Category | Example of specific immunodeficiency | Vaccine contraindications | Effectiveness and comments, including risk-specific vaccines* |
Primary¶ | |||
B cell (humoral) | Severe antibody deficiencies (eg, X-linked agammaglobulinemia and common variable immunodeficiency) | OPVΔ, BCG, smallpox, LAIV, YF, and live-bacteria vaccines◊; no data for rotavirus vaccines | Effectiveness of any vaccine is uncertain if dependent only on humoral response (eg, PPSV23 or MPSV4); IVIG therapy interferes with response to all vaccines, therefore, annual IIV is the only vaccine given to patients receiving IVIG therapy; routine inactivated vaccines can be given if not receiving IVIG. |
Less severe antibody deficiencies (eg, selective IgA deficiency and IgG subclass deficiencies) | OPVΔ, BCG, YF vaccines; other live vaccines§ appear to be safe | All vaccines probably are effective; immune response may be attenuated; vaccines should be given as on the annual immunization schedule for immunocompetent people. | |
T cell (cell mediated and humoral) | Complete defects (eg, severe combined immunodeficiency, complete DiGeorge syndrome) | All live vaccines◊§¥ | All inactivated vaccines probably are ineffective. The only vaccine that should be given if the patient is receiving IVIG is annual IIV if there is some residual antibody production. |
Partial defects (eg, most patients with DiGeorge syndrome, hyperimmunoglobulin M syndrome, Wiskott-Aldrich syndrome, ataxia-telangiectasia) | All live vaccines◊§ | Effectiveness of any inactivated vaccine depends on degree of immunosuppression. Routine inactivated vaccines should be given. Those with ≥500 CD3+ T lymphocytes/mm3, ≥200 CD8+ T lymphocytes/mm3, and normal mitogen response should receive MMR and VAR vaccine (but not MMRV). PPSV23 in addition to PCV13 is indicated in ataxia-telangiectasia. | |
Complement | Persistent complement component, properdin, or mannose-binding lectin (MBL) deficiency | None | All inactivated and live-virus vaccines on the annual immunization schedule are safe and probably are effective; PPSV23 at two years or older and an MCV4 vaccine are recommended in addition to standard vaccines. |
Phagocytic function | Chronic granulomatous disease, leukocyte adhesion defects, myeloperoxidase deficiency | Live-bacteria vaccines◊ OPVΔ, smallpox, BCG, combined MMRV, LAIV§; withhold MMR and varicella in highly immunocompromised children; YF vaccine may have a contraindication or precaution depending on indicators of immune function‡ | All inactivated vaccines are safe and probably are effective†; live-virus vaccines probably are safe and effective. |
Secondary* | |||
HIV/AIDS | Rotavirus vaccine is recommended on standard schedule; MMR and VAR are recommended for HIV-infected children who are asymptomatic and are not highly immunocompromised**,¶¶; all inactivated vaccines, including IIV, may be effective; PPSV23 is recommended in addition to the standard PCV13 vaccine; consider Hib vaccine if not administered during infancy and MCV4 at 2 through 10 years of age. | ||
Malignant neoplasm, transplantation, autoimmune disease, immunosuppressive or radiation therapy | Live-virus and live-bacteria vaccines, depending on immune statusפ | Effectiveness of any vaccine depends on degree of immunosuppression; annual IIV is recommended unless receiving intensive chemotherapy or on anti-B cell antibodies; inactivated standard; PPSV23 is recommended at least eight weeks after last dose of PCV13. Vaccines are indicated if not highly immunosuppressed, but doses should be repeated after chemotherapy ends. | |
Asplenia (functional, congenital anatomic, surgical) | None | All standard vaccines are safe and likely effective; PPSV23 at 24 months or older; MCV4-D (Menactra) should not be used before four weeks after completion of the four-dose series of PCV13 (eg, 22 months of age or older), because of interference with antibody response to PCV13 when vaccines are administered concurrently; other MCV4 vaccines are used in infants and toddlers as licensed by age without concern for interference with PCV13. In addition to standard vaccines, consider Hib vaccine if not administered during infancy. | |
Chronic kidney disease | LAIV | All standard vaccines are indicated; PPSV23 is recommended at 24 months or older in addition to standard PCV13. | |
CNS anatomic barrier defect (cochlear implant, congenital dysplasia of the inner ear, persistent CSF communication with naso-/oropharynx) | None | All standard vaccines are indicated; PCV13 if not received as standard; PPSV23 at two years or older (≥8 weeks after receipt of PCV13). |
Do you want to add Medilib to your home screen?