Avoid live vaccines in immunosuppressed patients, MHRA reminds clinicians

Healthcare professionals are warned to exclude the presence of significant immunosuppression before administering live attenuated vaccines, following reports of fatal infections in immunocompromised individuals.

Live vaccines include MMR, BCG and yellow fever. | iStock
Live vaccines include MMR, BCG and yellow fever. | iStock

Live attenuated vaccines should not routinely be given to people who are clinically immunosuppressed, whether due to drug treatment or underlying illness. Minor immunodeficiency does not necessarily contraindicate vaccination.

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If primary care professionals are in any doubt as to whether a person due to receive a live attenuated vaccine may be immunosuppressed, immunisation should be deferred until specialist advice has been sought, including from an immunologist if required.

Close contacts of immunosuppressed individuals should be fully immunised to minimise the risk of infection of vaccine-preventable diseases in immunosuppressed individuals.

The reports that prompted the MHRA's reminder included four neonates who died from disseminated BCG or tuberculosis infection after exposure to a TNF antagonist in utero. As a precaution, infants who have been exposed to immunosuppressive treatment from the mother either in utero during pregnancy or via breastfeeding should have any live attenuated vaccination deferred for as long as a postnatal influence on the immune status of the infant remains possible. In the case of in utero exposure to biological medicines, vaccination should not be considered until the child is at least 6 months old.

There were also reports of elderly patients receiving shingles vaccine (Zostavax) when they may have been immunosuppressed as a result of lymphoproliferative disorders or treatment for a transplant, and subsequently experiencing adverse reactions possibly associated with a disseminated viral infection caused by the vaccine strain.

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