Pedemy All toolsChoose the condition or medicine and see which vaccines to give, which to hold, and how long to wait.
This tool helps a clinician decide which vaccines a child with weakened immunity can receive and when. It first asks who is being vaccinated (the child, an infant exposed to a biologic in pregnancy, or a household contact), then the cause and the stage of treatment, and shows which live and inactivated vaccines to give or hold.
It covers systemic steroids (high dose is 2 mg/kg/day or 20 mg/day or more for 14 days or more, with a 4-week wait after stopping before live vaccines), chemotherapy and stem cell transplant, biologics and other immunosuppressants including anti-B-cell antibodies such as rituximab, asplenia and sickle cell disease, and HIV with CD4 thresholds for MMR and varicella.
Household contacts should receive all vaccines, including MMR, varicella and rotavirus, with simple precautions. Timing after specific drugs varies, so confirm complex cases with the treating oncology, rheumatology, transplant or infectious diseases team.
Prednisone or equivalent 2 mg/kg/day or more, or 20 mg/day or more if over 10 kg, for 14 days or more. Wait at least 4 weeks after stopping. Shorter courses, low doses and inhaled or topical steroids do not prevent live vaccines.
At least 3 months after chemotherapy ends, and at least 6 months after anti-B-cell therapy such as rituximab. Inactivated influenza vaccine should be given every year during treatment.
Yes, if not severely immunosuppressed for at least 6 months: CD4 15% or more at age 5 years or younger, or CD4 15% or more and 200 cells/µL or more when older. Use separate MMR and varicella, not MMRV, and no LAIV.
Yes. They should get MMR, varicella and rotavirus. Wash hands after diaper changes for 4 weeks after rotavirus vaccine, and avoid contact if a varicella vaccine rash appears.
Yes, MMR, varicella and rotavirus are given on schedule. The only exception is LAIV (nasal flu vaccine), which should be replaced by the injection.
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