Which vaccines should not be administered to an immunocompromised individual receiving high-dose systemic glucocorticoids?

Which vaccines should not be administered to an immunocompromised individual receiving high-dose systemic glucocorticoids?

• A. MMR and Varicella
• B. DTaP and IPV
• C. Hib and Polio
• D. Influenza (inactivated)

Answer: (A)

The key concept is that live attenuated vaccines should be avoided in patients who are immunocompromised from high-dose systemic glucocorticoids. High-dose steroids markedly impair cell-mediated and humoral immunity, so a vaccine that contains replicating live organisms could cause a vaccine-strain infection or disseminated disease in this person. MMR and Varicella are live attenuated vaccines, so they should not be given to someone on high-dose steroids. In contrast, inactivated vaccines like DTaP, IPV, Hib, and influenza (inactivated) do not contain replicating pathogens and are generally considered safe for immunocompromised patients, although the immune response may be weaker.

The key concept is that live attenuated vaccines should be avoided in patients who are immunocompromised from high-dose systemic glucocorticoids. High-dose steroids markedly impair cell-mediated and humoral immunity, so a vaccine that contains replicating live organisms could cause a vaccine-strain infection or disseminated disease in this person. MMR and Varicella are live attenuated vaccines, so they should not be given to someone on high-dose steroids. In contrast, inactivated vaccines like DTaP, IPV, Hib, and influenza (inactivated) do not contain replicating pathogens and are generally considered safe for immunocompromised patients, although the immune response may be weaker.