MMR Vaccination After Kawasaki Disease
Defer MMR vaccination for 11 months after high-dose IVIG (2 g/kg) treatment for Kawasaki disease. 1, 2
Standard Timing Recommendation
The American Heart Association explicitly states that measles, mumps, and rubella immunizations should be deferred for 11 months after receiving high-dose IVIG used to treat Kawasaki disease. 1 This recommendation is based on the interference that high-dose immune globulin preparations have with live attenuated vaccine replication and immune response. 1
Rationale for the 11-Month Interval
- High-dose IVIG (2 g/kg) contains antiviral antibodies that neutralize vaccine virus strains, preventing adequate immune response if MMR is given too early. 1, 2
- The duration of antibody interference depends directly on the dose of immune globulin administered, with higher doses requiring longer intervals. 1
- Research demonstrates that vaccination at 6 months post-IVIG results in poor seroconversion rates (only 88% for measles after initial dose), whereas waiting until 12 months achieves adequate protection with booster vaccination. 3, 2
Additional IVIG Doses
If a patient received additional IVIG for refractory Kawasaki disease (total dose 4 g/kg), extend the interval to at least 9 months, though 11 months remains safest. 4 One study found that after 4 g/kg total IVIG, measles antibodies became negative in all patients by 9 months, but the standard 11-month recommendation provides an additional safety margin. 4
Exception for High-Risk Exposure
During a measles outbreak or high-risk exposure situation, MMR may be administered earlier than 11 months, but the child must be re-immunized at least 11 months after IVIG administration if serological testing shows inadequate response. 1, 2 This approach prioritizes immediate protection during active disease transmission while ensuring long-term immunity.
Non-Live Vaccines
All routine non-live vaccines (DTaP, Hib, hepatitis A and B, pneumococcal, meningococcal, inactivated polio, inactivated influenza) can be administered according to the standard schedule without any delay after IVIG treatment. 2 There is no interference between IVIG and inactivated vaccines.
Special Consideration for Aspirin Therapy
Children on long-term aspirin therapy (standard for Kawasaki disease patients during the first 6-8 weeks and indefinitely for those with coronary abnormalities) must receive only inactivated influenza vaccine annually, never live-attenuated formulations. 2 This is critical because aspirin use increases the risk of Reye syndrome with influenza infection.
Patients on Additional Immunosuppression
If the patient received infliximab or other biologics for IVIG-resistant Kawasaki disease, or is on high-dose corticosteroids (≥2 mg/kg or ≥20 mg/day for ≥2 weeks), live-attenuated vaccines including MMR are contraindicated until immunosuppression is discontinued. 1, 2 Ideally, complete all live-attenuated vaccinations 2-4 weeks before initiating these therapies if possible. 1, 2
Common Pitfall
The majority of children treated for Kawasaki disease in real-world practice receive MMR vaccination too early. 5 A recent Australian study found that 76% of children breached the 11-month guideline for their first MMR dose, leaving them potentially unprotected. 5 Healthcare systems must implement alerts or tracking mechanisms to ensure appropriate timing, as this represents an avoidable risk to vaccine-preventable disease protection.
Verification of Immunity
Serological testing after MMR vaccination can be considered in high-risk patients or those who received vaccination at suboptimal intervals to confirm adequate immune response, with booster doses administered if titers are inadequate. 2