Contraindications to Influenza Vaccine
The only absolute contraindication to influenza vaccination is a history of severe allergic reaction (anaphylaxis) to a previous dose of the same vaccine type or to any component of that specific vaccine formulation. 1
Absolute Contraindications by Vaccine Type
Egg-Based Inactivated Influenza Vaccines (IIV4s) and LAIV4
- History of severe allergic reaction (anaphylaxis) to any influenza vaccine of any type or valency is an absolute contraindication 2, 1
- History of severe allergic reaction to any component of the specific vaccine (excluding egg protein, which is addressed separately) is an absolute contraindication 2
Cell Culture-Based Inactivated Vaccine (ccIIV4)
- History of severe allergic reaction to a previous dose of any ccIIV or any component of ccIIV4 is an absolute contraindication 1
Recombinant Influenza Vaccine (RIV4)
- History of severe allergic reaction to a previous dose of any RIV or any component of RIV4 is an absolute contraindication 1
Live Attenuated Influenza Vaccine (LAIV4) - Additional Contraindications
Beyond allergic reactions, LAIV4 has several specific contraindications 1:
- Concomitant aspirin or salicylate-containing therapy in children and adolescents
- Children aged 2-4 years with asthma or history of wheezing
- Immunocompromised persons
- Close contacts and caregivers of severely immunosuppressed persons requiring a protected environment
- Pregnant women
- Receipt of influenza antiviral medications within the previous 48 hours
Precautions (Not Contraindications)
Universal Precautions for All Vaccine Types
- Moderate or severe acute illness with or without fever 1
- History of Guillain-Barré Syndrome within 6 weeks of receipt of influenza vaccine 1
LAIV4-Specific Precautions
- Asthma in persons aged ≥5 years 1
- Chronic medical conditions predisposing to influenza complications (chronic pulmonary, cardiovascular, renal, hepatic, neurologic, hematologic, or metabolic disorders) 1
Critical Clarification: Egg Allergy Is NOT a Contraindication
Egg allergy of any severity is no longer considered a contraindication to influenza vaccination. 1 This represents a major shift in clinical practice:
For Patients with Urticaria (Hives) Only After Egg Exposure
- Any licensed, recommended influenza vaccine appropriate for age and health status can be administered in any setting 2
- No special precautions or observation periods are required beyond standard 15-minute post-vaccination monitoring 2
For Patients with Severe Egg Allergy Reactions
Severe reactions include angioedema, respiratory distress, lightheadedness, recurrent vomiting, or reactions requiring epinephrine 2:
- Any licensed influenza vaccine can still be administered 2, 1
- If using egg-based vaccines (not ccIIV4 or RIV4), vaccination should occur in a medical setting supervised by a provider capable of recognizing and managing severe allergic reactions 2, 1
- Preferred approach: Use ccIIV4 or RIV4, which contain no egg protein and can be given in any setting 1
Important Clinical Pitfalls to Avoid
Cross-Reactivity Between Vaccine Types
- If a patient had anaphylaxis to an egg-based vaccine, ccIIV4 is considered a precaution (not contraindication) and can be administered with medical supervision 2
- Alternative vaccine formulations remain options even after severe reactions to one type 1
Provider Preparedness Requirements
- All vaccination providers must be familiar with their office emergency plan and certified in cardiopulmonary resuscitation 2, 3
- Equipment and personnel for rapid recognition and treatment of anaphylaxis must be available at all vaccination sites 3
- Standard 15-minute observation period applies to all patients to monitor for syncope 2