What is a contraindication to the administration of the live virus measles vaccine, specifically considering conditions such as Human Immunodeficiency Virus (HIV) or immunosuppression?

Contraindications to Live Virus Measles Vaccine Administration

HIV or evidence of moderate immunosuppression is a contraindication to the administration of the live virus measles vaccine. 1

Analysis of Contraindications

HIV and Immunosuppression

• Severe immunosuppression is a clear contraindication to measles vaccination due to the risk of vaccine-associated measles infection, which has been linked to deaths in severely immunocompromised individuals 1
• For HIV-infected persons specifically, the Advisory Committee on Immunization Practices (ACIP) recommends withholding MMR or other measles-containing vaccines from those with evidence of severe immunosuppression 1
• Severe immunosuppression in HIV-infected individuals is defined as:
  • CD4+ T-lymphocyte counts <750 for children <12 months
  • CD4+ T-lymphocyte counts <500 for children 1-5 years
  • CD4+ T-lymphocyte counts <200 for persons ≥6 years
  • CD4+ T-lymphocytes <15% of total lymphocytes for children <13 years
  • CD4+ T-lymphocytes <14% for persons ≥13 years 1

Allergy to Eggs or Chickens

• Neither egg allergy nor chicken allergy is a contraindication to measles vaccination
• Despite the fact that measles and mumps vaccines are grown in chick embryo fibroblast tissue culture, the amount of egg proteins in the final product is minimal
• No evidence in the guidelines suggests that egg or chicken allergies contraindicate measles vaccination

IVIG Administration

• IVIG administered 6 months ago for Kawasaki disease is not a contraindication to measles vaccination
• While immune globulin can interfere with the immune response to measles vaccine, the recommended interval to wait after IVIG administration is typically 3-11 months depending on the dose 2
• Since 6 months have passed since IVIG administration, this would not be a contraindication

Special Considerations for Immunocompromised Patients

Post-Exposure Prophylaxis

• For severely immunocompromised patients exposed to measles, immune globulin should be administered regardless of vaccination status 2
• The recommended dose is 0.5 mL/kg of body weight (maximum dose 15 mL) if administered intramuscularly 1
• Intravenous immune globulin (IGIV) at 400 mg/kg may be considered as an alternative 2

Corticosteroid Therapy

• Systemic corticosteroids can cause immunosuppression when used at high doses
• Steroid therapy is considered immunosuppressive when equivalent to prednisone ≥2 mg/kg/day or ≥20 mg/day for ≥14 days 1
• Patients who have received such doses should avoid measles vaccination for at least 1 month after cessation of therapy 1

Clinical Decision Algorithm

1. Assess immune status:

   • If severely immunocompromised (including HIV with low CD4 counts) → Contraindicated
   • If moderately immunocompromised → Contraindicated
   • If immunocompetent → Proceed with vaccination

2. Check for recent immune globulin administration:

   • If IVIG received within past 3-11 months (depending on dose) → Delay vaccination
   • If >6 months since standard dose IVIG → Proceed with vaccination

3. Evaluate steroid use:

   • If high-dose systemic steroids (≥20 mg/day prednisone for ≥14 days) within past month → Contraindicated
   • If low-dose, topical, or short-term steroids → Proceed with vaccination

4. Assess for allergies:

   • Egg or chicken allergies → Not contraindicated, proceed with vaccination

In conclusion, among the options presented, HIV or evidence of moderate immunosuppression is the only true contraindication to the administration of the live virus measles vaccine.