Contraindications and precautions associated with influenza vaccinations
While the instructions given below apply to vaccines included in the national vaccination programme, they can also be applied to other influenza vaccines.
Who can an influenza vaccine not be administered to?
An influenza vaccine should not be administered to a person in whom a previous influenza vaccination has caused a severe and immediate allergic reaction (anaphylaxis).
An injectable vaccine may not be administered to infants aged under six months.
The Fluenz Tetra vaccine administered as a nasal spray must not be given to
- a child aged under two years
- a person aged 18 or over
- a person whose immune system is greatly weakened due to either an illness or its treatment
- a child receiving salicylate treatment.
Precautions and issues to be noted when administering vaccinations
A child with asthma
A vaccination administered as a nasal spray should be postponed if
- the child’s asthma is not under proper therapeutic control
- the child has a respiratory infection with wheezing symptoms.
If the child's asthma is under proper therapeutic control, the vaccine can be administered. Regular asthma medication is not a contraindication if the child has not been wheezing in the last three days.
Alternatively, a vaccine containing killed viruses can be administered to the child.
Administering a nasal spray vaccine to family members of a person with immune deficiency
A nasal spray vaccine may usually be administered to those close to a person with immune deficiency. This vaccine should not be administered to them, however, if the person's immune deficiency is extremely severe. Immune deficiency is severe if, for example, the person has to be isolated due to their illness or is having an organ transplant.
If someone close to such a person nevertheless wishes to have the nasal spray vaccine, they may not be in contact with the person in isolation for approximately two weeks after its administration. It is possible that the vaccine viruses could infect a person with severe immune deficiency close to the vaccine recipient.
The risk of the vaccine viruses causing a serious disease is very small, however, as they have been attenuated and can only multiply in the upper respiratory tract.
Antiviral drugs may reduce the effectiveness of the nasal spray vaccine
Antivirals used to treat influenza may reduce the effectiveness of a nasal spray vaccine. The vaccination can be administered once two days have passed since the last dose of the medication.
Administering antiviral agents against influenza within two weeks of the vaccination may reduce the vaccine's effectiveness in protecting the recipient.
Antivirals are not known to affect the protective effectiveness of the injectable influenza vaccine.
Fever
No vaccinations may be administered while the recipient has a fever or febrile infection; the vaccination must be postponed until the recipient has recovered.
Egg allergy
In most cases, a person allergic to chicken eggs can receive the vaccine normally.
Influenza vaccines contain very small residues of egg protein.
- The risk of an actual serious reaction, anaphylaxis, is very low.
- It is possible that recipients allergic to chicken eggs may develop some degree of symptoms.
- Most of those allergic to eggs do not develop symptoms.
Pregnancy
Nasal spray vaccines are not recommended for pregnant women. An injectable influenza vaccine may be administered at any stage of pregnancy.
Age
The nasal spray vaccine is not recommended for children under 2 years of age, as the live attenuated vaccine may cause wheezing in the respiratory tract in this age group.
The European Medicines Authority (EMA) has also not granted a marketing authorisation for this vaccine for administration to those aged 18 and over, as it does not provide sufficient protection in adults. The mucous membranes in the upper respiratory tract of an adult contain a large number of antibodies which prevent the proliferation of the pathogens in the nasal spray vaccine, and the recipient thus does not develop adequate protection.
Formaldehyde allergy
A formaldehyde allergy is usually not a contraindication to administering the influenza vaccine.
Injectable influenza vaccine doses only contain small traces of formaldehyde: depending on the product, at maximum 10 or 30 micrograms/dose.
Formaldehyde allergy is usually manifested as a delayed local irritation symptom on the skin. It does not increase the vaccine recipient’s risk of an anaphylactic reaction.
Antibiotic allergy
Those allergic to antibiotics can usually be vaccinated, even if antibiotic residues are listed in the summary of product characteristics. If the vaccine recipient has had severe allergic reactions following an influenza vaccination, the decision to administer the influenza vaccination should be made by the treating physician together with the recipient.
Acetylsalicylate treatment
The manufacturer notes that drugs containing acetylsalicylic acid should not be given to a child within 4 weeks of the administration of a nasal spray vaccine. If the child is given drugs containing acetylsalicylate before this period has passed, they may develop the Reye's syndrome.
Guillain-Barré syndrome, GBS
The decision to administer an influenza vaccination to a person newly diagnosed with the Guillain-Barré syndrome (GBS) should be made by the treating physician together with the recipient. The possibility of GBS symptoms becoming worse or recurring for a time following vaccination cannot be fully excluded. However, it should be remembered that the risk of developing GBS caused by influenza is much higher than the risk of getting it as a result of the vaccination.
