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What time interval is needed between the administration of live attenuated vaccines?
  1. Petra Zimmermann1,2,3,4,
  2. Andrew J Pollard5,
  3. Nigel Curtis3,4,6
  1. 1 Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland
  2. 2 Department of Paediatrics, Fribourg Hospital HFR, Fribourg, Switzerland
  3. 3 Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
  4. 4 Infectious Diseases Research Group, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
  5. 5 Oxford Vaccine Group, Department of Paediatrics, University of Oxford and the NIHR Oxford Biomedical Research Centre, Oxford, UK
  6. 6 Infectious Diseases Unit, The Royal Children’s Hospital Melbourne, Parkville, Victoria, Australia
  1. Correspondence to Dr Petra Zimmermann, Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland; petra.zimmermann{at}

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Clinical scenario

A mother consults you for her daughter’s 12-month-old measles–mumps–rubella (MMR) vaccination. The girl’s vaccination record reveals she had a Bacillus-Calmette-Guérin (BCG) vaccine 2 weeks prior because the family is planning to travel to India. You wonder what duration is needed between the administration of live attenuated vaccines to avoid diminishing vaccine responses.

Structured clinical question

What time interval is needed between the administration of live attenuated vaccines to avoid interfering with the immune response to either vaccine?

Search strategy and outcome

In February 2020, MEDLINE (1946 to present) was searched without any language limitations using the Ovid interface with the search terms detailed in the online supplementary data.

Supplemental material


Our search identified 4592 studies. Of these, 16 fulfilled the inclusion criteria of studies in humans investigating interference on immunogenicity of two or more live attenuated vaccines administered simultaneously or consecutively (table 1; online supplementary results and table 1). References were hand-searched for additional publications, and no further relevant studies were found. One study was excluded because insufficient details were provided.1

View this table:
Table 1

Findings of studies that have investigated the interference on vaccine immunogenicity of two or more different live attenuated vaccines administered consecutively


Generally, simultaneous administration of vaccines on the same day is recommended to avoid missing opportunities for vaccination and to increase the probability that a child is …

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  • Correction notice This article has been corrected since it was published online. There were some typographical errors in table 1 and these have now been updated.

  • Contributors PZ did the search and prepared the manuscript and tables. AJP and NC were involved in planning the study, interpreting results and multiple revisions of the manuscript. All authors gave approval for submission of this manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; internally peer reviewed.

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