American Board of Internal Medicine (ABIM) Certification Practice Exam

After solid organ transplantation, which of the following vaccines is contraindicated?

1. Influenza vaccine

2. Tdap vaccine

3. MMR vaccine

4. Hepatitis B vaccine

The correct answer is: MMR vaccine

Following solid organ transplantation, the use of live attenuated vaccines is typically contraindicated. Among the options provided, the MMR (measles, mumps, and rubella) vaccine is classified as a live attenuated vaccine. This means that it contains a weakened form of the viruses that can still provoke an immune response but may lead to serious complications in patients who are immunocompromised, such as those who have undergone organ transplantation. After transplantation, patients are generally placed on immunosuppressive therapies to prevent organ rejection. This immunosuppression renders them more susceptible to infections and diminishes their ability to mount an adequate immune response, raising the risk of vaccine-related complications. Therefore, administering live vaccines like MMR to these patients could lead to significant health risks, making it essential to avoid them. In contrast, the influenza, Tdap, and Hepatitis B vaccines can be safely administered to transplant recipients as they are either inactivated or subunit vaccines, which do not pose the same risks associated with live vaccines. It is important for healthcare providers to ensure that transplant recipients are adequately vaccinated with non-live vaccines to help protect them against vaccine-preventable diseases.