IDSA guidelines urge vaccinations for immunocompromised patients

December 9, 2013

New guidelines released by the Infectious Diseases Society of America stress the importance of the influenza vaccine and other vaccines for immunocompromised patients, including those with HIV and cancer.

According to the guidelines, which were published in Clinical Infectious Diseases, vaccination rates are lower among these patients partly because their physicians may be concerned about the safety and effectiveness of these vaccines. There has not been a comprehensive set of guidelines that addresses all vaccinations.

“The guidelines provide ‘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,” Lorry G. Rubin, MD, director 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, said in an IDSA press 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.”

Most vaccinations are covered in the guidelines, includingHaemophilus influenzae type b, hepatitis A, diphtheria-tetanus-acellular pertussis, tetanus-diphtheria-acellular pertussis, HPV, influenza, measles-mumps-rubella, meningococcal, pneumococcal, polio, rotavirus, varicella and zoster.

Among the most notable recommendations is that most immunocompromised patients aged at least 6 months should receive an annual influenza vaccine, but not the live-attenuated vaccine nasal spray. Patients who are receiving intensive chemotherapy or who have received anti-B-cell antibodies within the previous 6 months may not benefit from an influenza vaccine. In addition, the guidelines recommend vaccines for immunocompetent individuals who live with immunocompromised patients.

The patients/conditions covered in the guidelines include:

• Congenital immune deficiencies;
• HIV/AIDS;
• Cancer;
• Solid organ transplant;
• Stem cell transplant;
• Chronic inflammatory conditions (such as rheumatoid arthritis and Crohn’s disease);
• Sickle cell disease and asplenia;
• Cochlear implants;
• Cerebrospinal fluid leaks.

Disclosure: The guideline authors report various financial relationships with Abbott, AiCuris, Amino Up Chemical, Astellas Pharma, Clinigen, Cubist, Dyax, GlaxoSmithKline, MedImmune, Merck, Nutricia, Pfizer, Roche, UCB, UpToDate Inc., Vical and ViroPharma.