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Vaccines in Immunocompromised Patients
Aka: Vaccines in Immunocompromised Patients, Immunodeficiency and Immunization, Immunization in Immunocompromised Patients, Vaccination in Immunocompromised Patients
- See Also
- Immunization in HIV
- Immunization in Pregnancy
- Pediatric Vaccination (Primary Series)
- Adult Vaccination
- Grading: Immunosuppressants
- High Level Immunosuppression
- Biological Agent (e.g. Humira)
- Prednisone dose >=20 mg/day for >=14 days
- Low Level Immunosuppression
- Prednisone dose <=20 mg/day
- Minimal Immunosuppression (should not impact Immunization, may receive live Vaccination)
- Prednisone for <14 days
- Precautions
- Inactivated Vaccines
- Not harmful, but immunodeficient patients may have reduced immunogenic response to Vaccines
- Best to time inactivated Vaccines at least 2 weeks before starting immunosuppressants
- Do not delay indicated Vaccines in patients already immunodeficient
- Shingrix is safe in low Level Immunosuppression
- Shingrix efficacy and safety data are lacking in 2019, for those on High Level Immunosuppression
- Live Vaccines
- See Live Attenuated Vaccine
- Avoid Live Vaccines (e.g. MMR, Varicella) for those on high level immunosuppression
- Live Vaccines are best given at least 4 weeks before starting immunosuppression
- Do not use Flumist (Live Attenuated Influenza Vaccine) for immunocompromised patients
- Use inactivated infuenza Vaccine instead
- Do not use Zostavax (live Shingles Vaccine) in HIV Infection or high level immunosuppression
- Shingrix (recombinant, inactivated Vaccine released 2018) has replaced Zostavax and is preferred
- See Zostavax for indications (e.g. prior to immunosuppression medications)
- Prevention: Routine Vaccinations Recommended for patients on Immunosuppression
- Influenza Vaccine yearly
- Prevnar 13 (followed by Pneumovax 23 at least 8 weeks later)
- Immunocompromised adults >=19 years old
- Gardasil 9
- Give 3 doses (instead of 2 doses as used in standard series)
- References
- (2019) Presc Lett 26(12): 68
- (2014) Presc Lett 21(2): 10