Who Should Not Be Immunized and Why

Written by Amy Boulanger | Published on November 14, 2014
Medically Reviewed by Kenneth R. Hirsch, MD on November 14, 2014

Complications of Immunization

The CDC advises certain individuals not to get specific vaccines. This is because different vaccines have different components. Certain individuals with a compromised immune system are typically advised to wait. People who have experienced allergic reactions to a particular vaccine are generally told to avoid follow-up doses.

Below are guidelines for those who shouldn’t get some of the more common vaccines. 

Influenza (Flu) Vaccine

Anyone who meets the following criteria should not get vaccinated for influenza:

  • allergy to chicken eggs
  • past reaction to the flu vaccine
  • infants younger than 6 months old
  • anyone who is currently moderately to severely ill

People with a history of Guillain-Barre syndrome (GBS) should discuss the risks of the flu vaccine with their doctor.

Those who shouldn’t get the live influenza vaccine (LAIV) (nasal spray flu vaccine) include:

  • adults over 50
  • children under 23 months of age
  • young children with a history of asthma or wheezing
  • pregnant women
  • people with chronic diseases, such as heart disease, liver disease, or asthma
  • people with certain muscle or nerve diseases that can cause breathing problems
  • people who have compromised immune systems
  • people working or living with those who have compromised immune systems
  • children or adolescents on long-term aspirin treatment

Hepatitis A

Hepatitis A (HepA) is a virus that causes liver disease. It’s primarily spread through consuming food or water that has been contaminated by human fecal waste, but it can also be spread through close contact. The Centers for Disease Control and Prevention (CDC) recommends routine HepA vaccinations for all adults if they didn’t receive the vaccination during childhood. It also emphasizes the importance of receiving the vaccine for individuals traveling to high-risk areas. These areas include:

  • Mexico
  • Central and South America
  • Africa
  • parts of Asia
  • eastern Europe

However, there are certain people who should not get this vaccine. Risk factors include:

  • past severe reaction to HepA vaccine
  • severe allergy to component(s) of the HepA vaccine, such as alum

People who are sick are generally advised to wait for the vaccination. Pregnant women may also be advised to wait for the vaccination. However, the risk to the fetus is low. If a pregnant woman is at high risk for HepA, vaccination may still be recommended.

Hepatitis B

Hepatitis B (HepB) is another virus that can cause liver disease. It can spread from infected blood or body fluids as well as from mother to her newborn child. People with chronic HepB infection are at increased risk of end stage liver disease (cirrhosis) as well as liver cancer.  Routine vaccination is recommended. However, certain individuals should not receive the HepB vaccine. Risk factors include:

  • severe allergy to yeast or other vaccine components
  • past severe reaction to HepB vaccine
  • moderate to severe current illness

People who have been vaccinated against HepB should wait at least 28 days before giving blood. The vaccine can cause false positive results on blood screening tests.

HPV (Human Papillomavirus)

Most HPV infections go away without the need for treatment. However, the HPV vaccine can help prevent cervical cancer in women if it’s administered before they become sexual active. It can also help prevent other HPV-related diseases including:

  • vulvar cancer
  • vaginal cancer
  • anal cancer
  • penile cancer
  • throat cancer
  • genital warts

The CDC advises the following people to avoid the HPV vaccine:

  • those with severe allergies to previous doses or HPV vaccine components
  • pregnant women (breast-feeding is fine)
  • people with a current moderate-to-severe illness

Tdap

The Tdap vaccine protects against tetanus, diphtheria, and pertussis. The Td vaccine protects against tetanus and diphtheria. Widespread vaccination has greatly decreased the serious consequences of these diseases.

Routine vaccines are recommended. However, there are certain people who should not get these vaccines, including:

  • people who have had severe allergic reaction to past doses of DTP, DTaP, DT, or Td
  • people who have had severe allergic reaction to any component of a vaccine
  • people who have had a coma or seizures within seven days after receiving the DTP or DTaP vaccines
  • people who are currently moderately to severely ill  

Other concerns to discuss with your doctor before getting the Tdap vaccine include:

  • having epilepsy
  • experiencing severe swelling from past doses of DTP, DTaP, DT, Td, or Tdap
  • having had Guillain Barré syndrome (GBS)

Requirements vary for each vaccine. You may be able to get one of the vaccine options but not another.

Shingles

Shingles is caused by reactivation of the chickenpox virus (varicella zoster virus).  This virus is a member of the herpes virus family of viruses but it’s not the same virus that causes cold sores or genital herpes. Shingles is more common in people over 50. It’s also seen in individuals who have a weakened immune system.

Adults over age 60 are recommended to get one dose of the shingles vaccine for protection. However, certain people should not receive this vaccine. Avoid the shingles vaccine if you:  

  • have allergies to  gelatin, neomycin (an antibiotic), or other vaccine components
  • have a weakened immune system
  • are pregnant, might be pregnant, or intend to get pregnant within the next month
  • are currently moderately to severely ill

Certain groups are more likely to have a weakened immune system. This includes individuals who:

  • have AIDS
  • are on certain drugs, such as high-dose steroids
  • are currently being treated for cancer
  • have bone or lymphatic cancers

These individuals should not get the shingles vaccine.

Meningococcal Disease

Meningococcal disease is a bacterial illness. It can affect all ages. However, it’s most common in:

  • infants younger than a year old
  • individuals without a spleen or who have certain genetic immune deficiencies (complement deficiency)
  • college freshmen who live in dorms

Meningococcal vaccination is recommended in young adulthood. There are two types of vaccine offered in the United States. MCV4 is the newer meningococcal conjugate vaccine. MPSV4 is the older meningococcal polysaccharide vaccine.

Individuals who shouldn’t receive the meningococcal vaccine include:

  • anyone with a current moderate-to-severe illness
  • anyone with a history of allergic reactions to the meningococcal vaccine
  • anyone allergic to a vaccine component
  • anyone who has had Guillain-Barre syndrome (GBS)

Meningococcal vaccines can be administered to pregnant women. However, MPSV4 is preferred. The MCV4 vaccine has not been studied as much in pregnant women.

Children with sickle cell disease should get this vaccine at a different time than their other vaccines, as should children with damage to their spleens. 

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