Skip directly to site content Skip directly to search


Español  Other Languages


Centers for Disease Control and Prevention. CDC twenty four seven. Saving Lives, Protecting People
 Search
		×
			Vaccines site
			Vaccines site
				All CDC
				Submit
			For a full list of topics:A-Z Index
			Advanced Search
		Advanced Search


Advisory Committee on Immunization Practices (ACIP)








Grading of Recommendations, Assessment, Development, and Evaluation (GRADE): Safety of Influenza Vaccines for Persons with Egg Allergy						Print
																Related Pages
										On This Page
			IntroductionMethodsSummary
		
Introduction
Most of the influenza vaccines currently approved and available in the United States are produced by the propagation of influenza viruses in eggs (1-7).  These vaccines therefore can contain small quantities of egg proteins.  As of the 2022-23 influenza season, ACIP has recommended annual influenza vaccination for all persons aged 6 months and older with egg allergy, regardless of severity of previous allergic reactions to egg and with any licensed influenza vaccine that is otherwise appropriate for the recipient’s age and health status (8).  For those with a history of severe allergic reaction to egg (defined as any symptom other than hives), an additional recommendation has been made that such individuals be vaccinated in a medical setting, supervised by a provider who is able to recognize and manage a severe allergic reaction.  This recommendation differs from those of the American Academy of Pediatrics, which since the 2016-17 influenza season has recommended that no measures beyond those recommended for any recipient of any vaccine are needed for persons with egg allergy (9).  Such measures are also not recommended by the Joint Task Force of the American Academy of Allergy, Asthma and Immunology (AAAAI) and the American College of Allergy, Asthma and Immunology (ACAAI) (10).  Additionally, vaccination providers are recommended to be prepared for the possibility of severe allergic reactions when administering any vaccine to any recipient (11). The current review was performed to assess whether the safety of influenza vaccines for persons with egg allergy favors routine vaccination of this population without additional measures, regardless of severity of previous allergic reactions to egg.Methods
A systematic literature review using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach was performed to assess published evidence concerning the safety of influenza vaccines for persons with egg allergy.  Medline, Embase, PsycInfo, CINAHL, NTIS, Scopus, Cochrane Library, and ClinicalTrials.gov were searched from inception through October 26, 2021.  Report types included were those describing randomized controlled trials, observational studies, case reports, case series, safety surveillance system reports (including Vaccine Adverse Event Reporting System and other safety surveillance system reports).  Abstracts for which no associated papers were found were included.   Animal studies, duplicate reports, clinical trial registry summaries, and review articles were excluded.  Clinical trial registry summaries and bibliographies of relevant review articles were reviewed in order to help identify additional eligible reports.  Data included were those evaluating egg-based vaccines only, administered to egg-allergic individuals either by full-dose (single-step) administration protocol (in which the whole dose volume is administered in one step) or a split-dose protocol (in which the required dose volume is administered in two steps, most commonly 10% of the dose followed by an observation period, with the remaining 90% of the dose volume administered if no adverse effects are observed).  In instances where vaccine was not specified, determination of vaccine type was attempted where it was possible to make a reasonable assumption based upon the location and influenza season in which the study was conducted and vaccine administration method used. Data with unknown vaccine type, unspecified/unclear administration protocol, graded (≥3 steps) dosing, and/or unknown denominator were excluded.  GRADE assessment was performed with stratification based on vaccine type (seasonal inactivated influenza vaccine, monovalent H1N1pdm09 inactivated influenza vaccine, or live attenuated influenza vaccine) and severity of egg allergy (e.g., egg allergy of all severities vs those with a history of severe allergy/anaphylaxis to egg).Table 1: Policy Questions and PICO
Table 1: Policy Questions and PICO
Policy question
Does available evidence concerning safety of influenza vaccines in persons with a history of egg allergy favor routine vaccination without additional safety measures, regardless of severity of previous allergic reaction to egg?**Population**
Persons of any age with a history of allergy to eggs, or who have had an allergic reaction to influenza vaccine believed to be secondary to egg allergy.Intervention
Receipt of any influenza vaccine.Comparison
Placebo, nonegg-based influenza vaccine, non-influenza control vaccine, no vaccine, no comparator.Outcomes§
***Critical:***
Death
Anaphylaxis meeting Brighton criteria Levels 1-3*
Anaphylaxis otherwise classified*
Allergic reaction symptoms requiring hospitalization
***Important:***
Allergic reaction symptoms requiring outpatient or emergency department medical attention†
Allergic reaction including cardiovascular symptoms, respiratory symptoms, angioedema, or generalized urticaria*These outcomes are combined in the evidence profile tables.
†Includes instances described as being treated with medications, without specific mention of transfer to a different care setting.§Reactions occurring up to four hours post-vaccination.Table 2: Outcomes and Rankings

Table 2: Outcomes and Rankings
Outcome§
Importance
Included in evidence profileDeath
Critical
YesAnaphylaxis meeting Brighton criteria Levels 1-3*
Critical
YesAnaphylaxis otherwise classified*
Critical
YesAllergic reaction symptoms requiring hospitalization
Critical
YesAllergic reaction symptoms requiring outpatient or emergency department medical attention†
Important
YesAllergic reaction including cardiovascular symptoms, respiratory symptoms, angioedema, or generalized urticaria
Important
Yes*These outcomes are combined in the evidence profile tables.†Includes instances described as being treated with medications without mention of transfer to a different care setting.§Reactions occurring up to four hours post-vaccination.Table 3. Summary of Studies Reporting Occurrences of Outcomes of Interest
Table 3a: Seasonal Inactivated Influenza Vaccines
Table 3a: Seasonal Inactivated Influenza Vaccines
Author
Publication year
Age
N intervention
Comparator
Events by outcome
Methodological quality concern*Anvari 2011 (12)
Not specified
86
None
None
UnclearChung 2010 (13)
Skin test group: Average 6.2
(95%CI 5.1-7.2) yrs
Non-skin test group: Average 3.9
(95%CI 3.3-4.5) yrs
171
None
None
ModerateComeau 2016† (14)
Not specified
88
None
None
UnclearDes Roches 2012-1 (15)
<2 yrs: 27
2-4 yrs: 83
5-11 yrs: 82
>12 yrs: 37
230
None
None
LowDes Roches 2012-2 (15)
<2 yrs: 29
2-4 yrs: 53
5-11 yrs: 51
>12 yrs: 4
137
None
None
UnclearErlewyn-Lajeunesse 2010† (16)
Not specified
16 doses§
None
Cardiovascular, respiratory, angioedema, or generalized urticaria: 1
UnclearEsposito 2008 (17)
6.03 +/- 3.33 yrs
44
Non-allergic group
Outpatient or emergency department medical attention: 1
Cardiovascular, respiratory, angioedema, or generalized urticaria: 1
LowGreenhawt 2012-1 (18)
Median 11-12 mos
31
Comparison of full- vs. split-dose (combined in this review)
None
LowGreenhawt 2012-2 (18)
Median 12 mos at diagnosis
112
None
None
LowHotte 2008† (19)
Not provided
164 doses§
None
None
UnclearHowe 2011 (20)
Not specified
69
Non-allergic group
None
UnclearJames 1998 (21)
Median 3 (1-46) yrs
83
Non-allergic group
Outpatient or emergency department medical attention: 2
Cardiovascular, respiratory, angioedema, or generalized urticaria: 3
LowLeo 2010† (22)
Not provided
31
None
None
UnclearPark 2008† (23)
Mean 36.1 +/- 19.9 (11 to 105 mos)
33
None
None
UnclearPaschall 2011† (24)
Mean 3.8 yrs
65 doses§
None
None
UnclearShimizu 2016 (25)
Median 15
(IQR 13-20) mos
17
None
None
LowThanik 2010† (26)
Not specified
214 doses§
None
None
Unclear
*Adapted from Murad MH et al, BMJ Evid Based Med 2018;23(2):60-62 (27). Domains assessed included Selection, Ascertainment, Causality (excluding items pertaining to alternative causes and dose-response effect), and Reporting.†Abstract only.§ Number of individuals unclear.Table 3b: Monovalent H1N1pdm09 Inactivated Influenza Vaccines
Table 3b: Monovalent H1N1pdm09 Inactivated Influenza Vaccines
Author
Publication year
Age
N intervention
Comparator
Events by outcome
Methodological quality concern*Didenko 2010 (28)
median 4 (2-11) yrs
6
None
None
ModerateForsdahl 2012 (29)
Mean 6.25 yrs
(10 mos-16.5 yrs)
80
None
Outpatient or emergency department medical attention: 1
Cardiovascular, respiratory, angioedema, or generalized urticaria: 1
ModerateGagnon 2010-1 (30)
173 <2 yrs
280 2-4 yrs
277 5-11 yrs
100 ≥12 yrs
830
Non-allergic group
Outpatient or emergency department medical attention: 4
Cardiovascular, respiratory, angioedema, or generalized urticaria: 6
LowGagnon 2010-2 (30)
Not specified
3640
None
Outpatient or emergency department medical attention: 68
Cardiovascular, respiratory, angioedema, or generalized urticaria: 26
UnclearGreenhawt 2010 (31)
Mean 5.5 (range 0.4-20.4) yrs
105
Non-allergic group
None
LowLeo 2010† (22)
Not specified
50
None
None
UnclearPaschall 2011† (24)
Mean 3.8 yrs
66
None
None
UnclearPien 2010 (32)
Mean 3.7 +/- 3.0 yrs
59
None
None
ModeratePitt 2011 (33)
Mean 5.6 (1-27) yrs
59
None
None
ModerateSchuler 2011 (34)
Mean 4.5 yrs
(10 mos-16 yrs)
62
None
Outpatient or emergency department medical attention: 4
ModerateSiret-Alatrista 2010 (35)
Unclear
53
None
None
UnclearSpiegel 2010† (36)
Range 1-56 yrs
150
None
None
UnclearUpton 2012 (37)
3-5 yrs:12
6-9 yrs:24
10-13 yrs:28
14+ yrs:10
75
None
None
Moderate
*Adapted from Murad MH et al, BMJ Evid Based Med 2018;23(2):60-62 (27).  Domains assessed included Selection, Ascertainment, Causality (excluding items pertaining to alternative causes and dose-response effect), and Reporting.†Abstract only.Table 3c: Seasonal Live Attenuated Influenza Vaccine
Table 3c: Seasonal Live Attenuated Influenza Vaccine
Author
Publication year
Age
N intervention
Comparator
Events by outcome
Methodological quality concern*Des Roches 2015 (38)
2-16 yrs
68
Non-allergic group
None
LowTurner 2015a (39)
Median 4.9 yrs
(2-17 yrs)
282
None
Cardiovascular symptoms, respiratory symptoms, angioedema, or generalized urticaria: 6
LowTurner 2015b (40)
Median 5.3 yrs
(2-18 yrs)
779
None
Cardiovascular symptoms, respiratory symptoms, angioedema, or generalized urticaria: 4
Low
*Adapted from Murad MH et al, BMJ Evid Based Med 2018;23(2):60-62 (27). Domains assessed included Selection, Ascertainment, Causality (excluding items pertaining to alternative causes and dose-response effect), and ReportingTable 4: GRADE Evidence Profile Tables
Table 4a: Seasonal inactivated influenza vaccine administered full or split dose, egg allergy of all severities.
Table 4a—Seasonal inactivated influenza vaccine administered full or split dose, egg allergy of all severities.
Certainty assessment
Impact
Certainty
ImportanceNo of studies
Study design
Methodological
Quality*
Inconsistency
Indirectness
Imprecision
Other considerations1. Death17
observational studies
seriousa
not serious
seriousb
seriousc
none
0/1591 (0%)
Very low
CRITICAL2. Anaphylaxis17
observational studies
seriousa
not serious
seriousb
seriousc
none
0/1591 (0%)
Very low
CRITICAL3. Allergic reaction symptoms requiring hospitalization17
observational studies
seriousa
not serious
seriousb
seriousc
none
0/1591 (0%)
Very low
CRITICAL4. Allergic reaction symptoms requiring outpatient or emergency department medical attention (includes instances treated with medications)17
observational studies
seriousa
not serious
seriousb
seriousc
none
3/1591 (0.2%)
Very low
IMPORTANT5. Allergic reaction including cardiovascular symptoms, respiratory symptoms, angioedema, or generalized urticaria17
observational studies
seriousa
not serious
seriousb
seriousc
none
5/1591 (0.3%)
Very low
MPORTANT
*Adapted from Murad MH et al, Methodological quality and synthesis of case series and case reports, BMJ Evid Based Med 2018;23(2):60-62 (27).  Domains assessed included Selection, Ascertainment, Causality (excluding items pertaining to alternative causes and dose-response effect), and Reporting.
**Explanations**
a. All are cohort studies without comparator interventions, with the exception of one randomized study which compared administration of full dose vs split dose. Because full-dose and split- dose administration are treated as equivalent in this assessment, this study is treated here as a cohort study. Ten of 17 are of unclear methodological quality. Seven of 17 are abstracts.
b. Includes 322/1591 (20%) persons with a history of severe allergy/anaphylaxis to egg.
c. Cannot assess imprecision as these are proportions with no confidence intervals. However, some degree of imprecision should be assumed.Table 4b: Seasonal inactivated influenza vaccine administered full or split dose, persons with a history of severe allergy/anaphylaxis to egg
Table 4b: Seasonal inactivated influenza vaccine administered full or split dose, persons with a history of severe allergy/anaphylaxis to egg
Certainty assessment
Impact
Certainty
ImportanceNo of studies
Study design
Methodological
Quality*
Inconsistency
Indirectness
Imprecision
Other considerations1. Death10a
observational studies
seriousb
not serious
not serious
seriousc
none
0/322 (0%)
Very low
CRITICAL2. Anaphylaxis10a
observational studies
seriousb
not serious
not serious
seriousc
none
0/322 (0%)
Very low
CRITICAL3. Allergic reaction symptoms requiring hospitalization10a
observational studies
seriousb
not serious
not serious
seriousc
none
0/322 (0%)
Very low
CRITICAL4. Allergic reaction symptoms requiring outpatient or emergency department medical attention (includes instances treated with medications)9a
observational studies
seriousb
not serious
not serious
seriousc
none
0/295 (0%)d
Very low
IMPORTANT5. Allergic reaction including cardiovascular symptoms, respiratory symptoms, angioedema, or generalized hives8a
observational studies
seriousb
not serious
not serious
seriousc
none
0/291 (0%)e
Very low
IMPORTANT
*Adapted from Murad MH et al, Methodological quality and synthesis of case series and case reports, BMJ Evid Based Med 2018;23(2):60-62 (27). Domains assessed included Selection, Ascertainment, Causality (excluding items pertaining to alternative causes and dose-response effect), and Reporting.
**Explanations**
a. Includes only studies which explicitly mentioned inclusion of persons with severe allergy/anaphylaxis to egg for whom outcomes can be discerned.
b. All are cohort studies without comparator intervention groups, including administration via either full dose or split-dose (2-step) protocols. Four of 10 are of unclear methodological quality. Two of 10 are abstracts.
c. Cannot assess imprecision as these are proportions with no confidence intervals. However, some degree of imprecision should be assumed.
d. One study including (n=27) removed from denominator which reported events, but unclear whether they occurred in persons with severe allergy/anaphylaxis to egg.
e. Two studies (n=31) removed from denominator which reported events, but unclear whether they occurred in persons with severe allergy/anaphylaxis to egg.Table 4c: Monovalent inactivated influenza vaccine administered full or split dose, egg allergy of all severities.
Table 4c—Monovalent inactivated influenza vaccine administered full or split dose, egg allergy of all severities
Certainty assessment
Impact
Certainty
ImportanceNo of studies
Study design
Methodological
Quality*
Inconsistency
Indirectness
Imprecision
Other considerations1. Death13
observational studies
very seriousa
not serious
seriousb
seriousc
none
0/5235 (0%)
Very low
CRITICAL2. Anaphylaxis13
observational studies
very seriousa
not serious
seriousb
seriousc
none
0/5235 (0%)d
Very low
CRITICAL3. Allergic reaction symptoms requiring hospitalization13
observational studies
very seriousa
not serious
seriousb
seriousc
none
0/5235 (0%)
Very low
CRITICAL4. Allergic reaction symptoms requiring outpatient or emergency department medical attention (includes instances treated with medications)13
observational studies
very seriousa
not serious
seriousb
seriousc
none
77/5235 (1.5%)
Very low
IMPORTANT5. Allergic reaction including cardiovascular symptoms, respiratory symptoms, angioedema, or generalized urticaria13
observational studies
seriousa
not serious
seriousb
seriousc
none
33/5235 (0.6%)
Very low
IMPORTANT
*Adapted from Murad MH et al, Methodological quality and synthesis of case series and case reports, BMJ Evid Based Med 2018;23(2):60-62 (27).  Domains assessed included Selection, Ascertainment, Causality (excluding items pertaining to alternative causes and dose-response effect), and Reporting.
**Explanations**
a. All were cohort studies without comparator intervention groups, including administration via either full dose or split-dose (2-step) protocols. Five of 13 are of unclear methodological quality. Three of 13 are abstracts.
b. Includes 66/5235 (1.3%) persons with a history of severe allergy/anaphylaxis to egg.
c. Cannot assess imprecision as these are proportions without confidence intervals. However, some degree of imprecision should be assumed.
d. One instance of Brighton Level 1 anaphylaxis in a person with “possible egg allergy” was reported in a Vaccine Adverse Event Reporting System (VAERS) surveillance summary from the 2009-10 influenza season (41). This instance is not included in GRADE as no denominator of persons or doses administered is available. However, it was reported that 127,075,320 doses of monovalent influenza vaccine were distributed in the United States for the season.Table 4d: Monovalent inactivated influenza vaccine administered full or split dose, persons with a history of severe/allergy anaphylaxis to egg.
Table 4d—Monovalent inactivated influenza vaccine administered full or split dose, persons with a history of severe/allergy anaphylaxis to egg
Certainty assessment
Impact
Certainty
ImportanceNo of studies
Study design
Methodological
Quality*
Inconsistency
Indirectness
Imprecision
Other considerations1. Death3
observational studies
very seriousb
not serious
not serious
seriousc
none
0/66 (0%)
Very low
CRITICAL2. Anaphylaxis3
observational studies
very seriousb
not serious
not serious
seriousc
none
0/66 (0%)
Very low
CRITICAL3. Allergic reaction symptoms requiring hospitalization3
observational studies
very seriousb
not serious
not serious
seriousc
none
0/66 (0%)
Very low
CRITICAL4. Allergic reaction symptoms requiring outpatient or emergency department medical attention (includes instances treated with medications)3
observational studies
very seriousb
not serious
not serious
seriousc
none
0/66 (0%)
Very low
IMPORTANT5. Allergic reaction including cardiovascular symptoms, respiratory symptoms, angioedema, or generalized urticaria3
observational studies
very seriousb
not serious
not serious
seriousc
none
0/66 (0%)
Very low
IMPORTANT
*Adapted from Murad MH et al, Methodological quality and synthesis of case series and case reports, BMJ Evid Based Med 2018;23(2):60-62 (27). Domains assessed included Selection, Ascertainment, Causality (excluding items pertaining to alternative causes and dose-response effect), and Reporting.
**Explanations**
a. Includes only studies which explicitly mentioned inclusion of persons with severe allergy/anaphylaxis to egg for whom outcomes can be discerned.
b. Cohort studies without comparator intervention groups, including administration via either full dose or split-dose (2-step) protocols.
c. Cannot assess imprecision as these are proportions without confidence intervals. However, some degree of imprecision should be assumed.Table 4e: Live attenuated influenza vaccine, egg allergy of all severities
Table 4e: Live attenuated influenza vaccine, egg allergy of all severities
Certainty assessment
Impact
Certainty
ImportanceNo of studies
Study design
Methodological
Quality*
Inconsistency
Indirectness
Imprecision
Other considerations1. Death3
observational studies
seriousa
not serious
seriousb
seriousc
none
0/1129 (0%)
Very low
CRITICAL2. Anaphylaxis3
observational studies
seriousa
not serious
seriousb
seriousc
none
0/1129 (0%)
Very low
CRITICAL3. Allergic reaction symptoms requiring hospitalization3
observational studies
seriousa
not serious
seriousb
seriousc
none
0/1129 (0%)
Very low
CRITICAL4. Allergic reaction symptoms requiring outpatient or emergency department medical attention (includes instances treated with medications3
observational studies
seriousa
not serious
seriousb
seriousc
none
0/1129 (0%)
Very low
IMPORTANT5. Allergic reaction including cardiovascular symptoms, respiratory symptoms, angioedema, or generalized urticaria3
observational studies
seriousa
not serious
seriousb
seriousc
none
10/1129 (0.9%)
Very low
IMPORTANT
*Adapted from Murad MH et al, Methodological quality and synthesis of case series and case reports, BMJ Evid Based Med 2018;23(2):60-62 (27). Domains assessed included Selection, Ascertainment, Causality (excluding items pertaining to alternative causes and dose-response effect), and Reporting.
**Explanations**
a. All are cohort studies without a comparison intervention, including administration via either full dose or split-dose (2-step) protocols.
b. Includes 412/1129 (36%) persons with a history of severe allergy/anaphylaxis to egg.
c. Cannot assess imprecision as these are proportions without no confidence intervals. However, some degree of imprecision should be assumedTable 4f: Live attenuated influenza vaccine, persons with a history of severe allergy/anaphylaxis to egg
Table 4f: Live attenuated influenza vaccine, persons with a history of severe allergy/anaphylaxis to egg
Certainty assessment
Impact
Certainty
ImportanceNo of studies
Study design
Methodological
Quality*
Inconsistency
Indirectness
Imprecision
Other considerations1. Death3a
observational studies
seriousb
not serious
not serious
seriousc
none
0/412 (0%)
Very low
CRITICAL. Anaphylaxis3a
observational studies
seriousb
not serious
not serious
seriousc
none
0/412 (0%)
Very low
CRITICAL3. Allergic reaction symptoms requiring hospitalization3a
observational studies
seriousb
not serious
not serious
seriousc
none
0/412 (0%)
Very low
CRITICAL4. Allergic reaction symptoms requiring outpatient or emergency department medical attention (includes instances treated with medications)3a
observational studies
seriousb
not serious
not serious
seriousc
none
0/412 (0%)
Very low
IMPORTANT5. Allergic reaction including cardiovascular symptoms, respiratory symptoms, angioedema, or generalized urticaria1a
observational studies
seriousb
not serious
not serious
very seriousd
none
0/27 (0%)e
Very low
IMPORTANT
*Adapted from Murad MH et al, Methodological quality and synthesis of case series and case reports, BMJ Evid Based Med 2018;23(2):60-62 (27). Domains assessed included Selection, Ascertainment, Causality (excluding items pertaining to alternative causes and dose-response effect), and Reporting.
**Explanations**
a. Includes only studies which explicitly mentioned inclusion of persons with severe allergy/anaphylaxis to egg for whom outcomes can be discerned.
b. All are cohort studies with no comparison groups, including administration via either full dose or split-dose (2-step) protocols.
c. Cannot assess imprecision as these are proportions without confidence intervals. However, some degree of imprecision should be assumed.
d. Cannot assess imprecision as these are proportions without confidence intervals. However, some degree of imprecision should be assumed. Very low denominator count.
e. Two studies (n=385) removed from denominator which reported events, but unclear whether they occurred in persons with severe allergy/anaphylaxis to egg.Table 5. Summary of Evidence for Outcomes of Interest
Table 5. Summary of Evidence for Outcomes of Interest
Outcome
Importance
Included in profile
Certainty*Death
Critical
Yes
Very lowAnaphylaxis meeting Brighton criteria Levels 1-3
Critical
Yes
Very lowAnaphylaxis otherwise classified
Critical
Yes
Very lowAllergic reaction symptoms requiring hospitalization
Critical
Yes
Very lowAllergic reaction symptoms requiring outpatient or emergency department medical attention
Important
Yes
Very lowAllergic reaction including cardiovascular symptoms, respiratory symptoms, angioedema, or generalized urticaria
Important
Yes
Very low*Certainty was assessed as Very low for every outcome for each of the three vaccine types (seasonal inactivated, monovalent inactivated, and live attenuated).Summary
Overall across vaccine types, frequency of adverse events was low, with no occurrences of the predefined critical outcomes among studies for which denominators were available. Important outcomes such as reaction symptoms requiring outpatient or emergency department medical attention (the majority being instances in which medications were given, without explicit mention of transfer to another clinical setting; Appendix 2) and reactions including cardiovascular symptoms, respiratory symptoms, angioedema, or generalized urticaria were uncommon.
Limitations:
All studies were observational without comparison groups, with the exception of one randomized study comparing full- and split- dosing for which these two groups were combined and the study treated as a cohort study.
For eight studies, data were available only from abstracts, which contain limited information.
Some studies employed skin testing with egg proteins and/or vaccine prior to decision to vaccinate, or to guide selection of administration protocol. This might introduce selection bias.
There was variability in level of detail in which reactions were described.
Observation time post-vaccination varied (under 4 hours for most studies; generally 30 min to 2 hours), and time elapsed post-vaccination not often reported for reactions that occurred after the recipient left the vaccination setting.
Data specifically for persons with severe allergy/anaphylaxis to egg were limited. Not all studies specified that persons with severe egg allergy/anaphylaxis were included.  Not all studies which included such persons reported reactions specifically for this subgroup.Appendix 1: Studies Included in Review of Evidence
Appendix 1 Table A: Seasonal influenza vaccines (N=20)
Appendix 1 Table A: Seasonal influenza vaccines (N=20)
Author and publication year
Study design
Country
Season(s)
Age
N of egg allergic persons
Intervention vaccine
Comparator
Funding sourceAnvari 2011 (12)
Cohort
United States
2010-11
Not provided
86
Seasonal inactivated vaccine
No comparator group
UnclearChung 2010 (13)
Retrospective cohort
United States
2002-03 through 2008-09
Skin test group: Average 6.2 yrs
(95%CI 5.1-7.2 yrs)
Non-skin test group: Average 3.9 yrs
(95%CI 3.3-4.5 yrs)
171
Seasonal inactivated vaccine
No comparator group
Housestaff research and education
fund.Comeau 2016† (14)
Cohort
Australia
2012-2016
Not provided.
Based at a children’s hospital.
88
26 (30%) with anaphylaxis to egg
Seasonal inactivated vaccine
No comparator group
UnclearDes Roches 2012 (15)
Prospective cohort
Canada
2010-11 and 2011-12
<2 yrs: 27
2-4 yrs: 83
5-11 yrs: 82
>12 yrs: 37
230
101 (44%) with a history of severe allergy to egg.
Seasonal inactivated vaccine
No comparator group
Canadian governmentDes Roches 2012 (15)
Retrospective
cohort
Canada
2008-09
and
2009-10
<2 yrs: 29
2-4 yrs: 53
5-11 yrs: 51
>12 yrs: 4
137
227 doses
31 (23%) with a history of severe egg allergy
Seasonal inactivated vaccine
No comparator group
Canadian governmentDes Roches 2015 (38)
Prospective cohort
Canada
2013-14
2-16 yrs (total sample; egg allergic and non-egg allergic groups)
68 with egg allergy
27 (40%) with a history of anaphylaxis to egg
Seasonal live attenuated vaccine
Non-allergic comparator group
UnclearErlewyn-Lajeunesse 2010† (16)
Retrospective cohort
United Kingdom
2009-10
Children; ages not specified
16 doses
4/15 (27%) to persons with known anaphylaxis to egg
Seasonal inactivated vaccine
No comparator group
UnclearEsposito 2008 (17)
Prospective cohort
Italy
2007-08
6.03 +/- 3.33 yrs for egg-allergic
44
11 (27%) severely egg-allergic: 9 having had mild-to moderate anaphylaxis and 2 severe anaphylaxis)
Seasonal virosomal vaccine
No comparator intervention
Comparison group of 44 without egg allergy
Italian governmentGreenhawt 2012 (18)
Randomized controlled trial
United States
2010-11
and
2011-12
Median 11 mos at diagnosis in split- dose group; 12 mos at diagnosis in full-dose group
31
14* (45%) with a history of anaphylaxis to egg
Seasonal inactivated vaccine
Comparison of split dose vs full dose (these groups are combined)
ACAAI; National Center for Research ResourcesGreenhawt 2012 (18)
Retrospective cohort
United States
2010-11
and
2011-12
Median 12 mos at diagnosis
112
87* (78% per abstract) had experienced anaphylaxis to egg.
Seasonal inactivated vaccine
No comparator group
ACAAI; National Center for Research ResourcesHotte 2008† (19)
Retrospective cohort
Canada
2000 through 2006
Not provided.
Conducted at a children’s hospital.
115
173 doses, 95% of which were full- or split-dose.
Seasonal inactivated vaccine
No comparator group
UnclearHowe 2011 (20)
Prospective cohort
United States
2009-10
Children; ages not provided
69 egg-allergic.
13 (19%) with documented anaphylaxis to egg
Seasonal inactivated vaccine
No comparator intervention.
Comparison group of 14 non egg-allergic.
UnclearJames 1998 (21)
Prospective cohort
United States
1994 through 1997
Median 3 yrs, range 1-46 yrs
83
27 (33%) with history of anaphylaxis to egg.
Seasonal inactivated vaccine
No comparator intervention
Comparator group of 124 non egg-allergic
AAAAILeo 2010† (22)
Cohort
Canada
2009-10
Not provided.
31
Seasonal inactivated vaccine
No comparator group
UnclearPark 2008† (23)
Retrospective cohort
United States
2006
Mean 36.1 +/- 19.9 mos
(range 11 to 105 mos)
33 of whom received vaccine via single dose.
Seasonal inactivated vaccine
No comparator group
UnclearPaschall 2011† (24)
Retrospective cohort
United States
2009-10
Mean 3.8 yrs
65 doses
Seasonal influenza vaccine
No comparator group
UnclearShimizu 2016 (25)
Cohort
Japan
2013
Median 15 mos
(IQR 13-20 mos)
17
8 (47%) with history of anaphylaxis to egg.
Seasonal inactivated vaccine
No comparator group
UnclearThanik 2010† (26)
Retrospective cohort
United States
2007-08
and
2008-09
Pediatric patients, ages not specified.
214 doses
Seasonal inactivated vaccine
No comparator group
UnclearTurner 2015 (39)
Prospective cohort
United Kingdom
2013-14
Median 4.9 yrs
(range 2-17 yrs)
282 children
115 (41%) with prior anaphylaxis to egg; however, those who required invasive ventilation for an egg reaction were excluded).
Seasonal LAIV
No comparator group
UK GovernmentTurner 2015 (34)
Prospective cohort
United Kingdom
2014-15
Median 5.3 yrs
(range 2-18 yrs)
779
270 (34.7%) with prior anaphylaxis to egg; however, those who required invasive ventilation for a reaction to egg were excluded
Seasonal LAIV
No comparator group
UK Government
*Numbers not provided but are calculated from percentages provided.
†Abstract only.Appendix 1 Table B: Monovalent H1N1pdm09 influenza vaccines (N=13)
Table B: Monovalent H1N1pdm09 influenza vaccines (N=13)
Author and publication year
Study design
Country
Season(s)
Age
N of egg allergic persons
Intervention vaccine
Comparator
Funding sourceDidenko 2010 (28)
Cohort
Brazil
2009
Median 4 yrs (range 2-37) yrs
For those who received full or split dose, median 4 (range 2-11 yrs
6
Monovalent H1N1pdm09 vaccine
No comparator group
UnclearForsdahl 2012 (29)
Retrospective cohort
Norway
2009-10
Mean 6.25 yrs
(Range 10 mos-16.5 yrs)
80
19 (24%) had serious reaction to egg (anaphylaxis or cardiovascular reaction)
Monovalent H1N1pdm09 vaccine
No comparator group
No study sponsor and author received no funding.Gagnon
2010 (30)
Prospective cohort
Canada
2009-10
173 <2 yrs
280 2-4 yrs
277 5-11 yrs
100 ≥12 yrs
830
Monovalent H1N1pdm09 vaccine
Comparator group of non allergic.
Canadian governmentGagnon
2010 (30)
PMID: 20579720
Prospective cohort
Canada
2009-10
Not specified
3640
Monovalent H1N1pdm09 vaccine
No comparator group
Canadian GovernmentGreenhawt 2010 (31)
Prospective cohort
United States
2009-10
Mean 5.5
(range 0.4-20.4) yrs
105
25 (24%) with a history of anaphylaxis to egg
Monovalent H1N1pdm09 vaccine
No comparator intervention
Comparator group of non-allergic
UnclearLeo 2010* (22)
Cohort
Canada
2009-10
Not provided
50
Monovalent H1N1pdm09 vaccine
No comparator group
UnclearPaschall 2011* (24)
Retrospective cohort
United States
2009-10
Mean 366.8 yrs
66
Monovalent H1N1pdm09 vaccine
No comparator group
UnclearPien 2010 (32)
Cohort
United States
2009-10
<10 yrs
Mean 3.7 yr +/- 3.0 yrs
59
Monovalent H1N1pdm09 vaccine
No comparator group
UnclearPitt 2011 (33)
Cohort
Canada
2009-10
Mean 5.6 yrs, range 1-27 yrs
59
Monovalent H1N1pdm09 vaccine
No comparator intervention
Comparator group of non-allergic
UnclearSchuler 2011 (41)
Prospective
cohort
Canada
2009-10
Mean 4.5 yrs, range 10 mos-16 yrs
62
Monovalent H1N1pdm09 vaccine
No comparator group
UnclearSiret-Alatrista 2010* (35)
Cohort
France
2009-10
Unclear
53
Monovalent H1N1pdm09 vaccine
No comparator group
UnclearSpiegel 2010* (36)
Retrospective cohort
United States
2009-10
Range 1-56 yrs
150
Monovalent H1N1pdm09 vaccine
No comparator group
UnclearUpton 2012 (37)
Prospective cohort
Canada
2009-10
3-5 yrs:12
6-9 yrs:24
10-13 yrs:28
14+ yrs:10
75
22 (29%) with prior anaphylaxis to egg (24 with anaphylaxis history vaccinated; unclear whether they include two vaccinated via 5-step protocol).
Monovalent H1N1pdm09 vaccine
No comparator group
Unclear*Abstract only.Appendix 2: Event Descriptions by Outcome
**Appendix 2 Table A: Death**
Appendix 2 Table A: Death
Author
Publication year
Vaccine
N egg allergic
N with severe allergy/ anaphylaxis to egg
EventsNo studies reported this outcome.**Appendix 2 Table B: Anaphylaxis**
Appendix 2 Table B: Anaphylaxis
Author
Publication year
Vaccine
N egg allergic
N with severe allergy/ anaphylaxis to egg
EventsNo studies reported this outcome.**Appendix 2 Table C: Hospitalization**
Appendix 2 Table C: Hospitalization
Author
Publication year
Vaccine
N egg allergic
N with severe allergy/ anaphylaxis to egg
EventsNo studies reported this outcome.**Appendix 2 Table D: Outpatient/Emergency Care**
Appendix 2 Table D: Outpatient/Emergency Care
Author
Publication year
Vaccine
N egg allergic
N with severe allergy/ anaphylaxis to egg
EventsEsposito 2008 (17)
Seasonal virosomal
44
11
1 instance bronchospasm in mildly allergic recipient, received bronchodilator and steroid.James 1998 (21)
Seasonal inactivated
83
27
1 instance (>1 hour post-vaccination) emesis, mild cough, wheeze; received nebulizer treatment.*
1 instance (>1 hour post-vaccination) erythema at injection site; received hydroxizine.*Forsdahl 2012 (29)
Monovalent inactivated
80
19
1 instance wheal on lip, diffuse rash, and loose stools; recipient previously unexposed to egg but had a positive serum specific IgE; received antihistamine.Gagnon 2010-1 (30)
Monovalent inactivated
830
–
1 instance wheeze; received bronchodilator.
1 instance hives; received antihistamine.
1 instance ocular pruritis; received antihistamine.
1 instance angioedema; received antihistamine.Gagnon 2010-2 (30)
Monovalent inactivated
3640
–
1 instance mouth/throat tingling and dyspnea 10-15 min post-vaccination; received epinephrine, observed in emergency department.
1 instance wheezing 30 min post-vaccination; received epinephrine and bronchodilator, observed.
66 instances skin and respiratory symptoms; received antihistamine:
42 instances skin involvement
17 instances throat tingling/tightening
7 instances cough (4 also received bronchodilator)Schuler 2011 (41)
Monovalent inactivated
62
–
1 hyporesponsive episode; sent to emergency department.
2 instances hives; received antihistamine.
1 instance erythema/itching of face; received antihistamine.
*Unclear whether these events occurred in persons with severe allergy/anaphylaxis to egg.**Appendix 2 Table E: Cardiovascular Symptoms, Respiratory Symptoms, Angioedema, or Generalized Urticaria**
Appendix 2 Table E: Cardiovascular Symptoms, Respiratory Symptoms, Angioedema, or Generalized Urticaria
Author
Publication year
Vaccine
N egg allergic
N with severe allergy/ anaphylaxis to egg
EventsErlewyn-Lajeunesse 2010 (16)
Seasonal inactivated vaccine
16 doses
4
1 instance subjective wheeze*Esposito 2008 (17)
Seasonal inactivated vaccine
44
11
1 instance bronchospasm in mildly allergic recipient, received bronchodilator and steroid.James 1998 (21)
Seasonal inactivated vaccine
83
27
1 instance mild throat itching, cough, and wheeze.*
1 instance (>1 hour post-vaccination) emesis, mild cough, wheeze treated with nebulizer.*
1 instance mild URI symptoms.*Forsdahl 2012 (29)
Monovalent inactivated
80
19
1 instance sneezing without bronchospasm; recipient previously unexposed to egg but had a positive serum specific IgE.Gagnon 2010-1 (30)
Monovalent inactivated
830
–
1 instance sensation of throat closure
1 instance hoarse voice
1 instance angioedema
1 instance bilateral wheeze
2 instances generalized urticariaGagnon 2010-2 (30)
Monovalent inactivated
3640
–
1 instance mouth/throat tingling and dyspnea 10-15 min post-vaccination; received epinephrine, observed in emergency department, recovered.
1 instance wheezing 30 min post-vaccination; received epinephrine and bronchodilator, observed 4 hours, recovered.
17 instances throat tingling/tightening
7 instances cough (4 also received bronchodilator)Turner 2015a (39)
Seasonal live attenuated
282
115
6 instances rhinitis within 2 hours post-vaccination.*Turner 2015b (34)
Seasonal live attenuated
779
270
4 instances rhinitis within 2 hours post-vaccination.*
*Unclear whether these events occurred in persons with severe allergy/anaphylaxis to egg.Appendix 3: Literature Search Strategy
**Literature through October 26, 2021**
Appendix 3: Literature Search Strategy
Database
Strategy**Medline****(OVID)****1946-**
(Egg* ADJ5 (allerg* OR sensitivit* OR hypersensitivit* OR anaphylaxis))
AND
((influenza OR flu OR laiv) ADJ5 vaccin*)**Embase****(OVID)****1947-**
(Egg* ADJ5 (allerg* OR sensitivit* OR hypersensitivit* OR anaphylaxis))
AND
((influenza OR flu OR laiv) ADJ5 vaccin*)**PsycInfo****(OVID)****1967-**
(Egg* ADJ5 (allerg* OR sensitivit* OR hypersensitivit* OR anaphylaxis))
AND
((influenza OR flu OR laiv) ADJ5 vaccin*)**CINAHL****(Ebsco)**
(Egg* N5 (allerg* OR sensitivit* OR hypersensitivit* OR anaphylaxis))
AND
((influenza OR flu OR laiv) N5 vaccin*)**NTIS**
(Egg* N5 (allerg* OR sensitivit* OR hypersensitivit* OR anaphylaxis))
AND
((influenza OR flu OR laiv) N5 vaccin*)**Scopus**
TITLE-ABS-KEY((Egg* W/5 allerg*) OR (Egg* W/5 sensitivit*) OR (Egg* W/5 hypersensitivit*) OR (Egg* W/5 anaphylaxis)) AND TITLE-ABS-KEY((influenza W/5 vaccin*) OR (flu W/5 vaccin*) OR (laiv W/5 vaccin*))**Cochrane Library**
((Egg* NEAR/5 allerg*) OR (Egg* NEAR/5 sensitivit*) OR (Egg* NEAR/5 hypersensitivit*) OR (Egg* NEAR/5 anaphylaxis)):ti,ab
AND
((influenza NEAR/5 vaccin*) OR (flu NEAR/5 vaccin*) OR (laiv NEAR/5 vaccin*)):ti,ab**Clinicaltrials.gov**
Egg Allergy OR egg sensitivity OR egg hypersensitivity
AND
Influenza OR flu OR vaccine OR vaccinationReferences
Afluria Quadrivalent [Package Insert]. Parkville, Victoria, Australia: Seqirus; 2023.
Flumist Quadrivalent [Package Insert]. Gaithersburg, MD: MedImmune; 2023.
Fluarix Quadrivalent [Package Insert]. Dresden, Germany: GlaxoSmithKline; 2023.
FluLaval Quadrivalent [Package Insert]. Quebec City, QC, Canada: ID Biomedical Corporation of Quebec; 2023.
Fluzone Quadrivalent [Package Insert]. Swiftwater, PA: Sanofi Pasteur; 2023.
Fluzone High-Dose Quadrivalent [Package Insert]. Swiftwater, PA: Sanofi Pasteur; 2023.
Fluad Quadrivalent [Package Insert]. Holly Springs, NC: Seqirus; 2023.
Grohskopf LA, Blanton LH, Ferdinands JM, Chung JR, Broder KR, Talbot HK, et al. Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices – United States, 2022-23 Influenza Season. MMWR Recomm Rep. 2022 Aug 26;71(1):1-28.
American Academy of Pediatrics, Committee on Infectious Diseases. Recommendations for Prevention and Control of Influenza in Children, 2016-2017. Pediatrics. 2016;138(4); e20162527.
Greenhawt M, Turner PJ, Kelso JM. Administration of influenza vaccines to egg allergic recipients: A practice parameter update 2017. Ann Allergy Asthma Immunol. 2018 Jan;120(1):49-52.
Kroger A, Bahta L, Long S, Sanchez P. General best practice guidelines for immunization. Available at : https://www.cdc.gov/vaccines/hcp/acip-recs/general-recs/index.html.
Anvari S, Scurlock AM, Jones SM, Perry TT, Hall PH. Influenza vaccination can be safely administered to most egg-allergic patients. J Ark Med Soc. 2011;108(6):103-4.
Chung EY, Huang L, Schneider L. Safety of influenza vaccine administration in egg-allergic patients. Pediatrics. 2010;125(5):e1024-30.
Comeau J, Orr K, Mehr S, Wood N. Why is Australian policy still cautious with influenza vaccination in severe egg allergic children? Intern Med J. 2016;46 (Suppl. 4):6 [Abstract].
Des Roches A, Paradis L, Gagnon R, Lemire C, Begin P, Carr S, et al. Egg-allergic patients can be safely vaccinated against influenza. J Allergy Clin Immunology. 2012;130(5):1213-6.e1.
Erlewyn-Lajeunesse M, Keeton D, King R, Boardman A, Ravenscroft D, Du Toit G, et al. Multicentre audit of influenza immunisation in children allergic to egg. Allergy. 2010;65(Suppl. 92):364-5. [Abstract].
Esposito S, Gasparini C, Martelli A, Zenga A, Tremolati E, Varin E, et al. Safe administration of an inactivated virosomal adjuvanted influenza vaccine in asthmatic children with egg allergy. Vaccine. 2008;26(36):4664-8.
Greenhawt MJ, Spergel JM, Rank MA, Green TD, Mansoor D, Sharma H, et al. Safe administration of the seasonal trivalent influenza vaccine to children with severe egg allergy. Ann Allergy Asthma Immunol. 2012;109(6):426-30.
Hotte SL. A 6-year Experience with Influenza Vaccination in Egg Allergic Patients. J Allergy Clin Immunol 2008;121(2)(Suppl. 1):s239. [Abstract].
Howe LE, Conlon AS, Greenhawt MJ, Sanders GM. Safe administration of seasonal influenza vaccine to children with egg allergy of all severities. Ann Allergy Asthma Immunol. 2011;106(5):446-7.
James JM, Zeiger RS, Lester MR, Fasano MB, Gern JE, Mansfield LE, et al. Safe administration of influenza vaccine to patients with egg allergy. J Pediatr. 1998;133(5):624-8.
Leo SH, Dean J, Chan ES. Safety of H1N1 and seasonal influenza vaccines in egg allergic patients in British Columbia. Allergy Asthma Clin Immunology. 2010; 6(SUPPL. 2):4. [Abstract].
Park AY, Pien GC, Brown-WHiltehorn TF, Spergel JM. Administration of Influenza Vaccine to Patients with Egg Allergy. J Allerg Clin Immunol 2008; 121(2)(Suppl. 1):s240. [Abstract].
Paschall VL, Siles RI, Bhatti H, Nolder PJ, Melton AL. Do egg-specific IgE levels predict reactions to seasonal influenza or H1N1 vaccination? J Allergy Clin Immunol. 2011; 127(2)(Suppl):AB182. [Abstract].
Shimizu M, Imai T, Yamazaki S, Yagawa A, Miyazawa T, Nakamura T, et al. [Safety of Influenza Vaccination in Children with Severe Allergy to Hen’s Eggs: A Prospective Case Series Study]. Arerugi. 2016;65(2):128-33.
Thanik ES, Cox AL, Sampson HA. Administration of a low egg-containing influenza vaccine [fluarix] in an egg-alphallergic pediatric population. J Allergy Clin Immunol. 2010;125(2)(Suppl 1):AB25. [Abstract].
Murad MH, Sultan S, Haffar S, Bazerbachi F. Methodological quality and synthesis of case series and case reports. BMJ Evid Based Med. 2018 Apr;23(2):60-3.
Didenko I, Ferreira F, Ferrao A, Salgado M, Reis R, Tomaz E, et al. Influenza A (H1N1) vaccination in individuals with egg allergy. Revista Portuguesa de Imunoalergologia. 2010;18(3):243-52.
Forsdahl BA. Reactions of Norwegian children with severe egg allergy to an egg-containing influenza A (H1N1) vaccine: a retrospective audit. BMJ Open. 2012;2:e000186.
Gagnon R, Primeau MN, Des Roches A, Lemire C, Kagan R, Carr S, et al. Safe vaccination of patients with egg allergy with an adjuvanted pandemic H1N1 vaccine. J Allergy Clin Immunol. 2010;126(2):317-23.
Greenhawt MJ, Chernin AS, Howe L, Li JT, Sanders G. The safety of the H1N1 influenza A vaccine in egg allergic individuals. Ann Allergy Asthma Immunol. 2010;105(5):387-93.
Pien GC, LeBenger KS, Carotenuto DR, Difilippi M, Scolpino D, Simmons JM, et al. Coordination of multidisciplinary resources for vaccination of egg-allergic individuals during an H1N1 (novel) influenza pandemic. Allergy Asthma Proc. 2010;31(6):507-10.
Pitt T, Kalicinsky C, Warrington R, Cisneros N. Assessment of epicutaneous testing of a monovalent Influenza A (H1N1) 2009 vaccine in egg allergic patients. Allergy Asthma Clin Immunol. 2011;7(1):3.
Schuler JE, King WJ, Dayneka NL, Rastelli L, Marquis E, Chad Z, et al. Administration of the adjuvanted pH1N1 vaccine in egg-allergic children at high risk for influenza A/H1N1 disease. Can J Public Health. 2011 May-Jun;102(3):196-9.
Siret-Alatrista A, Bouali F, Demoly M, Bousquet PJ, Demoly P. The 2009-2010 H1N1 vaccination campaign for patients with egg allergy in a region of France. Allergy. 2011;66(2):298-9.
Spiegel W, Anolik R. Administration of H1N1 vaccine in an eggallergic population. Ann Allergy Asthma Immunol. 2010 November;105(5)(Suppl.):A4. [Abstract].
Upton JE, Hummel DB, Kasprzak A, Atkinson AR. No systemic reactions to influenza vaccination in egg-sensitized tertiary-care pediatric patients. Allergy Asthma Clini Immunol. 2012;8:2.
Des Roches A, Samaan K, Graham F, Lacombe-Barrios J, Paradis J, Paradis L, et al. Safe vaccination of patients with egg allergy by using live attenuated influenza vaccine. J Allergy Clin Immunol Pract. 2015;3(1):138-9.
Turner PJ, Southern J, Andrews NJ, Miller E, Erlewyn-Lajeunesse M, Investigators SS. Safety of live attenuated influenza vaccine in atopic children with egg allergy. J Allergy Clin Immunol. 2015;136(2):376-81.
Turner PJ, Southern J, Andrews NJ, Miller E, Erlewyn-Lajeunesse M et al. Safety of live attenuated influenza vaccine in young people with egg allergy: multicentre prospective cohort study. BMJ. 2015;351:h6291.
Halsey NA, Griffioen M, Dreskin SC, Dekker CL, Wood R, Sharma D, et al. Immediate hypersensitivity reactions following monovalent 2009 pandemic influenza A (H1N1) vaccines: Reports to VAERS. Vaccine. 2013;31(51):6107-12.Top of Page
							
					
							Last Reviewed:  August 21, 2023						Source: 	National Center for Immunization and Respiratory Diseases
					Facebook
        Twitter
        LinkedIn
        Syndicate homeACIP Home
Meeting Information
Committee Informationplus icon
Role of the ACIP in CDC’s Vaccine Recommendations
Charter
Economics Studies
Committee Membersplus icon
ACIP Membership Roster
Apply for ACIP Membership
Work Groupsplus icon
VaST Reportsplus icon
June 28, 2021
May 24, 2021
May 17, 2021
March 29, 2021
Recommendationsplus icon
Shared Clinical Decision-Making Recommendations
Evidence Based Recommendationsplus icon
About GRADE
Grade Evidence Tables
Evidence to Recommendations Frameworks Vaccines & ImmunizationsImmunization SchedulesVFC ResolutionsVaccine Information Statements (VISs)
  1600 Clifton Road, N.E., Mailstop A27
Atlanta, GA 30329-4027acip@cdc.gov


About CDC
					Contact Us
					800-232-4636
 Facebook Twitter Instagram LinkedIn Youtube Pinterest Snapchat
 CONTACT CDC
				Contact Us
							Call 800-232-4636
							Email Us
			ABOUT CDC
				About CDC
							Jobs
							Funding
			POLICIES
				Accessibility
							External Links
							Privacy
							Policies
							No Fear Act
							FOIA
							OIG
							Nondiscrimination
							Vulnerability Disclosure Policy
			CONNECT WITH US
				Facebook
								Twitter
								Instagram
								LinkedIn
							Youtube
								Pinterest
								Snapchat
								Email
			LANGUAGES
				Español
							繁體中文
							Tiếng Việt
							한국어
							Tagalog
							Русский
							العربية
							Kreyòl Ayisyen
							Français
							Polski
							Português
							Italiano
							Deutsch
							日本語
							فارسی
							English


U.S. Department of Health & Human Services
			Accessibility
			External Links
			Privacy
			Policies
			No Fear Act
			FOIA
			Nondiscrimination
			OIG
			Vulnerability Disclosure Policy
			USA.gov


Exit Notification / Disclaimer Policy Close
 Links with this icon  indicate that you are leaving the CDC website. The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website.
				Linking to a non-federal website does not constitute an endorsement by CDC or any of its employees of the sponsors or the information and products presented on the website.
				You will be subject to the destination website's privacy policy when you follow the link.
				CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website. Website Disclaimers
 Cancel Continue