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TABLE 5

Influenza Vaccine Contraindications and Precautions

VaccineContraindicationPrecautionProvider DiscretionNot Contraindication
IIVa • Anaphylaxis or severe allergic reaction to previous influenza vaccination • Moderate to severe illness, including COVID-19  • Minor illness, with or without fever 
  • History of GBS within 6 wk of previous influenza vaccination  • Egg allergy 
LAIV • Anaphylaxis or severe allergic reaction to previous influenza vaccination • Moderate to severe illness, including COVID-19 • Defer to resolution of symptoms or use IIV if a patient has nasal congestion that could impede vaccine delivery • Minor illness, with or without fever 
 • Allergy to gelatin • History of GBS within 6 wk of previous influenza vaccination  • Egg allergy 
 • Age 2–4 y with diagnosis of asthma or history of wheezing in last 12 mo • Diagnosis of asthma and age ≥5 y   
 • Cochlear implants • Certain underlying chronic conditions that might predispose to complications after influenza (eg, chronic pulmonary disease, cardiovascular disease, renal, hepatic, neurologic, hematologic, or metabolic disorders)   
 • Active cerebrospinal fluid leaks    
 • Immunosuppression because of any cause, including    
  • Primary or acquired immunodeficiency, including HIV    
  • Immunosuppressive or immunomodulatory therapy    
  • Anatomic or functional asplenia    
 • Close contacts or caregivers of severely immunocompromised individuals    
 • On aspirin or salicylate-containing medications    
 • Receiving or recently received influenza antiviral medicationb    
 • Currently pregnant    
VaccineContraindicationPrecautionProvider DiscretionNot Contraindication
IIVa • Anaphylaxis or severe allergic reaction to previous influenza vaccination • Moderate to severe illness, including COVID-19  • Minor illness, with or without fever 
  • History of GBS within 6 wk of previous influenza vaccination  • Egg allergy 
LAIV • Anaphylaxis or severe allergic reaction to previous influenza vaccination • Moderate to severe illness, including COVID-19 • Defer to resolution of symptoms or use IIV if a patient has nasal congestion that could impede vaccine delivery • Minor illness, with or without fever 
 • Allergy to gelatin • History of GBS within 6 wk of previous influenza vaccination  • Egg allergy 
 • Age 2–4 y with diagnosis of asthma or history of wheezing in last 12 mo • Diagnosis of asthma and age ≥5 y   
 • Cochlear implants • Certain underlying chronic conditions that might predispose to complications after influenza (eg, chronic pulmonary disease, cardiovascular disease, renal, hepatic, neurologic, hematologic, or metabolic disorders)   
 • Active cerebrospinal fluid leaks    
 • Immunosuppression because of any cause, including    
  • Primary or acquired immunodeficiency, including HIV    
  • Immunosuppressive or immunomodulatory therapy    
  • Anatomic or functional asplenia    
 • Close contacts or caregivers of severely immunocompromised individuals    
 • On aspirin or salicylate-containing medications    
 • Receiving or recently received influenza antiviral medicationb    
 • Currently pregnant    

COVID-19, coronavirus disease 2019; GBS, Guillain-Barre syndrome.

a

Egg-based IIVs for children include Afluria quadrivalent, Fluarix quadrivalent, FluLaval quadrivalent, and Fluzone quadrivalent. Flucelvax quadrivalent is a cell culture-based IIV for children.

b

Within 48 hours (oseltamivir, zanamivir), 5 days (peramivir), or 17 days (baloxavir) of stopping influenza antiviral therapy.

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