Immunisation in the immunocompromised host
Why immunosuppression makes live vaccines dangerous and non-live vaccines weaker, the Australian Immunisation Handbook levels of immunocompromise, timing around steroids, DMARDs, rituximab and transplant, and the current 21vPCV, Shingrix and HPV recommendations.
Tier 1Medical sciences concept
Written with AI assistance and fact-checked against the sources below. For exam study, not clinical decisions. How notes are made
At a glance
- Immunosuppression causes two separate problems: live vaccines can replicate uncontrolled and cause disease, and non-live vaccines give weaker, shorter responses.
- Vaccinate before immunosuppression where possible: live at least 4 weeks before, non-live at least 2 weeks before.
- The Australian Immunisation Handbook grades people as mildly, moderately or severely immunocompromised. Live vaccines are generally fine if mild, generally contraindicated if moderate and contraindicated if severe. Asplenia is the exception: graded moderate, but live vaccines are safe.
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Sources
- Australian Immunisation Handbook: Vaccination for people who are immunocompromisedAU/NZAustralian Technical Advisory Group on Immunisation (ATAGI), updated 2026
- Australian Immunisation Handbook: Pneumococcal disease (adult 21vPCV schedule)AU/NZAustralian Technical Advisory Group on Immunisation (ATAGI), updated June and September 2026
- Australian Immunisation Handbook: Zoster (herpes zoster)AU/NZAustralian Technical Advisory Group on Immunisation (ATAGI)
- 2013 IDSA clinical practice guideline for vaccination of the immunocompromised hostClinical Infectious Diseases (Rubin et al.), 2013
- Last updated
- 14 November 2026
What changed
- 14 November 2026 Personal emails, About story and Australian-style copy