21st February 2024

Special considerations

Vaccines have very few absolute contraindications and have few side effects. The most common absolute contraindication to vaccines includes:

• Confirmed anaphylactic reaction to previous vaccine dose
• Confirmed anaphylactic reaction to a component within the vaccine

Special considerations should be undertaken with the following patient populations:

• Egg/Latex allergy
• Primary/acquired immunodeficiency
  • This includes acute/chronic lymphoma and leukaemia; HIV/AIDS; cellular immunodeficiency due to SCID; Wiskott-Aldrich syndrome; DiGeorge syndrome; and recent stem cell transplant within the past 24 months. 
• Immunosuppressive therapies, including biological therapies
  • This includes chemotherapy, radiotherapy, high-dose corticosteroids, immunosuppression for solid organ transplants, and higher doses of methotrexate and azathioprine.
  • Low-dose corticosteroids and lower doses of non-biologic immune-modulating medications are not sufficient immunosuppression to withhold live vaccines. 
• Pregnancy

Patients with the above special consideration should not receive live, attenuated vaccines. Before administration, the relevant speciality prescribing the immunosuppressive therapy should be consulted. In pregnancy, live vaccinations should not be given due to the theoretical risk of foetal infection. Other vaccine types are safe to be administered to all these patient groups.