From the Guidelines
The only absolute contraindication for COVID-19 vaccination is a history of severe allergic reaction (anaphylaxis) to a previous dose of the same COVID-19 vaccine or to any component of the vaccine. People with known allergies to polyethylene glycol (PEG) in mRNA vaccines (Pfizer-BioNTech and Moderna) or polysorbate 80 in viral vector vaccines (Johnson & Johnson/Janssen) should avoid those specific formulations 1. Individuals who experienced myocarditis or pericarditis after a first dose of an mRNA COVID-19 vaccine should generally avoid additional doses of any COVID-19 vaccine, though this is considered a precaution rather than an absolute contraindication. For people with a history of Guillain-Barré syndrome following vaccination, caution is advised when considering COVID-19 vaccination. Pregnancy and immunocompromised status are not contraindications; in fact, these groups are considered high priority for vaccination due to increased risk of severe COVID-19 disease. The risk-benefit assessment strongly favors vaccination for most individuals, as the risks of COVID-19 disease typically outweigh the rare adverse events associated with vaccination.
Some key considerations for specific populations include:
- Cancer patients: COVID-19 vaccination is recommended, with careful consideration of the timing and interval between the vaccine and the last cycle of chemotherapy 1.
- Patients with rheumatic and musculoskeletal diseases: vaccination is recommended, with consideration of the potential for a blunted immune response in patients receiving certain immunomodulatory therapies 1.
- Patients with a history of severe allergic reactions: caution is advised, and alternative vaccine formulations may be considered 1.
Overall, the benefits of COVID-19 vaccination outweigh the risks for most individuals, and vaccination is recommended for all eligible populations, with careful consideration of individual risk factors and medical history.
From the Research
Evidence-Based Contraindications for COVID-19 Vaccination
The COVID-19 vaccination has been widely recommended as a safe and effective way to protect against COVID-19. However, there are certain populations and conditions where the risk-benefit profile may be contraindicated. The following are some evidence-based contraindications for COVID-19 vaccination:
- Age: COVID-19 vaccination is not recommended for children less than 12 years of age 2.
- Immunocompromised state: Patients with compromised immune status may develop a weaker and less stable immune response to vaccination, which may not always translate into clinical benefit 3.
- Autoimmune diseases: Certain autoimmune diseases, such as rheumatic diseases, may be a contraindication for COVID-19 vaccination due to the potential risk of exacerbating the underlying condition 4.
- Chronic cardiovascular and pulmonary conditions: Patients with chronic cardiovascular and pulmonary conditions may be at increased risk of adverse events from COVID-19 vaccination 4.
- Active or treated cancers: Patients with active or treated cancers may be at increased risk of adverse events from COVID-19 vaccination, and the benefits and risks of vaccination should be carefully considered 4.
- Pregnancy: COVID-19 vaccination is not recommended for pregnant women, although the risks and benefits should be carefully considered on a case-by-case basis 3.
- History of anaphylaxis: Patients with a history of anaphylaxis to polyethylene glycol or polysorbate should be contraindicated for mRNA COVID-19 vaccines 5.
- Guillain-Barré Syndrome: There have been reports of Guillain-Barré Syndrome following the administration of adenovirus vector-based COVID-19 vaccines, although the causality between the vaccine and the suspected adverse reaction cannot be readily assumed 6.
Special Populations
Certain special populations, such as those with immunocompromised states, autoimmune diseases, and chronic cardiovascular and pulmonary conditions, may require careful consideration of the risks and benefits of COVID-19 vaccination. These populations may be at increased risk of adverse events from vaccination, and the benefits and risks should be carefully weighed on a case-by-case basis.
Adverse Events
COVID-19 vaccination has been associated with certain adverse events, including:
- Anaphylaxis 5
- Guillain-Barré Syndrome 6
- Heart inflammation 2
- Blood clots formation 2
- Adverse events in immunocompromised patients 3
These adverse events should be carefully considered when weighing the risks and benefits of COVID-19 vaccination, particularly in special populations.