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Vaccination guidelines for altered immune states and chronic diseases

Clinical Rule of Thumb

Live attenuated vaccines are generally contraindicated in pregnant and severely immunocompromised patients due to the risk of uncontrolled viral replication. Inactivated, recombinant, and mRNA vaccines are generally safe and often highly recommended to protect these vulnerable groups.

Pregnancy

Highly Recommended

  • Flu (IIV) - any trimester
  • Tdap - during every pregnancy (27-36 weeks)
  • COVID-19
  • RSV (32-36 weeks)

Contraindicated (Avoid)

  • MMR
  • Varicella
  • Live Attenuated Influenza (LAIV)
  • Yellow Fever (unless high risk)

Immunocompromised (HIV, Chemo, Transplant)

Highly Recommended

  • Pneumococcal (PCV20)
  • Flu (IIV)
  • COVID-19
  • Meningococcal
  • Hib
  • Shingrix (RZV)

Contraindicated (Avoid)

  • All Live Vaccines (MMR, Varicella, Rotavirus, LAIV, Yellow Fever, Oral Typhoid)

Asplenia / Sickle Cell Disease

Highly Recommended

  • Pneumococcal (PCV20/PPSV23)
  • Meningococcal (MenACWY and MenB)
  • Hib
  • Flu (IIV)
  • COVID-19

Chronic Liver Disease / End-Stage Renal Disease

Highly Recommended

  • Hepatitis A
  • Hepatitis B (double dose for ESRD often required)
  • Pneumococcal
  • Flu (IIV)