Practice Guidelines

IDSA Releases Recommendations on Vaccinations in Immunocompromised Patients

Am Fam Doctor. 2014 Nov one;90(nine):664-666.

Central Points for Practise

• Vaccines should be administered before planned immunosuppression, with live vaccines given four weeks in advance and inactivated vaccines given ii weeks in accelerate.

• Immunocompetent persons who live with an immunocompromised patient can safely receive inactivated vaccines.

• Varicella and zoster vaccines should non be administered to highly immunocompromised patients.

• Annual vaccination with inactivated influenza vaccine is recommended for immunocompromised patients half-dozen months and older, except those who are unlikely to respond.

From the AFP Editors

Vaccination of immunocompromised patients is important because impaired host defenses predispose patients to an increased risk of vaccine-preventable infections. These patients also accept a greater take a chance of exposure to pathogens because of their frequent contact with medical environments. Master care physicians who provide care for immunocompromised persons share responsibility with subspecialists for ensuring that appropriate vaccines are administered to these patients and for recommending appropriate vaccinations for other members of the household. Recommended vaccination schedules for immunocompetent children and adults are published annually by the Advisory Commission on Immunization Practices (ACIP) of the Centers for Illness Control and Prevention. However, these schedules exercise not accost vaccinations for immunocompromised persons who are at greater risk of morbidity and mortality from vaccine-preventable infections. To address this gap, the Infectious Diseases Society of America (IDSA) recently published bear witness-based recommendations for vaccinations in immunocompromised persons and their household members.

The guideline covers children and adults with principal (congenital) immunodeficiency; those with secondary immunodeficiency caused past human immunodeficiency virus (HIV) infection, cancer chemotherapy, stem cell or solid organ transplant, sickle cell affliction, and surgical asplenia; and patients with chronic inflammatory diseases who are receiving systemic corticosteroids, immunomodulators, or biologic agents. The guideline includes several tables, one for each condition, that list specific vaccines that are recommended and contra-indicated, with the level of evidence associated with each recommendation. Some of the recommendations distinguish between high- and depression-level immunosuppression. High-level immunosuppression includes patients who have a primary immunodeficiency; who are receiving chemotherapy; who have received a solid organ transplant within the previous two months; who have HIV infection and a CD4 cell count less than 200 per mm3 (0.20 × 109 per L; for adults and older children) or less than fifteen% (for infants and young children); who are receiving daily corticosteroid therapy equivalent to twenty mg of prednisone or greater for at least 14 days; or who are receiving biologic immunomodulators. Afterwards hematopoietic stem prison cell transplant, the duration of loftier-level immunosuppression depends on the blazon of transplant (longer for allogenic than for autologous); type of donor and stem cell source; and posttransplant complications, such as graft vs. host affliction.

Planned Immunosuppression

When feasible, vaccines should exist administered before planned immunosuppression. Live vaccines should be given at least iv weeks in advance and should be avoided in the two weeks before immunosuppression is started. Inactivated vaccines should be administered at to the lowest degree two weeks in advance.

Vaccination in Household Members

Immunocompetent persons who live in the same household every bit the immunocompromised patient can safely receive inactivated vaccines according to the recommended schedule from ACIP. If the immunocompromised patient is 6 months or older, household members may receive the inactivated influenza vaccine, or the live attenuated influenza vaccine if they are healthy, not pregnant, and two to 49 years of age. Exceptions include those who alive with an immunocompromised person who received a hematopoietic stem cell transplant in the previous two months, who has graft vs. host illness, or who has severe combined immunodeficiency. Live attentuated influenza vaccine should not exist administered to these persons or, if administered, contact between the immunocompromised patient and household fellow member should be avoided for seven days. [ corrected]

Salubrious immunocompetent persons who live with an immunocompromised patient should receive the following live vaccines based on ACIP's recommended schedule: combined measles, mumps, and rubella (MMR); rotavirus for infants two to seven months of age; varicella; and zoster (Tabular array i). These persons can safely receive the yellow fever and oral typhoid vaccines for travel. Oral polio vaccine should not be administered to persons who live with an immunocompromised patient.

Table ane.

Prophylactic of Assistants of Live Vaccines to Contacts of Immunocompromised Persons

Live vaccine Shedding of agent? (site) Transmissibility from vaccinated immunocompetent person? Recommendation for administering vaccines (when indicated) to salubrious immunocompetent contacts of immunocompromised patients

Influenza, alive attenuated, nasal

Aye (nasal secretions)

Rare (from ane vaccinated toddler)

Administer; vaccinated persons should avoid shut contact for seven days with persons with hematopoietic stalk jail cell transplant or astringent combined immunodeficiency

Measles, mumps, and rubella

Measles: no

No, except female parent-to-babe manual of rubella vaccine virus via breast milk

Administer

Mumps: no

Rubella: yes (nasopharynx, in low titer; breast milk)

Polio, oral

Yeah (stool)

Yep, with rare cases of vaccine-associated paralytic poliomyelitis

Practice not administrate

Rotavirus, oral

Yes (stool)

Yes, but no reported cases of symptomatic infection in contacts

Administrate

Typhoid, oral

No

No

Administer

Varicella

Yes (pare lesions)

Rare, limited to vaccinees with pare lesions

Administrate; if skin lesions develop, vaccinated persons should avoid shut contact with immunocompromised persons

Yellow fever

No, except possibly shed in chest milk

Yeah (at to the lowest degree three cases of encephalitis in infants exposed to the vaccine via breastfeeding)

Administer, except to women who are breastfeeding

Zoster

Yes (rarely recovered from injection site vesicles)

Not reported

Administer to persons 60 years and older; if skin lesions develop, vaccinated persons should avoid shut contact with immunocompromised persons

Highly immunocompromised patients should avoid handling diapers of infants who take received rotavirus vaccine for four weeks after vaccination. Immunocompromised patients should avert contact with persons who develop skin lesions after receiving varicella or zoster vaccines until the lesions resolve.

Varicella and Zoster Vaccination

Varicella vaccine should not exist administered to highly immunocompromised patients. Nevertheless, select patients (e.thou., those with HIV infection who are non highly immunocompromised, those with a primary immunodeficiency without lacking T cell–mediated immunity) should receive two doses of vaccine iii months apart. Varicella vaccination can be considered in patients who do non have prove of immunity (i.e., age-appropriate varicella vaccination, serologic prove of immunity, clinician-diagnosed or -verified history of varicella or zoster, or laboratory-proven varicella or zoster) and who are receiving long-term, low-dose immunosuppressant drugs. When indicated, varicella vaccine should exist administered as a unmarried-antigen product and not combined with the MMR vaccine.

Zoster vaccine should exist administered to patients 60 years and older who are receiving therapy to induce low-level immunosuppression. The vaccine should not be administered to highly immunocompromised patients.

Influenza Vaccination

Annual administration of inactivated influenza vaccine is recommended for immunocompromised patients six months and older, except those who are unlikely to respond (e.g., those receiving intensive chemotherapy, those who have received anti–B-jail cell antibodies within the previous half dozen months). Live attenuated flu vaccine should not exist administered to immunocompromised persons.

Guideline source: Infectious Diseases Guild of America

Show rating organisation used? Yes

Literature search described? Yes

Guideline developed by participants without relevant financial ties to industry? No

Published source: Clinical Infectious Diseases, February one, 2014

Available at: http://cid.oxfordjournals.org/content/58/3/e44.full

To run into the full commodity, log in or buy access.

Coverage of guidelines from other organizations does non imply endorsement past AFP or the AAFP.

A collection of Practise Guidelines published in AFP is available at https://www.aafp.org/afp/practguide.

Copyright © 2014 past the American Academy of Family Physicians.
This content is owned by the AAFP. A person viewing information technology online may brand one printout of the cloth and may employ that printout only for his or her personal, non-commercial reference. This material may non otherwise exist downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether at present known or afterwards invented, except as authorized in writing past the AAFP. Contact afpserv@aafp.org for copyright questions and/or permission requests.

Near RECENT ISSUE

Mar 2022

Access the latest issue of American Family Physician

Read the Upshot


Email Alerts

Don't miss a unmarried issue. Sign up for the free AFP email table of contents.

Sign Up Now