From the Guidelines
After receiving 2 gm/kg of intravenous immunoglobulin (IVIG) for Kawasaki disease, live attenuated vaccines should be postponed for 11 months. These include measles-mumps-rubella (MMR), varicella, and rotavirus vaccines. Inactivated vaccines can be administered according to the regular schedule without delay. The postponement of live vaccines is necessary because IVIG contains antibodies that can neutralize the vaccine viruses, potentially reducing vaccine effectiveness 1. The 11-month waiting period is specifically recommended for the 2 gm/kg dose used in Kawasaki disease treatment, which is higher than IVIG doses used for other conditions 1. During this waiting period, the child may have passive immunity from the administered antibodies, but this protection will gradually decrease over time. Some key points to consider:
- Measles, mumps, and varicella immunizations should be deferred for 11 months after receiving high-dose IVIG 1.
- Children in whom risk of exposure to measles is high may receive vaccination earlier and then be re-immunized at least 11 months after IVIG administration if they have an inadequate serological response 1.
- The interval should be extended to 11 months after high-dose (2 g/kg) infusion 1. Once the waiting period is complete, the regular vaccination schedule can resume, and any missed live vaccines should be administered at that time. It's essential to document the IVIG administration in the child's medical record to ensure appropriate timing of future vaccinations.
From the Research
Vaccines to be Postponed after Immunoglobulin Administration for Kawasaki Disease
The administration of 2gm/kg immunoglobulin for Kawasaki disease may interfere with the response to live vaccines. The following vaccines should be postponed:
- Measles vaccine: according to 2, an interval of 9 months is suggested between the infusion of 4 g/kg of intravenous immune globulin and measles vaccination. However, for a dose of 2 g/kg, the interval may be shorter, but the exact duration is not specified.
- MMR/MMRV vaccines: 3 recommends that live vaccines, including MMR/MMRV, be postponed for 11 months after treatment of Kawasaki disease with intravenous immunoglobulin (IVIG).
- Live vaccines: 4 suggests that the appropriate duration between live vaccinations and Infliximab therapy for KD patients could be shorter, but more studies are warranted to establish the safe duration.
Duration of Postponement
The duration of postponement for each vaccine is as follows:
- Measles vaccine: at least 9 months after infusion of 4 g/kg of intravenous immune globulin, but the exact duration for a 2 g/kg dose is not specified 2.
- MMR/MMRV vaccines: 11 months after treatment of Kawasaki disease with intravenous immunoglobulin (IVIG) 3.
- Live vaccines: the safe duration is unclear and may be shorter than currently recommended, but more studies are needed 4.
Key Considerations
- The exact duration of postponement for each vaccine may vary depending on the specific circumstances and the dose of immunoglobulin administered.
- The decision to postpone vaccination should be made on a case-by-case basis, taking into account the individual child's health status and the potential risks and benefits of vaccination 3, 2.