Who Should Not Get the Influenza (Flu) Vaccines?
Different influenza vaccines are licensed by the FDA and approved for use in different groups of people according to a person’s age, state of health and personal history of allergies or reactions to previous vaccinations. By federal law, pharmaceutical companies producing vaccines for release in the US. must publish information that accompanies vials of vaccine shipped to public health clinics and doctors’ offices that contain information about the vaccine’s ingredients, safety and effectiveness data from pre-licensure clinical trials, contraindications and precautions, reported vaccine adverse events, age use recommendations and more.
Prior to receiving an influenza vaccination or any vaccination, NVIC encourages consumers to read information contained in the vaccine manufacturer package insert carefully.
Note: There are certain influenza vaccines that are licensed for use by people in certain age groups. For example, high-dose flu shots are not licensed for use by people under age 65 years and flu shots administered intradermally are not licensed for use by children under age 18 years. Refer to the specific vaccine’s product insert in Influenza Quick Facts for additional information.
According to most manufacturer’s package inserts for influenza vaccines, children younger than six months of age and people with severe, life-threatening allergies to influenza vaccine or any ingredient in the vaccine should not receive flu shots.
Most influenza vaccine package inserts with the exception of Flucelvax, using Madin Darby canine kidney cells for production, and Flublok, using armyworm cells for production, list an allergy to egg and egg protein as a contraindication to vaccination because most influenza vaccines are made using chicken eggs.
However, in 2016, the CDC’s Advisory Committee on Immunization Practices (ACIP) revised flu shot recommendations for people with egg allergies and stated that individuals with an allergy to egg can receive any type of flu vaccine, whether manufacturers use chicken eggs for production or not. CDC officials state that individuals who develop hives from egg products may be vaccinated without any special precautions, while those who have experienced a severe anaphylactic reaction (one involving respiratory distress, angioedema or use of epinephrine) should be monitored in a setting where there is a health care professional trained to recognize and quickly treat an anaphylactic reaction. While CDC officials state that allergic reactions can occur in individuals who are allergic to eggs, they consider it to be rare and not serious enough to warrant a contraindication.1 2
Currently, a history of GBS or a severe allergy to a vaccine component or history of a life threatening allergic reaction to a previous flu shot are the only CDC approved official contraindications (medical reasons for not getting vaccinated) to receiving inactivated influenza vaccines.3 However, the CDC also states that influenza vaccination should be postponed if a child or adult has “moderate or severe acute illness with or without a fever,” which is listed as a “precaution” for receipt of any vaccine. 4
Live Nasal Spray Flu Vaccine (FluMist): A new formulation of live FluMist nasal spray influenza vaccine will be available for the 2018-2019 flu season as an option when appropriate.5 The reintroduction of FluMist reverses a 2016 CDC decision recommending against the use of this vaccine which was determined to be ineffective at preventing influenza.6 FluMist is available in the U.S. and, due to the possibility of vaccinated persons shedding and transmitting live vaccine strain influenza virus to others, recently vaccinated persons are advised to avoid close contact with immune-compromised individuals for at least 21 days.
- Individuals who should not get a live nasal spray influenza vaccine:
- Children younger than two years old
- Adults 50 years and older
- People with a history of a severe allergic reaction to any component of the vaccine or to a previous dose of any influenza vaccine
- People who are allergic to eggs
- Children two years through 17 years of age who are receiving aspirin therapy or aspirin-containing therapy.
- Pregnant women
- People with weakened immune systems (immunosuppression)
- Children two to four years old who have asthma or have had a history of wheezing in the past 12 months
- People who have taken influenza antiviral drugs within the previous 48 hours
- People who care for severely immunocompromised persons who require a protective environment (or otherwise avoid contact with those persons for 7 days after getting the nasal spray vaccine).
Individuals who should talk to their doctor before getting the live nasal spray flu vaccine:
There are also other “warnings and precautions” for the nasal spray flu vaccine. You should talk to your doctor if you have:
- Asthma: Children and adults of any age with asthma might be at increased risk for wheezing after getting the nasal spray flu vaccine.
- A chronic condition like lung disease, heart disease, kidney or liver disorders, neurologic/neuromuscular, or metabolic disorders. The safety of the live nasal spray flu vaccine has not been established in people with underlying medical conditions that place them at high risk of serious flu complications. See People at High Risk of Developing Flu–Related Complications.
- If you ever had GBS (a severe paralyzing illness). Talk to your doctor about your GBS history.
- If you have gotten any other vaccines in the past 4 weeks, or if you are not feeling well.
IMPORTANT NOTE:NVIC encourages you to become fully informed about Influenza and the Influenza 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.
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1 CDC. Prevention and Control of Seasonal Influenza with Vaccines Recommendations of the Advisory Committee on Immunization Practices — United States, 2016–17 Influenza Season MMWR Aug. 26, 2016; 65(5):1–54.
2 CDC. Flu Vaccine and People with Egg Allergies Sept. 2, 2016.
3 CDC. Seasonal Influenza Vaccine Safety - A Summary for Clinicians: Contraindications and Precautions. Oct. 3, 2017.
4 CDC. Vaccine Recommendations and Guidelines of the ACIP: Contraindications and Precautions. Oct. 4, 2017.
5 Walker, M. ACIP Reinstates FluMist for 2018-2019 Flu Season. MEDPAGE TODAY Feb. 21, 2018
6 CDC. ACIP votes down use of LAIV for 2016-2017 flu season. Jun. 22, 2016