DTaP

• Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component
• Encephalopathy (e.g., coma, decreased level of consciousness, prolonged seizures) not attributable to another identifiable cause within 7 days of administration of previous dose of DTP or DTaP
  

• Progressive neurologic disorder, including infantile spasms, uncontrolled epilepsy, progressive encephalopathy; defer DTaP until neurologic status clarified and stablized.
• Temperature of ≥105° F (≥40.5° C or higher) within 48 hours after vaccination with a previous dose of DTP or DTaP
• Collapse or shock-like state (i.e., hypotonic hyporesponsive episode) within 48 hours after receiving a previous dose of DTP/DTaP
• Seizure ≤3 days after receiving a previous dose of DTP/DTaP
• Persistent, inconsolable crying lasting ≥3 hours within 48 hours after receiving a previous dose of DTP/DTaP
• GBS <6 weeks after a previous dose of tetanus toxoid-containing vaccine
• History of arthus-type hypersensitivity reactions after a previous dose of tetanus or diphtheria-toxoid containing vaccines (including MCV4); defer vaccination until at least 10 years have elapsed since the last tetanus toxoid-containing vaccine
• Moderate or severe acute illness with or without fever

• Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component

• GBS <6 weeks after previous dose of tetanus toxoid-containing vaccine
• History of arthus-type hypersensitivity reactions after a previous dose of tetanus or diphtheria-toxoid containing vaccines (including MCV4); defer vaccination until at least 10 years have elapsed since the last tetanus toxoid-containing vaccine
• Moderate or severe acute illness with or without fever

Tdap

• Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component
• Encephalopathy (e.g., coma, decreased level of consciousness, prolonged seizures) not attributable to another identifiable cause, within 7 days of administration of previous dose of DTP, DTaP, or Tdap
  

• GBS <6 weeks after a previous dose of tetanus toxoid-containing vaccine
• Progressive or unstable neurologic disorder, uncontrolled seizures, or progressive encephalopathy; defer vaccination until a treatment regimen has been established and the condition has stabilized
• History of arthus-type hypersensitivity reactions after a previous dose of tetanus or diphtheria-toxoid containing vaccines (including MCV4); defer vaccination until at least 10 years have elapsed since the last tetanus toxoid-containing vaccine
• Moderate or severe acute illness with or without fever

• Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component

• Pregnancy
• Moderate or severe acute illness with or without fever

• Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component
• Pregnancy
• Known severe immunodeficiency (e.g., from hematologic and solid tumors, receipt of chemotherapy, congenital immunodeficiency, long-term immunosuppressive therapy4; or patients with HIV infection who are severely immunocompromised)3

• Recent (≤11 months) receipt of antibody-containing blood product (specific interval depends on product)5
• History of thrombocytopenia or thrombocytopenic purpura
• Need for tuberculin skin testing6
• Moderate or severe acute illness with or without fever

• Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component
• Age < 6 weeks

• Moderate or severe acute illness with or without fever

• Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component

• Infant weighing <2000 gm 7
• Moderate or severe acute illness with or without fever

• Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component

• Pregnancy
• Moderate or severe acute illness with or without fever

• Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component
• Known severe immunodeficiency (e.g., from hematologic and solid tumors, receipt of chemotherapy, congenital immunodeficiency, long-term immunosuppressive therapy4; or patients with HIV infection who are severely immunocompromised)3
• Pregnancy

• Recent (≤11 months) receipt of antibody-containing blood product (specific interval depends on product)8
• Moderate or severe acute illness with or without fever

• Severe allergic reaction (e.g., anaphylaxis) after a previous dose (of PCV7, PCV13, or any diphtheria toxoid-containing vaccine) or to a component of a vaccine (PCV7, PCV13, or any diphtheria toxoid-containing vaccine)

• Moderate or severe acute illness with or without fever

• Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component, including egg protein
  

• GBS <6 weeks after a previous dose of influenza vaccine
• Moderate or severe acute illness with or without fever

• Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component, including egg protein
• Pregnancy
• Immunosuppression
• Certain chronic medical conditions9

• GBS <6 weeks after a previous dose of influenza vaccine
• Moderate or severe acute illness with or without fever

• Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component

• Moderate or severe acute illness with or without fever

• Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component

• Moderate or severe acute illness with or without fever
  

• Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component

• Moderate or severe acute illness with or without fever
  

• Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component

• Pregnancy
• Moderate or severe acute illness with or without fever

• Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component
• SCID

• Altered immunocompetence other than SCID
• History of intussusception
• Chronic gastrointestinal disease10
• Spina bifida or bladder exstrophy10
• Moderate or severe acute illness with or without fever

• Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component
• Substantial suppression of cellular immunity
• Pregnancy

• Moderate or severe acute illness with or without fever

Abbreviations
DT = diphtheria and tetanus toxoids; DTaP = diphtheria and tetanus toxoids and acellular pertussis; GBS = Guillian-Barré syndrome; HBsAg = hepatitis B surface antigen; Hib = Haemophilus influenzae type b; HIV = human immunodeficiency virus; HPV = human papillomavirus; IPV = inactivated poliovirus; LAIV = live, attenuated influenza vaccine; MCV4 = quadrivalent meningococcal conjugate vaccine; MMRV = measles, mumps, rubella, and varicella; MPSV4 = quadrivalent meningococcal polysaccharide vaccine; PCV = pneumococcal conjugate vaccine; PPSV = pneumococcal polysaccharide vaccine; SCID = severe combined immunodeficiency; Td = tetanus and diphtheria toxoids; Tdap = tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis; TIV = trivalent inactivated influenza vaccine.

Footnotes

1. Events or conditions listed as precautions should be reviewed carefully. Benefits of and risks for administering a specific vaccine to a person under these circumstances should be considered. If the risk from the vaccine is believed to outweigh the benefit, the vaccine should not be administered. If the benefit of vaccination is believed to outweigh the risk, the vaccine should be administered. Whether and when to administer DTaP to children with proven or suspected underlying neurologic disorders should be decided on a case-by-case basis.
2. HIV-infected children may receive varicella and measles vaccine if CD4+ T-lymphocyte count is >15%. (Source: Adapted from American Academy of Pediatrics. Passive immunization. In: Pickering LK, ed. Red book: 2009 report of the committee on infectious diseases. 28th ed. Elk Grove Village, IL: American Academy of Pediatrics: 2009.)
3. MMR and varicella vaccines can be administered on the same day. If not administered on the same day, these vaccines should be separated by at least 28 days.
4. Substantially immunosuppressive steroid dose is considered to be ≥2 weeks of daily receipt of 20 mg or 2 mg/kg body weight of prednisone or equivalent.
5. See text and Table 5 in the ACIP General Recommendations for details.
6. Measles vaccination might suppress tuberculin reactivity temporarily. Measles-containing vaccine can be administered on the same day as tuberculin skin testing. If testing cannot be performed until after the day of MMR vaccination, the test should be postponed for ≥4 weeks after the vaccination. If an urgent need exists to skin test, do so with the understanding that reactivity might be reduced by the vaccine.
7. Hepatitis B vaccination should be deferred for infants weighing <2,000 g if the mother is documented to be HBsAg-negative at the time of the infant's birth. Vaccination can commence at chronological age 1 month or at hospital discharge. For infants born to HBsAg-positive women, hepatitis B immune globulin and hepatitis B vaccine should be administered within 12 hours after birth, regardless of weight.
8. Vaccine should be deferred for the appropriate interval if replacement immune globulin products are being administered (see Table 5).
9. Source: CDC. Prevention and control of seasonal influenza with vaccines: recommendations of the Advisory Committee on Immunization Practices (ACIP), 2010. MMWR 2010;59(No. RR-8).
10. For details, see CDC. Prevention of rotavirus gastroenteritis among infants and children: recommendations of the Advisory Committee on Immunization Practices. MMWR 2009;58(No. RR-2).