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Subsections
ACIP Immunization Contraindications and Precautions

Immunizations

ACIP Immunization Contraindications and Precautions

Influenza Vaccine

  • Influenza, inactivated (IIV)
    • Contraindications
      • Severe allergic reaction (e.g., anaphylaxis) after previous dose of any influenza vaccine
        • Any egg-based IIV, ccIIV, RIV, or LAIV of any valency
    • Precautions
      • 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 (RIV)
    • Contraindications
      • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component
      • SCID
      • History of intussusception
    • Precautions
      • Altered immunocompetence other than SCID
      • Chronic gastrointestinal disease
      • Spina bifida or bladder exstrophy
      • Moderate or severe acute illness with or without fever
  • Influenza, live attenuated (LAIV)
    • Previously issued guidance regarding contraindications and precautions is provided below for informational purposes
      • Contraindications
        • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component
        • Concomitant use of aspirin or salicylate- containing medication in children and adolescents
        • LAIV4 should not be administered to persons who have taken
        • Children aged 2 through 4 years who have received a diagnosis of asthma or whose parents or caregivers report that a health care provider has told them during the preceding 12 months
          • Child had wheezing or asthma or
          • Whose medical record indicates a wheezing episode has occurred during the preceding 12 months
        • Persons with active CSF/oropharyngeal communications/leaks
        • Close contacts and caregivers of severely immunosuppressed persons
          • Who require a protected environment
        • Pregnancy
        • Persons w/ cochlear implant
        • Altered immunocompetence
        • Anatomic or functional asplenia (e.g. sickle cell disease)
      • Precautions
        • GBS within 6 weeks after a previous dose of any type of influenza vaccine
        • Asthma in persons aged 5 years or older
        • Medical conditions which might predispose to higher risk of complications attributable to influenza
        • Moderate or severe acute illness with or without fever
  • Influenza, cell culture-based inactivated injectable
    • Contraindications
      • Severe allergic reaction (e.g., anaphylaxis) to any ccIIV of any valency, or to any component of ccIIV4
    • Precautions
      • Guillain-Barré syndrome (GBS) within 6 weeks after a previous dose of any type of influenza vaccine
      • 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
      • Moderate or severe acute illness with or without fever

Tetanus, Diphtheria, Pertussis Vaccine (Td, Tdap)

  • Contraindications
    • Td
      • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component
    • DTaP
      • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component
      • 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 or DTaP
    • Tdap
      • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component
      • 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
  • Precautions
    • 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 Vaccine

  • Contraindications
    • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component
    • Severe immunodeficiency
      • Hematologic and solid tumors
      • Receipt of chemotherapy
      • Congenital immunodeficiency
      • Long-term immunosuppressive therapy
      • Patients with HIV infection who are severely immunocompromised
    • Pregnancy
    • Family history of altered immunocompetence
      • Unless verified clinically or by laboratory testing as immunocompetent
  • Precautions
    • 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

Human Papillomavirus Vaccine

  • Contraindications
    • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component
    • Pregnancy
      • HPV vaccination not recommended
  • Precautions
    • Moderate or severe acute illness with or without fever

Zoster Vaccine

  • Contraindications
    • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component
  • Precautions
    • Moderate or severe acute illness with or without fever
    • Current herpes zoster infection

Measles, Mumps, Rubella (MMR) Vaccine

  • Contraindicated
    • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component
    • Severe immunodeficiency
      • Hematologic and solid tumors
      • Receipt of chemotherapy
      • Congenital immunodeficiency
      • Long-term immunosuppressive therapy
      • Patients with HIV infection who are severely immunocompromised
    • Pregnancy
    • Family history of altered immunocompetence
      • Unless verified clinically or by laboratory testing as immunocompetent
  • Precautions
    • Recent (< 11 months) receipt of antibody-containing blood product
      • Specific interval depends on product
    • History of thrombocytopenia or thrombocytopenia purpura
    • Need for tuberculin skin testing or interferon-gamma release assay (IGRA) testing
    • Moderate or severe acute illness w/ or w/o fever

Inactivated Polio Vaccine

  • Contraindications
    • A severe reaction (e.g., anaphylaxis, after a previous dose or to a vaccine component)
  • Precautions
    • Moderate or severe acute illness with or without fever
    • Pregnancy

Rotavirus Vaccine

  • Precaution
    • Immunocompromised status (excluding HIV infection)
    • Chronic GI disorder
    • RV1 only: spina bifida or bladder exstrophy
    • Moderate or severe acute illness w/ or w/o fever
    • HIV infection: <15% or total CD4 cell count of <200/mm3
    • HIV infection: ≥15% or total CD4 cell count of ≥200/mm3
  • Contraindicated
    • Severe combined immunodeficiency (SCID)
    • Severe allergic rxn (e.g., anaphylaxis) to previous dose or to a vaccine component
    • History of intussusception

Pneumococcal Conjugate (PCV13, PCV15, PCV20) Vaccine

  • Contraindications
    • Severe allergic reaction (e.g., anaphylaxis)
      • After a previous dose or to a vaccine component
      • To any diphtheria-toxoid–containing vaccine or to its vaccine component
    Precautions
    • Moderate or severe acute illness with or without fever

Pneumococcal Polysaccharide (PPSV23) Vaccine

  • Contraindications
    • Severe allergic reaction (e.g., anaphylaxis) after a previous dose of PCV or any diphtheria-toxoid– containing vaccine or to a component of a vaccine (PCV or any diphtheria-toxoid– containing vaccine)
  • Precautions
    • Moderate or severe acute illness with or without fever

Hepatitis A Vaccine

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

Hepatitis B Vaccine

  • Contraindications
    • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component
    • Hypersensitivity to yeast
  • Precautions
    • Moderate or severe acute illness with or without fever

Meningococcal, Conjugate (MenACWY)

  • Contraindications
    • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component
    • 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
  • Precautions
    • Moderate or severe acute illness with or without fever
    • Preterm birth (MenACWY-CRM)

Meningococcal Subgroup B (MenB) Vaccine

  • Contraindications
    • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component
  • Precautions
    • Moderate or severe acute illness with or without fever
    • Pregnancy
    • For Men2B-4C only: latex sensitivity

Haemophilus influenzae type b (Hib) Vaccine

  • Contraindications
    • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component
    • Age <6 weeks
  • Precautions
    • Moderate or severe acute illness with or without fever

RSV (JYNNEOS)

  • Contraindications
    • Severe allergic reaction (e.g., anaphylaxis) after a previous JYNNEOS dose or any component of vaccine
  • Precautions
    • Less effective in severely immunocompromised persons
      • Has shown to be safe and immunogenic in persons with well-controlled HIV, atopic dermatitis, eczema, or other exfoliative skin conditions

References

  1. Centers for Disease Control and Prevention (CDC). Vaccine Recommendations and Guidelines of the ACIP: Contraindications and Precautions. Available at: https://www.cdc.gov/vaccines/hcp/acip-recs/general-recs/contraindications.html. [Accessed August 2025]

Contributor(s)

  1. Pacheco, Caleb S., MD
  2. Hernandez, James, DO
  3. Singh, Ajaydeep, MD

Updated/Reviewed: August 2025