The Australian Immunisation Handbook 10th Edition 2013

• Yellow fever vaccine is generally contraindicated in immunocompromised
travellers going to yellow fever endemic countries. The vaccine can, however,
be considered on a case-by-case basis, including in persons with HIV (see
4.23 Yellow fever).
If there is uncertainty around the level of immunocompromise and when vaccine
administration may be safe, this should be discussed with the treating physician
and expert advice should be sought (see also ‘Immunocompromise associated
with corticosteroid administration’ above).
Household contacts of immunocompromised persons
To best protect immunocompromised persons, whether adults or children, their
household and other close contacts should be fully vaccinated according to
current recommendations. Annual influenza vaccination is recommended for
all household contacts (≥6 months of age) of immunocompromised persons.
Assessment of the need for household contacts of immunocompromised persons
to receive pertussis-containing and/or varicella vaccines is also very important
(see 4.12 Pertussis and 4.22 Varicella). 85-87
The use of live attenuated viral vaccines in contacts of immunocompromised
persons (MMR, MMRV, varicella and rotavirus vaccines, where indicated) is
safe, and strongly recommended to reduce the likelihood of contacts infecting
the immunocompromised person. Persons ≥50 years of age who are household
contacts of an immunocompromised person are also recommended to receive
zoster vaccine. Although there is no risk of transmission of the MMR vaccine
viruses, and an almost negligible risk of transmission of varicella-zoster vaccine
virus (from varicella or zoster vaccine), there is a small risk of transmission of the
rotavirus vaccine virus. Hand washing and careful disposal of soiled nappies is
recommended to minimise transmission. Immunocompromised persons should
avoid contact with persons with varicella and herpes zoster, where possible. (See
also 4.9 Measles, 4.17 Rotavirus, 4.22 Varicella and 4.24 Zoster).
Oncology patients
Paediatric and adult patients undergoing cancer chemotherapy who have not completed a
primary vaccination schedule before diagnosis
Live vaccines, including BCG, MMR, zoster and varicella vaccines, are
contraindicated in cancer patients receiving immunosuppressive therapy and/or
who have poorly controlled malignant disease. These vaccines are recommended
to be administered to seronegative persons at least 3 months after completion
of chemotherapy, provided the underlying malignancy is in remission. 88
Administration of live attenuated viral vaccines (MMR-containing or varicellacontaining
vaccines) should be deferred if blood products or immunoglobulins
have been recently administered (see Table 3.3.6 Recommended intervals between
either immunoglobulins or blood products and MMR, MMRV or varicella vaccination).
148 The Australian Immunisation Handbook 10th edition