Vaccines using live micro-organisms can cause disseminated disease in immunocompromised patients. These vaccines are contraindicated in these patients and alternative measures must be taken to prevent infection by the target pathogens.
Issues to consider:
(1) type of vaccine
(2) level of immunosuppression in the patient
(3) vaccination of family members or close associated
Vaccines that are contraindicated for the patient's family members:
(1) live oral polio (immunocompromised patient should avoid close contact for 6 weeks)
(2) smallpox
Vaccines which may be used in children taking low dose corticosteroids (receiving less than 2 mg/kg/day prednisone):
(1) measles-mumps-rubella (MMR)
(2) varicella
Vaccines which may be given to some patients with HIV disease:
(1) measles-mumps-rubella (MMR)
(2) varicella
Vaccines which should be considered in bone marrow transplant patients (24 or more months after transplant with no graft-vs-host disease and if not receiving immunosuppressive therapy):
(1) measles-mumps-rubella (MMR)
(2) inactivated polio vaccine
Vaccines that should be administered to a transplant candidate prior to transplant if seronegative or negative history:
(1) measles-mumps-rubella (MMR)
(2) varicella
Although rabies vaccine contains inactivated virus, administration to an immunocompromised patient may require caution because the patient may not develop protective immunity.
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