TABLE 1. Contraindications and precautions1 to commonly used vaccines in adults.*† Vaccine Contraindications Precautions
Severe allergic reaction (e.g., anaphylaxis) after previous
Moderate or severe acute illness with or without fever.
dose of any influenza vaccine or to a vaccine component,
History of Guillian-Barré syndrome (GBS) within 6 weeks of previous
Severe allergic reaction (e.g., anaphylaxis) after previous
Moderate or severe acute illness with or without fever.
dose of any influenza vaccine or to a vaccine component,
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
Certain chronic medical conditions such as asthma,
drugs for 14 days after vaccination.
diabetes, heart or kidney disease.3
Severe allergic reaction (e.g., anaphylaxis) after a previous
Moderate or severe acute illness with or without fever.
GBS within 6 weeks after a previous dose of tetanus toxoid--containing
For Tdap only: Encephalopathy (e.g., coma, decreased
level of consciousness, or prolonged seizures), not
History of arthus-type hypersensitivity reactions after a previous dose of
attributable to another identifiable cause, within 7 days of
tetanus or diptheria toxoid–containing vaccine; defer vaccination until
administration of previous dose of DTP, DTaP, or Tdap.
at least 10 years have elapsed since the last tetanus toxoid--containing
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.
Severe allergic reaction (e.g., anaphylaxis) after a previous
Recent (≤11 months) receipt of antibody-containing blood product
(specific interval depends on product).5, 6
Known severe immunodeficiency (e.g., from hematologic
Moderate or severe acute illness with or without fever.
and solid tumors, receipt of chemotherapy, congenital
Receipt of specific antivirals (i.e., acyclovir, famciclovir, or valacyclovir) 24
immunodeficiency, or long-term immunosuppressive
hours before vaccination; if possible, delay resumption of these antiviral
therapy4 or patients with HIV infection who are severely
drugs for 14 days after vaccination.
Severe allergic reaction (e.g., anaphylaxis) after a previous
Moderate or severe acute illness with or without fever.
Severe allergic reaction (e.g., anaphylaxis) to a vaccine
Moderate or severe acute illness with or without fever.
Receipt of specific antivirals (i.e., acyclovir, famciclovir, or valacyclovir) 24
Known severe immunodeficiency (e.g., from hematologic
hours before vaccination; if possible, avoid use of these antiviral drugs
and solid tumors, receipt of chemotherapy, or long-term
immunosuppressive therapy4 or patients with HIV infection
who are severely immunocompromised).
Measles, mumps, rubella Severe allergic reaction (e.g., anaphylaxis) after a previous
Moderate or severe acute illness with or without fever.
Recent (within 11 months) receipt of antibody-containing blood
Known severe immunodeficiency (e.g., from hematologic
product (specific interval depends on product).5, 6
and solid tumors, receipt of chemotherapy, congenital
History of thrombocytopenia or thrombocytopenic purpura.
immunodeficiency, or long-term immunosuppressive
Need for tuberculin skin testing.7
therapy4 or patients with HIV infection who are severely
Severe allergic reaction (e.g., anaphylaxis) after a previous
Moderate or severe acute illness with or without fever.
Severe allergic reaction (e.g., anaphylaxis) after a previous
Moderate or severe acute illness with or without fever.
Severe allergic reaction (e.g., anaphylaxis) after a previous
Moderate or severe acute illness with or without fever.
Severe allergic reaction (e.g., anaphylaxis) after a previous
Moderate or severe acute illness with or without fever.
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.
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. See CDC. Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices (ACIP), 2010. MMWR 2010;59(No. RR-8) at www.cdc.gov/vaccines/pubs/acip-list.
4. Substantially immunosuppressive steroid dose is considered to be ≥2 weeks of daily receipt of 20 mg or 2 mg/kg body weight of prednisone or equivalent. 5. Vaccine should be deferred for the appropriate interval if replacement immune globulin products are being administered. 6. See Table 5 in CDC. General Recommendations on Immunization: Recommendations of the Advisory Committee on Immunization Practices [ACIP] at www.cdc.gov/vaccines/pubs/acip-list.htm. 7. 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 ≥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: “General Recommendations on Immunization: Recommendations of the Advisory Committee on Immunization Practices” MMWR 2011; 60(No. RR-2), p.40-41 and Appendix A in “The Pink Book” Epidemiology and Prevention of Vaccine Preventable Diseases, 12th Edition 2011 at http://www.cdc.gov/vaccines/pubs/pinkbook/default.htm.
† Latex allergy: some types of prefilled syringes contain natural rubber latex or dry natural latex rubber. Consult the package insert for any vaccine administered.
More information on vaccine components, contraindications and precautions is also available from specific vaccine package inserts, the ACIP recommendations for specific vaccines, and is summarized in “The Pink Book” Epidemiology and Prevention of Vaccine Preventable Diseases, 12th Edition 2011 at http://www.cdc.gov/vaccines/pubs/pinkbook/default.htm.
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TABLE 1. Contraindications and precautions 1 to commonly used vaccines in adults.*† Vaccine Contraindications Precautions Severe allergic reaction (e.g., anaphylaxis) after previous Moderate or severe acute illness with or without fever. dose of any influenza vaccine or to a vaccine component, History of Guillian-Barré syndrome (GBS) within 6 weeks of previous Severe allergic r