Vaccine contraindications in immunocompromised patients

What it is

A vaccine may be contraindicated in a patient who is immunocompromised, and the contraindication is taken vaccine by vaccine. Live vaccines are the ones held back. For a vaccine that is not live, studies may still be ongoing as to whether it is safe to give, and for one of them immunoglobulin is preferred over the vaccine.

Injection site:

• Intradermal: BCG.
• Subcutaneous: yellow fever and MMR.
• Oral: OPV and rotavirus.
• Intramuscular: the rest of the vaccines.

The live vaccines are the group that is held back, and they are set out on the mnemonic MR. V ROY BCG-Typhoid: MMR, rotavirus, varicella, the respiratory intranasal influenza vaccine, OPV, yellow fever, BCG and oral typhoid. MMR is measles, mumps and rubella; the varicella vaccine is also used in the zoster vaccine; rotavirus is oral and is contraindicated in SCID; only the nasal spray influenza vaccine is live, not the intramuscular one; yellow fever is a travel vaccine; OPV is used in some countries and not in the US; BCG is the TB vaccine, with a scar on the arm; and the oral typhoid vaccine, Ty21a, is the live one, not the injected version. The live attenuated vaccines given in early infancy are BCG, rotavirus and oral polio vaccine.