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 with Attenuated Organisms

Safe Alternative



Bacillus Calmette-Guerin (BCG)


Herpes zoster (Zostavax)


influenza, live virus (Flumist)

inactivated virus vaccine

measles-mumps-rubella (MMR), measles-mumps-rubella-varicella (MMRV)


polio, live oral

inactivated virus vaccine

rotavirus (Rota Teq, Rotarix)


smallpox or Vaccinia (ACAM2000)


typhoid (Ty21a)

Vi capsular polysaccharide

Varicella (Varivax)


yellow fever (YF-Vax)



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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