Adult Immunization Schedule Appendix – Guide to Contraindications and Precautions to Commonly Used Vaccines

Guide to Contraindications and Precautions to Commonly Used Vaccines

Adapted from Table 4-1 in Advisory Committee on Immunization Practices (ACIP) General Best Practice Guidelines for Immunization: Contraindication and Precautions and ACIP’s Recommendations for the Prevention and Control of 2021-22 seasonal influenza with Vaccines.

Interim clinical considerations for use of COVID-19 vaccines including contraindications and precautions

Vaccine

Vaccine

Vaccine

Contraindications1

Contraindications1

Contraindications1

Precautions2

Precautions2

Precautions2

Haemophilus influenzae type b (Hib)

Vaccine

Haemophilus influenzae type b (Hib)

  • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3
  • For Hiberix, ActHib, and PedvaxHIB only: History of severe allergic reaction to dry natural latex
Contraindications1
  • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3
  • For Hiberix, ActHib, and PedvaxHIB only: History of severe allergic reaction to dry natural latex
  • Moderate or severe acute illness with or without fever
Precautions2
  • Moderate or severe acute illness with or without fever

Hepatitis A (HepA)

Vaccine

Hepatitis A (HepA)

  • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3 including neomycin
Contraindications1
  • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3 including neomycin
  • Moderate or severe acute illness with or without fever
Precautions2
  • Moderate or severe acute illness with or without fever

Hepatitis B (HepB)

Vaccine

Hepatitis B (HepB)

  • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3 including yeast
Contraindications1
  • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3 including yeast
  • Moderate or severe acute illness with or without fever
Precautions2
  • Moderate or severe acute illness with or without fever

Hepatitis A- Hepatitis B vaccine [HepA-HepB, (Twinrix®)]

Vaccine

Hepatitis A- Hepatitis B vaccine [HepA-HepB, (Twinrix®)]

  • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3 including neomycin and yeast
Contraindications1
  • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3 including neomycin and yeast
  • Moderate or severe acute illness with or without fever
Precautions2
  • Moderate or severe acute illness with or without fever

Human papillomavirus (HPV)

Vaccine

Human papillomavirus (HPV)

  • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3
Contraindications1
  • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3
  • Moderate or severe acute illness with or without fever
Precautions2
  • Moderate or severe acute illness with or without fever

Influenza, egg-based, inactivated injectable (IIV4)

Vaccine

Influenza, egg-based, inactivated injectable (IIV4)

  • 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)
Contraindications1
  • 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)
  • Guillain-Barré syndrome (GBS) within 6 weeks after a previous dose of any type of influenza vaccine
  • Persons with egg allergy with symptoms other than hives (e.g., angioedema, respiratory distress) or required epinephrine or another emergency medical intervention: Any influenza vaccine appropriate for age and health status may be administered. If using IIV4 or LAIV4, administer in medical setting under supervision of health care provider who can recognize and manage severe allergic reactions
  • Moderate or severe acute illness with or without fever
Precautions2
  • Guillain-Barré syndrome (GBS) within 6 weeks after a previous dose of any type of influenza vaccine
  • Persons with egg allergy with symptoms other than hives (e.g., angioedema, respiratory distress) or required epinephrine or another emergency medical intervention: Any influenza vaccine appropriate for age and health status may be administered. If using IIV4 or LAIV4, administer in medical setting under supervision of health care provider who can recognize and manage severe allergic reactions
  • Moderate or severe acute illness with or without fever

Influenza, cell culture-based inactivated injectable

Vaccine

Influenza, cell culture-based inactivated injectable

  • Severe allergic reaction (e.g., anaphylaxis) to any ccIIV of any valency, or to any component3 of ccIIV4
Contraindications1
  • Severe allergic reaction (e.g., anaphylaxis) to any ccIIV of any valency, or to any component3 of ccIIV4
  • 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.
  • 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
Precautions2
  • 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.
  • 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 injectable
[(RIV4), Flublok® Quadrivalent]

Vaccine

Influenza, recombinant injectable
[(RIV4), Flublok® Quadrivalent]

  • Severe allergic reaction (e.g., anaphylaxis) to any RIV of any valency, or to any component3 of RIV4
Contraindications1
  • Severe allergic reaction (e.g., anaphylaxis) to any RIV of any valency, or to any component3 of RIV4
  • 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.
  • 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
Precautions2
  • 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.
  • 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, live attenuated [LAIV4, Flumist® Quadrivalent]

Vaccine

Influenza, live attenuated [LAIV4, Flumist® Quadrivalent]

  • 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)
  • Adults age 50 years or older
  • Anatomic or functional asplenia
  • Immunocompromised due to any cause including 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.
Contraindications1
  • 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)
  • Adults age 50 years or older
  • Anatomic or functional asplenia
  • Immunocompromised due to any cause including 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.
  • Guillain-Barré syndrome (GBS) within 6 weeks after a previous dose of any type of influenza vaccine
  • Asthma in persons aged 5 years old 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
Precautions2
  • Guillain-Barré syndrome (GBS) within 6 weeks after a previous dose of any type of influenza vaccine
  • Asthma in persons aged 5 years old 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

Measles, mumps, rubella (MMR)

Vaccine

Measles, mumps, rubella (MMR)

  • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3
  • Severe immunodeficiency (e.g., hematologic and solid tumors, receipt of chemotherapy, congenital immunodeficiency, long-term immunosuppressive therapy or patients with HIV infection who are severely immunocompromised)
  • Pregnancy
  • Family history of altered immunocompetence, unless verified clinically or by laboratory testing as immunocompetent
Contraindications1
  • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3
  • Severe immunodeficiency (e.g., hematologic and solid tumors, receipt of chemotherapy, congenital immunodeficiency, long-term immunosuppressive therapy or patients with HIV infection who are severely immunocompromised)
  • Pregnancy
  • Family history of altered immunocompetence, unless verified clinically or by laboratory testing as immunocompetent
  • Recent (≤11 months) receipt of antibody-containing blood product (specific interval depends on product)
  • History of thrombocytopenia or thrombocytopenic purpura
  • Need for tuberculin skin testing or interferon-gamma release assay (IGRA) testing
  • Moderate or severe acute illness with or without fever
Precautions2
  • Recent (≤11 months) receipt of antibody-containing blood product (specific interval depends on product)
  • History of thrombocytopenia or thrombocytopenic purpura
  • Need for tuberculin skin testing or interferon-gamma release assay (IGRA) testing
  • Moderate or severe acute illness with or without fever
Meningococcal ACWY MenACWY)

[MenACWY-CRM (Menveo®); MenACWY-D (Menactra®); MenACWY-TT (MenQuadfi®)]

Vaccine
Meningococcal ACWY MenACWY)

[MenACWY-CRM (Menveo®); MenACWY-D (Menactra®); MenACWY-TT (MenQuadfi®)]

  • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3
  • 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
Contraindications1
  • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3
  • 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
  • Moderate or severe acute illness with or without fever
Precautions2
  • Moderate or severe acute illness with or without fever

Meningococcal B (MenB)
[MenB-4C (Bexsero); MenB-FHbp (Trumenba)]

Vaccine

Meningococcal B (MenB)
[MenB-4C (Bexsero); MenB-FHbp (Trumenba)]

  • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3
Contraindications1
  • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3
  • Pregnancy
  • For MenB-4C only: Latex sensitivity
  • Moderate or severe acute illness with or without fever
Precautions2
  • Pregnancy
  • For MenB-4C only: Latex sensitivity
  • Moderate or severe acute illness with or without fever

Pneumococcal conjugate (PCV13)

Vaccine

Pneumococcal conjugate (PCV13)

  • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3
  • Severe allergic reaction (e.g., anaphylaxis) to any diphtheria-toxoid– containing vaccine or to its vaccine component3
Contraindications1
  • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3
  • Severe allergic reaction (e.g., anaphylaxis) to any diphtheria-toxoid– containing vaccine or to its vaccine component3
  • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3
  • Severe allergic reaction (e.g., anaphylaxis) to any diphtheria-toxoid– containing vaccine or to its vaccine component3
Precautions2
  • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3
  • Severe allergic reaction (e.g., anaphylaxis) to any diphtheria-toxoid– containing vaccine or to its vaccine component3

Pneumococcal polysaccharide (PPSV23)

Vaccine

Pneumococcal polysaccharide (PPSV23)

  • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3
Contraindications1
  • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3
  • Moderate or severe acute illness with or without fever
Precautions2
  • Moderate or severe acute illness with or without fever
Tetanus, diphtheria, and acellular pertussis (Tdap)

Tetanus, diphtheria (Td)

Vaccine
Tetanus, diphtheria, and acellular pertussis (Tdap)

Tetanus, diphtheria (Td)

  • 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
Contraindications1
  • 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
  • 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
Precautions2
  • 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 (VAR)

Vaccine

Varicella (VAR)

  • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3
  • Severe immunodeficiency (e.g., hematologic and solid tumors, receipt of chemotherapy, congenital immunodeficiency, long- term immunosuppressive therapy or patients with HIV infection who are severely immunocompromised)
  • Pregnancy
  • Family history of altered immunocompetence, unless verified clinically or by laboratory testing as immunocompetent
Contraindications1
  • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3
  • Severe immunodeficiency (e.g., hematologic and solid tumors, receipt of chemotherapy, congenital immunodeficiency, long- term immunosuppressive therapy or patients with HIV infection who are severely immunocompromised)
  • Pregnancy
  • Family history of altered immunocompetence, unless verified clinically or by laboratory testing as immunocompetent
  • 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
Precautions2
  • 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

Zoster recombinant vaccine (RZV)

Vaccine

Zoster recombinant vaccine (RZV)

  • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3
Contraindications1
  • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3
  • Moderate or severe acute illness with or without fever
  • Pregnancy or breastfeeding
  • Current herpes zoster infection
Precautions2
  • Moderate or severe acute illness with or without fever
  • Pregnancy or breastfeeding
  • Current herpes zoster infection
  1. When a contraindication is present, a vaccine should NOT be administered. Kroger A, Bahta L, Hunter P. ACIP General Best Practice Guidelines for Immunization.
  2. 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. Kroger A, Bahta L, Hunter P. ACIP General Best Practice Guidelines for Immunization.
  3. Vaccination providers should check FDA-approved prescribing information for the most complete and updated information, including contraindications, warnings, and precautions. See Package inserts for U.S.-licensed vaccines.
Page last reviewed: February 17, 2022