There are certain circumstances when you should not receive a given vaccine, either temporarily or permanently. Most of these situations are obvious. If you have ever had a severe allergic reaction to a vaccine in the past, you should never get another dose of that vaccine. Similarly, if after receiving a certain vaccine, you or your child had one of the other rare or severe reactions listed, you will probably want to avoid that vaccine in the future, unless you and your doctor agree that the benefits outweigh the risks of a repeat reaction.
Some people have other allergies that also preclude certain vaccinations. If you have ever had a severe allergic reaction to eggs, you should not receive the influenza vaccine. Similarly, if you have had a severe reaction to any one of the ingredients in a vaccine, such as yeast, gelatin, latex, or certain antibiotics, then you should never receive a vaccine with that ingredient. Please inform your doctor of any allergies before receiving any vaccines. The complete list of ingredients can be found in the package insert of a given vaccine. Your doctor should have a copy in his or her office, or you can find the information on the Internet.
Some other illnesses or chronic conditions preclude the use of certain vaccines. If you have asthma, other significant lung disease, heart disease, or diabetes, or if you are on long-term aspirin therapy, you should not receive the nasal influenza vaccine. Instead, people with the listed chronic conditions should be protected with the injectable flu vaccine. One reason for this recommendation is that there is an increased risk of wheezing after the nasal flu vaccine.
If individuals have had Guillain-Barré syndrome (GBS) in the past, they should not receive the nasal influenza vaccine. They also will want to discuss the matter with their physician and might not want to get the injectable influenza or meningitis vaccine either. There is some concern that these vaccines are associated with a higher risk of recurring GBS.
If your child has an unstable, progressive neurological disorder, you should discuss the benefits and risk of the DTaP or Tdap vaccine with your doctor before giving them to your child. However, a stable neurological disorder, such as cerebral palsy or even seizures, is not a reason to avoid those vaccines.
Immune deficiencies also require care with vaccinations. A weakened immune system might be caused by cancers such as leukemia, infections such as AIDS, or chemotherapy or radiation therapy. Certain medications, such as steroids, and certain other medical treatment, such as blood transfusions or gamma globulin injections, can also temporarily alter the immune system. In all these situations, there are complicated rules as to when, if ever, to vaccinate with certain vaccines, and you will need to discuss these rules with your doctor.
Pregnant women should not be vaccinated with the human papillomavirus or any live virus vaccines such as the MMR, varicella, shingles, or nasal influenza vaccine. Although the risk is theoretical, it is possible that the weakened virus could cause an infection in the mother that would then spread to the fetus. For similar reasons, the injectable polio vaccine is usually avoided during pregnancy but can be given in certain circumstances. There are no reasons to avoid any vaccines while breast-feeding.
If you have a moderate or severe illness at the time the vaccine is scheduled to be given, you should usually defer the vaccine until you have recovered. Unfortunately, we cannot find a good definition of “moderate illness.” However, the following illnesses are considered only a mild illness, and vaccines may still be given: diarrhea, ear infections, and upper respiratory infections with or without a low-grade fever. In our office, we usually recommend deferring vaccines for fevers over 102ºF.