Influenza Vaccination in Acutely Ill Individuals

Key Decision Framework

The Centers for Disease Control and Prevention recommends that minor illnesses with or without fever do not contraindicate influenza vaccination, but persons with moderate to severe acute febrile illness should defer vaccination until their symptoms have resolved 1, 2, 3
Minor upper respiratory infections, such as runny nose or mild sore throat, with or without fever, are not contraindications for vaccination, according to the American Academy of Pediatrics 1, 3
The American Academy of Pediatrics also states that allergic rhinitis does not preclude vaccination 3
Mild diarrhea does not contraindicate vaccination, as per the Centers for Disease Control and Prevention 1
Low-grade fever alone without moderate-to-severe systemic symptoms is acceptable for vaccination, according to the American Academy of Pediatrics 3

The Centers for Disease Control and Prevention states that injectable inactivated vaccines can be safely administered during rhinitis, regardless of severity, with no special precautions needed beyond standard vaccination practices 4
Minor respiratory symptoms do not affect vaccine delivery or efficacy for injectable inactivated vaccines, as per the Centers for Disease Control and Prevention 1
The American Academy of Pediatrics recommends that live attenuated intranasal vaccine can be given with mild rhinitis, but should be deferred if significant nasal congestion would impede vaccine delivery to the nasopharyngeal mucosa 1, 2, 3, 4

The Centers for Disease Control and Prevention recommends deferring vaccination for patients with confirmed COVID-19 if they have moderate or severe illness until recovery 6
For patients with mild or asymptomatic COVID-19, further deferral may be considered to avoid confusing COVID-19 symptoms with post-vaccination reactions, as per the Centers for Disease Control and Prevention 6

The American Academy of Pediatrics advises against over-deferring vaccination for minor symptoms like mild cold, low-grade fever, or allergic rhinitis 3, 4
The Centers for Disease Control and Prevention states that moderate-to-severe illness is a precaution, not an absolute contraindication, and clinical judgment should be used to determine whether the patient appears systemically ill 2, 3, 5