https://immattersacp.org/weekly/archives/2013/12/10/2.htm

IDSA issues vaccination guideline for immunocompromised patients

Most people with compromised immune systems should receive the flu shot and other vaccinations, noted a new guideline released by the Infectious Diseases Society of America (IDSA).


Most people with compromised immune systems should receive the flu shot and other vaccinations, noted a new guideline released by the Infectious Diseases Society of America (IDSA).

Written to address a void in comprehensive recommendations for vaccinations of all different types of immunocompromised patients, the IDSA's “Clinical Practice Guideline for the Vaccination of the Immunocompromised Host” appeared online Dec. 5 in Clinical Infectious Diseases. The new guideline is designed to help primary care physicians and specialists who treat immunocompromised patients, as well as vaccinating people who live with immunocompromised patients.

The guideline is meant to provide one-stop shopping for clinicians caring for children and adults with compromised immune systems and includes recommendations and evidence for vaccinations ranging from influenza; chicken pox; hepatitis A; measles, mumps and rubella; pneumococcus; and herpes zoster.

The guideline notes most immunocompromised patients 6 months or older should receive the annual flu shot but should not receive the live attenuated influenza vaccine that comes in the form of a nasal spray. However, patients who are receiving intensive chemotherapy or who have received anti-B-cell antibodies in the previous 6 months are unlikely to benefit.

Other recommendations include the following:

  • Specialists should share responsibility with the primary care clinician for ensuring that appropriate vaccinations are given to patients and members of their households (strong recommendation, low-quality evidence).
  • Vaccines should be given before planned immunosuppression if feasible (strong recommendation, moderate evidence).
  • Live vaccines should be administered 4 or more weeks before immunosuppression (strong recommendation, low evidence) and should be avoided within 2 weeks of beginning immunosuppression (strong recommendation, low evidence).
  • Inactivated vaccines should be administered 2 or more weeks before immunosuppression (strong recommendation, moderate evidence).
  • Immunocompetent individuals who live with immunocompromised patients can safely receive inactivated vaccines based on the CDC/Advisory Committee on Immunization Practices' annually updated recommended vaccination schedules for children and adults.
  • Healthy immunocompetent individuals who live with immunocompromised patients should receive live vaccines based on the CDC annual schedule for combined measles, mumps, and rubella vaccines (strong recommendation, moderate evidence); rotavirus vaccine in infants aged 2 to 7 months (strong recommendation, low evidence); varicella vaccine (strong recommendation, moderate evidence); and zoster vaccine (strong recommendation, moderate evidence).

Other recommendations were made for international travel, varicella and zoster vaccines, and congenital immune deficiencies, as well as in populations of patients with HIV, cancer and hematopoietic stem-cell transplants.