Problem List for Influenza Vaccination
All persons aged ≥6 months should receive annual influenza vaccination unless they have specific contraindications. 1, 2
Indications (Who Should Get the Flu Shot)
Universal Recommendation
Priority Groups at Higher Risk for Severe Complications
When vaccine supply is limited, prioritize these populations:
- All children aged 6 months through 59 months (under 5 years)
- All adults aged ≥50 years
- Pregnant women (any trimester)
- Residents of nursing homes and long-term care facilities
- American Indian or Alaska Native persons
- Persons with extreme obesity (BMI ≥40 for adults) 1
Chronic Medical Conditions:
- Chronic pulmonary disease (including asthma and cystic fibrosis)
- Cardiovascular disease (except isolated hypertension)
- Chronic renal dysfunction
- Chronic hepatic disease
- Chronic metabolic disease (including diabetes mellitus)
- Neurologic/neuromuscular disorders
- Hematologic disorders (including sickle cell anemia and hemoglobinopathies)
- Immunosuppression from any cause (medications, HIV, immunodeficiency disorders) 3, 4, 5, 1
Special Pediatric Considerations:
- Children/adolescents (6 months through 18 years) receiving aspirin or salicylate-containing medications (risk of Reye syndrome) 4, 5, 1
- Any condition compromising respiratory function or secretion handling (neurodevelopmental disorders, spinal cord injuries, seizure disorders, neuromuscular abnormalities) 4, 5, 6
Contacts of High-Risk Persons
- Healthcare personnel (all paid and unpaid workers in healthcare settings)
- Household contacts and caregivers of children <5 years and high-risk individuals
- Close contacts of severely immunosuppressed persons 3, 4, 1
Contraindications (Absolute - Do NOT Vaccinate)
For ALL Influenza Vaccines (IIV, RIV, LAIV)
- History of severe allergic reaction (anaphylaxis) to any component of that specific vaccine 3, 1, 7, 2
For Inactivated Influenza Vaccine (IIV)
- Infants <6 months of age 4, 5
- History of severe allergic reaction to egg protein (labeled contraindication, though ACIP now recommends vaccination can proceed with appropriate precautions) 3, 1, 7
For Live Attenuated Influenza Vaccine (LAIV) - Additional Contraindications
LAIV has extensive contraindications beyond IIV:
- Children <2 years of age
- Adults ≥50 years of age
- Pregnancy
- Immunosuppression (any cause, including medications or HIV)
- Children/adolescents receiving aspirin or salicylate therapy
- Severe allergic reaction to egg protein, gentamicin, gelatin, or arginine 3, 4, 5
Medical Conditions (LAIV contraindicated):
- Asthma (any age)
- Children aged 2-4 years with history of wheezing or recurrent wheezing in past 12 months
- Chronic pulmonary, cardiovascular, renal, hepatic, neurologic/neuromuscular, hematologic, or metabolic disorders
- Conditions compromising respiratory function or secretion handling
- Close contacts/caregivers of severely immunosuppressed persons requiring protected environment 3, 4, 5
Precautions (Generally Defer, But May Proceed If Benefits Outweigh Risks)
For ALL Influenza Vaccines
- Moderate to severe acute illness with or without fever (defer until illness resolves; minor illnesses are NOT contraindications) 3, 4, 5, 1, 8
- History of Guillain-Barré syndrome within 6 weeks of previous influenza vaccination (balance individual risk vs. benefit, especially for high-risk patients) 3, 5, 6, 8, 3
For LAIV Specifically
- Significant nasal congestion that would impede vaccine delivery to nasopharyngeal mucosa (defer until resolution or use IIV instead) 4, 5, 8, 3
Special Considerations for Egg Allergy
Despite labeled contraindications, current ACIP guidance states:
- Persons with egg allergy of any severity can receive any age-appropriate influenza vaccine
- Those with history of severe egg allergy can receive IIV with additional safety precautions or use egg-free vaccines (RIV or ccIIV)
- Vaccination should occur in medical setting supervised by provider able to recognize/manage severe allergic reactions 1, 7, 2
Key Clinical Pitfalls to Avoid
Do NOT withhold vaccination for minor illnesses - Mild upper respiratory symptoms, low-grade fever, or allergic rhinitis are NOT contraindications 4, 5, 6, 8
Do NOT confuse LAIV and IIV contraindications - LAIV has far more contraindications; when in doubt, use IIV 3, 4, 5
Do NOT delay vaccination in high-risk patients with egg allergy - Current evidence supports safe administration with appropriate precautions 1, 7, 2
Do NOT assume GBS history is absolute contraindication - It's a precaution; weigh individual risk, especially for high-risk patients who may benefit most from vaccination 3, 5, 6, 8
Vaccinate pregnant women with IIV or RIV only - LAIV is contraindicated in pregnancy 3, 4, 6, 8