Can someone with an autoimmune disorder sleep with someone who has received a live vaccine?

Sleeping with Someone Who Has Received a Live Vaccine When You Have an Autoimmune Disorder

Close contacts of individuals with autoimmune disorders can safely receive live vaccines, and intimate contact including sleeping together is generally safe with minimal precautions.

Risk Assessment for Different Live Vaccines

Live vaccines can potentially shed virus, but the risk to immunocompromised household contacts varies significantly by vaccine type:

Safe Contact (No Special Precautions)

• Most live vaccines pose minimal risk to immunocompromised close contacts 1
• Live attenuated influenza vaccine has low transmission risk 1
• MMR (measles, mumps, rubella) vaccine does not require special precautions for close contacts 1

Precautions Needed

• Varicella/zoster vaccines: If the vaccinated person develops a rash or blisters at the injection site, direct contact should be avoided until the rash resolves 1
• Rotavirus vaccine: For infants who received this vaccine, household members should wash hands thoroughly after diaper changes 1

Contraindicated for Household Contacts

• Oral polio vaccine: This is the only live vaccine specifically contraindicated for household contacts of immunocompromised individuals due to risk of transmission and potential for vaccine-associated paralytic polio 1
  • Note: Oral polio vaccine is no longer available in the United States 1

Factors Affecting Risk

The risk to an immunocompromised person depends on:

1. Type of autoimmune disorder - severity varies widely
2. Degree of immunosuppression from medications:
   • High-dose steroids (≥20mg prednisone daily)
   • Conventional DMARDs (methotrexate, azathioprine)
   • Biologic agents (TNF inhibitors, rituximab)
3. Type of live vaccine received by the close contact

Practical Recommendations

For someone with an autoimmune disorder sleeping with a partner who received a live vaccine:

1. For most live vaccines: No special precautions needed 1

2. If partner received varicella or zoster vaccine:

   • Monitor for development of rash/blisters at injection site
   • If rash develops, avoid direct contact until it resolves 1
   • Consider prophylactic varicella zoster immune globulin (VZIG) if exposure occurs and you are severely immunocompromised 1

3. General hygiene measures:

   • Regular handwashing
   • Avoid sharing personal items during the first 2-4 weeks after vaccination

Special Considerations

• Pregnancy: If you are pregnant and have an autoimmune disorder, your partner can still receive most vaccines, including live vaccines 1

• Newborns: If you have a newborn and are on immunosuppressive therapy, special considerations apply for the rotavirus vaccine 1

• Severely immunocompromised patients: Those with severe combined immunodeficiency or receiving intense immunosuppression may need more cautious approaches 1

The medical consensus strongly supports vaccination of household contacts as this creates a "protective cocoon" around vulnerable individuals with autoimmune disorders 1. This protection through community immunity outweighs the minimal risks of vaccine virus transmission.