Contraindications and precautions for the use of influenza vaccines – United States, 2023-24 influenza season*

Vaccine type	Contraindications	Precautions
Egg-based IIV4s	History of severe allergic reaction (eg, anaphylaxis) to any component of the vaccine^¶ or to a previous dose of any influenza vaccine (ie, any egg-based IIV, ccIIV, RIV, or LAIV)^Δ	Moderate or severe acute illness with or without fever History of Guillain-Barré syndrome within 6 weeks of receipt of influenza vaccine
ccIIV4	History of severe allergic reaction (eg, anaphylaxis) to a previous dose of any ccIIV or any component of ccIIV4^Δ	Moderate or severe acute illness with or without fever History of Guillain-Barré syndrome within 6 weeks of receipt of influenza vaccine History of severe allergic reaction to a previous dose of any other influenza vaccine (ie, any egg-based IIV, RIV, or LAIV)^◊
RIV4	History of severe allergic reaction (eg, anaphylaxis) to a previous dose of any RIV or any component of RIV4^Δ	Moderate or severe acute illness with or without fever History of Guillain-Barré syndrome within 6 weeks of receipt of influenza vaccine History of severe allergic reaction to a previous dose of any other influenza vaccine (ie, any egg-based IIV, ccIIV, or LAIV)^◊
LAIV4	History of severe allergic reaction (eg, anaphylaxis) to any component of the vaccine^¶ or to a previous dose of any influenza vaccine (ie, any egg-based IIV, ccIIV, RIV, or LAIV)^Δ Concomitant aspirin- or salicylate-containing therapy in children and adolescents^Δ Children aged 2 through 4 years who have received a diagnosis of asthma or whose parents or caregivers report that a health care provider has told them during the preceding 12 months that their child had wheezing or asthma or whose medical record indicates a wheezing episode has occurred during the preceding 12 months Children and adults who are immunocompromised due to any cause, including but not limited to immunosuppression caused by medications, congenital or acquired immunodeficiency states, HIV infection, anatomic asplenia, or functional asplenia (eg, due to sickle cell anemia) Close contacts and caregivers of severely immunosuppressed persons who require a protected environment Pregnancy Persons with active communication between the CSF and the oropharynx, nasopharynx, nose, or ear or any other cranial CSF leak Persons with cochlear implants^§ Receipt of influenza antiviral medication within the previous 48 hours for oseltamivir and zanamivir, previous 5 days for peramivir, and previous 17 days for baloxavir^¥	Moderate or severe acute illness with or without fever History of Guillain-Barré syndrome within 6 weeks of receipt of influenza vaccine Asthma in persons aged ≥5 years Other underlying medical conditions that might predispose to complications after wild-type influenza infection (eg, chronic pulmonary, cardiovascular [except isolated hypertension], renal, hepatic, neurologic, hematologic, or metabolic disorders [including diabetes mellitus])

ACIP: Advisory Committee on Immunization Practices; ccIIV: cell culture–based inactivated influenza vaccine (any valency); ccIIV4: cell culture–based inactivated influenza vaccine, quadrivalent; CSF: cerebrospinal fluid; FDA: Food and Drug Administration; IIV: inactivated influenza vaccine (any valency); IIV4: inactivated influenza vaccine, quadrivalent; LAIV: live attenuated influenza vaccine (any valency); LAIV4: live attenuated influenza vaccine, quadrivalent; RIV: recombinant influenza vaccine (any valency); RIV4: recombinant influenza vaccine, quadrivalent.

* Manufacturer package inserts and updated CDC and ACIP guidance should be consulted for additional information concerning, but not limited to, indications, contraindications, warnings, and precautions. When a contraindication is present, a vaccine should not be administered. When a precaution is present, vaccination should generally be deferred but might be indicated if the benefit of protection from the vaccine outweighs the risk for an adverse reaction (refer to the General Best Practice Guidelines for Immunization, available at https://www.cdc.gov/vaccines/hcp/acip-recs/general-recs/index.html). Package inserts for US-licensed vaccines are available at https://www.fda.gov/vaccines-blood-biologics/vaccines/vaccines-licensed-use-united-states.

¶ Although a history of severe allergic reaction (eg, anaphylaxis) to egg is a labeled contraindication to the use of egg-based IIV4s and LAIV4, ACIP recommends that all persons aged ≥6 months with egg allergy should receive influenza vaccine, and that any influenza vaccine (egg based or nonegg based) that is otherwise appropriate for the recipient’s age and health status can be used.

Δ Labeled contraindication noted in package insert.

◊ If administered, vaccination should occur in a medical setting and should be supervised by a health care provider who can recognize and manage severe allergic reactions. Providers can consider consultation with an allergist in such cases to assist in identification of the component responsible for the allergic reaction.

§ Age-appropriate injectable vaccines are recommended for persons with cochlear implant because of the potential for CSF leak, which might exist for a period after implantation. Providers might consider consultation with a specialist concerning risk for persistent CSF leak if an age-appropriate inactivated or recombinant vaccine cannot be used.

¥ Use of LAIV4 in context of influenza antivirals has not been studied; however, interference with activity of LAIV4 is biologically plausible, and this possibility is noted in the package insert for LAIV4. In the absence of data supporting an adequate minimum interval between influenza antiviral use and LAIV4 administration, the intervals provided are based on the half-life of each antiviral. The interval between influenza antiviral receipt and LAIV4 for which interference might potentially occur might be further prolonged in the presence of medical conditions that delay medication clearance (eg, renal insufficiency). Influenza antivirals might also interfere with LAIV4 if initiated within 2 weeks after vaccination. Persons who receive antivirals during the period starting with the specified time before receipt of LAIV4 through 2 weeks after receipt of LAIV4 should be revaccinated with an age-appropriate IIV or RIV4.

Reproduced from: Grohskopf LA, Blanton LH, Ferdinands JM, et al. Prevention and control of seasonal influenza with vaccines: Recommendations of the Advisory Committee on Immunization Practices — United States, 2023–24 influenza season. MMWR Suppl 2023; 72:1.

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Contraindications and precautions for the use of influenza vaccines – United States, 2023-24 influenza season*