Contraindications for Influenza Vaccine
The primary absolute contraindication to influenza vaccination is a history of severe allergic reaction (e.g., anaphylaxis) to any component of the specific vaccine formulation or to a previous dose of the same vaccine type. 1
Absolute Contraindications by Vaccine Type
Inactivated Influenza Vaccines (IIV4s - Egg-Based)
- History of severe allergic reaction (anaphylaxis) to any component of the vaccine 1
- History of severe allergic reaction to a previous dose of any influenza vaccine (egg-based IIV, ccIIV, RIV, or LAIV) 1
Cell Culture-Based Inactivated Vaccine (ccIIV4)
- History of severe allergic reaction to a previous dose of any ccIIV or any component of ccIIV4 1
Recombinant Influenza Vaccine (RIV4)
- History of severe allergic reaction to a previous dose of any RIV or any component of RIV4 1
Live Attenuated Influenza Vaccine (LAIV4)
LAIV4 has the most extensive contraindication list: 1
- History of severe allergic reaction to any component of the vaccine or to a previous dose of any influenza vaccine 1
- Concomitant aspirin or salicylate-containing therapy in children and adolescents 1
- Children aged 2-4 years with asthma or wheezing history (diagnosis of asthma, parent/caregiver report of wheezing in past 12 months, or documented wheezing episode in past 12 months) 1
- Immunocompromised persons due to any cause (including medications, HIV infection) 1
- Close contacts and caregivers of severely immunosuppressed persons requiring a protected environment 1
- Pregnant women 1
- Receipt of influenza antiviral medications within the previous 48 hours 1
Precautions (Not Absolute Contraindications)
Precautions mean vaccination should generally be deferred but may be given if benefits outweigh risks: 1
- Moderate or severe acute illness with or without fever (applies to all vaccine types) 1
- History of Guillain-Barré Syndrome within 6 weeks of receipt of influenza vaccine (applies to all vaccine types) 1
- Asthma in persons aged ≥5 years (LAIV4 only) 1
- Chronic medical conditions that predispose to influenza complications (LAIV4 only - including chronic pulmonary, cardiovascular, renal, hepatic, neurologic, hematologic, or metabolic disorders including diabetes) 1
Critical Clarification: Egg Allergy Is NOT a Contraindication
Despite egg allergy being a labeled contraindication on package inserts, ACIP explicitly recommends that persons with egg allergy of any severity may receive any licensed, recommended, and age-appropriate influenza vaccine. 1
- Patients with severe egg allergy reactions (angioedema, respiratory distress, lightheadedness, recurrent emesis, or requiring epinephrine) should be vaccinated in a medical setting with supervision if using egg-based vaccines 1
- Cell culture-based (ccIIV4) or recombinant (RIV4) vaccines are preferred alternatives for those with severe egg reactions, as they contain no egg protein 1
Cross-Reactivity Between Vaccine Types
If a patient had anaphylaxis to one vaccine type, alternative formulations may be used as precautions (not contraindications): 1
- History of anaphylaxis to egg-based IIV or LAIV: Consider ccIIV4 or RIV4 under medical supervision 1
- History of anaphylaxis to ccIIV: Consider RIV4 under medical supervision 1
- History of anaphylaxis to RIV: Consider ccIIV4 under medical supervision 1
- All such vaccinations should occur in a medical setting with personnel capable of recognizing and managing severe allergic reactions 1
Common Pitfalls to Avoid
Do not automatically exclude patients with egg allergy from influenza vaccination - this outdated practice contradicts current ACIP guidelines and unnecessarily leaves vulnerable patients unprotected. 1, 2
Do not confuse precautions with contraindications - precautions allow for vaccination when benefits outweigh risks, whereas contraindications mean the vaccine should not be given. 1
Do not administer LAIV4 to young children with any history of wheezing - this is a firm contraindication for ages 2-4 years, though it becomes only a precaution at age 5 and older. 1