Immunocompromised host vaccinations

Live virus vaccines should not be given to an immunocompromised host. 

The number of immunocompromised persons is continually increasing as advances are made in medicine. The life expectancy for persons with cancer, HIV infection, and solid organ or bone marrow transplantation is increasing. Vaccination provides one tool to prevent infection in the immunocompromised host however, the individual s immuno-suppressed state will alter the response to vaccine. In general all vaccinations should be updated prior to the person becoming immunosuppressed, if possible. Once a person becomes significantly immunosuppressed, live virus vaccines should be avoided. 

Household contacts of immunocompromised persons should have all routine vaccines as scheduled, including yearly influenza vaccination. Children in the household may receive live virus vaccines without special precautions however, if a rash develops following varicella vaccination, contact should be avoided with the immunocompromised host until the rash resolves. 

Immunocompromised hosts should receive annual influenza vaccination with TIV but not LAIV. 

In contrast to antibacterial antibiotic therapy, inhibition of viral replication is usually difficult to achieve. Therefore preventive strategies, such as vaccination, are frequendy more successful and clinically important. However, vaccines are not available for all viruses furthermore, some viruses, such as Epstein-Barr virus (EBV) and cytomegalovirus (CMV), are ubiquitously present and usually not very pathogenic unless in an immunocompromised host. One strategy to combat viral infecdons in the immunocompromised host is the application of neutralizing mAbs. One such mAh is directed to the F protein of the respiratory syncytial virus (RSV), which afflicts premature newborns with often severe pulmonary infections this mAh appears to be useful in such situations (91). Other mAbs to viral antigens are in development. 

Pirofski LA, Casadevafl A. Use of hcensed vaccines for active immunization of the immunocompromised host. Chn Microbiol Rev 1998 11 1—26. 

Recombinant DNA vaccines offer alternatives as subunit vaccines and organisms can be engineered to produce antigens or even epitopes. A hepatitis vaccine has been engineered using yeast as the host cell. Adverse reactions are rare to subunit vaccines, making them safer for use in immunocompromised patients. 

Vaccination in compromised hosts (e.g., those with chronic disease, such as diabetes, connective tissue disease, or alcoholics or those with cancer or HIV disease) must be individualized based on the disease state and its treatment. The Centers for Disease Control and Prevention (CDC) has classified persons with immunocompromised conditions into three groups " ... 

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