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Vaccine Contraindications and Precautions for ADULTS Only

Recommendations and Guidelines

The contents of this page were excerpted from the ACIP General Recommendations (January 28, 2011) and include corrections detailed in errata dated July 29, 2011 and any changes to recommendations as of February 2014.

Consult the main contraindications page for links to other contraindications and precautions materials.

printer friendly version Printer-friendly version of this chart [2 pages]
Source: Immunization Action Coalition

Also see Conditions Commonly Misperceived as Contraindications to Vaccination.

Also available Chart of Contraindications and Precautions to Commonly Used Vaccines for childhood vaccines

Guide to Contraindications and Precautions to Commonly Used Vaccines in Adults1,*,

Vaccine Contraindications1 Precautions1

Influenza, inactivated injectable (IIV)

  • Severe allergic reaction (e.g., anaphylaxis) after a previous dose of any influenza vaccine or to a vaccine component, including egg protein
Influenza, live attenuated (LAIV)2
  • Severe allergic reaction (e.g., anaphylaxis) after a previous dose of any influenza vaccine or to a vaccine component, including egg protein
  • Conditions for which the ACIP recommends against use, but which are not contraindications in vaccine package insert: immune suppression, certain chronic medical conditions such as asthma, diabetes, heart or kidney disease, and pregnancy3
  • Moderate or severe acute illness with or without fever
  • History of GBS within 6 weeks of previous influenza vaccination
  • Receipt of specific antivirals (i.e., amantadine, rimantadine, zanamivir, or oseltamivir) 48 hours before vaccination. Avoid use of these antiviral drugs for 14 days after vaccination

Tetanus, diphtheria, pertussis (Tdap)

Tetanus, diphtheria (Td)

  • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component

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

  • Moderate or severe acute illness with or without fever
  • GBS within 6 weeks after a previous dose of tetanus toxoid-containing vaccine
  • History of arthus-type hypersensitivity reactions after a previous dose of tetanus or diphtheria toxoid-containing vaccine; defer vaccination until at least 10 years have elapsed since the last tetanus-toxoid containing vaccine

For Tdap only: Progressive or unstable neurologic disorder, uncontrolled seizures, or progressive encephalopathy until a treatment regimen has been established and the condition has stabilized

Varicella (Var)2
  • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component
  • Known severe immunodeficiency (e.g., from hematologic and solid tumors, receipt of chemotherapy, primary or acquired immunodeficiency, or long-term immunosuppressive therapy4 or patients with human immunodeficiency virus [HIV] infection who are severely immunocompromised)
  • Pregnancy
  • Moderate or severe acute illness with or without fever
  • Recent (within 11 months) receipt of antibody-containing blood product (specific interval depends on product)5
  • Receipt of specific antivirals (i.e., acyclovir, famciclovir, or valacyclovir) 24 hours before vaccination; avoid use of these antiviral drugs for 14 days after vaccination
Human papillomavirus (HPV)
  • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component
  • Moderate or severe acute illness with or without fever
  • Pregnancy
Zoster (HZV)
  • Severe allergic reaction (e.g., anaphylaxis) to a vaccine component
  • Known severe immunodeficiency (e.g., from hematologic and solid tumors, receipt of chemotherapy, or long-term immunosuppressive therapy4 or patients with HIV infection who are severely immunocompromised)
  • Pregnancy
  • Moderate or severe acute illness with or without fever
  • Receipt of specific antivirals (i.e., acyclovir, famciclovir, or valacyclovir) 24 hours before vaccination; avoid use of these antiviral drugs for 14 days after vaccination
Measles, mumps, rubella (MMR)2
  • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component
  • Known severe immunodeficiency (e.g., from hematologic and solid tumors, receipt of chemotherapy, congenital immunodeficiency, or long-term immunosuppressive therapy4 or patients with HIV infection who are severely immunocompromised)
  • Pregnancy
  • Moderate or severe acute illness with or without fever
  • Recent (within 11 months) receipt of antibody-containing blood product (specific interval depends on product)5
  • History of thrombocytopenia or thrombocytopenic purpura
  • Need for tuberculin skin testing6
Pneumococcal (PCV13 or PPSV23)
  • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component (including to any vaccine containing diphtheria toxoid for PCV13)
  • Moderate or severe acute illness with or without fever
Meningococcal: conjugate (MCV4), polysaccharide (MPSV4)
  • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component
  • Moderate or severe acute illness with or without fever
Hepatitis A (HepA)
  • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component
  • Moderate or severe acute illness with or without fever
Hepatitis B (HepB)
  • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component
  • Moderate or severe acute illness with or without fever

Abbreviations
DT = diphtheria and tetanus toxoids; DTaP = diphtheria and tetanus toxoids and acellular pertussis; GBS = Guillian-Barré syndrome; HBsAg = hepatitis B surface antigen; Hib = Haemophilus influenzae type b; HIV = human immunodeficiency virus; HPV = human papillomavirus; IPV = inactivated poliovirus; LAIV = live, attenuated influenza vaccine; MCV4 = quadrivalent meningococcal conjugate vaccine; MMRV = measles, mumps, rubella, and varicella; MPSV4 = quadrivalent meningococcal polysaccharide vaccine; PCV = pneumococcal conjugate vaccine; PPSV = pneumococcal polysaccharide vaccine; SCID = severe combined immunodeficiency; Td = tetanus and diphtheria toxoids; Tdap = tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis; TIV = trivalent inactivated influenza vaccine.

Footnotes


  1. Vaccine package inserts and the full ACIP recommendations for these vaccines should be consulted for additional information on vaccine-related contraindications and precautions and for more information on vaccine excipients. Events or conditions listed as precautions should be reviewed carefully. Benefits of and risks for administering a specific vaccine to a person under these circumstances should be considered. If the risk from the vaccine is believed to outweigh the benefit, the vaccine should not be administered. If the benefit of vaccination is believed to outweigh the risk, the vaccine should be administered. A contraindication increases the chance of a serious adverse reaction. Therefore, a vaccine should not be administered when a contraindication is present.
  2. LAIV, MMR, and varicella vaccines can be administered on the same day. If not administered on the same day, these live vaccines should be separated by at least 28 days.
  3. For a complete list of conditions that CDC considers to be reasons to avoid getting LAIV, see CDC. "Prevention and Control of Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices (ACIP)," 2010. MMWR 2010;59(No. RR-8).
  4. Immunosuppressive steroid dose is considered to be 2 or more weeks of daily receipt of 20 mg prednisone or equivalent. Vaccination should be deferred for at least 1 month after discontinuation of such therapy. Providers should consult ACIP recommendations for complete information on the use of specific live vaccines among persons on immune-suppressing medications or with immune suppression because of other reasons.
  5. Vaccine should be deferred for the appropriate interval if replacement immune globulin products are being administered (see Table 5 in CDC. "General Recommendations on Immunization: Recommendations of the Advisory Committee on Immunization Practices [ACIP]." MMWR. 2011;60(No. RR-2).
  6. Measles vaccination might suppress tuberculin reactivity temporarily. Measles-containing vaccine may be administered on the same day as tuberculin skin testing. If testing cannot be performed until after the day of MMR vaccination, the test should be postponed for at least 4 weeks after the vaccination. If an urgent need exists to skin test, do so with the understanding that reactivity might be reduced by the vaccine.

*Adapted from “Table 6. Contraindications and Precautions to Commonly Used Vaccines” found in: CDC. “General Recommendations on Immunization: Recommendations of the Advisory Committee on Immunization Practices (ACIP).” MMWR 2011; 60(No. RR-2), p. 40-41, and from Atkinson W, Wolfe S, Hamborsky J, eds. Appendix A. Epidemiology and Prevention of Vaccine-Preventable Diseases.

†Regarding latex allergy: some types of prefilled syringes contain natural rubber latex or dry natural latex rubber. Consult the package insert for any vaccine given.

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