Table 8.
Vaccination summary for immunocompromised patients. (Adapted from Centers for Disease Control and Prevention [2012] and Rahier et al. [2009, 2010].)
| Vaccine | Live vaccine | Timing | Contraindications1 | People needing vaccination other than IMT |
|---|---|---|---|---|
| Bacterial infections | ||||
| Pneumococcal (polysaccharide) | No | One dose with booster 5 years later2 or every 3–5 years3 | Everyone ≥65 years of age; people with chronic diseases (cardiovascular, lung, liver, kidney, metabolic, functional or anatomic asplenia, HIV, IBD); alcoholism; smoking; residents of nursing homes or long-term facilities | |
| Meningococcal | No | Two-dose series (at least 2 months apart) OR every 5 years for patients who remain at increased risk of infection4 | Functional asplenia or persistent complement component deficiencies; HIV | |
| Tetanus and diphtheria | No | Every 10 years | Everyone | |
| Pertussis | No | One booster in adulthood | Everyone | |
| Measles, mumps, rubella (MMR) | Yes | Two-dose series (4 weeks apart) | IC patients5; household contacts can receive this vaccine. Pregnancy | Everyone |
| Poliomyelitis | No/yes | Use injectable inactivated vaccine for IC patients5 and their household contacts.> | ||
| Oral live vaccine should not be given to either. | ||||
| BCG | Yes | Contraindicated for IC individuals5; household contacts can receive this vaccine | ||
| Viral infections | ||||
| Influenza A & B | No | Annual | Specific contraindication for the live attenuated vaccine: IC patients5, pregnancy, certain chronic medical conditions such as asthma, diabetes, heart or kidney disease. | Everyone ≥ 6 months of age |
| Health care workers | ||||
| People with chronic diseases (cardiovascular, lung, kidney, metabolic, severe anaemia, HIV, IBD) | ||||
| Varicella zoster | Yes | Two-dose series (at least 4 weeks apart) | IC patients5; Pregnancy | Any adult without history of chicken pox or herpes zoster6 |
| Human papillomavirus (HPV) – Female | No | Three-dose series through age 26 years (0, 1 and 6 months)7 | ||
| Human papillomavirus (HPV) – Male | No | Three-dose series through age 26 years (0, 1 and 6 months)7 | ||
| Hepatitis A | No | Two-dose series8 | International travellers to endemic countries; close contact with a person infected by HAV infection; men who have sex with men; users of injectable drugs; employees of daycare centres; certain laboratory workers; people exposed to HAV; chronic liver disease | |
| Hepatitis B | No | Three-dose series (0, 1 and 6 months) | Sexually active persons who are not in long-term mutually monogamous relationship; users of injectable drugs; men who have sex with men; health care workers; patients with diabetes ≤60 yrs of age, end-stage renal disease; household contacts and sex partners of persons with chronic HBV infection; international travellers to endemic countries endemics |
Contraindications apart from severe allergic reaction (e.g. anaphylaxis) after previous dose of any influenza vaccine or to a vaccine component.
According to the Sands et al. [2004] and the Centers for Disease Control and Prevention [2012].
According to Vermeire et al. [2010] and Culver and Travis [2010].
According to Centers for Disease Control and Prevention [2012].
Immunocompromised patients generally include patients with known severe immunodeficiency from haematological and solid tumours, receipt of chemotherapy, congenital immunodeficiency, long-term immunosuppressive therapy or patients with HIV infection who are severely immunocompromised. Significant immunosuppressive steroid dose is considered to be ≥2 weeks of daily intake of 20 mg or 2 mg/kg of prednisone or equivalent.
The Food and Drug Administration (FDA) licensed the zoster vaccine (one-dose vaccine) for adults ≥50 years of age; the Advisory Committee on Immunization Practices (ACIP) recommends that vaccination start at 60 years of age.
According to Centers for Disease Control and Prevention [2012]. The second dose can be given 1–2 months after the first dose; the third should be given 6 months after the first.
If Havrix used: schedule at 0 and 6–12 months; if Vagta used: schedule at 0 and 6–18 months. If combined vaccine for HAV and HBV (Twinrix), administer 3 doses at 0, 1 and 6 months.
IMT, immunosuppressive therapy; IC, immunocompromised; IBD, inflammatory bowel disease; HIV, human immunodeficiency virus; HBV, hepatitis B virus; HAV, hepatitis A virus.