For many years, Immunisation against Infectious Disease (the Green Book) has contained a recommendation that when two live vaccines are required in the same individual, then the vaccines should either be given on the same day, or separated by an interval of at least four weeks. This was based on early studies with measles and smallpox vaccines,1 and supported by the theory that interferon production stimulated by the replication of first vaccine prevented replication of the second agent, thus leading to a poor response to the second vaccine.
Following the recent introduction into the routine schedule of two live vaccines not given by a parenteral route (live attenuated nasal influenza vaccine and oral rotavirus vaccine) the evidence to support this general recommendation was reviewed. Based upon the available evidence and on the different immune mechanisms used by the various vaccines, in February 2014 the JCVI 2 agreed that the guidance to either administer the vaccines on the same day or at four week interval period should not be generalised to all live vaccines. They concluded therefore, that intervals between vaccines should be based only upon specific evidence for any interference of those vaccines. To ensure timely protection from live vaccines, therefore, the JCVI agreed that the current guidance should be updated (table).
- Recommendation
- Europe
- United Kingdom
- Yellow fever
