September 4, 2013
Who Should Not Receive Specific—or Any—Flu Vaccines

Atlanta—While the recommendations for who should receive influenza vaccinations are fairly common knowledge—everyone older than 6 months should get a flu jab with rare exceptions—who should avoid the vaccine is not as widely understood. That’s why the CDC recently issued a seasonal flu update on that topic.

Those who should never receive the flu shot include those who have had a severe allergic reaction to the vaccine and those with a history of Guillain-Barré Syndrome that occurred after receiving influenza vaccine and who are not at risk for severe illness from influenza, according to the CDC. (Those who have had the syndrome but are at high risk of flu complications should consult with their physicians to determine whether they should get a vaccination.)

Influenza vaccine also has not been approved for infants younger than 6 months old.

While those who are mildly ill usually can receive flu vaccinations, people with moderate or severe illness should wait until they recover before getting immunized, the CDC said.

More specific restrictions apply to the following categories, according to public health officials:

• Those under 65 years of age who should not receive the high-dose flu shot
• Those under 18 years old or over 64 years old who should not receive the intradermal flu shot

In addition, the nasal spray vaccine (LAIV) is not recommended for adults 50 years of age and older or children from 6 through 23 months of age.

The restriction also applies to anyone who has ever had a severe reaction to eggs, defined as angioedema, respiratory distress, lightheadedness, recurrent emesis, or requiring epinephrine or another emergency medical intervention.

Those with a mild reaction to egg—which only involved hives—may receive the flu shot with additional precautions, usually in a physician’s office. The recombinant hemagglutinin influenza vaccine, available as a trivalent formulation (RIV3) for 2013-2014, however, is “egg-free and may be used for persons aged 18-49 years who have no other contraindications,” according to the CDC.

In addition to the usual precautions involving past Guillain-Barré Syndrome or current illness, nasal spray vaccine also is contraindicated in some other situations. Those include people who have had a severe reaction to the vaccine in the past; asthma patients or children younger than 5 years of age who have had episodes of wheezing within the past year; pregnant women; muscle or nerve disorder patients with breathing or swallowing problems; children or adolescents on long-term aspirin treatment; anyone with a nasal condition serious enough to make breathing difficult, such as a very stuffy nose; and anyone with a weakened immune system or in contact with someone with a weakened immune system who receives care in a protected environment, such as a bone marrow transplant unit.

Nasal spray vaccine may be used, however, by close contacts of other people with a weakened immune system, such as those with HIV, and by health care personnel in neonatal intensive care units or oncology clinics, the CDC says.

U.S. Pharmacist Social Connect