Vaccine type | Contraindications | Precautions |
Egg-based IIV4s |
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ccIIV4 |
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RIV4 |
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LAIV4 |
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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.Do you want to add Medilib to your home screen?