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Contraindications and precautions for influenza vaccine

Who should not receive the vaccine?

Influenza vaccination is contraindicated for individuals who have had documented anaphylaxis to any ingredient in the vaccine or to a previous dose of inactivated influenza vaccine. These individuals should not receive the vaccine.

Other considerations


Immunocompromised
Individuals who are immunocompromised can receive an influenza vaccination. Those who are immunocompromised are at high risk of severe influenza and complications. If possible, offer vaccination prior to the initiation of chemotherapy or immune suppressant medication. When this is not possible, influenza vaccination can be given while an individual is receiving most treatments. Following cessation of chemotherapy, normal immune responses return after about 30 days.(20) Specialist’s advice should be sought when considering influenza vaccination of individuals who have received a haematopoietic stem cell or solid organ transplantation in the preceding 6 months. The response to influenza vaccination in those with a poorly functioning immune system is likely to be low;(21) additional preventative strategies are important to reduce their exposure to influenza. It is advisable for all close contacts of immunocompromised people, aged from 6 months, to also receive an influenza vaccine (unfunded).

Egg allergy or egg anaphylaxis
AFLURIA QUAD, AFLURIA QUAD JUNIOR, FLUAD QUAD or FLUQUADRI can be administered to people with a history of egg allergy or egg anaphylaxis, although the data sheet advises caution in people who have a history of egg anaphylaxis. Studies have shown that influenza vaccines containing one microgram or less of ovalbumin do not trigger anaphylaxis insensitive individuals.(22) Each dose of AFLURIA QUAD, AFLURIA QUAD JUNIOR, FLUAD QUAD and FLUQUADRI contains less than one microgram of ovalbumin.(17-19)

Seafood, shellfish or other food allergy or anaphylaxis
People with a seafood or shellfish allergy or anaphylaxis can receive the influenza vaccine, including FLUAD QUAD, which contains the MF-59® adjuvant. The MF-59® adjuvant contains squalene, a compound that occurs naturally in plants, animals and even human sebum. In this instance, the MF-59® adjuvant in FLUAD QUAD is derived from the spiny dog fish, an abundant species of shark; squalene derived from this species is also used widely in the cosmetics industry. Allergy or anaphylaxis to other foods or products are not a contraindication for influenza vaccination.

Sulfonamide (sulphur) allergy
AFLURIA QUAD, AFLURIA QUAD JUNIOR, FLUAD QUAD or FLUQUADRI can be given to people with a sulfonamide (sulphur) allergy. Sulfonamide(sulphur) antibiotics, such as co-trimoxazole, sulfasalazine, and sulphite preservatives used in food, are different to medicines containing the words sulfate or sulphate, (eg, neomycin sulphate).(23) Sulfate itself does not cause allergic reactions. It is safe to use a sulfate when a person has a sulfonamide allergy or a sulfite intolerance.

Anticoagulant medication
AFLURIA QUAD, AFLURIA QUAD JUNIOR, FLUAD QUAD or FLUQUADRI can be administered to people on anticoagulants, including aspirin, dabigatran (Pradaxa®), enoxaparin(Clexane®), heparin, rivaroxaban (Xarelto®), ticagrelor (Brilinta™) and warfarin.24 After vaccination, apply firm pressure over the injection site without rubbing for 10 minutes to reduce the risk of bruising.

Latex
AFLURIA QUAD, AFLURIA QUAD JUNIOR, FLUAD QUAD and FLUQUADRI are latex-free.(17-19)

Antibiotics
AFLURIA QUAD and AFLURIA QUAD JUNIOR contain traces of Neomycin and polymixin B.(17) FLUAD QUAD contains traces of Kanamycin and neomycin.(19) The vaccines should be used with caution in people with known anaphylaxis to these respective antibiotics. No antibiotics are used to manufacture FLUQUADRI.(18)

History of Guillain–Barré syndrome (GBS)
No association was found between administering 16 a million doses of influenza vaccine and GBS in adults aged from 65 years in the US.(25) The risk of developing GBS is increased following influenza infection, and the magnitude of the risk is several times greater than that possibly occurring following influenza vaccination.(26-28) If GBS has occurred within 6 weeks of previous influenza vaccination, the decision to give an influenza vaccine should be based on careful consideration of the potential benefits and risks. For details of these benefits and risks refer to the Immunisation Handbook 2020 – Section 11.6.2 . 

Blood products
Blood products are not used in the manufacturing processes for AFLURIA QUAD,AFLURIA QUAD JUNIOR, FLUAD QUAD or FLUQUADRI. (17-19)

Thiomersal
AFLURIA QUAD, AFLURIA QUAD JUNIOR, FLUAD QUAD or FLUQUADRI are free of preservatives. They do not contain thiomersal. (17-19)

REFERENCES
17. Medsafe. Data sheet – Afluria Quad/Afluria Quad Junior [Internet]. Wellington: New Zealand Medicines and Medical Devices Safety Authority; 2017 [updated 2022 November; cited 2023 February 28] . Available from: https://www.medsafe.govt.nz/Medicines/infoSearch.asp

18. Medsafe. Data sheet – FluQuadri [Internet] Wellington: New Zealand Medicines and Medical Devices Safety Authority; 2022 [updated 2022 December 2; cited 2023 February 3]. Available from: https://www.medsafe.govt.nz/Medicines/infoSearch.asp

19. Medsafe. Data sheet – Fluad Quad [Internet]. Wellington: New Zealand Medicinesand Medical Devices Safety Authority; 2020 [updated 2022 November 11; cited 2023 February 3]. Available from: https://www.medsafe.govt.nz/Medicines/infoSearch.asp

20. Pollyea DA, Brown JMY, Horning SJ. Utility of influenza vaccination for oncology patients. J Clin Oncol. 2010;28(14):2481-90.

21. Beck CR, McKenzie BC, Hashim AB, Harris RC, Nguyen-Van- Tam JS. Influenza vaccination for immunocompromised patients: Systematic review and meta-analysis by etiology. J Infect Dis. 2012;206(8):1250-9.

22. Australasian Society of Clinical Immunology and Allergy. Vaccination of the egg-allergic individual [Internet]. Sydney: Australasian Society of Clinical Immunology and Allergy; 2017 [Available from: https:// www.allergy.org.au/images/stories/ pospapers/ASCIA_Guidelines_ vaccination_egg_allergic_individual_2017.pdf

23. Australasian Society of Clinical Immunology and Allergy. Sulfonamide antibioti callergy [Internet]. Sydney: Australasian Society of Clinical Immunology and Allergy Inc; 2019 [Available from: https://www.allergy.org.au/images/pcc/ASCIA_PCC_ Sulfonamide_antibiotic_allergy_2016.pdf

24. Kuo AM, Brown JN, Clinard V. Effect of influenza vaccination on international normalized ratio during chronic warfarin therapy. J Clin Pharm Ther.2012;37(5):505-9

25. Perez-Vilar S, Wernecke M, Arya D, et al. Surveillance for Guillain-Barre syndrome after influenza vaccination among U.S. Medicare beneficiaries during the 2017- 2018 season. Vaccine, 2019. 37(29): p. 3856-3865.

26. Bresee JS. 2018. Inactivated influenza vaccines, in Plotkin's Vaccines (7th edition), Plotkin S, Orenstein W, Offit P, et al. (eds). Elsevier: Philadelphia, US.

27. Jefferson T, Di Pietrantonj C, Rivetti A, et al. Vaccines for preventing influenza in healthy adults. Cochrane Database Syst Rev, 2010(7): p. CD001269.

28. Vellozzi C, Iqbal S, Broder K. Guillain-Barre syndrome, influenza, and influenza vaccination: the epidemiologic evidence. Clinical Infectious Diseases, 2014. 58(8): p. 1149-55.



Also see Administration of influenza vaccine