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Chart of Contraindications and Precautions to Commonly Used Vaccines

For Childhood Vaccines

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 January 2014.

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

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Source: Immunization Action Coalition

Also see Conditions Commonly Misperceived as Contraindications to Vaccination

Also available Contraindications and precautions for ADULTS only

Guide to Contraindications1 and Precautions1 to Commonly Used Vaccines*,
Vaccine Contraindications1 Precautions1

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
  • Infant weighing less than 2000 grams (4 lbs, 6.4 oz)2
Rotavirus
(RV5 [RotaTeq], RV1 [Rotarix])
  • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component
  • Severe combined immunodeficiency (SCID)
  • History of intussusception
  • Moderate or severe acute illness with or without fever
  • Altered immunocompetence other than SCID
  • Chronic gastrointestinal disease3
  • Spina bifida or bladder exstrophy3

Diphtheria, tetanus, pertussis (DTaP)

Tetanus, diphtheria, pertussis (Tdap)

Tetanus, diphtheria (DT, Td)

  • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component
  • For pertussis-containing vaccines: encephalopathy (e.g., coma, decreased level of consciousness, prolonged seizures) not attributable to another identifiable cause within 7 days of administration of a previous dose of DTP or DTaP (for DTaP); or of previous dose of DTP, DTaP, or Tdap (for Tdap)
  • Moderate or severe acute illness with or without fever
  • 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 tetanus or diphtheria toxoid-containing vaccine; defer vaccination until at least 10 years have elapsed since the last tetanus-toxoid containing vaccine
  • For pertussis-containing vaccines: progressive or unstable neurologic disorder (including infantile spasms for DTaP), uncontrolled seizures, or progressive encephalopathy until a treatment regimen has been established and the condition has stabilized

For DTaP only:

  • Temperature of 105° F or higher (40.5° C or higher) within 48 hours after vaccination with a previous dose of DTP/DTaP
  • Collapse or shock-like state (i.e., hypotonic hyporesponsive episode) within 48 hours after receiving a previous dose of DTP/DTaP
  • Seizure within 3 days after receiving a previous dose of DTP/DTaP
  • Persistent, inconsolable crying lasting 3 or more hours within 48 hours after receiving a previous dose of DTP/DTaP
Haemophilus influenzae type b (Hib)
  • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component
  • Age younger than 6 weeks
  • Moderate or severe acute illness with or without fever
Inactivated poliovirus vaccine (IPV)
  • 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
Pneumococcal
(PCV13 or PPSV23)
  • For PCV13, severe allergic reaction (e.g., anaphylaxis) after a previous dose of PCV7 or PCV13 or to a vaccine component, including to any vaccine containing diphtheria toxoid
  • For PPSV23, severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component
  • Moderate or severe acute illness with or without fever
Measles, mumps, rubella (MMR)4
  • 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 therapy5 or patients with human immunodeficiency virus [HIV] infection who are severely immunocompromised)6
  • 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)7
  • History of thrombocytopenia or thrombocytopenic purpura
  • Need for tuberculin skin testing8
Varicella (Var)4
  • 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 therapy5 or patients with HIV infection who are severely immunocompromised)6
  • 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)7
  • 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.
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
Influenza, inactivated injectable (IIV)
  • Severe allergic reaction (e.g., anaphylaxis) after a previous dose of any IIV or LAIV or to a vaccine component, including egg protein
  • Moderate or severe acute illness with or without fever
  • History of GBS within 6 weeks of previous influenza vaccination
  • Persons who experience only hives with exposure to eggs may receive RIV (if age 18–49) or, with additional safety precautions, IIV.9
Influenza, recombinant (RIV)
  • Severe allergic reaction (e.g., anaphylaxis) after a previous dose of RIV or to a vaccine component. RIV does not contain any egg protein.9
  • Moderate or severe acute illness with or without fever
  • History of GBS within 6 weeks of previous influenza vaccination
Influenza, live attenuated (LAIV)4, 9
  • Severe allergic reaction (e.g., anaphylaxis) after a previous dose of IIV or LAIV 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 pregnancy4, 9
  • 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.
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
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
Zoster (HZV) 4
  • 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 therapy5 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.

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 is a condition in a recipient that increases the chance of a serious adverse reaction. Therefore, a vaccine should not be administered when a contraindication is present. Whether and when to administer DTaP to children with proven or suspected underlying neurologic disorders should be decided on a case-by-case basis.
  2. Hepatitis B vaccination should be deferred for preterm infants and infants weighing less than 2000 g if the mother is documented to be hepatitis B surface antigen (HBsAg)-negative at the time of the infant’s birth. Vaccination can commence at chronological age 1 month or at hospital discharge. For infants born to women who are HBsAg-positive, hepatitis B immunoglobulin and hepatitis B vaccine should be administered within 12 hours of birth, regardless of weight.
  3. For details, see CDC. “Prevention of Rotavirus Gastroenteritis among Infants and Children:
    Recommendations of the Advisory Committee on Immunization Practices. (ACIP)
    MMWR. 2009;58(No. RR–2).
  4. LAIV, MMR, varicella, and zoster 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.
  5. 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.
  6. HIV-infected children may receive varicella and measles vaccine if CD4+ T-lymphocyte count is >15%. (Source: Adapted from American Academy of Pediatrics. Immunization in Special Clinical Circumstances. In: Pickering LK, ed. Red Book: 2012 Report of the Committee on Infectious Diseases. 29th ed. Elk Grove Village, IL: American Academy of Pediatrics: 2012.)
  7. 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)”.
  8. Measles vaccination might suppress tuberculin reactivity temporarily. Measles-containing vaccine can 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.
  9. For more information on use of influenza vaccines among persons with egg allergies and a complete list of conditions that CDC considers to be reasons to avoid getting LAIV, see Prevention and Control of Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices (ACIP) — United States, 2013–14. MMWR 2013;62(RR07):1–43.

*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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