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Risk of Transmission Associated With Live Attenuated Vaccines Given to Healthy Persons Caring for or Residing With an Immunocompromised Patient

  • Mini Kamboj (a1) and Kent A. Sepkowitz (a1)



Persons who receive live attenuated vaccine may occasionally transmit the vaccine strain to others. The risk of such transmission is a concern, especially for persons who provide care to immunocompromised patients (ie, family and healthcare workers [HCWs]). Since the Advisory Committee on Immunization Practices released guidelines 10 years ago, several new live attenuated products have been introduced, and additional information on older vaccines has become available. To better define the risk of transmission associated with live vaccines, we reviewed the currently available literature.


A review of the medical literature revealed no major risk of transmission associated with any live attenuated vaccine. A theoretical risk continues to exist for the live attenuated intranasal influenza vaccine and the smallpox vaccine.


The available data support routine vaccination with live attenuated vaccines for all household contacts of immunocompromised patients and for HCWs caring for such Patients. The benefit for immunocompromised patients of providing herd immunity against this group of potentially devastating pathogens outweighs the risk, if any, of secondary transmission.


Corresponding author

Memorial Sloan-Kettering Cancer Center, Infectious Diseases, 1275 York Avenue, New York, NY 10021 (


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1.Alexander, LN, Seward, JF, Santibanez, TA, et al.Vaccine policy changes and epidemiology of poliomyelitis in the United States. JAMA 2004;292:16961701.
2.Prevots, DR, Burr, RK, Sutter, RW, Murphy, TV. Poliomyelitis prevention in the United States. Updated recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 2000;49(RR-5): 122.
3.Update: Outbreak of poliomyelitis—Dominican Republic and Haiti, 2000-2001. MMWR Morb Mortal Wkly Rep 2001;50:855856.
4.Khetsuriani, N, Prevots, DR, Quick, L, et al.Persistence of vaccine-derived polioviruses among immunodeficient persons with vaccine-associated paralytic poliomyelitis. J Infect Dis 2003;188:18451852.
5.Poliovirus infections in four unvaccinated children—Minnesota, August-October 2005. MMWR Morb Mortal Wkly Rep 2005;54:10531055.
6.ACIP issues recommendations for vaccines and immune globulins in immunocompromised persons. Advisory Committee on Immunization Practices. Am Fam Physician 1993;48:337340.
7.Update: vaccine side effects, adverse reactions, contraindications, and precautions. Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 1996;45(RR-12): 135.
8.Takahashi, M, Otsuka, T, Okuno, Y, Asano, Y, Yazaki, T. Live vaccine used to prevent the spread of varicella in children in hospital. Lancet 1974;2:128890.
9.Tsolia, M, Gershon, AA, Steinberg, SP, Gelb, L. Live attenuated varicella vaccine: evidence that the virus is attenuated and the importance of skin lesions in transmission of varicella-zoster virus. National Institute of Allergy and Infectious Diseases Varicella Vaccine Collaborative Study Group. J Pediatr 1990;116:184189.
10.Salzman, MB, Sharrar, RG, Steinberg, S, LaRussa, P. Transmission of varicella-vaccine virus from a healthy 12-month-old child to his pregnant mother. J Pediatr 1997;131:151154.
11.Bruneil, PA, Argaw, T. Chickenpox attributable to a vaccine virus contracted from a vaccine with zoster. Pediatrics 2000;106: E28.
12.Kappagoda, C, Shaw, P, Burgess, M, Botham, S, Cramer, L. Varicella vaccine in non-immune household contacts of children with cancer or leukaemia. J Paediatr Child Health 1999;35:341345.
13.Diaz, PS, Au, D, Smith, S, et al.Lack of transmission of the live attenuated varicella vaccine virus to immunocompromised children after immunization of their siblings. Pediatrics 1991;87:166170.
14.Gershon, AA. Vaccines. 4th ed. Philadelphia: WB Saunders; 2003.
15.Gershon, AA, Steinberg, SP. Live attenuated varicella vaccine: protection in healthy adults compared with leukemic children. National Institute of Allergy and Infectious Diseases Varicella Vaccine Collaborative Study Group. J Infect Dis 1990;161:661666.
16.American Academy of Pediatrics. Committee on Infectious Diseases. Varicella vaccine update. Pediatrics 2000;105:136141.
17.Watson, JC, Hadler, SC, Dykewicz, CA, Reef, S, Phillips, L. Measles, mumps, and rubella—vaccine use and strategies for elimination of measles, rubella, and congenital rubella syndrome and control of mumps: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 1998;47(RR-8): 157.
18.Millson, DS. Brother-to-sister transmission of measles after measles, mumps, and rubella immunisation. Lancet 1989;1:271.
19.Monafo, WJ, Haslam, DB, Roberts, RL, Zaki, SR, Bellini, WJ, Coffin, CM. Disseminated measles infection after vaccination in a child with a congenital immunodeficiency. J Pediatr 1994;124:273276.
20.Measles pneumonitis following measles-mumps-rubella vaccination of a patient with HIV infection, 1993. MMWR Morb Mortal Wkly Rep 1996;45:603606.
21.Sawada, H, Yano, S, Oka, Y, Togashi, T. Transmission of Urabe mumps vaccine between siblings. Lancet 1993;342:371.
22.Nakayama, T, Oka, S, Komase, K, et al.The relationship between the mumps vaccine strain and parotitis after vaccination. J Infect Dis 1992;165:186187.
23.Exposure to mumps during air travel—United States, April 2006. MMWR Morb Mortal Wkly Rep 2006;55:401402.
24.Mumps epidemic—Iowa, 2006. MMWR Morb Mortal Wkly Rep 2006;55:366368.
25. FluMist [package insert]. Gathersburg, MD: Medlmmune Vaccines, Inc.; 2006.
26.Harper, SA, Fukuda, K, Cox, NJ, Bridges, CB. Using live, attenuated influenza vaccine for prevention and control of influenza: supplemental recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 2003;52(RR-13): 18.
27.Vesikari, T. Randomized, double-blind, placebo-controlled trial of the safety, transmissibility and phenotypic stability of a live, attenuated, cold-adapted influenzavirus vaccine (CAIV-T) in children attending day care. In: Program and abstracts of the 41st Annual Interscience Conference on Antimicrobial Agents and Chemotherapy (Chicago). 2001:262. Abstract G-450.
28.Talbot, TR, Crocker, DD, Peters, J, et al.Duration of virus shedding after trivalent intranasal live attenuated influenza vaccination in adults. Infect Control Hosp Epidemiol 2005;26:494500.
29.Izurieta, HS, Haber, P, Wise, RP, et al.Adverse events reported following live, cold-adapted, intranasal influenza vaccine. JAMA 2005;294:27202725.
30.Smith, NM, Bresee, JS, Shay, DK, Uyeki, TM, Cox, NJ, Strikas, RA. Prevention and control of influenza: recommendations of the Advisory Committee on Immunization Practices (ACIP) MMWR Recomm Rep 2006;55(RR-10): 142.
31.Sepkowitz, KA. How contagious is vaccinia? N Engl J Med 2003;348:439446.
32.Secondary and tertiary transfer of vaccinia virus among U.S. military personnel—United States and worldwide, 2002-2004. MMWR Morb Mortal Wkly Rep 2004;53:103105.
33.Wharton, M, Strikas, RA, Harpaz, R, et al.Recommendations for using smallpox vaccine in a pre-event vaccination program. Supplemental recommendations of the Advisory Committee on Immunization Practices (ACIP) and the Healthcare Infection Control Practices Advisory Committee (HICPAC). MMWR Recomm Rep 2003;52(RR-7):116.
34.Casey, C, Vellozzi, C, Mootrey, GT, et al.Surveillance guidelines for smallpox vaccine (vaccinia) adverse reactions. MMWR Recomm Rep 2006;55(RR-1):116.
35.Lane, JM, Fulginiti, VA. Transmission of vaccinia virus and rationale for measures for prevention. Clin Infect Dis 2003;37:281284.


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