Contraindications and Precautions for Influenza Vaccination

Absolute Contraindications

The primary absolute contraindication to influenza vaccination is a history of severe allergic reaction to any component of the specific vaccine formulation or to a previous dose of the same vaccine type, as recommended by the Centers for Disease Control and Prevention (CDC) 1, 2
History of severe allergic reaction to any component of the inactivated influenza vaccine or to a previous dose of any influenza vaccine is a contraindication for inactivated influenza vaccines (IIV4s - Egg-Based) 3
History of severe allergic reaction to a previous dose of any cell culture-based inactivated vaccine (ccIIV) or any component of ccIIV4 is a contraindication for ccIIV4 3
History of severe allergic reaction to a previous dose of any recombinant influenza vaccine (RIV) or any component of RIV4 is a contraindication for RIV4 3
Live Attenuated Influenza Vaccine (LAIV4) has several contraindications, including history of severe allergic reaction to any component of the vaccine or to a previous dose of any influenza vaccine, concomitant aspirin or salicylate-containing therapy in children and adolescents, children aged 2-4 years with asthma or wheezing history, immunocompromised persons, close contacts and caregivers of severely immunosuppressed persons, pregnant women, and receipt of influenza antiviral medications within the previous 48 hours, as recommended by the CDC 3, 4, 5

Moderate or severe acute illness with or without fever is a precaution for all vaccine types, as recommended by the CDC 3
History of Guillain-Barré Syndrome within 6 weeks of receipt of influenza vaccine is a precaution for all vaccine types, with a strength of evidence rated as moderate 3, 6
Asthma in persons aged ≥5 years is a precaution for LAIV4, as recommended by the CDC 3
Chronic medical conditions that predispose to influenza complications is a precaution for LAIV4, including chronic pulmonary, cardiovascular, renal, hepatic, neurologic, hematologic, or metabolic disorders, as recommended by the CDC 3

The American College of Physicians (ACP) and the CDC recommend that persons with egg allergy of any severity may receive any licensed, recommended, and age-appropriate influenza vaccine, with precautions for those with severe egg allergy reactions 1, 2, 7
Patients with severe egg allergy reactions should be vaccinated in a medical setting with supervision if using egg-based vaccines, as recommended by the ACP and the CDC 1, 2
Cell culture-based (ccIIV4) or recombinant (RIV4) vaccines are preferred alternatives for those with severe egg reactions, as they contain no egg protein, as recommended by the ACP and the CDC 1, 2
The CDC recommends that if a patient had anaphylaxis to one vaccine type, alternative formulations may be used as precautions, not contraindications, with a strength of evidence rated as high 1, 2, 7

History of severe allergic reaction (anaphylaxis) to any influenza vaccine of any type or valency is an absolute contraindication, as recommended by the Centers for Disease Control and Prevention (CDC) 8
History of severe allergic reaction to any component of the specific vaccine (excluding egg protein) is an absolute contraindication, according to the CDC guidelines 8

For patients with urticaria (hives) only after egg exposure, any licensed, recommended influenza vaccine can be administered in any setting, with no special precautions or observation periods required beyond standard 15-minute post-vaccination monitoring, as stated by the CDC 8
For patients with severe egg allergy reactions, any licensed influenza vaccine can still be administered, but if using egg-based vaccines, vaccination should occur in a medical setting supervised by a provider capable of recognizing and managing severe allergic reactions, as recommended by the CDC 8

All vaccination providers must be familiar with their office emergency plan and certified in cardiopulmonary resuscitation, and equipment and personnel for rapid recognition and treatment of anaphylaxis must be available at all vaccination sites, as required by the CDC 8
A standard 15-minute observation period applies to all patients to monitor for syncope, as recommended by the CDC 8