Saar Kuzi
Alessandra Coutinho Fernandes
William Cope
Richard Tapping
Kashif Ahmad
Reda Sadki
Shubhra Kanti Karmaker Santu
Adam P Rusch
Elle Meisner
Nereyda Ochoa
Landon J. Kunzelman
James DotimasFA16 Immunization Module’s Updates
How to Vaccinate Immunocompromised Patients
http://http://images.slideplayer.com/14/4441609/slides/slide_21.jpg
Before vaccinating an immunocompromised individual, the physician needs to take into account the varying severity of immunocompromised patients.
1) For severely immunocompromized patients not infected with HIV:
- In general, severely immunocompromised patients should not be administered live attenuated vaccines. Doing so would promote microbial proliferation.
- Vaccinations during chemotherapy and/or radiation therapy are advised against, due to a diminished antibody response.
- Passive immunization or inactivated immunization is recommended for immunocompromised patients
2) For patients with HIV:
- In general, HIV patients should not be administered live attenuated vaccines.
- However, MMR vaccinations are recommended, regardless of HIV infection or lack thereof.
- A specific type of polio vaccine (Enhanced Inactivated Polio Vaccine [eIPV]) is recommended for HIV-positive patients.
- Pneumococcal vaccines (S. pneumoniae, meningitis, etc.) are recommended for HIV patients older than 2 years of age.
- Before an HIV positive patient receive an Hib vaccine against H. influenzae, the physician should take into account the risk of disease and the calculated effectiveness in the patient.
3) For patients with conditions that can lead to a diminished immune function:
- Certain antigens and certain vaccines will be more effective in a patient based on the medical condition that is compromising the patient’s immune response.
| Renal failure | Diabetes | Hepatic Cirrhosis | Asplenia |
| Serum antibody levels are lower | Patients present with abnormal immune surveillance | Patients often present with leukopenia (decreased leukocyte count), decreased complement activity, defects in leukocyte chemotaxis, and cell-mediated immunity defects | Two weeks before a splenectomy, pneumococcal, meningococcal, and Hib vaccines should be administered |
| There is an increased risk of Hep. B and Pneumococcus infections | One-time pneumococcal vaccine and an annual flu vaccines are recommended | One-time pneumococcal vaccine and an annual flu vaccines are recommended | Polyvalent pneumococcal vaccines (immunizes against multiple strains of a microbe) are recommended for patients older than 2 years of age |
| Immunizing the patient in the early stages of renal failure with repeat vaccinations or increased vaccine dosage is recommended | Pneumococcal and flu vaccine does not have any contraindications with insulin or glucose treatment | Hib vaccines should be administered in infancy at the same dosage and frequency as healthy children |
http://www.cdc.gov/Mmwr/Preview/Mmwrhtml/00023141.htm
https://cgscholar.com/community/community_profiles/fa16-immunization-module/community_updates/41211
http://www2a.cdc.gov/nip/isd/ycts/mod1/courses/genrec/11110.asp?seg=B
@lee seymour very informative! your post brings to mind the story of the bubble boy which we covered earlier in the course. In regards to vaccinating severely immunocompromised patients, I would assume those with SCID can by no means receive any sort of vaccination?
Great post, very thorough elaboration of some protocol for vaccinating immunocompromised patients. What I wonder is this: Why do we give any vaccines, even inactivated vaccines, to patients whose immune system doesn't work? If the immune system cannot function, how do vaccines help these patients build immunity? Maybe certain components of their immune system still function, at least enough to recognize antigen, present it, form immunological synapses, and generate viable memory plasma cells or cytotoxic T lymphocytes. If this is the case, I would imagine that higher-than-normal doses would be required to elicit a healthy immune response to the same vaccine.
@lee seymour, great read and very informative. The table at the end was interesting to see how diseases effect certain vaccines. I am also curious as to how many people are not able to receive certain vaccines and how that effects 'herd immunity'. I think your message would also be an important message to people that are anti-vax and why certain people are unable to be vaccinated.
@ Lee Seymour I never considered how immunizations would be performed in people that are immunocompromised, so it is nice to see that there is a protocol to ensure they have vaccinations. I think it would be very important to be able to immunize immunocompromised patients because they are so susceptible to death as a result of illness because of the reduced effectiveness of their immune system. It would be interesting to see the difference in the way the immune system reacts to vaccinations in immunocompromised patients compared to those that are not immunocompromised.