Vaccines in immunocompromised patients

Q: Immunosuppressed patients should not receive which of the following vaccines while in the ICU or on discharge?

A) Pneumococcus (PCV13 and PPSV23)
B) Seasonal influenza 
C) Hepatitis A & B 
D) Tetanus, diphtheria, pertussis (Tdap) 
E) Measles, mumps, rubella (MMR)


Answer: E

Out of all of the above, only MMR is the live attenuated vaccine. All live attenuated vaccines should be either avoided or given with extreme caution to the immunocompromised patients. Similar such vaccines are influenza nasal spray, rotavirus, varicella vaccine, oral typhoid. yellow fever and some formulations of the Japanese encephalitis vaccine. 

#infectious-diseases


References:

1. Grohskopf LA, Sokolow LZ, Broder KR, et al. Prevention and control of seasonal influenza with vaccines: Recommendations of the Advisory Committee on Immunization Practices – United States, 2018-19 influenza season. MMWR Recomm Rep 2018; 67:1. 

2. Singh JA, Saag KG, Bridges SL Jr, et al. 2015 American College of Rheumatology guideline for the treatment of rheumatoid ahritis. Arthritis Rheumatol 2016; 68:1. 

3. van Assen S, Agmon-Levin N, Elkayam O, et al. EULAR recommendations for vaccination in adult patients with autoimmune inflammatory rheumatic diseases. Ann Rheum Dis 2011; 70:414. 

4. O'Neill SG, Isenberg DA. Immunizing patients with systemic lupus erythematosus: a review of effectiveness and safety. Lupus 2006; 15:778.