Immunization of the immunocompromised child: key principles Flashcards
What are the general principles of immunization of the immunocompromised child?
- Indirect protection
* vaccinate household contacts and pets - Inactivated vaccines may be given safely
- responses may be diminished or absent
- increase in dose or number of doses may be indicated
- Live vaccines usually contraindicated
- exceptions: isolated IgA deficiency, IgG subclass deficiency, complement deficiency, anatomical or functional asplenia
- Live viral vaccines safe for phagocyte or neutrophil disorders (CGD)
- live bacterial vaccines contraindicated
- Live vaccines can be given to HIV patients who aren’t severely immunocompromised
- Additional vaccines
* PPSV 23 or HIB - Duration of immune response may be diminished, necessitating extra booster dose
- Children at ongoing risk of Hep B need annual testing and may need booster - Timing: should be given at time when max immune response can be anticipated
- Don’t assume response to vaccine
- measure titres 1-3 mo after - Travel: seek advice
- Immune globulin: pathogen specific after exposure
What are vaccine considerations in CGD and other phagocyte/neutrophil disorders?
Can have inactivated vaccines
Can have LIVE VIRAL vaccines
CANNOT have LIVE BACTERIAL vaccines
What are vaccine considerations in HIV?
Can have live vaccines if not severely immunocompromised
[Nelsons says VZV can be given if CD4 >=15%]
immunocompromised definition: CD4 < 200 or <15% (<5yrs)
Vaccination post IVIG?
Defer for 3-11 months [11 months for high doses given in kawasaki]
No delay in vaccines for live oral or intranasal vaccines, or inactivated vaccines
When to retest vaccine responses in immunocompromised children?
1-3 mo post vaccination
In which immunocompromised kids can live vaccines be given?
isolated IgA deficiency
IgG subclass deficiency
Complement deficiency
Anatomical or functional asplenia
Phagocyte or neutrophil disorders (CGD) *** but LIVE BACTERIAL vaccines contraindicated
HIV patients who aren’t severely immunocompromised
When can you give vaccines for planned immunosuppression?
- inactivated vaccines > 2 wk before
- live vaccines > 4 wk before
Note: MMR can be given as early as 6 mo
When can you give vaccines for urgent temporary immunosuppression?
Defer until immune system has recovered
Inactivated vaccines can be given but response diminished. Repeat doses when immune system recovered
When can you give live vaccines for patient on high dose steroid therapy?
What is the definition of high dose steroid therapy?
High dose steroid therapy: 1 month after discontinuation
( prednisone >/= 2 mg/kg/day or >/=20 mg/day if wt > 10 kg for >/=14 days)
live vaccines are not contraindicated for lower doses or shorter durations of treatment with topical, inhaled, or locally injected steroid therapy (except high dose ICS and flu vaccine —> see CPS flu statement)
When can you give live vaccines for patient on chemotherapy?
3 months after discontinuation
When can you give live vaccines for patient on anti-B cell antibodies?
6 months
When can you give live vaccines for patient on long-term immunosuppression?
Statement doesn’t say you can or can’t give live vaccines (probs not)
inactivated when pt on lowest anticipated dose of immunosuppressive agents
When can you give vaccines for pt with solid organ transplant?
- inactivated: 3-6 mo post
- live: contraindicated
When can you give vaccines for patient post HSCT?
- reimmunize with all routine vaccines
- inactiviated: 3-12 mo post HSCT
- live: 24 months post-transplant (if no GVHD, immunosuppression discontinued at least 3 mo, transplant specialist consider pt immunocompetent)
When can you give live vaccines for donors of HSCT and solid organs?
- give all age appropriate
- no parenteral vaccines within 4 wks of harvest
