIP recommendations at www.cdc.gov/mmwr/volumes/71/rr/pdfs/rr7101a1-H.pdf. No changes to this general guidance were made for 2024-25 influenza season products.

Vaccine (of any valency) associated with previous serious or anaphylactic reaction Available 2024-25 influenza vaccines
Egg-based IIVs
and LAIV		 Cell-culture- based IIV: ccIIV (Flucelvax) Recombinant IIV: RIV (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 ccIIV and RIV 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: August 11, 2024

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, congenital or acquired immunodeficiency states, HIV infection, anatomic asplenia or functional asplenia (e.g., due to sickle cell anemia)
  • cranial cerebral spinal fluid (CSF) leak or cochlear implant (due to potential for CSF leak)
  • close contacts and caregivers of severely immunosuppressed people who require a protected environment
  • pregnancy
  • receipt of influenza antiviral medication within the previous 48 hours (for oseltamivir or zanamivir), previous 5 days (for peramivir), or previous 17 days (for 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: August 11, 2024

Everyone age 6 months of age or older with egg allergy and no contraindication to vaccination 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. As a general principle, all vaccines should be administered in settings in which personnel and equipment needed for rapid recognition and treatment of acute hypersensitivity reactions are available.

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

Last reviewed: August 11, 2024


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Last reviewed: August 11, 2024

No.

Last reviewed: August 11, 2024

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 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/vaccine-safety/about/febrile-seizures.html.

Last reviewed: August 11, 2024

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: August 11, 2024

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: August 11, 2024

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