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CPS Statement Flash Cards > Immunization of the immunocompromised child: key principles > Flashcards

Immunization of the immunocompromised child: key principles Flashcards

1
Q

Why is immunization important for children who are immunosuppressed?

A

Increased risk for severe disease from vaccine preventable disease
Goal to provide maximum protection while minimizing harm

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2
Q

What is an online resource practitioners can refer to resource on immunizations?

A

The Canadian Immunization Guide

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3
Q

How can “indirect protection” be provided to immunocompromised patients?

A

Household vaccination of family members ( ie: yearly flu shot and routine vaccinations)
- Vaccinate pets!

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4
Q

Are inactivated vaccines safe to give to this population? Are there any other considerations?

A

Inactivated vaccines are safe

  • Immune response may be diminished or absent thus increased in dose or number of doses may be indicated
    (ex: hepatitis B, conjugated pneumoccocal vaccines)
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5
Q

Why are live vaccines contraindicated among immunocompromised patients?

A

May cause disease by uncontrolled replication and are usually contraindicated

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6
Q

What are exceptions to the no live vaccine rule?

A 
Isolated IgA deficiency
IgG subclass deficiency
Complement deficiency
Anatomical or functional asplenia 
HIV** when NOT severely immunocompromised

Children with phagocyte or neutrophil disorders (including chronic granulomatous disease) can have live viral vaccines BUT NOT live bacterial vaccines such as BCG or live typhoid vaccine

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7
Q

List two examples of live vaccines

A

Rotavirus
MMRV
BCG
Live typhoid vaccine

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8
Q

What additional vaccines may an immunocompromised child require?

A
  • May require additional vaccines ex: 23-valent pneumoccocal polysaccharide
  • May require additional doses of vaccine (such as Haemophilus influenzae Type B)
  • May require boosters due to waning immune respones ex: Hep B boosters
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9
Q

Why should timing be considered when planning immunization?

A

Should be given when maximum immune response can be anticipated
Ex: If disease process leads to immune deterioration over time (ex: HIV, congenital immunodeficiency)
Ex: if immunosuppression is planned (ex: organ transplantation, starting steroids)

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10
Q

If time permits before planned immunosuppression, how should vaccines be administered?

A
  • Provide all live and inactivated vaccines prior to immunosuppression
  • Inactivated vaccines should be given TWO WEEKS before planned immunosuppression
  • Live vaccines should be given FOUR WEEKS before planned immunosuppression
  • Measles, mumps, rubella, varicella can be given as early as 6 months for solids organ transplant candidates if needed
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11
Q

If immunosuppression is urgent but temporary, how should vaccines be given?

A
  • Defer immunization until the immune system as recovered
    If risk of exposure to specific infection is high, inactivated vaccine may be given though response is likely to be diminished
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12
Q

How long after high dose steroid therapy can live vaccines be given?

A

1 month

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13
Q

How long after the completion of immunosuppressive chemotherapy can live vaccines be given?

A

3 months

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14
Q

How long after treatment with anti-B cell antibodies can live vaccines be given?

A

6 months

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15
Q

How dose of steroids is considered “high dose” and immunosuppressive?

A

High dose steroid therapy is defined as systemic treatment with:
- The equivalent of prednisone ≥2 mg/kg/day or ≥20 mg/day if weight >10 kg for ≥14 days

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16
Q

Are live vaccines contraindicated for lower dose steroids or with shorter treatment course?

A

No!

17
Q

Why is immunization after HSCT complicated?

A

No longer considered to be immune to conditions for which they received vaccines pre-transplant

18
Q

Which vaccines do you require after HSCT?

A

Require re-immunization with ALL routine vaccines

19
Q

When can reimmunization with inactivated vaccines be started after HSCT?

A
  • 3-12 months post
20
Q

When can reimmunization with live vaccines be started after HSCT?

A

24 months post transplant*

*Contingent on- no evidence of chronic graft versus host disease, immunosuppression has been discontinued for at least 3 months, and the transplant specialist considers the patient to be immunocompetent

21
Q

When can inactivated vaccines be given in the case of anticipated long term immunosuppression?

A
  • When the patient is on the lowest anticipated dose of immunosuppressive agents
  • If* feasible, ideally would hold or reduce dose of immunosuppressive agent temporarily to maximize respsonse
22
Q

When should recipients of solid organ transplants receive inactivated vaccines?

A
  • 3 to 6 months post transplant if baseline immunosuppressive levels are attained
23
Q

Can live vaccines be given to the recipient of a live organ transplant?

A

Generally no*

*Only extenuating circumstances in consultation with transplant expert

24
Q

Can donors of hematopoietic stems cells and solid organs receive vaccines?

A

Yes!

*Parenteral live vaccines should be avoided for 4 weeks prior to stem cell or organ harvest

25
Q

Can we assume response to vaccines?

A

No

26
Q

What factors may influence vaccine response?

A

Influenced by:

  • Underlying disease
  • Specific immunosuppressive drugs used
27
Q

How can vaccine response be measured? When should be done?

A
  • Can do antibody assay to measure response * very centre specific
  • Done within 1-3 months of the vaccination
28
Q

What other protective measures can be done if antibody response can’t be measured?

A
  • Immunglobulin if exposure

- If outbreak- keep at home!

29
Q

How should immunocompromised patients be advised prior to travel?

A
  • Advised regarding exposure risks

- Advised regarding which vaccines are indicated or contraindicated

30
Q

How can patients with defective antibody production be protected from vaccine preventable diseases?

A
  • Regular infusions of replacement immunoglobulin
31
Q

Which pathogen specific immunoglobulins are available?

A

Varicella
Hepatitis B
Injury where there is tetanus risk

32
Q

When can patients who have received an immunoglobulin receive a live vaccine?

A
  • *Parenteral live vaccines must wait 3 to 11 months after receiving
  • No delay for live intranasal vaccine or inactivated vaccines

CPS Statement Flash Cards (10 decks)

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