Monday, June 07, 2010

Which Vaccines are Live?

A patient posed an excellent question when she pointed out that the literature she received about her intravenous rheumatoid arthritis medication recommended that she avoid individuals who have recently received a live vaccine. Because she has many grandchildren who are in the age-range for various vaccinations, she was wondering--just which vaccines are "live?"

"Live" vaccines contain a weakened version of the disease. It is possible for individuals with weakened immune systems (due to disease, long-term steroid use, or because of medications such as chemotherapy or biological drugs that intentionally weaken the immune system) to become ill after being exposed to a live vaccine. A "live" vaccine could unintentionally cause a mild case of the illness that it is intended to prevent.

List of Live Vaccines
(These are "Not OK" for those with weak immune systems):

Influenza (Intranasal Mist):  Don't be confused--the intra-nasal flu mist vaccine is live--this is the one that is squirted directly into the nose. (The injected flu vaccine ("flu shot") is an inactivated or "killed" vaccine and not usually dangerous.)
Polio (Oral vaccine):  Note, only the polio vaccine that is taken by mouth is live; the injected polio vaccine is now the vaccine of choice for most patients.
Rotavirus (Oral and Injectable)
Rubella (German Measles) 
Smallpox (Vaccinia):  After vaccination the risk to persons with vulnerable immune systems is so great, that the vaccinated person is told not to have household or personal contact with pregnant women, infants, individuals with compromised immune systems until the vaccine scab has healed and fallen off. Check out the link for details.
Typhoid (Oral vaccine):  There is also a "killed" (inactive) injected version of the Typhoid Vaccine.
Varicella (Chickenpox)
Yellow Fever
Herpes Zoster vaccine (Shingles)
BCG (Tuberculosis):  This vaccine is rarely given in the U.S.; however, it is still administered in Mexico and in Europe.  (Please note this vaccine should NOT be confused with the TB skin test that is NOT a vaccine, but rather a screening test; the TB skin test, (PPD), is perfectly acceptable for anyone with a weakened immune system.)

List of Inactivated or "Killed" Vaccines
 (These are OK for most patients):

Influenza Injection ("Flu shot"):  Note that the injection is a killed vaccine, but the nasal flu mist vaccine is a live vaccine.
Haemophilus influenzae type b (Hib)
Diptheria Toxiod (included in the DTAP vaccine)
Tetanus Toxoid (Lock Jaw):  Typically combined with the diptheria vaccine
Pertussis (Whooping Cough)
Polio (Injection)
Hepatitis B
Typhoid Injectable: Note that there is also an oral version of the Typhoid vaccine available which is "live." The link gives information about both versions of the vaccine.
Meningococcal (Meningitis)
Japanese Encephalitis (Adult) and Japanese encephalitis (Pediatric)
Tick-Borne Encephalitis (TicoVac) (Not available in the U.S)
Rabies (see also National Network for Immunization Information: Rabies)
Pneumococcal polysaccharide vaccine (“Pneumonia Shot”)

 Sources of Information for Vaccines:

Vaccine Information Statements (VIS): Available in many languages.
CDC Vaccine Information Statements: Available in an audio version and in Spanish
National Vaccine Information Center
National Network for Immunization Information


Anonymous said...

Thank you for providing the information! I am currently pregnant and my mother has RA and has a compromised immune system. When our child is born and vaccinated she can not be around the baby after receiving any "live" vaccinations. Thanks again!

Unknown said...

Thanks for the info. As a person with RA and presently on Enbrel, I need to keep track of these things.

Unknown said...

Thanks for the info. This is very important for those of us with autoimmune conditions being treated with certain medications, or anyone with a compromised immune system.

Anonymous said...

This would explain the resent outbreaks . Childrens immune systems are down due too over vaccinating which is leading too low immune too protect them

Anonymous said...

I currently take Humira for RA, and also have grandchildren getting vaccines. How long do we have to stay away from someone who has been vaccinated with a live vaccination?

Carolyn Cooper, MPH, RN said...

Regarding the question above: The usual guidance for an immunosuppressed person is to avoid "close contact" with someone who has received a live vaccine for 2-3 weeks afterwards. When it comes to an infant, good advice is to avoid changing the diaper because waste products of the body shedding the vaccine elements can be present in the stool, etc. As long as the adults responsible for baby care are practicing good handwashing after performing routine diaper changes, there should be no problems in your contact with them.

Anonymous said...

I had a stem cell transplant 10 months ago, and work in a physicians office. Is this safe? It is a Maternal-Fetal Medicine office (high risk obstetrics). Is this safe? Also, what about my dogs yearly vaccines!

Carolyn Cooper, MPH, RN said...

To Anonymous (above): You have asked a really fascinating question regarding whether to be concerned about exposure to the vaccines your pet receives. I had to go looking for literature which discusses this very issue, and I was happy to find a very comprehensive, scholarly article which I will link. The article is from a 2003 journal of Clinical Infectious Disease: Human Illness Associated with the use of Vetrinary Vaccines"

There is certainly the possiblity that an immunocompromised person could be affected by a vaccine given to their pet; pet vaccines that are given via aerosol are particularly mentioned (i.e. Bordatella vaccine). There are a few documented cases of an owner becoming ill after being sprayed in the face with the pet vaccine when an animal suddenly pulls away during administration of the vaccine. Incidents like this may be under-reported, so it would be a good idea to inquire with your vet about the nature of the vaccine being adminstered and take precautions accordingly.

As for your first question about the safety of working in an MD's office. Every healthcare setting can be a potential source of infection--but then again airplanes and grocery stores are places to encounter a ridiculous number of germs unawares, so just be careful and prudent in general.

Practice excellent handwashing and avoid obviously ill individuals. Fortunately expectant mothers are usually in good health. If you were working in a different setting (dealing with contagious patients all day long), that would give me pause . . .

Anonymous said...

I have RA and I get biological meds such as orencia. I have a 3 and a half years old and he is supposed to get his vaccine soon when he turns 4. How I am supposed to protect myself living in the house.

Carolyn Cooper, MPH, RN said...

When your child has a live vaccine, the chances of acquiring an illness is probably quite low when you are in good health. But since you are immunocompromised by your treatment regimen, taking standard precautions such would be my best advice. Practice excellent handwashing and be especially certain of this when it comes to your child's toileting issues and bodily fluids. Practicing extra good hygiene in this situation should ease your mind considerably.