IMMUNIZATIONS IN IMMUNOSUPPRESSED PTS

IMMUNIZATIONS IN IMMUNOSUPPRESSED PTS is a topic covered in the Harrison's Manual of Medicine.

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Recommendations for vaccination of cancer pts receiving chemotherapy, pts with Hodgkin’s disease, and hematopoietic stem cell transplant recipients are listed in Table 79-3. In solid organ transplant recipients, the usual vaccines and boosters should be given before immunosuppression. Pts with continued immunosuppression should have pneumococcal vaccination repeated every 5 years and should not receive live vaccines.

TABLE 79-3: VACCINATION OF CANCER AND TRANSPLANT PTS RECEIVING CHEMOTHERAPYa
 Use in Indicated Pts
VaccineIntensive ChemotherapyHodgkin’s DiseaseHematopoietic Stem Cell Transplantation
Diphtheria-tetanusbPrimary series and boosters as necessaryNo special recommendationThree doses given 6–12 months after transplantation
PoliomyelitiscComplete primary series and boostersNo special recommendationThree doses given 6–12 months after transplantation
Haemophilus influenzae type b conjugatePrimary series and booster for childrenSingle dose for adultsThree doses given 6–12 months after transplantation (separated by 1 month)
HPVQuadrivalent HPV vaccine is approved for males and females 9–26 years of age. Check CDC website (www.cdc.gov/vaccines) for updated recommendations.Quadrivalent HPV vaccine is approved for males and females 9–26 years of age. Check CDC website (www.cdc.gov/vaccines) for updated recommendations.Quadrivalent HPV vaccine is approved for males and females 9–26 years of age. Check CDC website (www.cdc.gov/vaccines) for updated recommendations.
Hepatitis AAs indicated for normal hosts on the basis of occupation and lifestyleAs indicated for normal hosts on the basis of occupation and lifestyleAs indicated for normal hosts on the basis of occupation and lifestyle
Hepatitis BSame as for normal hostsAs indicated for normal hosts on the basis of occupation and lifestyleThree doses given 6–12 months after transplantation

PCV13

PPSV23d

Finish series prior to chemotherapy if possiblePts with splenectomy should receive PPSV23.Three doses of PCV13, beginning 3–6 months after transplantation, are followed by a dose of PPSV23 at least 8 weeks later. A second PPSV23 dose can be given 5 years later.
Quadrivalent meningococcal vaccineeShould be administered to splenectomized pts and to pts living in endemic areas, including college students in dormitoriesShould be administered to splenectomized pts and to pts living in endemic areas, including college students in dormitories. An additional dose can be given after 5 years.Should be administered to splenectomized pts and to pts living in endemic areas, including college students in dormitories. An additional dose can be given after 5 years.
InfluenzaSeasonal immunizationSeasonal immunizationSeasonal immunization (A seasonal dose is recommended and can be given as early as 4 months after transplantation; if given <6 months after transplantation, an additional dose is recommended.)
Measles/mumps/rubellaContraindicatedContraindicated during chemotherapyAfter 24 months in pts without graft-versus-host disease
Varicella-zoster virusfContraindicatedgContraindicatedContraindicated (CDC recommends use on a case-by-case basis following reevaluation.)
aThe latest recommendations by the Advisory Committee on Immunization Practices and the CDC guidelines can be found at http://www.cdc.gov/vaccines.
bA single dose of tetanus–diphtheria–acellular pertussis (TDaP), followed by a booster dose of tetanus-diphtheria (Td) every 10 years, is recommended for adults.
cLive-virus vaccine is contraindicated; inactivated vaccine should be used.
dTwo types of vaccine are used to prevent pneumococcal disease. A conjugate vaccine active against 13 serotypes (13-valent pneumococcal conjugate vaccine, or PCV13) is currently administered in three separate doses to all children. A polysaccharide vaccine active against 23 serotypes (23-valent pneumococcal polysaccharide vaccine, or PPSV23) elicits titers of antibody lower than those achieved with the conjugate vaccine, and immunity may wane more rapidly. Because the ablative chemotherapy given to recipients of hematopoietic stem cell transplants eradicates immunologic memory, revaccination is recommended for all such pts. Vaccination is much more effective once immunologic reconstitution has occurred; however, because of the need to prevent serious disease, pneumococcal vaccine should be administered 6–12 months after transplantation in most cases. Because PPSV23 includes serotypes not present in PCV13, recipients of stem cell transplants should receive a dose of PPSV23 at least 8 weeks after the last dose of PCV13. Although antibody titers from PPSV23 clearly decay, experience with multiple doses of PPSV23 is limited, as are data on the safety, toxicity, or efficacy of such a regimen. For this reason, the CDC currently recommends the administration of one additional dose of PPSV23 at least 5 years after the last dose to immunocompromised pts, including transplant recipients, as well as pts with Hodgkin’s disease, multiple myeloma, lymphoma, or generalized malignancies. Beyond this single additional dose, further doses are not recommended at this time.
eMeningococcal conjugate vaccine MenACWY is recommended for adults 55 years old, and meningococcal polysaccharide vaccine (MPSV4) is recommended for those 56 years old.
fIncludes both varicella vaccine for children and zoster vaccine for adults.
gContact the manufacturer for more information on use in children with acute lymphocytic leukemia.
Abbreviations: CDC, Centers for Disease Control and Prevention; HPV, human papillomavirus; PCV, pneumococcal conjugate vaccine; PPSV, pneumococcal polysaccharide vaccine.

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TY - ELEC T1 - IMMUNIZATIONS IN IMMUNOSUPPRESSED PTS ID - 623636 Y1 - 2017 PB - Harrison's Manual of Medicine UR - https://harrisons.unboundmedicine.com/harrisons/view/Harrisons-Manual-of-Medicine/623636/all/IMMUNIZATIONS_IN_IMMUNOSUPPRESSED_PTS ER -