Although persons receiving high doses of systemic corticosteroids daily or on alternate days during an interval of less than 14 days generally can receive MMR or its component vaccines immediately after cessation of treatment, some experts prefer waiting until 2 weeks after completion of therapy. Patients receiving cancer chemotherapy or radiation who have not received chemotherapy for at least 3 months may receive MMR or its component vaccines. Patients with leukemia in remission whose chemotherapy has been terminated for at least 3 months and transplant recipients who are beyond the period of immunosuppression may receive live-virus vaccines. Pneumococcal vaccine is recommended for any HIV-infected person who is more than 2 years old. Because influenza may result in serious illness and complications, vaccination against influenza is a prudent precaution in HIV-infected persons.
Immunosuppression increases the risk for vaccine-associated paralytic polio.
OPV should not be given to a person known to be infected with HIV regardless of the level of immunosuppression. OPV should also not be administered to a healthy family contact of a person with HIV infection. IPV should be substituted for OPV in these circumstances. OPV should not be given to any immunocompromised patient, their household members, or their close contacts. If polio immunization is indicated for these persons, IPV is recommended.