From the Guidelines
The MMR (measles, mumps, rubella) vaccine is a live attenuated vaccine that should be avoided in severely immunocompromised children. Children with compromised immune systems, such as those undergoing chemotherapy, those with primary immunodeficiency disorders, HIV with severe immunosuppression, or those on high-dose immunosuppressive medications, should not receive the MMR vaccine due to the risk of vaccine-strain viral replication causing disease 1. The live viruses in the vaccine, though weakened, can potentially cause infection in those without adequate immune function to control viral replication.
Key Considerations
- The risk of vaccine-strain viral replication causing disease is a significant concern in severely immunocompromised individuals 1.
- Household contacts of immunocompromised children can and should receive the MMR vaccine, as the risk of transmission of vaccine-strain virus is extremely low, while the risk of transmitting wild-type measles, mumps, or rubella to an unprotected immunocompromised child is much higher 1.
- Each immunocompromised child should have their vaccination status evaluated individually by their healthcare provider, as some with mild to moderate immunosuppression may still be candidates for MMR vaccination when the benefits outweigh the risks 1.
Evaluation and Recommendations
The evaluation of an immunocompromised child's vaccination status should consider the degree of immunosuppression, the risk of vaccine-strain viral replication, and the benefits of vaccination. Severely immunocompromised children should not receive the MMR vaccine, while those with mild to moderate immunosuppression may be candidates for vaccination on a case-by-case basis 1. Healthcare providers should weigh the risks and benefits of MMR vaccination for each immunocompromised child, taking into account the latest evidence and guidelines 1.
From the Research
Live Measles, Mumps, and Rubella (MMR) Vaccine in Immunocompromised Children
- The live MMR vaccine is generally contraindicated in immunocompromised individuals due to the risk of inciting vaccine strain infection in an immunocompromised host 2.
- However, a study published in JAMA network open found that live vaccinations, including MMR, may be safe and immunogenic in select pediatric solid organ transplant recipients 3.
- The study included 281 children who received 1 to 3 doses of MMR vaccine, and the majority of children developed protective antibodies following vaccination (86% for measles, 83% for mumps, and 99% for rubella) 3.
- Another study published in Archives of dermatological research suggested that MMR vaccines may be safely administered to patients on low-dose immunosuppressive agents 4.
- A systematic review of randomized trials, observational studies, and case reports found that live vaccinations, including MMR, were safe and sufficiently immunogenic in most studies, but some serious reactions and vaccine-related infections were reported in immunosuppressed patients 5.
Considerations for Vaccination
- The decision to vaccinate an immunocompromised child with live MMR vaccine 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 4, 5.
- The level of immunosuppression, the type of immunosuppressive therapy, and the specific vaccine being considered are all important factors to consider when making this decision 4, 5.
- It is essential to weigh the potential risks of vaccine-related infections against the benefits of protection against circulating measles, mumps, and rubella 3, 2.
Recommendations
- The American Academy of Pediatrics and other organizations provide guidelines for the vaccination of immunocompromised children, including those with solid organ transplants or immune-mediated inflammatory diseases 6.
- These guidelines recommend careful consideration of the individual's immune status and the potential risks and benefits of vaccination before administering live vaccines, including MMR 6, 4, 5.