Travellers who are immunocompromised

Most live vaccines, including BCG vaccine and live attenuated influenza, are contraindicated in travellers who are moderately or severely immunocompromised. The exceptions are:

• MMR (measles-mumps-rubella) and monovalent varicella vaccines can be safely administered to some people with certain inborn errors of immunity (see Table. Vaccination for people with inborn errors of immunity), people with asplenia or hyposplenia, and people with HIV who have an adequate CD4⁺ count (see Table. Levels of immunocompromise in children and adults with HIV). Combination MMRV (measles-mumps-rubella-varicella) vaccine is not recommended in people who are immunocompromised, due to a lack of published data on its use in this population.
• Yellow fever vaccine can be safely administered to some travellers who are not severely immunocompromised.^1,2 Booster doses may be recommended (see Yellow fever). Yellow fever vaccine is contraindicated for most people who are severely immunocompromised.

See Table. Types of medical conditions and immunosuppressive therapy and associated levels of immunocompromise for more details.

People who are immunocompromised should receive seasonal inactivated influenza vaccine before travelling if they have not received it in the past 12 months.

Additional non-live vaccines may be recommended before travel for some people who are immunocompromised. These may include:

• cholera vaccine (inactivated)
• hepatitis A vaccine
• hepatitis B vaccine
• polio vaccine
• Japanese encephalitis vaccine (inactivated)
• typhoid vaccine (inactivated)
• meningococcal vaccine(s)
• rabies vaccine

See the relevant disease-specific chapters for more details.

Providers should also discuss additional health precautions that people who are immunocompromised may need to consider while they are travelling overseas. These include:

• considering the need for antimalaria prophylaxis and protection against mosquito bites
• ensuring safe food and water consumption
• understanding the signs of infection to be aware of during travel
• ensuring they have a plan for access to antibiotics and health care if they become unwell overseas

1. Huber F, Ehrensperger B, Hatz C, et al. Safety of live vaccines on immunosuppressive or immunomodulatory therapy – a retrospective study in three Swiss travel clinics. Journal of Travel Medicine 2018;25(1):tax082.
2. de Jong W, de Man RA, Dalm VA, et al. Yellow fever vaccination for immunocompromised travellers: unjustified vaccination hesitancy? Journal of Travel Medicine 2019;26(6):taz015.