I have a healthy 5 year-old patient whose close household contact (her mother) is immunocompromised due to cancer chemotherapy. Can I administer live vaccines to the healthy child?

Yes. Household contacts and other close contacts of people who are immunocompromised (due to a disease, or treatment for a disease) should receive all routinely recommended vaccines, with the exception of smallpox vaccine. The live MMR, varicella, and rotavirus vaccines should be administered to susceptible household contacts and other close contacts of immunocompromised patients when indicated. MMR vaccine viruses are not transmitted to contacts, and transmission of vaccine strain varicella-zoster virus is rare. No specific precautions are needed unless the varicella vaccine recipient has a rash after vaccination, in which case direct contact with susceptible immunocompromised household contacts should be avoided until the rash resolves. All members of the household should wash their hands after changing the diaper of an infant who received rotavirus vaccine. This minimizes rotavirus transmission, as shedding may occur up to one month after the last dose.

Household and other close contacts of immunocompromised persons should receive annual influenza vaccination. Introduction of low levels of vaccine viruses into the environment likely is unavoidable when administering quadrivalent live attenuated influenza vaccine (LAIV4; Flumist, Medimmune). LAIV4 vaccine viruses are cold-adapted so they can replicate in the nose and generate an immune response without entering the lungs (that is, they are temperature sensitive and replicate poorly at core body temperatures). No instances have been reported of illness caused by attenuated vaccine virus infections among healthcare providers or immunocompromised patients. LAIV may be administered to healthy nonpregnant household and other close contacts of immunocompromised people unless the immunocompromised person is hospitalized in a protective environment, typically defined as a specialized patient-care area with a positive airflow relative to the corridor, high-efficiency particulate air filtration, and frequent air changes. A person who is administered LAIV4 should not have contact with an immunocompromised person in this type of protective environment for 7 days after administration.