Can a patient with otitis media (middle ear infection) receiving an antibiotic (e.g. amoxicillin) without fever get the MMR (measles, mumps, and rubella) vaccine?

Yes, Administer the MMR Vaccine

A patient with otitis media receiving antibiotic therapy without fever can and should receive the MMR vaccine—otitis media is explicitly NOT a contraindication to vaccination. 1

Why This Is Safe and Recommended

Otitis Media Is Not a Contraindication

• The ACIP explicitly lists otitis media among conditions "inappropriately regarded as contraindications to vaccination." 1
• Minor upper-respiratory tract illnesses (including otitis media) with or without fever are not valid reasons to delay vaccination. 1
• Current antimicrobial therapy is also specifically listed as a condition that should NOT prevent vaccination. 1

The Evidence Supports Vaccination During Minor Illness

• All vaccines can be administered to persons with minor acute illness, including mild upper-respiratory tract infections with or without fever. 1
• Over 97% of children with mild illnesses produced measles antibody after vaccination in U.S. studies. 1
• Only one limited study reported a lower seroconversion rate (79%) among children with minor, afebrile upper-respiratory infections, but this has not changed recommendations. 1

The Risk of Delaying Vaccination

• Failure to vaccinate children with minor illnesses can seriously impede vaccination efforts. 1
• Among persons whose compliance with medical care cannot be ensured, using every opportunity to provide appropriate vaccinations is critical. 1
• Delaying vaccination creates missed opportunities and leaves children vulnerable to vaccine-preventable diseases. 1

When to Actually Defer Vaccination

• Only defer MMR if the patient has moderate or severe acute illness with or without fever. 1
• The decision depends on severity of symptoms, not simply the presence of illness. 1
• Otitis media being treated with antibiotics and without fever clearly falls into the "minor illness" category. 1

Practical Implementation

• No routine physical examination or temperature measurement is required before vaccinating infants and children who appear healthy. 1
• Simply ask the parent/guardian if the child has moderate to severe illness—if not, proceed with vaccination. 1
• The presence of antibiotic therapy does not interfere with vaccine efficacy or safety. 1

Key Pitfall to Avoid

The most common error is inappropriately delaying vaccination for minor illnesses like otitis media. This misconception results in missed opportunities to administer recommended vaccines and leaves children unprotected. 1 The patient in this scenario—with otitis media, on antibiotics, and without fever—should receive the MMR vaccine at this visit.