Vaccination for people with immunocompromise – frequently asked questions (FAQs)

Vaccine vial with checklist
Vaccine vial with checklist

NCIRS fact sheets, FAQs and other resources

Key points

  • Immunocompromise means a weakened immune system. It can be caused by various medical conditions or medical therapies.
     
  • The severity of immunocompromise varies widely among individuals and is influenced by many factors, including underlying disease, exposure to medications and other individual risk factors.
     
  • Being immunocompromised may affect a person’s risk of infections, their ability to respond to vaccines and the safety of vaccine administration. 
     
  • Different immunisation strategies are available to improve protection for people who are immunocompromised – including booster doses, altered vaccine schedules and administering additional vaccines to prevent specific infections – and should be tailored to each individual’s needs.
     
  • Live vaccines are generally contraindicated in people with severe immunocompromise. In some cases, they can be given after careful assessment of risks and benefits.

Last updated: 23 June 2025

FAQs

What is immunocompromise?

Immunocompromise means a weakened immune system. It can be caused by various medical conditions (such as cancer or certain genetic disorders) or medical therapies (such as chemotherapy, rituximab, high-dose steroids or stem cell transplant).

The severity of immunocompromise varies widely among individuals and is influenced by many factors, including:

  • underlying disease (including severity and stage of the disease)
  • exposure to medications (including medication type and dose)
  • other individual risk factors (e.g. age, lifestyle and comorbidity).
Which medical conditions cause immunocompromise?

Immunocompromise due to a medical condition can be present from birth (an inborn error of immunity) or can occur later in life (secondary immunodeficiency).

  • Inborn errors of immunity, including primary immunodeficiencies, are a group of mostly rare conditions that are often present at birth but may not be detected until later in life. Examples include selective immunoglobulin A (IgA) deficiency, severe combined immunodeficiency and X-linked agammaglobulinemia.
  • Secondary immunodeficiencies due to medical conditions or treatments are more common causes of immunocompromise. These immunodeficiencies can occur due to many different types of conditions (e.g. cancer, autoimmune diseases) or subsequent treatments that can lead to an immunocompromised status. In some cases, these conditions or the treatments they require are lifelong, leaving individuals permanently immunocompromised. In other cases, the immune system can recover after the treatment is completed or if the underlying condition is well managed.

For more detailed information on these medical conditions, refer to the Inborn errors of immunity, including primary immunodeficiency and Secondary (acquired) immunodeficiency due to medical conditions sections of the Australian Immunisation Handbook.

Which medications cause immunocompromise?

Many medications can suppress the immune system, resulting in immunocompromise. They may be prescribed to treat a range of conditions – such as cancer and autoimmune disorders – or to prevent organ rejection after a transplant.

Commonly used immunosuppressive medications (i.e. that cause immunocompromise) include:

  • conventional immunosuppressive medications (e.g. corticosteroids, hydroxychloroquine, methotrexate)
  • chemotherapy
  • biological therapies (e.g. rituximab, infliximab)
  • small molecule targeted therapies (e.g. tofacitinib, imatinib).

Each immunosuppressive medication has a unique action on the immune system and suppresses the function of the immune system to varying degrees. These effects also depend on how long the medications are taken and at what dose.

More details on the action of the above immunosuppressive medications can be found in the Secondary (acquired) immunodeficiency due to medical therapies section of the Australian Immunisation Handbook.

Are people with immunocompromise at an increased risk of getting infectious diseases? 

Yes. People who are immunocompromised have an increased risk of getting infections and experiencing severe illness or complications as a result.

Depending on the type and severity of immunocompromise, this risk may be broad (e.g. receiving a stem cell transplant can increase the risk of all types of bacterial or viral infections) or more specific (e.g. not having a functioning spleen can increase risk of infection from encapsulated bacteria – that is, types of bacteria with a protective outer layer).

Are vaccines effective in people who are immunocompromised?

Vaccines are often still protective in people who are immunocompromised, but their level of effectiveness may vary depending on the individual’s specific condition and the type of vaccine.

People who are immunocompromised may have a weaker response to vaccines than those with healthy immune systems and may not achieve the same level of protection with the routine number of doses.

How can vaccine effectiveness be optimised in people who are immunocompromised?

Specific vaccination strategies – including receiving additional vaccines, booster doses or complete revaccination – can maximise the effectiveness of vaccine protection for people who are immunocompromised.

It is crucial for individuals with immunocompromise to consult with healthcare providers to determine the most appropriate vaccination strategy based on their specific situation.

Why do people with immunocompromise need tailored immunisation strategies? 

Each immunocompromised person is different and requires a vaccination strategy tailored to their unique situation because: 

  • the immune response to vaccination may be reduced or wane more quickly in immunocompromised people
  • some immunocompromised people are more susceptible to certain types of infectious diseases that require specific vaccines that are not routinely recommended for immunocompetent people
  • some therapies, such as stem cell transplant or cellular therapies (e.g. chimeric antigen receptor [CAR]-T cell therapy), reset the individual’s immune system and their previous immunisations may no longer be effective. In these circumstances, complete revaccination is often required.

More details on recommended vaccination schedules can be found in the Vaccination for people who are immunocompromised chapter of the Australian Immunisation Handbook and the National Immunisation Program Schedule.

Can live vaccines be given to people taking immunosuppressive medications? 

Live vaccines are contraindicated (i.e. must not be given) for people with severe immunocompromise while – and shortly after – taking certain immunosuppressive medications, due to the rare risk of developing infection caused by the vaccine. People with severe immunocompromise should avoid getting live vaccines or consult a specialist to make a case-by-case decision.

People with mild or moderate immunocompromise may be able to receive live vaccines, such as the measles-mumps-rubella and varicella vaccines, if the benefits outweigh the perceived risks as assessed by a specialist.

The safety of live vaccines for people with immunocompromise is influenced by the degree of immunocompromise, taking into account both the severity of the underlying condition and the type and dose of immunosuppressive therapy.

For guidance on specific therapies, healthcare providers can refer to the Australian Immunisation Handbook section on Principles of live vaccine administration for people with secondary immunodeficiency due to medical therapies.

Can people taking multiple immunosuppressive medications receive live vaccines? 

Decisions on whether people who have been prescribed multiple immunosuppressive medications should receive a particular live vaccine are made on a case-by-case basis, with input from a specialist healthcare provider.

The cumulative impact of an individual’s medications, and any potential impact from their underlying condition (or other individual risk factors), are weighed up against the potential risk of exposure to the vaccine preventable disease and the safety of vaccine administration.

Is there an optimal time for people receiving immunocompromising therapies to be vaccinated?

When possible, all indicated vaccines (i.e. vaccines that can be given to immunocompromised people) should be administered at least 2 weeks (for non-live vaccines) to 4 weeks (for live vaccines) before commencing any planned period of immunosuppression (such as immunosuppressive medication, chemotherapy or organ transplant).

If this is not possible, vaccines should be given after the completion of immunosuppressive therapies and when the individual’s immunity has recovered. The timing of recommencing vaccine administration after immune recovery is achieved ranges from 4 weeks to 24 months, and depends on: 

  • the type of immunosuppressive therapy prescribed
  • the degree of immunocompromise (due to the underlying condition)
  • the type of vaccine.

Guidance for healthcare providers on vaccine administration for people receiving immunosuppressive therapies or corticosteroids is available in the Australian Immunisation Handbook.

How should healthcare providers respond if a live vaccine is inadvertently given to a person who is immunocompromised? 

If a person who is immunocompromised is inadvertently given a live vaccine, they need prompt review to consider their degree of immunocompromise and the likelihood that they will have an adverse event.

If a person is severely immunocompromised, urgent management may be needed, guided by specialist input. This may include the administration of passive immunoglobulin and/or antivirals and/or antibacterials.

Seek advice from a specialist immunisation service or an infectious disease physician. Notify your relevant state or territory health authority and report as an Adverse Event Following Immunisation.

Can infants whose mothers received biological immunosuppressive medications during pregnancy get live vaccines?

Infants exposed to immunosuppressive biological medications in utero (i.e. while in the womb) should not receive live vaccines, including the BCG vaccine, until they are at least 6 months of age.

The exception is the oral rotavirus vaccine, which is safe to administer to most infants who are exposed to biological medications in utero, except those exposed to anti-CD20 antibodies (such as rituximab).

For further information on vaccination in infants exposed to immunosuppressive therapy, refer to the Infants exposed to immunosuppressive therapy in utero or through breastmilk section of Australian Immunisation Handbook immunocompromised chapter.

Can breastfed infants whose mothers are receiving immunosuppressive biological medications receive live vaccines?

Although some biological medications may pass into breastmilk, they are usually broken down in the infant’s digestive tract and are not absorbed into the bloodstream in an active form of sufficient concentration to cause immunosuppression in the infant.

For further information, see ‘Can infants whose mothers received biological immunosuppressive medications during pregnancy get live vaccines?’ in this FAQ and the Infants exposed to immunosuppressive therapy in utero or through breastmilk section of the Australian Immunisation Handbook.

Can close contacts of a person with immunocompromise safely receive live vaccines?

Live vaccines can be safely given to close contacts, including household members, of a person with immunocompromise.

Immunising close contacts against vaccine preventable diseases – such as measles, varicella (chickenpox) or rotavirus – can provide indirect protection to people who may not be able to safely receive live vaccines by reducing their risk of exposure to the infection.

More details on vaccinating Close contacts of people who are immunocompromised can be found in the Australian Immunisation Handbook.

Which vaccines should people who are immunocompromised consider getting before travel?

Travellers who are immunocompromised should consider getting travel vaccinations due to the high risk of severe illness from many vaccine preventable diseases that may occur while travelling.

Most non-live vaccines, such as influenza and COVID-19 vaccines, are safe for immunocompromised travellers, although additional doses may be needed for optimal protection.

Most live vaccines, including the BCG vaccine, are contraindicated for travellers who are moderately or severely immunocompromised. However, measles-mumps-rubella, monovalent varicella and yellow fever vaccines can be given to people who are not severely immunocompromised.

People who are immunocompromised should consult a healthcare provider before travel to review:

  • their conditions and medications
  • travel destination(s) and duration
  • the risk of disease exposure
  • non-vaccine-related prevention measures
  • access to care during travel.

For more information refer to the Travellers who are immunocompromised section of the Australian Immunisation Handbook.

When should serological testing be recommended to a person who is immunocompromised?

Serological testing (i.e. testing for the presence of antibodies or other markers of immunity) to determine the immune response to vaccination is not routinely recommended for individuals who are immunocompromised.

Serological testing – under the guidance of a qualified specialist (such as an infectious disease specialist) – may be helpful if the following three criteria are fulfilled:

  • A reliable serological test is available to detect the vaccine preventable disease in question.
  • A correlate of protection (i.e. the level of immune response above which an individual is considered protected) is clearly established.
  • The test results would be useful in guiding a clinical decision regarding revaccination and/or post-exposure management.
What should be done if an immunocompromised person is exposed to a vaccine preventable disease?

An immunocompromised person with possible exposure to a vaccine preventable disease should seek advice from their clinician as soon as possible, as they may need additional doses of vaccine and/or post-exposure prophylaxis.

The decision to administer vaccines and/or post-exposure prophylaxis will depend on the person’s vaccination status, their vulnerability to infection and the disease to which they were exposed.

See each disease-specific chapter in the Australian Immunisation Handbook for specific post-exposure prophylaxis recommendations.

Where can healthcare providers seek guidance on the safety of live vaccines for a condition or medication that is not referenced in the Australian Immunisation Handbook?

The Australian Immunisation Handbook section Secondary (acquired) immunodeficiency due to medical therapies gives guidance on the safety of live vaccines for a variety of immunocompromising conditions and medications, including commonly used biological medications.

This guidance is not exhaustive. Biological and small molecule immunosuppressive therapies are a large and growing group of drugs that will continue to expand.

Healthcare providers needing advice on conditions or treatments that are not covered in the Handbook can contact:

  • a specialist immunisation service
  • a specialist involved in the care of the person with the immunocompromising condition or who has prescribed an immunosuppressive therapy.

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