From the Guidelines
Patients who have been sick can generally receive the Tdap and MMR vaccines once they have recovered from their acute illness and no longer have a fever, with the most recent guidelines suggesting that mild illness is not a contraindication to vaccination 1.
Key Considerations
- A mild illness with or without low-grade fever is not a contraindication to vaccination, as supported by studies indicating the safety and efficacy of vaccinating persons with mild illnesses 2.
- For moderate to severe illnesses, it's best to wait until symptoms improve, primarily for the patient's comfort and to avoid confusing new symptoms with vaccine side effects rather than due to safety concerns.
- The immune response to vaccines may be somewhat diminished during illness, though this effect is usually not clinically significant.
Administration Guidelines
- Once recovered, patients can receive both Tdap and MMR vaccines during the same visit if needed, as they can be administered simultaneously at different injection sites.
- Healthcare providers should consider the patient's overall health status and medical history before administering the vaccines, taking into account any potential contraindications or precautions, such as a history of severe allergic reactions or moderate to severe acute illness with or without fever 1, 3.
Evidence-Based Recommendations
- The most recent and highest quality study, published in 2018, provides guidance on the prevention of pertussis, tetanus, and diphtheria with vaccines in the United States, including recommendations for vaccination in individuals with mild or moderate illnesses 1.
- Other studies, such as those published in 2002, 2006, and 2011, also support the safety and efficacy of vaccinating individuals with mild illnesses, but the 2018 study provides the most up-to-date and comprehensive guidance 2, 4, 5, 3.
From the Research
Vaccine Administration Guidelines
- The Tdap vaccine can be administered concurrently with the MMR vaccine, as shown in a study from 1993 6.
- A study from 2019 found that the MMR vaccine can be administered with or without co-administration of DTaP-IPV and VV, with similar immunogenicity and safety profiles 7.
- There is no specific guidance on when a patient can receive the Tdap and MMR vaccines if they have been sick, but the vaccines can be administered regardless of the time since the patient's last tetanus-diphtheria booster 8.
Vaccine Safety and Efficacy
- A study from 2011 found that a second dose of Tdap vaccine 5 years after the initial dose was well tolerated and immunogenic in adolescents and adults 9.
- Post-licensure safety surveillance for Tdap vaccines from 2005-2007 found that the majority of reported adverse events were common local and systemic signs and symptoms, such as injection site reactions, fever, and headache 10.
- The Tdap vaccine has been shown to be safe and effective in preventing pertussis infection, and its use is recommended for adolescents and adults to reduce the incidence of Bordetella pertussis infection 8.
Special Considerations
- The Tdap vaccine can be safely administered to patients who have been sick, but the decision to administer the vaccine should be made on a case-by-case basis, taking into account the patient's overall health and medical history.
- The MMR vaccine can be administered concurrently with the Tdap vaccine, but the decision to co-administer the vaccines should be made based on the patient's individual needs and medical history 6, 7.