Can individuals previously on immunosuppressant drugs receive the Measles, Mumps, and Rubella (MMR) vaccine?

From the Guidelines

Individuals who have previously been on immunosuppressant drugs can generally receive the Measles, Mumps, and Rubella (MMR) vaccine, but the timing is crucial, and it is recommended to wait at least 1 month after stopping high-dose corticosteroids or 3 months after stopping other immunosuppressants like methotrexate or biologics before receiving the vaccine. The decision to administer the MMR vaccine to individuals with a history of immunosuppressant drug use should be made on a case-by-case basis, taking into account the type and dosage of immunosuppressant drugs used, as well as the individual's current immune status 1.

Key Considerations

• The MMR vaccine contains live attenuated viruses, which can pose a risk to individuals with weakened immune systems 1.
• High-dose corticosteroids (>20 mg/day of prednisone for ≥2 weeks) can suppress the immune system, and it is recommended to wait at least 1 month after stopping these medications before receiving the MMR vaccine 1.
• For other immunosuppressants like methotrexate or biologics, a 3-month waiting period is typically recommended before receiving the MMR vaccine 1.
• Consultation with a healthcare provider is essential to determine the optimal timing for MMR vaccination and to assess the individual's immune status through blood tests if necessary.

Evidence-Based Recommendations

• A study published in 2020 in the Annals of the Rheumatic Diseases provides guidance on vaccination in adult patients with autoimmune inflammatory rheumatic diseases, including those on immunosuppressant therapy 1.
• The study suggests that live-attenuated vaccines, such as the MMR vaccine, may be considered in patients with autoimmune inflammatory rheumatic diseases who are on low-grade immunosuppression, but the decision should be made on a case-by-case basis.
• The Centers for Disease Control and Prevention (CDC) recommendations define immunosuppressive therapy, including glucocorticoid usage and dosages of other immunosuppressant medications, which can guide the decision to administer live-attenuated vaccines 1.

From the FDA Drug Label

Administration of live or live, attenuated vaccines is contraindicated in patients receiving immunosuppressive doses of corticosteroids. Killed or inactivated vaccines may be administered. However, the response to such vaccines may be diminished and cannot be predicted Indicated immunization procedures may be undertaken in patients receiving nonimmunosuppressive doses of corticosteroids as replacement therapy (e.g., for Addison’s disease).

The MMR vaccine is a live, attenuated vaccine. Therefore, individuals previously on immunosuppressant drugs, such as corticosteroids, should not receive the MMR vaccine if they are still receiving immunosuppressive doses. However, if they are receiving nonimmunosuppressive doses as replacement therapy, indicated immunization procedures may be undertaken. 2 2

From the Research

Administration of MMR Vaccine to Individuals on Immunosuppressant Drugs

• The administration of live vaccines, including the Measles, Mumps, and Rubella (MMR) vaccine, is generally contraindicated in individuals on immunosuppressive therapy due to safety concerns 3.
• However, studies have shown that live vaccinations can be safe and sufficiently immunogenic in most cases, with some serious reactions and vaccine-related infections reported in immunosuppressed patients 3, 4.
• A systematic review of randomized trials, observational studies, and case reports found that the administration of live vaccines, including MMR, was safe in most studies, but some serious vaccine-related adverse events occurred 3.
• A study on multiple myeloma patients on maintenance lenalidomide or bortezomib after autologous hematopoietic cell transplantation found that MMR vaccination was safe and well-tolerated 4.
• Another study on patients using IL-1 or IL-6 blockade found that live-attenuated vaccines, including MMR, were associated with some adverse events, but the findings were not sufficient to adapt existing guidelines 5.

Safety of MMR Vaccine in Specific Patient Populations

• In pediatric liver transplantation, live-attenuated MMR vaccines can be administered effectively and safely to patients receiving immunosuppressive therapy, with no serious adverse reactions reported 6.
• A nationwide cross-sectional study in Japan found that live attenuated vaccines, including MMR, were rarely administered to patients receiving biological agents, but were more commonly administered to patients receiving immunosuppressive agents, with few adverse events reported 7.
• The study also found that most physicians believed that patients receiving immunosuppressive agents should be immunized with live attenuated vaccines, and that immunization with live attenuated vaccines appeared safe in patients receiving immunosuppressive agents 7.

Considerations for MMR Vaccine Administration

• The decision to administer the MMR vaccine to individuals on immunosuppressant drugs should be made on a case-by-case basis, taking into account the individual's immune status and the potential risks and benefits of vaccination 3, 4, 6.
• Further studies are needed to determine the safety and efficacy of live attenuated vaccines in patients receiving immunosuppressive therapy, particularly in those receiving biological agents 5, 7.