Live vaccinations in dermatology for immunosuppressed patients: a narrative review

Divya M Shan; Rithi J Chandy; Andrew Fultz; John W Sanders; Steven R Feldman

doi:10.1007/s00403-024-02827-2

Live vaccinations in dermatology for immunosuppressed patients: a narrative review

Arch Dermatol Res. 2024 Mar 2;316(3):96. doi: 10.1007/s00403-024-02827-2.

Authors

Divya M Shan¹, Rithi J Chandy², Andrew Fultz², John W Sanders³, Steven R Feldman^{2

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Affiliations

¹ Center for Dermatology Research, Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, NC, USA. shandm@vcu.edu.
² Center for Dermatology Research, Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
³ Department of Infectious Diseases, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
⁴ Department of Pathology, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
⁵ Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
⁶ Department of Dermatology, University of Southern Denmark, Odense, Denmark.

PMID: 38430244
DOI: 10.1007/s00403-024-02827-2

Abstract

Given the higher susceptibility to infectious disease in patients receiving immunosuppressive therapies for inflammatory dermatologic conditions, immunization is important in this population. While live vaccines protect against life-threatening diseases, they can be harmful in immunosuppressed patients given the risk of replication of the attenuated pathogen and adverse reactions. The utilization of live vaccines in immunosuppressed patients depends on multiple factors such as the vaccine and therapy regimen. To provide an overview of evidence-based recommendations for the use of live vaccines in patients receiving immunosuppressive therapies for dermatological conditions. A literature search of the PubMed database was performed using keywords live vaccine, live-attenuated vaccine, dermatology, immunosuppressed, and immunocompromised, and specific immunosuppressive therapies: corticosteroids, glucocorticoids, methotrexate, azathioprine, cyclosporine, mycophenolate mofetil, biologics. Relevant articles written in English were included. Using these keywords, 125 articles were reviewed, of which 28 were ultimately selected. Recommendations for live vaccines can be determined on a case-by-case basis. Measles, mumps, rubella, varicella (MMRV) vaccines may be safely administered to patients on low-dose immunosuppressive agents while the yellow fever vaccine is typically contraindicated. It may be safe to administer live MMRV boosters to children on immunosuppressive therapies and the live herpes zoster vaccine to patients on biologics. Given poor adherence to immunization guidelines in immunosuppressed patients, dermatologists have a critical role in educating patients and general practitioners regarding live vaccines. By reviewing a patient's vaccination history and following immunization guidelines prior to initiating immunosuppressive therapies, physicians can mitigate morbidity and mortality from vaccine-preventable diseases.

Keywords: General dermatology; Immunosuppression; Immunosuppressive therapies; Live vaccines; Preventative care.

Publication types

Review

MeSH terms

Chickenpox Vaccine / administration & dosage
Chickenpox Vaccine / adverse effects
Dermatology*
Humans
Immunocompromised Host*
Measles-Mumps-Rubella Vaccine / administration & dosage
Measles-Mumps-Rubella Vaccine / adverse effects
Vaccination* / adverse effects
Vaccines, Attenuated / administration & dosage
Vaccines, Attenuated / adverse effects
Yellow Fever Vaccine / administration & dosage
Yellow Fever Vaccine / adverse effects

Substances

Chickenpox Vaccine
Measles-Mumps-Rubella Vaccine
Vaccines, Attenuated
Yellow Fever Vaccine