Live attenuated vaccines for patients with oral immunosuppressive agents

Abstract

Live attenuated vaccines are generally contraindicated for patients receiving immunosuppressive therapy. However, these patients are at risk of severe infection. In 21 previous reports, 400 patients under immunosuppressive therapy received 816 live attenuated vaccines. No life-threatening adverse events were observed. In our center, we conducted prospective studies of live attenuated vaccines in patients under immunosuppressive therapy for seven years. Patients who met specific immunological criteria (CD4 cell count≥500/mm³, lymphocyte blast transformation by phytohemagglutinin (PHA)≥101.6, and serum IgG level≥300 mg/dL) could receive live attenuated vaccines. The seroconversion rate for measles, rubella, varicella, and mumps was 80.0-95.7%, 100.0%, 59.1-61.9%, and 40.0-69.2%, respectively. In nationwide study, two-thirds of physicians wished to administer live vaccines for patients under immunosuppressants. Only two patients contracted vaccine-strain varicella in 781 immunizations. We demonstrated that live attenuated vaccines could be effective and safe even in patients with immunosuppressive agents, if their immunological parameters are within the acceptable level. We think that medical package inserts and several guidelines should be revised in the near future.