Vaccine Education Center

Vaccines and Special Situations

Most children and adults can receive all of the recommended vaccines. However, there are some special circumstances where vaccines cannot be given. Several of these circumstances are listed in this section.

Adoptees
Breastfeeding
Living with someone with weakened immunity
Missed vaccines
Pregnancy
Premature babies
Previous severe reactions
Steroids
Weakened immunity

Adoptees

For children who have received vaccines outside of the United States, you should be aware that doses are often missed and records may or may not be accurate, even when written. Therefore, your child's doctor may suggest beginning all immunizations again or testing for immunity if a blood test is available. Even if your child received some vaccines before arriving in the U.S., repeat doses are not dangerous.

The American Academy of Pediatrics offers a helpful brochure, A Healthy Beginning: Important Information for Parents of Internationally Adopted Children

The Immunization Action Coalition provides a list of multiple resources for families who have or are considering international adoption.

Breastfeeding

Infants who are being breastfed may receive all 14 vaccines routinely recommended for infants. Antibodies in breast milk do not interfere with any of the currently recommended vaccines.

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Living with someone with weakened immunity

The only vaccine that wasn't given to a child who was living in the home of someone with weakened immunity was the oral polio vaccine. The oral polio vaccine was contagious and was potentially dangerous to someone suffering from a weakened immune system. However, this vaccine is no longer recommended for use.

The MMR, rotavirus, shingles, intranasal influenza and varicella vaccines can all be given to people who are living in the same home as someone with weakened immunity. Although trace amounts of these live vaccine viruses can be detected for about two weeks in the throat of a vaccinated child, they are not contagious. The viruses that show up are so weakened, and exist in such miniscule amounts, that they do not endanger family members.

Children receiving the hepatitis B, Hib, hepatitis A, polio (shot), influenza (shot), pneumococcus, and diphtheria, tetanus and pertussis vaccines are not contagious to someone with weakened immunity.

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Missed vaccines

Vaccines are given as a series of shots over a scheduled period of time (see Vaccine Schedule). However, if a shot is missed, you do not need to start the series of doses all over again. The series can be continued as usual, simply picking up where you left off.

Pregnancy

Children living in the home of a pregnant woman can receive all recommended vaccines.

Because pregnant women are at increased risk of severe and occasionally fatal influenza infection, they are recommended to receive the influenza vaccine if they will be pregnant during influenza season.

Pregnant women should also ask about getting the Tdap vaccine later during their second trimester or during their third trimester. Young babies are particularly susceptible to pertussis or whooping cough (the “p” in Tdap). By getting a booster dose of the Tdap vaccine before delivery, expectant mothers will be less likely to catch and transmit this disease to their babies. Dads, grandparents, and other teens and adults who will be around the baby should also get a dose if they have not had the booster.

Additional information about vaccines and pregnancy»

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Premature babies

Most premature infants, including those with low birth weights, can be immunized at the usual chronological age. In other words, a child born two months early should still receive his or her first immunizations at 2 months of age (not at 4 months of age).

An exception to this rule is the hepatitis B vaccine. Premature infants (children born within 36 weeks of conception with a birth weight of less than 4.4 pounds) whose mothers are not infected with hepatitis B virus should receive the hepatitis B vaccine at 1 month of age or at hospital discharge, whichever comes first. However, premature infants whose mothers are infected with hepatitis B virus should receive the vaccine at birth, independent of birth weight.

If an infant is at least 6 weeks old and has been hospitalized since birth, the first dose of rotavirus vaccine should be delayed until the infant is discharged from the hospital unless discharge occurs after 15 weeks of age. Due to a lack of safety data, the rotavirus vaccine cannot be started after an infant is more than 15 weeks old.

Previous severe reactions

People with severe allergic reactions to a vaccine should not receive another dose of that vaccine. Some children have severe hypersensitivity (or anaphylactic) reactions to vaccines. Although these are extremely rare, you should watch out for the following reactions, which usually occur within 15 to 30 minutes of receiving a vaccine:

• Difficulty breathing
• Hives
• Low blood pressure
• Shock

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Steroids

Steroids, which can weaken the immune system, are often given to people with diseases such as asthma, rheumatologic diseases and poison ivy. If people are taking steroids for any reason, they should discuss with their doctor whether it is safe to proceed with the vaccination schedule. In general, the following rules apply:

Steroid creams or sprays (aerosols)

It is safe to be vaccinated. The use of topical or inhaled steroids does not prevent the administration of vaccines.

Steroids taken by mouth for less than two weeks

It is safe to be vaccinated.

High doses of steroids taken by mouth for more than two weeks

People should not receive live, "weakened" vaccines if they have been taking high doses of steroids by mouth for more than two weeks. (A high dose is considered to be that greater than 2 milligrams (mg) per kilogram [2.2 pounds] of prednisone per day). The live viral vaccines include measles, mumps, rubella, varicella (chickenpox), rotavirus and the intranasal version of influenza. These vaccines can be given about three months after steroids have been stopped, although the rotavirus vaccine has age restrictions and the influenza vaccine is seasonal, so patients should discuss their situation with their healthcare provider.

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Weakened immunity

If a child or adult has leukemia, lymphoma, other types of cancers or AIDS, they should not receive vaccines made with what is known as the "live, weakened" viruses — that is, they should not receive the measles, mumps, rubella (MMR), intranasal influenza (FluMist®), rotavirus or varicella vaccines.

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Reviewed by: Paul A. Offit, MD
Date: March 2012