Live vaccines: revised recommendations for administration

Public Health England has issued revised recommendations for the administration of more than one live vaccine.

When certain live vaccines are administered at the same time, interferon production stimulated by the first vaccine can lead to a poor response to the second vaccine. | SCIENCE PHOTO LIBRARY
When certain live vaccines are administered at the same time, interferon production stimulated by the first vaccine can lead to a poor response to the second vaccine. | SCIENCE PHOTO LIBRARY

Following the introduction of two non-parenteral live vaccines (nasal influenza vaccine and oral rotavirus vaccine) into the routine immunisation schedule, the Joint Committee on Vaccination and Immunisation concluded that the guidance to either administer the vaccines on the same day or with a four-week interval should not be generalised to all live vaccines, but should be based on specific evidence for any interference of those vaccines. 

A subsequent review of the available evidence resulted in the issue of new recommendations as follows:

Vaccine combinations Recommendations
Yellow fever and MMR

Minimum 4-week interval.

Do not administer on the same day.

Varicella (and zoster) vaccine and MMR If not administered on the same day, a minimum 4-week interval.
Tuberculin skin testing (Mantoux) and MMR

If test has already been initiated, MMR should be delayed until the skin test has been read unless protection against measles is required urgently.

If child has had recent MMR and requires a tuberculin test, a 4-week interval should be observed.

All currently used live vaccines (BCG, rotavirus, live attenuated influenza vaccine, oral typhoid vaccine, yellow fever, varicella, zoster and MMR) and tuberculin (Mantoux) skin testing. Apart from the combinations listed above, these live vaccines can be administered at any time before or after each other. This includes tuberculin (Mantoux) skin testing.
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