Medscape Medical News
December 5, 2013
IDSA Guidelines: Vaccinate Immunocompromised Patients
Featuring: Dr. Lorry G. Rubin, Director, Pediatric Infectious Diseases, Cohen Children's Medical Center
Most immunocompromised people should be vaccinated against influenza and other infections, according to new guidelines from the Infectious Diseases Society of America (IDSA), published online December 5 in Clinical Infectious Diseases.
"The goal of presenting these guidelines is to decrease morbidity and mortality from vaccine preventable infections in immunocompromised patients," the authors write. Vaccination rates for immunocompromised patients have been low historically, in part because physicians may be concerned about safety and efficacy.
"The guideline provides 'one-stop shopping' for clinicians caring for children and adults with compromised immune systems and includes recommendations and evidence for all vaccinations, from influenza to chicken pox," lead author Lorry G. Rubin, MD, director of the Division of Pediatric Infectious Diseases at the Steven and Alexandra Cohen Children's Medical Center of New York in New Hyde Park and professor of pediatrics at Hofstra North Shore-LIJ School of Medicine, Hempstead, New York, said in a news release. "Previously, the recommendations were difficult to retrieve because in most cases information had to be accessed individually by vaccine rather than by the category of patient disease."
The guidelines target primary care physicians and specialists caring for patients with compromised immune systems resulting from HIV infection or AIDS, cancer, solid organ transplantation (eg, kidney or liver), stem cell transplantation, sickle cell disease or asplenia, congenital immune deficiencies, chronic inflammatory conditions (eg, rheumatoid arthritis or Crohn's disease), cochlear implants, or cerebrospinal fluid leaks.
In addition, the guidelines include recommendations for vaccination of people living with immunocompromised patients.
The recommendations cover most available vaccines, including hepatitis A; measles, mumps, and rubella; other childhood vaccinations; and those for pneumococcus and herpes zoster.
Specific recommendations include the following:
• If feasible, vaccines should be given before planned immunosuppression.
• Live vaccines should be given at least 4 weeks before immunosuppression and should be avoided within 2 weeks of initiating immunosuppression.
• Inactivated vaccines should be given at least 2 weeks before immunosuppression.
• Most immunocompromised patients at least 6 months of age should receive annual influenza vaccination as an injection, but they should not receive live attenuated influenza vaccine administered as a nasal spray.
• Influenza vaccine is unlikely to benefit patients who are receiving intensive chemotherapy or who have received anti-B-cell antibodies in the previous 6 months.
• Immunocompetent persons living in a household with immunocompromised patients can safely receive inactivated vaccines based on the Centers for Disease Control and Prevention–Advisory Committee on Immunization Practices annually updated recommended vaccination schedules for children and adults or for travel.
• Persons living in a household with immunocompromised patients at least 6 months of age should annually receive influenza vaccine, either inactivated influenza vaccine or live attenuated influenza vaccine, provided they are healthy, not pregnant, and aged between 2 and 49 years.
An expert panel developed these guidelines, which are based on limited evidence. Experts included adult and pediatric specialists in gastroenterology, immunology, infectious diseases, hematology, oncology, rheumatology, and stem cell and solid-organ transplantation.
Some of the guidelines authors reported various financial disclosures with ViroPharma, Roche, the Centers for Disease Control and Prevention, Abbott, UCB, Merck, Dyax, Cubist, Nutricia, Up-To-Date, Inc, GlaxoSmithKline, Pfizer, Amino Up Chemical, Pfizer, MedImmune, Sanofi Pasteur, Vical, Clinigen, Astellas Pharma, and/or AiCuris.