Contents

10 Influenza

10.6 Contraindications and precautions

10.6.1 Contraindications

See section 1.4 for general contraindications for all vaccines.

Fluvax is contraindicated for children aged under 5 years (see section 10.7) due to the increased risk of febrile events. The Ministry of Health recommends that Fluvax not be given to children aged under 9 years.

10.6.2 PrecautionsTop

Known egg allergy

Non-anaphylactic egg allergy is not a contraindication to influenza vaccination. A history of anaphylaxis to egg has been considered a contraindication to influenza vaccination. However, there is increasing evidence that it can be given safely.48, 49 Reported cases of anaphylaxis after influenza vaccination in egg-allergic individuals all occurred over 20 years ago, at a time when vaccine egg (ovalbumin) content was much higher than it is now.

For extra safety, for patients with definite previous egg anaphylaxis and who cannot tolerate any egg ingestion, the available vaccine with the lowest egg content (not exceeding 1.0 µg per dose) should be chosen and administered in hospital using a split-dose protocol (10 percent dose given, wait at least 30 minutes then give remainder of dose),50 as shown in Figure 10.6.

Figure 10.6: Influenza vaccination of the egg-allergic individual

Figure 10.6: Influenza vaccination of the egg-allergic individual

Adapted from: Australasian Society of Clinical Immunology and Allergy Inc. 2010. Guidelines for Medical Practitioners: Influenza vaccination of the egg-allergic individual. URL: www.allergy.org.au/health-professionals/papers/influenza-vaccination-of-the-egg-allergic-individual (accessed 8 October 2013).

History of Guillain-Barré syndrome

There appears to be a small increase in the risk of Guillain-Barré syndrome (GBS) following seasonal influenza vaccination (less than one additional case per million doses administered). This risk is substantially less than the risk of developing severe complications from influenza infection.11, 30 There is also more risk of developing GBS from wild-type influenza (4–7 cases per 100,000 persons) than from the inactivated vaccine strains.10

New Zealand hospitalisations for GBS showed no increase during the 1990s despite the marked increase in vaccine use during this period, but did show a marked year-to-year variation. In particular, the doubling of vaccine use in 1997 (with the introduction of funded vaccine) was not associated with any increase in GBS hospitalisations. No excess risk for GBS following influenza vaccine in children has been documented. No association between influenza vaccines and any other neurological disease has been substantiated.

Co-administration with PCV13

Individuals (or their parents/guardians) who are recommended to receive both influenza vaccine and 13-valent pneumococcal conjugate vaccine (PCV13) should be advised of the increased risk of fever following concomitant administration of these vaccines.45, 46 Separation of the vaccines by two days can be offered, but is not essential. (See also section 15.6.2).