A 12-month-old with Kawasaki disease received IV immunoglobulin (IVIG) 2 months ago. The child is in the clinic for follow-up and scheduled immunizations. Which vaccine should be delayed? Select all that apply.

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Kawasaki disease is treated with aspirin and IVIG to prevent coronary artery aneurysms. Antibodies acquired from the IVIG therapy will remain in the body for up to 11 months and may interfere with the desired immune response to live vaccines. Therefore, live vaccines (eg, varicella, MMR) should be delayed for 11 months after IVIG administration as this therapy may decrease the child's ability to produce the appropriate amount of antibodies to provide lifelong immunity (Options C and E). (Option A) Hib vaccine is not a live vaccine, and final dose (fourth) is recommended between age 12-15 months, according to the Centers for Disease Control and Prevention (CDC). (Option B) Hep B vaccine is not a live vaccine; the CDC recommends that the final dose (third) be administered between age 6-18 months. (Option D) PCV is also not a live vaccine, and the final dose (fourth) is recommended between age 12-15 months, according to the CDC. Educational objective: Live vaccines (eg, varicella, MMR) should be delayed for up to 11 months after IVIG administration as IVIG therapy may decrease the child's ability to produce the appropriate amount of antibodies to provide lifelong immunity.

A 12-Month-Old with Kawasaki Disease Received IV Immunoglobulin (IVIG) 2