Disease & Vaccine Information

Who should not get the COVID-19 vaccine?

Updated March 07, 2022


who should not get

Contraindications

Below are the age groups authorized to receive COVID-19 vaccines, as approved or authorized by the U.S. Food and Drug Administration (FDA): 

  • COMIRNATY mRNA vaccine is FDA approved for use in persons 16 years and older. The FDA has also determined that COMIRNATY is interchangeable with the Pfizer-BioNTech mRNA vaccine, which also has an EUA status. This means that both vaccines can be used interchangeably in individuals 12 years and older. Persons under 12 years of age should not receive this vaccine.
  • Moderna mRNA vaccine is authorized for persons 18 years of age and older. Persons under 18 years of age should not receive this vaccine.
  • Janssen/Johnson & Johnson viral vector vaccine is authorized for persons 18 years of age and older. Persons under 18 years of age should not receive this vaccine.

No data is available on the safety of administering mRNA COVID-19 vaccines with other vaccines. When COVID-19 vaccines were initially authorized for use, CDC health officials recommended that COVID-19 vaccines be administered alone, and not within 14 days of receiving another vaccine. 

However, at the May 12, 2021 CDC ACIP meeting, health officials updated their guidance and stated that the COVID-19 vaccine could be co-administered with other vaccines.  The CDC stated that their initial guidance recommending that COVID-19 vaccines be administered alone was not based on safety immunogenicity concerns, but rather out of an abundance of caution. The CDC continues to acknowledge that there is no safety or immunogenicity studies on co-administration of the COVID-19 vaccine with any vaccine. 

According to CDC interim clinical consideration guidelines for use of mRNA COVID-19 vaccines published on September 27, 2021, contraindications to receiving the Moderna, Pfizer-BioNTech, and/or Janssen/Johnson & Johnson vaccine include a history of: 

  • Severe allergic reaction to any ingredient contained within the vaccine or after a previous dose of the COVID-19 vaccine;
  • Immediate allergic reaction of any seriousness to any ingredient contained within the vaccine (including polyethylene glycol [PEG) or diagnosed allergy to a COVID-19 vaccine ingredient;

The CDC also states that persons that have a contraindication to one of the mRNA COVID-19 vaccines should not receive a second dose, and may be able to receive the Janssen/Johnson & Johnson COVID-19 vaccine, and vice versa, provided precautions are followed.  

Persons with an allergy to polysorbate may receive mRNA COVID vaccines, though previously this was considered a contraindication due to potential cross-reactive hypersensitivity to the polyethylene glycol (PEG) contained in these vaccines. However, a polysorbate allergy remains as a contraindication to receiving the Janssen/Johnson & Johnson COVID-19 vaccine. Guidance encourages providers to make distinctions between true allergic reactions versus other types of reactions, such as syncope or other vaccine side effects, to more accurately determine if a person who has reacted should receive a second dose of an mRNA COVID-19 vaccine. 

Precautions

Individuals with a history of previously receiving dermal fillers have experienced swelling near or at the site of filler injection after mRNA COVID-19 vaccine. While a history of receipt of dermal fillers is not a contraindication to receiving mRNA COVID-19 vaccines, the CDC advises that anyone who experiences swelling after vaccination should contact their health care provider immediately. 

The CDC cautions on the use of mRNA COVID-19 vaccines in persons who have a history of immediate allergic reaction to any injectable therapy or other vaccine, and states that precautions should be considered in consultation with an allergist-immunologist as follows: 

  • Persons with a contraindication to mRNA COVID-19 vaccines (including known PEG allergy) may be given to vaccination with Janssen/Johnson & Johnson COVID-19 vaccine.
  • Persons who have received the first dose of an mRNA COVID-19 and who have a contraindication to the second dose, should wait at least 28 days before receiving the Janssen/Johnson & Johnson COVID-19 vaccine.
  • Persons with a contraindication to Janssen/Johnson & Johnson COVID-19 vaccine (including diagnosed polysorbate allergy) may be given mRNA COVID-19 vaccines, and notes that polysorbate allergy is a precaution.

Special Populations and Conditions

Myocarditis and Pericarditis

According to the CDC, there is insufficient data on the safety or efficacy of COVID-19 vaccine in persons with a past history of myocarditis and pericarditis. The CDC, however, has stated that persons with a history of myocarditis and pericarditis that is unrelated to vaccination be vaccinated once symptoms have fully resolved. In persons who develop myocarditis or pericarditis following receipt of an mRNA COVID-19 vaccine, the CDC recommends that the second dose be deferred. 

The CDC also states that a second dose of mRNA vaccine can be considered in certain circumstances in this population following complete resolution of symptoms. These circumstances may include risk of severe illness, community spread, person infection risk, as well as the availability of additional data on the safety and long-term health outcomes of this population. 

Immunocompromised Populations

According to the Pfizer-BioNTech, Moderna, and Johnson & Johnson/Janssen Fact Sheet for Healthcare Providers Administering Vaccine, as well as the COMIRNATY mRNA COVID-19 vaccine package insert, individuals who are immunocompromised, including persons receiving immunosuppressive therapies, may not have an adequate immune response to vaccination.         Persons with certain immunosuppressive conditions who have previously received two doses of mRNA COVID-19 vaccines may receive a third dose of mRNA COVID-19 vaccine although it is not known whether a subsequent dose will offer any additional benefit. The third dose is recommended to be administered at least 28 days following the second dose. 

Previous History of Monoclonal Antibody or Convalescent Plasma Use

There is a lack of safety data on the use of mRNA COVID-19 vaccines in persons who have been treated for COVID-19 illness using monoclonal antibodies or convalescent plasma. As evidence appears to indicate that reinfection with SARS-CoV-2 virus is uncommon within 90 days of initial infection, health officials recommend that COVID-19 vaccination be deferred for at least three months following receipt of antibody therapy. 

Pregnancy and Lactation

According to the Pfizer-BioNTech, Moderna, and Johnson & Johnson/Janssen Fact Sheet for Healthcare Providers Administering Vaccine, as well as the COMIRNATY mRNA COVID-19 vaccine package insert, there is insufficient data to determine the safety of COVID-19 vaccines in pregnant women, and it is not known whether these vaccines can cause harm to the mother or developing baby. There is also no safety data on the use of mRNA COVID-19 vaccines in lactating women, or the effects of the vaccine on the breastfed baby.        

IMPORTANT NOTE: NVIC encourages you to become fully informed about covid-19 and the covid-19 vaccine by reading all sections in the Table of Contents, which contain many links and resources such as the manufacturer product information inserts, and to speak with one or more trusted health care professionals before making a vaccination decision for yourself or your child. This information is for educational purposes only and is not intended as medical advice.

 

Updated October 20, 2021


References:

1 U.S. Centers for Disease Control and Prevention. Age groups approved or authorized to receive COVID-19 vaccine by vaccine product.  In: Interim Clinical Considerations for Use of COVID-19 Vaccines Currently Approved or Authorized in the United States. Sept. 27, 2021.

2 U.S. Centers for Disease Control and Prevention. Coadministration of COVID-19 vaccines with other vaccines. In: Interim Clinical Considerations for Use of COVID-19 Vaccines Currently Approved or Authorized in the United States. Sept. 27, 2021.

3 Woodworth K. Clinical Considerations for Pfizer-BioNTech COVID-19 Vaccination in Adolescents. U.S. Centers for Disease Control and Prevention May 12, 2021.

4 U.S. Centers for Disease Control and Prevention. Coadministration of COVID-19 vaccines with other vaccines.  In: Interim Clinical Considerations for Use of COVID-19 Vaccines Currently Approved or Authorized in the United States. Sept. 27, 2021.

5 U.S. Centers for Disease Control and Prevention. Contraindications and precautions.  In: Interim Clinical Considerations for Use of COVID-19 Vaccines Currently Approved or Authorized in the United States. Sept. 27, 2021.

6 U.S. Centers for Disease Control and Prevention. Contraindications and precautions. In: Interim Clinical Considerations for Use of COVID-19 Vaccines Currently Approved or Authorized in the United States. Sept. 27, 2021.

7 U.S. Centers for Disease Control and Prevention. Considerations for vaccination of people with certain underlying medical conditions.  In: Interim Clinical Considerations for Use of COVID-19 Vaccines Currently Approved or Authorized in the United States. Sept. 27, 2021.

8  U.S. Centers for Disease Control and Prevention. Contraindications and precautions.  In: Interim Clinical Considerations for Use of COVID-19 Vaccines Currently Approved or Authorized in the United States. Sept. 27, 2021.

9 U.S. Centers for Disease Control and Prevention. Considerations for vaccination of people with certain underlying medical conditions. In: Interim Clinical Considerations for Use of COVID-19 Vaccines Currently Approved or Authorized in the United States. Sept. 27, 2021.

10 U.S. Centers for Disease Control and Prevention. Considerations for vaccination of people with certain underlying medical conditions. In: Interim Clinical Considerations for Use of COVID-19 Vaccines Currently Approved or Authorized in the United States. Sept. 27, 2021.

11 U.S. Food and Drug Administration. Pfizer-BioNTech COVID-19 Vaccine – Fact Sheet for Healthcare Providers Administering Vaccine. Sept. 22, 2021.

12 U.S. Food and Drug Administration. Package Insert – COMIRNATY. Aug. 23, 2021.

13 U.S. Food and Drug Administration. Moderna COVID-19 Vaccine Fact Sheet for Healthcare Providers Administering Vaccine. Aug. 27, 2021.

14 U.S Food and Drug Administration. Janssen COVID-19 Vaccine - Fact Sheet for Healthcare Providers Administering Vaccine. Aug. 27, 2021.

15 U.S. Centers for Disease Control and Prevention. Considerations for use of an additional mRNA COVID-19 vaccine dose after an initial 2-dose COVID-19 mRNA vaccine series for immunocompromised people. In: Interim Clinical Considerations for Use of COVID-19 Vaccines Currently Approved or Authorized in the United States. Sept. 27, 2021.

16 U.S. Centers for Disease Control and Prevention. COVID-19 vaccination and SARS-CoV-2 infection. In: Interim Clinical Considerations for Use of COVID-19 Vaccines Currently Approved or Authorized in the United States. Sept. 27, 2021.

17 U.S. Food and Drug Administration. Pfizer-BioNTech COVID-19 Vaccine – Fact Sheet for Healthcare Providers Administering Vaccine. Sept. 22, 2021.

18 U.S. Food and Drug Administration. Package Insert – COMIRNATY. Aug. 23, 2021.

19 U.S. Food and Drug Administration. Moderna COVID-19 Vaccine Fact Sheet for Healthcare Providers Administering Vaccine. Aug. 27, 2021.

20 U.S Food and Drug Administration. Janssen COVID-19 Vaccine - Fact Sheet for Healthcare Providers Administering Vaccine. Aug. 27, 2021.

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