Some children have weakened immune systems because of chronic diseases or medications they’re taking. These include
- Children born with abnormalities of the immune system
- Children infected with human immunodeficiency virus, which causes acquired immunodeficiency syndrome (AIDS), including those who have full-blown AIDS
- Children who have cancer
- Children who have had organ transplants
- Children with diseases that require them to take certain medicines, including corticosteroids
If your child falls into one of these categories, your pediatrician may decide that the benefits of giving certain vaccines outweigh the risks that your youngster’s immune system problems pose. Your doctor also may choose to wait until your child’s immune system is stronger before giving these vaccines.
Here are a few points to keep in mind and discuss with your doctor.
- For a child with a weakened immune system, your pediatrician may suggest delaying or not using immunizations containing live viruses in particular because of the risk of serious effects from the vaccine. These include vaccines such as measles-mumps-rubella (MMR), chickenpox (varicella), and the nasal spray influenza vaccine. (Although the oral polio vaccine contains a live virus, it is no longer used in the United States.) If a child has had chemotherapy, live-virus vaccines are often given 3 months or more after the treatment is completed.
- In general, vaccines with inactivated viruses and bacteria can be used in children who have weakened immune systems with no increased risk. However, the effectiveness of these immunizations can vary in these children and may be reduced in some cases. Vaccines with inactivated viruses or parts of bacteria that do not have an increased risk of side effects in children with weakened immune systems include diphtheria, tetanus, and acellular pertussis; hepatitis A; hepatitis B; polio; Haemophilus influenzae type B; pneumococcal; meningococcal; and the killed influenza vaccines (those given by shot).
- Children taking corticosteroids can have weakened immune systems. The decision of whether to use vaccines in these youngsters often depends on the dose of steroids taken, as well as how these medicines are given. For example, when steroids are given in the form of topical medicines (applied directly to the skin), or if they’re inhaled in an aerosol formulation (often to treat asthma or allergies), they don’t interfere with the immune system. This means live-virus vaccines can be given to these youngsters. Also, children taking steroid pills in low or moderate doses can safely be given live-virus vaccines.