Close contacts of people who are immunocompromised

• Optimising vaccination of close contacts can reduce disease exposure and provide indirect protection against many vaccine-preventable diseases for people who are immunocompromised.
• Close contacts of people who are immunocompromised should stay up to date with all routine vaccinations.
• Close contacts of people who are immunocompromised can safely receive all live vaccines.

For more details about the immunosuppressive potential of various medications and medical conditions, see:

• Table. Types of medical conditions and immunosuppressive therapy and associated levels of immunocompromise
• Table. Immunosuppressive potential of cancer and organ rejection therapies
• Table. Immunosuppressive potential of conventional (non-biological) immunosuppressive therapies
• Table. Immunosuppressive potential of small molecule targeted therapies
• Table. Immunosuppressive potential of biological therapies
• Table. Immunosuppressive potential of corticosteroids
• Table. Immunosuppressive potential of certain medical conditions

Close contacts of people who are immunocompromised should stay up to date with all routine vaccinations. This includes seasonal vaccinations such as influenza (for all close contacts aged ≥6 months; see Influenza).

Close contacts of people who are immunocompromised can safely receive all live vaccines according to routine schedules. Importantly, these vaccinations provide indirect protection for people who are immunocompromised, who may not be able to receive live vaccines.

MMR (measles-mumps-rubella) vaccines

Household contacts of people who are immunocompromised can safely receive MMR-containing vaccines. The vaccine viruses are not transmissible from vaccinated people to others.

Varicella vaccine

Household contacts of people who are immunocompromised can safely receive varicella-containing vaccines. It is important to vaccinate these people against varicella (see Varicella).

Transfer of the varicella vaccine virus strain to a person who is immunocompromised is extremely rare, but it is possible. If the person who was vaccinated develops a varicella-like or zoster-like rash, the virus can spread from the vesicle fluid of the skin lesions.¹ In this situation, the person who was vaccinated should cover the rash and avoid direct contact with the person who is immunocompromised, until the rash has resolved.

Rotavirus vaccine

Infants living in households with people who are immunocompromised can safely receive oral rotavirus vaccines. The exception to this is infants who were born to mothers who received anti-CD20 therapies (such as rituximab), particularly in the 2nd and 3rd trimester, as these infants are not recommended to receive rotavirus vaccine. (see Vaccination for infants exposed to immunosuppressive therapy in utero or through breastmilk and Rotavirus).

Infants may shed viral antigens in their stools for up to 4 weeks after rotavirus vaccination, but transmission of disease is rare.^2,3 The very small risk of transmission of rotavirus vaccine virus can be minimised by effective hand hygiene after contact with the infant who was vaccinated, especially after handling faeces (such as when changing nappies) and before food preparation.

The benefit of protecting people who are immunocompromised from naturally occurring rotavirus by vaccinating infants in the household outweighs the theoretical risk of transmitting the vaccine virus.

Cholera vaccine

Routine cholera vaccination of healthy travellers is not recommended. However, cholera vaccination is recommended for certain travellers who may have a very high risk of exposure to cholera (see Cholera).

Cholera bacteria may be shed in the stool for 7 days (or longer) after immunisation with live cholera vaccine.⁴ The vaccine strain can be transmitted to unvaccinated close contacts, including those who are immunocompromised. After receiving live oral cholera vaccine, care should be taken to ensure strict hand hygiene for both the person who received the vaccine and household members who are immunocompromised.

Typhoid vaccine

Similar to other live oral vaccines, precautions should be taken to avoid the theoretical risk of vaccine strain virus transmission to immunocompromised close contacts (see Typhoid fever). After receiving live oral typhoid vaccine, care should be taken to ensure strict hand hygiene for both the person who received the vaccine and household members who are immunocompromised.

Q fever

Household contacts of people who are immunocompromised can safely receive Q fever vaccine, if indicated by the usual Q fever eligibility criteria (see Q fever).

BCG vaccine

Household contacts of people who are immunocompromised can safely receive BCG vaccine, if indicated by the usual BCG eligibility criteria (see Tuberculosis).

1. Nagel MA, Gershon AA, Mahalingam R, Niemeyer CS, Bubak AN. Varicella vaccines. In: Orenstein W, Offit P, Edwards KM, Plotkin S, eds. Plotkin's Vaccines. Philadelphia, PA: Elsevier; 2023. (Accessed 11/1/2025). https://www.sciencedirect.com/science/article/pii/B9780323790581000633
2. Bennett A, Pollock L, Jere KC, et al. Duration and density of fecal rotavirus shedding in vaccinated Malawian children with rotavirus gastroenteritis. Journal of Infectious Diseases 2020;222:2035-40.
3. Chiu M, Bao C, Sadarangani M. Dilemmas with rotavirus vaccine: the neonate and immunocompromised. Pediatric Infectious Disease Journal 2019;38(6S Suppl 1):S43-6.
4. Chen WH, Greenberg RN, Pasetti MF, et al. Safety and immunogenicity of single-dose live oral cholera vaccine strain CVD 103-HgR, prepared from new master and working cell banks. Clinical and Vaccine Immunology 2014;21:66-73.