Table 2.
Summary of the Infectious Diseases Society of America guideline on vaccination of immunocompromised patients
| HIV | CTX | After CTX | Before HSCT | After HSCT | Before SOT | After SOT | Inflammatory diseases | Asplenia or SCD | Cochlear implants or CSF leak | |
|---|---|---|---|---|---|---|---|---|---|---|
| Hib | C | U | U | U | H | U | U | U | R | U |
| HAV | U | U | U | U | R | R | R | U | U | U |
| HBV | H | U | R | U | R | H | R | U | U | U |
| DTP | U | U | U | U | H | U | U | U | U | U |
| HPV | H | U | U | U | H | U | H | U | U | U |
| IIV | R | R | U | R | R | R | R | R | U | U |
| LAIV | C | NO | U | NO | NO | NO | NO | NO | NO | U |
| MMR | C | NO | U | C | C | C | NO/C | C | U | U |
| MMRV | NO | NO | U | C | NO | C | NO | C | U | U |
| MEN | H | U | U | U | H | U | U | U | H | U |
| PCV | R | R | U | R | H | R | R | R | R | R |
| PPSV | R | R | U | R | R | R | R | R | R | R |
| IPV | U | U | U | U | H | U | U | U | U | U |
| ROT | U | NO | U | NO | NO | C | NO | C | U | U |
| VZV | C | NO | U | C | C | C | NO/C | C | U | U |
| ZV | NO | NO | U | C | NO | C | NO | C | U | U |
HIV: human immunodeficiency virus-infected patients. Vaccine recommendations differ according to lymphocyte count (CD4 counts of ≥ or < 200 cells/mm3 in adults and ≥ or < 15% CD4 T-lymphocyte percentage). CTX: during chemotherapy. After CTX: 3 months after chemotherapy or 6 months after anti-B-cell antibodies, patients should be vaccinated according to the routine vaccination schedule. Vaccines administered during cancer chemotherapy should not be considered valid doses unless there is documentation of a protective antibody level. Before HSCT: before hematopoietic stem cell transplantation, candidate should be updated with their vaccination according to routine schedule. Live-attenuated vaccine should be given at least 4 weeks and inactivated vaccines at least 2 weeks before starting the conditioning regimen. After HSCT: after hematopoietic stem cell transplantation patients should be fully re-immunized with more vaccine doses than for immunocompetent. Before SOT: before solid organ transplantation, candidate should be updated with their vaccination according to routine schedule. Live-attenuated vaccine should be given at least 4 weeks before transplantation. After SOT: after solid organ transplantation, recipient should be updated with inactivated vaccine according to routine schedule. Live-attenuated vaccines could be used with caution if patient is seronegative, clinically stable on low immunosuppression, after assessment of risk and benefits, with close follow-up and appropriate education of the patient and its primary care physician [115]. Inflammatory diseases: vaccine recommendations for patients with inflammatory diseases depend on the level of immunosuppression, whether it is planned, low-level or high-level. Low-level immunosuppression includes treatment with prednisone < 2 mg/kg with a maximum of ≤ 20 mg/day; methotrexate ≤ 0.4 mg/kg/week; azathioprine ≤ 3 mg/kg/day; or 6-mercaptopurine ≤ 1.5 mg/kg/day. High-level immunosuppression regimens include treatment with doses higher than those listed for low-dose immunosuppression and biologic agents such as tumor necrosis factor antagonists or rituximab. Asplenia or SCD: patients with asplenia or sickle cell disease should be continuously vaccinated against encapsulated bacteria. Influenza vaccination is essential given the high risk of pneumococcal infection following influenza. Cochlear implants or CSF leak: patients with profound hearing loss have or are scheduled to receive a cochlear implant, have an inner ear-cerebrospinal fluid communication or other sort of cerebrospinal fluid leak should be vaccinated against pneumococcus
C recommended in certain conditions (see Rubin et al. [89] for details, and Suresh et al. [115] for the latest recommendation on MMR and VZV after SOT), CSF cerebrospinal fluid, CTX chemotherapy, DTP diphtheria-tetanus-pertussis vaccine, H highly recommended, some patients will require more doses and/or higher dosage than immunocompetent person, HAV hepatitis A vaccine, HBV hepatitis B vaccine, Hib Haemophilus influenzae type b vaccine; HIV human immunodeficiency virus, HPV human papillomavirus vaccine, HSCT hematopoietic stem cell transplantation, IIV inactivated influenza vaccine, IPV inactivated poliovirus vaccine, LAIV live-attenuated influenza vaccine, MEN meningococcal conjugate vaccine, MMR measles-mumps-rubella vaccine, MMRV measles–mumps–rubella–varicella vaccine, NO not recommended, PCV pneumococcal conjugate vaccine, PPSV pneumococcal polysaccharide vaccine, R highly recommended (patient is at increased risk), ROT rotavirus vaccine, SCD sickle cell disease, SOT solid organ transplantation, U recommended as usually (in routine vaccination of immunocompetent person), VZV varicella vaccine, ZV zoster vaccine