M-R-Vax II Disease Interactions

In general, the use of measles, mumps, and rubella vaccine or any single component is contraindicated in patients with primary or acquired immunodeficiency. Since these vaccines contain live attenuated viruses, the absence of immune competence may potentiate the replication of vaccine virus, increase adverse host reactions, and compromise serum antibody response. Likewise, the vaccine should not be administered to anyone with a family history of congenital or hereditary immunodeficiency until the individual's immune status can be assessed and is determined to be adequate. In the case of HIV infection, patients without overt clinical manifestations suggesting severe immunodeficiency should be vaccinated because measles can be particularly severe and potentially fatal in the presence of HIV. However, immunization may be less effective in these patients, and they should be monitored for vaccine-preventable diseases.

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Ideally, vaccination should occur when an individual is healthy, thus minimizing the risk of an adverse host reaction and/or vaccine failure. However, a current or recent infection does not necessarily preclude the use of vaccines, depending on the severity of the patient's symptoms and their etiology. Superficial infections and minor acute illnesses such as a mild upper respiratory infection with or without low-grade fever do not contraindicate immunization, particularly if prompt administration of a vaccine is deemed necessary or beneficial. In fact, when vaccines are administered during the course of a minor illness, the risk of adverse events is not increased, and serum antibody response is not often diminished. On the other hand, if fever or symptoms suggest a moderate or severe illness, it is usually appropriate to withhold vaccination until the patient has recovered. In addition to the potential risks already mentioned, evolving signs and symptoms of the illness can sometimes confound the diagnosis of a vaccine reaction if it develops. In the presence of any infection, the decision to administer or withhold/defer immunization should take into consideration the benefits versus the risks to an individual patient.

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Transient thrombocytopenia has been reported within 4 to 6 weeks following vaccination with measles, mumps and rubella vaccine. Caution is advised in children with thrombocytopenia and those patients with history of thrombocytopenia after vaccination. The decision to vaccinate should consider both the potential benefits and risks to the patient.

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