Pediatrics in Review
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(Pediatrics in Review. 1997;18:66-67.)
© 1997 American Academy of Pediatrics

Complications of Immunizations

Rabia Agha, MD*
* Albert Einstein College of Medicine Montefiore Medical Center Bronx, NY
The pediatric immunization schedule includes multiple vaccines that protect against a series of important bacterial and viral pathogens. These vaccines consist of either live attenuated, killed or inactivated agents, or toxoids or bacterial polysaccharides conjugated to proteins. Live attenuated viral vaccines mandated for children are the measles-mumps-rubella (MMR) and oral polio vaccines (OPV). Other available live vaccines include varicella, vaccinia, yellow fever, and BCG typhoid Ty21a (oral).

Immunocompromised patients can be immunized safely with killed or inactivated vaccines, although the efficacy of immunization may be diminished. However, special considerations apply to the administration of live vaccines to children whose immune systems are compromised, who may be categorized into distinct groups:

Children in the first category should not be immunized with live viral vaccines. Uninhibited by an effective host immune system, the vaccine virus may replicate sufficiently to cause disease. In addition, OPV should not be given to household contacts of immunocompromised patients; the vaccine virus is shed fecally for weeks following administration and can infect a household member whose immune system is impaired. It is particularly important, on the other hand, to be sure that close contacts of immunosuppressed patients are protected against measles. This vaccine virus is not shed, and if wild disease is brought into the household, it can be devastating to the compromised host.

The only . . . [Full Text of this Article]

Henry M. Adam, MD
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Pediatrics Pediatrics in Review
Copyright © 1997 by the American Academy of Pediatrics.