Vaccines Immunosuppressants

AZATHIOPRINE VACCINES i effectiveness of vaccines, t risk of adverse/toxic effects of live vaccines (e.g. measles, mumps, rubella, oral polio, BCG, yellow fever, varicella, TY21a typhoid), e.g. vaccinal infections Disseminated infection due to enhanced replication of vaccine virus in the presence of diminished immunocompetence Do not vaccinate when patients are on immunosuppressants. Vaccination should be deferred for at least 3 months after discontinuing immunosuppressants/myelosuppres-sants. If an individual has been recently vaccinated, do not initiate therapy for at least 2 weeks after vaccination... 

Influenza vaccine should be given yearly to all adults 50 years of age or older. Younger adults with chronic disorders of the cardiovascular or pulmonary systems, chronic metabolic diseases, renal dysfunction, immunosuppression, or disorders that compromise respiratory function should also be vaccinated. Women who will be pregnant during the winter months should be vaccinated against influenza. 

Measles, mumps, and rubella vaccine is a live virus vaccine that should be used with caution in immunosuppressed children, such as those with cancer receiving chemotherapy, solid organ or bone marrow transplantation, or receiving other immunosuppressive drugs, such as steroids in a dose... 

The 23-valent pneumococcal polysaccharide vaccine is recommended for use in all adults 65 years of age or older and adults less than 65 years who have medical comorbidities that increase the risk for serious complications from S. pneumoniae infection, such as chronic pulmonary disorders, cardiovascular disease, diabetes mellitus, chronic liver disease, chronic renal failure, functional or anatomic asplenia, and immunosuppressive disorders. Alaskan natives and certain Native American populations are also at increased risk. Children over the age of 2 years may be vaccinated with the 23-valent pneumococcal polysaccharide vaccine if they are at increased risk for invasive S. pneumoniae infections, such as children with sickle cell anemia or those receiving cochlear implants. 

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. 

Solid organ transplant recipients have a blunted immune response to vaccines because the immunosuppressive regimens used to prevent organ rejection inhibit both T- and B-cell proliferation. Many of these patients will also have secondary hypogammaglobulinemia post-transplantation. Prior to transplant, children should complete primary immunization schedules if possible accelerated schedules may be used. Adults should have all vaccinations updated prior to transplantation.16... 

Patients with chronic conditions that cause limited immune deficiency (e.g., renal disease, diabetes, liver disease, and asplenia) and who are not receiving immunosuppressants may receive live attenuated and killed vaccines, and toxoids. 

General contraindications to vaccine administration include a history of anaphylactic reaction to a previous dose or an unexplained encephalopathy occurring within 7 days of a dose of pertussis vaccine. Immunosuppression and pregnancy are temporary contraindications to live vaccines. Whenever possible, transplant patients should be immunized before transplantation. Live vaccines generally are not given after transplantation. 

The vaccine should not be given to immunosuppressed patients (except those infected with HIV) or pregnant women. HIV-infected persons who have never had measles or have never been vaccinated should be given measles-containing vaccine unless there is evidence of severe immunosuppression. The vaccine should not be given within 1 month of any other live vaccine unless the vaccine is given on the same day (as with the MMR vaccine). Measles vaccine is indicated in all persons born after 1956 or in those who lack documentation of wild virus infection either by history or antibody titers. 

The vaccine should not be given to immunosuppressed individuals, although MMR vaccine should be administered to young children with HIV without severe immunosuppression as soon as possible after their first birthday. The vaccine should not be given to individuals with anaphylactic reaction to neomycin. 

The vaccine is contraindicated in immunosuppressed or pregnant patients. Children with asymptomatic or mildly symptomatic HIV should receive two doses of varicella vaccine 3 months apart. 

Medical indications Chronic pulmonary disease (excluding asthma) chronic cardiovascular diseases, diabetes mellitus chronic liver diseases, including liver disease as a result of alcohol abuse (e.g., cirrhosis) chronic alcoholism, chronic renal failure or nephrotic syndrome functional or anatomic asplenia (e.g, sickle cell disease or splenectomy [if elective splenectomy is planned, vaccinate at least 2 weeks before surgery]) immunosuppressive conditions and cochlear implants and cerebrospinal fluid leaks. Vaccinate as close to HIV diagnosis as possible. 

Vaccines Yes. Wyeth Vaccine, called VIG or vaccinia immune globulin, one dose by scarification. (Pre- and post-exposure vaccination recommended if greater than three years passed since last vaccine.) Persons who are pregnant, have clinical immunosuppression (such as persons who have undergone heart and other transplant operations and take medicines to control rejection of their new, transplanted organ), eczema, and/or leukemia/ lymphoma would be contraindicated for such vaccine. As one example, the fatality rate for immunosuppressed persons taking such vaccine could be as high as 75 percent or more. 

Chickenpox Chickenpox is a highly contagious viral infection that causes rash-like blisters on the skin surface and mucous membranes. It is generally mild and not normally life-threatening. For adults, the symptoms are more serious and uncomfortable than for children. The disease can also be deadly for some people, such as pregnant women, people with leukemia, or immunosuppressed patients. Varivax (varicella virus vaccine live) from Merck Co. was tested on about 11,000 children and adults and was approved by the FDA in March 1995 as a chickenpox vaccine. 

One likely reason for the prevalence of helminths is their undoubted ability to down-regulate the host immune system at both the antigen-specific and polyclonal levels [3], In many chronic diseases, such as schistosomiasis and lymphatic filariasis, peripheral blood T cells show dramatically impaired parasite antigen-specific responsiveness [4], as discussed in more detail below. Moreover, from early reports of immunosuppression in animal models of infection, to studies in Africa linking vaccine failure to heavy helminth infection, there is clear evidence that infections can diminish reactivity to bystander antigens, particularly with increasing intensity of... 

New vaccines have to be evalnated regarding their immunostimnlatory and immunosuppressing properties (1). When traditional methodologies are nsed, this evaluation is demanding and yet incomplete, with only a few biological responses measured. Consequently, the development and introdnction of new powerful techniques that allow rapid toxicological and immnnological evalnation are essential (2). 

Systemic fungal infections hypersensitivity to the drug IM use in ITP administration of live virus vaccines (eg, smallpox) in patients receiving immunosuppressive corticosteroid doses (see Warnings). 

Immunosuppression During therapy, do not use live virus vaccines (eg, smallpox). Do not immunize patients who are receiving corticosteroids, especially high doses, because of possible hazards of neurological complications and a lack of antibody response. This does not apply to patients receiving corticosteroids as replacement therapy. 

Hepatitis A (Inactivated) Hepatitis B (Recombinant) Vaccine (Twinrix) [Vaccine/lnactivated] Uses Active imimmization against A/B Action Active immunity Dose 1 mL IM at 0, 1, 6 mo Caution [C, +] Contra Component sensitivity Disp Single-dose vials, syringes SE Fever, fatigue, pain at site, HA Interactions -1- Immune response w/ corticost oids, immunosuppressants EMS None OD Unlikely... 

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