From the Guidelines
The MMR (measles, mumps, rubella) vaccine should not be avoided in children living in households with immunocompromised individuals, as the benefits of vaccination in preventing morbidity and mortality from wild-type measles, mumps, and rubella viruses outweigh the theoretical risks of vaccine virus transmission to immunocompromised household contacts. According to the 2013 IDSA clinical practice guideline for vaccination of the immunocompromised host 1, healthy immunocompetent individuals who live in a household with immunocompromised patients should receive the combined measles, mumps, and rubella (MMR) vaccine based on the CDC annual schedule. The guideline states that the MMR vaccine can be safely administered to individuals who live in a household with immunocompromised patients, with a strong, moderate recommendation 1.
The risks of vaccine virus transmission to immunocompromised household contacts are extremely rare, and the benefits of vaccination in preventing morbidity and mortality from wild-type measles, mumps, and rubella viruses are well-established 1. In fact, ensuring all household members are fully vaccinated creates "cocooning protection" for the immunocompromised person, which is especially important for preventing the spread of vaccine-preventable diseases in households with immunocompromised individuals 1.
Some key points to consider when administering the MMR vaccine to children living in households with immunocompromised individuals include:
- The MMR vaccine contains weakened live viruses that cannot cause disease in healthy individuals 1
- Theoretical risk of vaccine virus transmission to immunocompromised household contacts is extremely rare, with only a few documented cases of transmission, such as mother-to-infant transmission of rubella vaccine virus via breast milk 1
- Caution is advised if the immunocompromised person has severe combined immunodeficiency (SCID) or is undergoing intensive chemotherapy with profound immunosuppression, and consultation with healthcare providers for both the child and the immunocompromised person is recommended before vaccination 1
- The standard MMR vaccination schedule includes doses at 12-15 months and 4-6 years of age, and household members should be up-to-date with all routinely recommended vaccinations, including annual influenza vaccine 1
From the Research
Live Measles, Mumps, and Rubella (MMR) Vaccine and Immunocompromised Individuals
- The MMR vaccine is a live vaccine, and its administration to immunocompromised individuals is typically contraindicated due to safety concerns 2.
- However, there are exceptions, such as children infected with HIV who do not have severe immunosuppression, where the MMR vaccine may be given 3.
- For household contacts of immunocompromised patients, including healthcare workers, the risk of transmission associated with live attenuated vaccines, such as MMR, is considered low 4.
- The benefits of providing herd immunity to immunocompromised patients through vaccination of household contacts and healthcare workers may outweigh the risk of secondary transmission 4.
Vaccination Guidelines for Immunocompromised Individuals
- Immunocompromised children are at a higher risk of developing infections and associated higher rates of mortality and morbidity, making vaccination a crucial aspect of their care 5, 6.
- Inactive vaccines are generally considered safe and immunogenic for immunocompromised individuals, even after the introduction of immunosuppression 5.
- Live vaccines, including MMR, are typically contraindicated in immunocompromised patients, but emerging data support the safety and effectiveness of live vaccines in certain immunocompromised individuals 5.
- Care providers should remain vigilant in maintaining patients' vaccination status based on current vaccination guidelines and create a multidisciplinary approach to optimizing vaccination 5.