What are the contraindications and precautions for administering the COVID-19 vaccine to adults with specific health conditions?

Contraindications for administering COVID-19 vaccines to adults with specific health conditions include:

• Confirmed anaphylactic reaction to a previous dose of the same COVID-19 vaccine or to any component (excipient) of the vaccine. Specialist advice should be sought in cases of possible previous allergic reactions to vaccine components.
• History of confirmed thrombosis with thrombocytopenia syndrome (TTS) after receiving the Janssen COVID-19 vaccine contraindicates further Janssen vaccination.
• Acute illness with systemic symptoms or fever should lead to postponement of vaccination until full recovery to avoid misattribution of symptoms.

Precautions and considerations include:

• People with a history of Guillain-Barré syndrome, capillary leak syndrome, or transverse myelitis should be vaccinated with caution, as very rare cases have been reported post-vaccination, particularly with AstraZeneca and Janssen vaccines.
• Individuals with immunosuppression (due to disease or treatment), including those with haematological malignancies, HIV, or on immunosuppressive therapies, may have a suboptimal immune response but are still recommended to receive vaccination.
• Pregnant and breastfeeding women should be offered mRNA vaccines (Pfizer-BioNTech or Moderna) with no known risk to mother or fetus; vaccination can continue if pregnancy is discovered after starting the course.
• People with neurological or neuromuscular diseases, diabetes, adrenal insufficiency, asplenia or splenic dysfunction, and morbid obesity are recommended to receive vaccination due to higher risk of severe COVID-19.
• Vaccination should be deferred in individuals with suspected or confirmed COVID-19 infection until recovery and ideally at least 4 weeks after symptom onset or positive test, especially in those at highest risk of serious illness.
• Observation for 30 minutes post-vaccination is advised for those who received AstraZeneca vaccine or have a history of allergic reactions.

Healthcare professionals should be alert to rare but serious adverse events such as myocarditis, pericarditis, vaccine-induced immune thrombocytopenia and thrombosis (VITT), and acute disseminated encephalomyelitis (ADEM), and advise patients accordingly.

Overall, the benefits of COVID-19 vaccination outweigh the risks for adults with specific health conditions, but individual assessment and specialist advice are recommended when contraindications or precautions apply.

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