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Subsections
ACIP Immunization Contraindications and Precautions

Immunizations

ACIP Immunization Contraindications and Precautions

Influenza Vaccine

  • Influenza, inactivated (IIV4)
    • Contraindications
      • Severe allergic reaction (e.g., anaphylaxis) after previous dose of any influenza vaccine
        • Any egg-based IIV, ccIIV, RIV, or LAIV of any valency
    • Precautions
      • Guillain-Barré syndrome (GBS) within 6 weeks after a previous dose of any type of influenza vaccine
      • Moderate or severe acute illness with or without fever
  • Influenza, recombinant (RIV4)
    • Contraindications
      • Severe allergic reaction (e.g., anaphylaxis) to any RIV of any valency, or to any component of RIV4
    • Precautions
      • Guillain-Barré syndrome (GBS) within 6 weeks after a previous dose of any type of influenza vaccine
      • Persons with a history of severe allergic reaction (e.g., anaphylaxis) after a previous dose of any egg-based IIV, ccIIV, or LAIV of any valency
        • If using RIV4, administer in medical setting under supervision of health care provider who can recognize and manage severe allergic reactions
        • May consult an allergist
      • Moderate or severe acute illness with or without fever
  • Influenza, live attenuated (LAIV4)
    • Previously issued guidance regarding contraindications and precautions is provided below for informational purposes
      • Contraindications
        • Severe allergic reaction (e.g., anaphylaxis) after previous dose of any influenza vaccine (i.e., any egg-based IIV, ccIIV, RIV, or LAIV of any valency)
        • Severe allergic reaction (e.g., anaphylaxis) to any vaccine component3 (excluding egg)
        • Anatomic or functional asplenia
        • Immunocompromised due to any cause including, but not limited to, medications and HIV infection
        • Close contacts or caregivers of severely immunosuppressed persons who require a protected environment
        • Pregnancy
        • Cochlear implant
        • Active communication between the cerebrospinal fluid (CSF) and the oropharynx, nasopharynx, nose, ear, or any other cranial CSF leak
        • Received influenza antiviral medications oseltamivir or zanamivir within the previous
          48 hours, peramivir within the previous 5 days, or baloxavir within the previous 17 days
      • Precautions
        • Guillain-Barré syndrome (GBS) within 6 weeks after a previous dose of any type of influenza vaccine
        • Asthma in persons aged 5 years or older
        • Persons with underlying medical conditions (other than those listed under contraindications) that might predispose to complications after wild-type influenza virus infection [e.g., chronic pulmonary, cardiovascular (except isolated hypertension), renal, hepatic, neurologic, hematologic, or metabolic disorders (including diabetes mellitus)]
        • Moderate or severe acute illness with or without fever
  • Influenza, cell culture-based inactivated injectable
    • Contraindications
      • Severe allergic reaction (e.g., anaphylaxis) to any ccIIV of any valency, or to any component of ccIIV4
    • Precautions
      • Guillain-Barré syndrome (GBS) within 6 weeks after a previous dose of any type of influenza vaccine
      • Persons with a history of severe allergic reaction (e.g., anaphylaxis) after a previous dose of any egg-based IIV, RIV, or LAIV of any valency
        • If using ccIV4, administer in medical setting under supervision of health care provider who can recognize and manage severe allergic reactions
        • May consult an allergist
      • Moderate or severe acute illness with or without fever

Tetanus, Diphtheria, Pertussis Vaccine

  • Contraindications
    • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3
    • For Tdap only
      • Encephalopathy (e.g., coma, decreased level of consciousness, prolonged seizures)
        • Not attributable to another identifiable cause
        • Within 7 days of administration of previous dose of DTP, DTaP, or Tdap
  • Precautions
    • Guillain-Barré syndrome (GBS)
      • Within 6 weeks after a previous dose of tetanus-toxoid–containing vaccine
    • History of Arthus-type hypersensitivity reactions
      • After a previous dose of diphtheria-toxoid– containing or tetanus-toxoid–containing vaccine
      • Defer vaccination until at least 10 years have elapsed since the last tetanus-toxoid–containing vaccine
    • Moderate or severe acute illness with or without fever
    • For Tdap only
      • Progressive or unstable neurological disorder, uncontrolled seizures, or progressive encephalopathy
        • Until a treatment regimen has been established and the condition has stabilized

Varicella Vaccine

  • Contraindications
    • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component
    • Severe immunodeficiency
      • Hematologic and solid tumors
      • Receipt of chemotherapy
      • Congenital immunodeficiency
      • Long-term immunosuppressive therapy
      • Patients with HIV infection who are severely immunocompromised
    • Pregnancy
    • Family history of altered immunocompetence
      • Unless verified clinically or by laboratory testing as immunocompetent
  • Precautions
    • Recent (≤ 11 months) receipt of antibody-containing blood product
      • Specific interval depends on product
    • Receipt of specific antiviral drugs (acyclovir, famciclovir, or valacyclovir) 24 hours before vaccination
      • Avoid use of these antiviral drugs for 14 days after vaccination
    • Use of aspirin or aspirin-containing products
    • Moderate or severe acute illness with or without fever

Human Papillomavirus Vaccine

  • Contraindications
    • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component
    • Pregnancy
      • HPV vaccination not recommended
  • Precautions
    • Moderate or severe acute illness with or without fever

Zoster Vaccine

  • Contraindications
    • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component
  • Precautions
    • Moderate or severe acute illness with or without fever
    • Current herpes zoster infection

Measles, Mumps, Rubella (MMR) Vaccine

  • Contraindicated
    • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component
    • Severe immunodeficiency
      • Hematologic and solid tumors
      • Receipt of chemotherapy
      • Congenital immunodeficiency
      • Long-term immunosuppressive therapy
      • Patients with HIV infection who are severely immunocompromised
    • Pregnancy
    • Family history of altered immunocompetence
      • Unless verified clinically or by laboratory testing as immunocompetent
  • Precautions
    • Recent (< 11 months) receipt of antibody-containing blood product
      • Specific interval depends on product
    • History of thrombocytopenia or thrombocytopenia purpura
    • Need for tuberculin skin testing or interferon-gamma release assay (IGRA) testing
    • Moderate or severe acute illness w/ or w/o fever

Inactivated Polio Vaccine

  • Contraindications
    • A severe reaction (e.g., anaphylaxis, after a previous dose or to a vaccine component)
  • Precautions
    • Moderate or severe acute illness with or without fever
    • Pregnancy

Rotavirus Vaccine

  • Precaution
    • Immunocompromised status (excluding HIV infection)
    • Chronic GI disorder
    • RV1 only: spina bifida or bladder exstrophy
    • Moderate or severe acute illness w/ or w/o fever
    • HIV infection: <15% or total CD4 cell count of <200/mm3
    • HIV infection: ≥15% or total CD4 cell count of ≥200/mm3
  • Contraindicated
    • Severe combined immunodeficiency (SCID)
    • Severe allergic rxn (e.g., anaphylaxis) to previous dose or to a vaccine component
    • History of intussusception

Pneumococcal Conjugate (PCV15, PCV20) Vaccine

  • Contraindications
    • Severe allergic reaction (e.g., anaphylaxis)
      • After a previous dose or to a vaccine component
      • To any diphtheria-toxoid–containing vaccine or to its vaccine component
    Precautions
    • Moderate or severe acute illness with or without fever

Pneumococcal Polysaccharide (PPSV23) Vaccine

  • Contraindications
    • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component
  • Precautions
    • Moderate or severe acute illness with or without fever

Hepatitis A Vaccine

  • Contraindications
    • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component including neomycin and yeast
  • Precautions
    • Moderate or severe acute illness with or without fever

Hepatitis B Vaccine

  • Contraindications
    • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component including neomycin
    • Pregnancy
      • Heplisav-B and PreHevbrio are not recommended due to lack of safety data in pregnant persons
      • Use other hepatitis B vaccines if HepB is indicated
  • Precautions
    • Moderate or severe acute illness with or without fever

Meningococcal, Conjugate (MenACWY)

  • Contraindications
    • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component
    • For MenACWY-D and Men ACWY-CRM only: severe allergic reaction to any diphtheria toxoid– or CRM197– containing vaccine
    • For MenACWY-TT only: severe allergic reaction to a tetanus toxoid-containing vaccine
  • Precautions
    • Moderate or severe acute illness with or without fever

Meningococcal Subgroup B (MenB) Vaccine

  • Contraindications
    • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component
  • Precautions
    • Moderate or severe acute illness with or without fever
    • Pregnancy
    • For Men2B-4C only: latex sensitivity

Haemophilus influenzae type b (Hib) Vaccine

  • Contraindications
    • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component
    • For Hiberix, ActHiB and PedvaxHIB only
      • Hx of severe allergic rxn to dry natural latex
  • Precautions
    • Moderate or severe acute illness with or without fever

References

  1. Centers for Disease Control and Prevention (CDC). Vaccine Recommendations and Guidelines of the ACIP: Contraindications and Precautions. Available at: https://www.cdc.gov/vaccines/hcp/acip-recs/general-recs/contraindications.html. [Accessed August 2023]

Contributor(s)

  1. Pacheco, Caleb S., MD
  2. Hernandez, James, DO
  3. Singh, Ajaydeep, MD

Updated/Reviewed: August 2023