Can a child with Hirschsprung disease who has undergone corrective surgery and is otherwise healthy receive the measles‑rubella (MMR) vaccine?

Yes, a child with Hirschsprung disease who has undergone corrective surgery and is otherwise healthy should receive the measles-rubella (MMR) vaccine on the standard schedule.

Hirschsprung disease itself is not a contraindication to MMR vaccination, and children who have recovered from corrective surgery without ongoing immunosuppression should follow the routine immunization schedule. 1

Key Contraindications to MMR Vaccine

The only true contraindications to MMR vaccination are: 1, 2

• Severe allergic reaction (anaphylaxis) to a prior vaccine dose or vaccine component
• Severe immunosuppression (≥2 mg/kg/day prednisone equivalent for ≥14 days, chemotherapy, or biologic agents) 3
• Pregnancy 3, 2
• Recent administration of immune globulin products 1

Hirschsprung disease does not appear on any list of contraindications for MMR vaccination. 3, 1

When to Vaccinate

• Minor illnesses, including diarrhea and gastrointestinal symptoms, are NOT contraindications to vaccination and should not delay immunization. 1

• Vaccination should only be deferred for moderate or severe febrile illness or severe immunosuppression—not for the underlying diagnosis of Hirschsprung disease. 1

• If the child appears healthy or has only minor symptoms following surgery, vaccination should proceed according to the standard schedule: first dose at 12-15 months and second dose at 4-6 years. 1, 4

Clinical Decision-Making Algorithm

1. Assess current immunosuppression status: Is the child on high-dose corticosteroids (≥2 mg/kg/day for ≥14 days), chemotherapy, or biologic agents? 3

   • If YES → defer MMR until at least 3 months after stopping immunosuppressive therapy 3
   • If NO → proceed with vaccination

2. Assess current clinical status: Does the child have moderate-to-severe febrile illness today? 1

   • If YES → defer until recovery
   • If NO or only minor symptoms → vaccinate today

3. Verify no other true contraindications (anaphylaxis history, pregnancy, recent immune globulin) 1, 2

Important Caveats

• Post-surgical status alone does not constitute immunosuppression. Children who have recovered from Hirschsprung surgery without ongoing immunosuppressive medications are considered immunocompetent. 1

• Do not postpone vaccination for routine medical conditions or minor gastrointestinal symptoms, as this creates unnecessary delays in protection and missed opportunities. 1

• The protective benefits of MMR vaccination far outweigh theoretical concerns in children with stable surgical conditions like corrected Hirschsprung disease. 1

• The evidence base for MMR safety is robust, with serious adverse events occurring in only 0.05% of recipients and vaccine-related infections in 0.2%. 3

Strength of Evidence

The recommendation to vaccinate is based on high-quality evidence showing MMR vaccine effectiveness of at least 95% for measles and 92% for preventing secondary household cases, with moderate certainty of evidence for safety in healthy children. 3, 5 The Canadian Association of Gastroenterology provides strong recommendations (100% consensus) that children with gastrointestinal conditions who are not on immunosuppressive therapy should receive MMR vaccine. 3