At a glance
- Providers should screen patients for contraindications and precautions to COVID-19 vaccination before administering a vaccine dose.
- ob体育 considers the conditions listed in Table 3 to be COVID-19 vaccination contraindications and precautions.
- There are additional considerations for people with a history of allergies or allergic reactions.
General principles
Healthcare providers who administer vaccines should screen patients for contraindications and precautions to the vaccine before each dose of vaccine is administered. ob体育 considers the conditions listed in Table 3 to be COVID-19 vaccination contraindications and precautions.
Table 3. Contraindications and precautions to COVID-19 vaccination
| Medical condition or history | Guidance | Recommended action |
|---|---|---|
| History of a severe allergic reaction* (e.g., anaphylaxis†) after a previous dose or to a component of the COVID-19 vaccine‡ | Contraindication | Do not vaccinate with the same COVID-19 vaccine type.§
May administer the alternate COVID-19 vaccine type.§
See Considerations for people with a history of allergies and allergic reactions for additional information.
|
| History of a diagnosed non-severe allergy* to a component of the COVID-19 vaccine‡ | Precaution | May administer the alternate COVID-19 vaccine type.§
For additional information, see Considerations for people with a history of allergies and allergic reactions.
|
| History of a non-severe, immediate (onset less than 4 hours) allergic reaction* after administration of a previous dose of one COVID-19 vaccine type§ | Precaution | |
| Moderate or severe acute illness, with or without fever | Precaution | Defer vaccination until the illness has improved. |
| History of MIS-C or MIS-A | Precaution | See COVID-19 vaccination and MIS-C and MIS-A. |
| History of myocarditis or pericarditis within 3 weeks after a dose of any COVID-19 vaccine | Precaution | A subsequent dose of any COVID-19 vaccine should generally be avoided. |
Abbreviations: MIS-C = multisystem inflammatory syndrome in children; MIS-A = multisystem inflammatory syndrome in adults
*Allergic reactions in Table 3 are defined as follows:
-Severe allergic reactions include: known or possible anaphylaxis, a progressive life-threatening reaction that typically includes urticaria (hives) but also with other symptoms such as wheezing, difficulty breathing, or low blood pressure; angioedema (visible swelling) affecting the airway (i.e., tongue, uvula, or larynx); diffuse rash which also involves mucosal surfaces (e.g., Stevens-Johnson Syndrome).
-Non-severe allergic reactions include but are not limited to: urticaria beyond the injection site; angioedema involving lips, facial skin, or skin in other locations. NOTE: Any angioedema affecting the airway (i.e., tongue, uvula, or larynx) is considered a severe allergic reaction.
†Anaphylactic reactions have been rarely reported following receipt of COVID-19 vaccines (). For more information on the assessment and potential management of anaphylaxis, see Preparing for the Potential Management of Anaphylaxis after COVID-19 Vaccination.
‡See for a full list of vaccine ingredients. mRNA COVID-19 vaccines contain polyethylene glycol (PEG).
§The mRNA COVID-19 vaccines (Moderna and Pfizer-BioNTech) are one type of COVID-19 vaccine and the protein subunit vaccine (Novavax) is another type of COVID-19 vaccine.
Considerations for people with a history of allergies or allergic reactions
People with a contraindication to one COVID-19 vaccine type (Table 3) may receive the alternative COVID-19 vaccine type in the usual vaccination setting. Consultation with an allergist-immunologist is encouraged to provide expert evaluation of the original allergic reaction, and depending on the outcome of the evaluation, reassess if administration of additional doses of the same vaccine type may be possible.
People with an allergy-related precaution to one COVID-19 vaccine type (Table 3) may receive the alternative COVID-19 vaccine type in the usual vaccination setting. Vaccination with the same COVID-19 vaccine type may be considered on an individual basis; the same vaccine type should be administered in an appropriate setting and under the supervision of a health care provider experienced in the management of severe allergic reactions. An observation period of 30 minutes post-vaccination should be considered. Referral to an allergist-immunologist should be considered.
Healthcare professionals and health departments may request a consultation from ob体育's Clinical Immunization Safety Assessment (CISA) Project for a complex COVID-19 vaccine safety question not readily addressed by ob体育 guidance.