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
Vaccinating Immunosuppressed Patients
The advent of vaccines has been an important milestone in the history of medicine. Vaccinations have reduced the rate of infection of many illnesses, and has even led to the eradication of small pox. While vaccines have been able to protect healthy individuals from getting sick, it’s important to look at the problems faced in vaccinating individuals with compromised immune systems.
According to the Centers for Disease Control and Prevention (CDC), individuals with a compromised immune system fall under 3 categories of immunosuppressive conditions.
1. Immunocompromised, Non-HIV infected Individuals.
2. HIV infected Individuals.
3. Individuals with conditions that compromise immunity.
Which category an individual falls into is important as the categories differ in recommendations for live-attenuated viral vaccines. All live-attenuated viral vaccines are contraindicated for individuals in category 1, while they pose no risk for individuals in category 3. Some live-virus vaccines are contraindicated for individuals that are infected with HIV, while some are not. The danger for using live-attenuated viral vaccines in severely immunocompromised individuals is the possibility of “rare reversion to natural virulence” of the virus that would result in infection [3]. Infection in immunosuppressed individuals can prove fatal as they have a limited ability to fight off infection.
The CDC has also published a table of specific immunocompromising conditions based on whether the condition is a primary or secondary immune deficiency. It also lists contraindicated vaccines for the condition as well as recommended vaccines and their effectiveness. The table can be found by following the link below. This resource is more specific than the 3 categories of immunosuppressive conditions and can be of more use for physicians that care for immunocompromised individuals. https://www.cdc.gov/vaccines/pubs/pinkbook/downloads/appendices/a/immuno-table.pdf
1) https://www.cdc.gov/mmwr/preview/mmwrhtml/00023141.htm
2) https://www.cdc.gov/vaccines/pubs/pinkbook/downloads/appendices/a/immuno-table.pdf
3) http://www.medscape.com/viewarticle/822239_1
This is quite interesting, @Jonathan; I never thought about the effect of primary or secondary immune deficiency. It is nice that there is a table readily available to consult as a physician caring for immunocompromised individuals.
Your post shows that there are certain people who should not be vaccinated due to personal health issues. I think that this issue should be talked about and highlight the importance for everyone, who can be vaccinated, to receive vaccinations. When more people in a community are vaccinated, fewer people will get sick. Since there are fewer people getting sick, those with compromised immune systems will be less at risk of infection because the prevalence of the disease is much lower due to vaccination.
@ Jonathan Silva, Interesting post. I am wondering what differences would be used to determine if an individual is in category 1 or category 3. Would it be by CBC Leukocyte count, or some other criteria?