Who Should and Who Should NOT Get a Flu Vaccine

Everyone 6 months of age and older, with rare exceptions, should get an influenza (flu) vaccine every season. Different influenza vaccines are approved for different age groups. Some people (for example, pregnant people and people with some chronic health conditions) should not get some types of influenza vaccines, and some people should not receive flu vaccines at all (though this is rare). Everyone should receive a flu vaccine that is appropriate for their age and health status. For people younger than 65 years, there is no preference for any one vaccine over another. Beginning with the 2022-2023 flu season, there are three flu vaccines that are preferentially recommended for people aged 65 and older. These are Fluzone High-Dose Quadrivalent vaccine, Flublok Quadrivalent recombinant flu vaccine, and Fluad Quadrivalent adjuvanted flu vaccine.

• Influenza (Flu) Shot
• Nasal Spray Flu Vaccine:
• Who Should be Prioritized for Flu Vaccination During a Vaccine Shortage

This page includes information on who should and who should not get a flu vaccine, and who should talk to a health care professional before vaccination. Talk to your health care provider if you have any questions regarding which influenza vaccines are best for you and your family.

All persons aged 6 months of age and older, with rare exception, are recommended for annual flu vaccination.

Vaccination is particularly important for people who are at higher risk of developing serious flu complications.

People who can get the flu shot:

Flu shots are appropriate for most people.

• Different flu shots are approved for people of different ages. Everyone should get a vaccine that is appropriate for their age.
• There are standard-dose inactivated flu vaccines that are approved for people as young as 6 months of age.
• Some vaccines are only approved for adults. For example, the recombinant flu vaccine is approved for people aged 18 years and older, and the adjuvanted and high-dose inactivated vaccines are approved for people 65 years and older.
• Pregnant people and people with certain chronic health conditions should get a flu shot.
• People with egg allergy may get any vaccine (egg-based or non-egg-based) that is otherwise appropriate for their age and health status. Beginning with the 2023-2024 season, additional safety measures are no longer recommended for flu vaccination of people with an egg allergy beyond those recommended for receipt of any vaccine, regardless of the severity of previous reaction to egg. Visit Flu Vaccine and People with Egg Allergies for more information about egg allergies and flu vaccine.

People who SHOULD NOT get a flu shot include:

• Children younger than 6 months of age are too young to get a flu shot.
• People with severe, life-threatening allergies to any ingredient in a vaccine, including flu vaccine (other than egg proteins), should not get that vaccine. This might include gelatin, antibiotics, or other ingredients.
• People who have had a severe allergic reaction to a dose of influenza vaccine should not get that flu vaccine again and might not be able to receive other influenza vaccines. If you have had a severe allergic reaction to an influenza vaccine in the past, it is important to talk with your health care provider to help determine whether vaccination is appropriate for you.

People who should talk to their health care provider before getting a flu shot:

If you have one of the following conditions, talk with your health care provider. He or she can help decide whether vaccination is right for you, and select the best vaccine for your situation:

• If you ever had Guillain-Barré Syndrome (a severe paralyzing illness, also called GBS), talk to your doctor about your GBS history. Some people with a history of GBS should not get a flu vaccine.
• If you had a severe allergic reaction to a previous dose of any other flu vaccine, talk to your health care provider.
• If you are feeling sick, talk to your doctor about your symptoms.

People who can get a nasal spray flu vaccine: The nasal spray vaccine is approved for people 2 years through 49 years of age. Many people in this age group can receive the nasal spray vaccine. The nasal spray vaccine is not recommended for some groups, such as people who are pregnant and people with some medical conditions.

People who SHOULD NOT get a nasal spray vaccine:

• Children younger than 2 years of age.
• Adults 50 years of age and older.
• People who have had a severe or life-threatening allergic reaction to any ingredient in the nasal spray vaccine (other than egg proteins).
• People who have had a severe allergic reaction to any flu vaccine.
• Children and adolescents 2 through 17 years of age who are receiving aspirin- or salicylate-containing medications.
• People with weakened immune systems (immunosuppression) due to any cause, including (but not limited to) immunosuppression from medications, congenital or acquired immune disorders, HIV infection, or asplenia.
• People who care for or are close contacts of severely immunocompromised persons who require a protected environment (or otherwise avoid contact with those persons for 7 days after getting the nasal spray vaccine).
• Pregnant people.
• Children 2 years through 4 years who have asthma or who have had a history of wheezing in the past 12 months.
• People with cerebrospinal fluid (CSF) leaks (communication and leakage of fluid between the space surrounding the brain and the nose, throat, ear, or any other place in the head).
• People with cochlear implants.
• People who have recently taken influenza antiviral drugs. This depends on the specific influenza antiviral medication that was taken, and how recently the last dose was taken.

People who should talk to their health care provider before getting a nasal spray vaccine:

If you have one of the following conditions, talk with your health care provider. He or she can help decide whether vaccination is right for you, and select the best vaccine for your situation:

• People with asthma 5 years and older.
• People with other underlying medical conditions that can put them at higher risk of developing serious flu complications. These include conditions such as chronic lung diseases, heart disease (except isolated hypertension), kidney disease, liver disorders, neurologic and neuromuscular disorders, blood disorders, or metabolic disorders (such as diabetes).
• People with moderate or severe acute illness with or without fever.
• People with Guillain-Barré Syndrome after a previous dose of influenza vaccine.

When vaccine supply is limited, vaccination efforts should focus on delivering vaccination to the following people (no hierarchy is implied by order of listing):

• Children aged 6 months through 4 years (59 months);
• People aged 50 years and older;*
• People with chronic pulmonary (including asthma) or cardiovascular (except isolated hypertension), renal, hepatic, neurologic, hematologic, or metabolic disorders (including diabetes mellitus);
• People who are immunosuppressed due to any cause, including immunosuppression caused by medications or by human immunodeficiency virus (HIV) infection;
• People who are or will be pregnant during the influenza season and people up to two weeks after delivery;
• People who are aged 6 months through 18 years who are receiving aspirin or salicylate-containing medications and who might be at risk for experiencing Reye syndrome after influenza virus infection;
• People who are residents of nursing homes and other long-term care facilities;
• American Indian or Alaska Native persons;
• People with extreme obesity (body-mass index [BMI] is 40 or greater);
• Health care personnel;
• Household contacts and caregivers of children under 5 years and adults aged 50 years and older; and
• Household contacts and caregivers of people with medical conditions that put them at increased risk for severe illness from influenza.

*Among adults, complications, hospitalizations, and deaths due to influenza are generally most common among people 65 years and older. However, adults 50 years and older are a priority group for vaccination because they may be more likely to have chronic medical conditions that put them at higher risk of severe influenza illness.

People with egg allergy may get any vaccine (egg-based or non-egg-based) that is otherwise appropriate for their age and health status. Previously, it was recommended that people with severe allergy to egg (those who have had any symptom other than hives with egg exposure) be vaccinated in an inpatient or outpatient medical setting. Beginning with the 2023-2024 season, additional safety measures are no longer recommended for flu vaccination of people with an egg allergy beyond those recommended for receipt of any vaccine, regardless of the severity of previous reaction to egg. All vaccines should be given in settings where allergic reactions can be recognized and treated quickly.