Vaccination of the Immunocompromised Host
Key Points
Key Points
- Impaired host defenses predispose patients to an increased rate or severity of vaccine-preventable infection.
- Such patients may also have greater exposure to pathogens due to frequent contact with medical environments.
- Data on safety, immunogenicity, and efficacy/effectiveness of vaccines for immunocompromised populations are limited.
- Immune system defects vary among and within categories of patients with immunodeficiency (eg, degree of immunodeficiency, nutritional status, immunosuppressive regimen), which may limit the generalizability of study findings.
- Inactivated vaccines can be administered to most immunocompromised patients, and live vaccines are contraindicated for most immunocompromised patients, with some important exceptions.
Responsibility for Vaccination
...sibility for Vaccina...
...Specialists caring for immunocompromi...
...caring for immunocompromised patients share...
Timing of Vaccination
...ing of Vaccinati...
...ld be administered prior to planned i...
...nes should be administered ≥4 weeks prior to im...
...be avoided within 2 weeks of initiation o...
.... Inactivated vaccines should be admin...
Household Members (See Table 1)
...d Members (See Table 1)...
...ent household members of immunocompromised patie...
...r for travel. (SR, M)21...
...Household members of immunocompromised patien...
...ted influenza vaccine (IIV) or (SR, H)21881...
...attenuated influenza vaccine (LAIV) provided th...
...tions include household members of an immun...
...if administered, contact between the imm...
...hy immunocompetent household members of immunocom...
...vaccine in infants ages 2-7 months, (SR, L)218...
...accine (VAR), (SR, M)21881...
...nd zoster vaccine (ZOS). (SR...
...receive vaccines for travel: yellow f...
...yphoid vaccine. (SR, L)21881...
...al poliovirus vaccine (OPV) should NO...
...ghly immunocompromised patients should avo...
...munocompromised patients should avoid...
Table 1. Safety of Administration of Live Vaccines to Contacts of Immunocompromised Persons
...fety of Administration of Live Vaccines to Contact...
...nza, live, attenuated nasal...
...ister; (SR, L)21881...
...accinated persons to avoid close contact with pers...
...R Shedding of Agent? (Site)...
...iovirus, oral Shedding of Age...
...us, oral Shedding of Agent? (Site...
...l Shedding of Agent? (Site)...
...Shedding of Agent? (Site) Tra...
...fever Shedding of Agent? (Site)...
...Shedding of Agent? (Site)...
International Travel
...rnational Trave...
.... Clinicians may administer inactivated vacc...
...ellow fever vaccine generally shoul...
...ptomatic HIV-infected adults with CD4 T...
...tomatic HIV-infected children age 9 mont...
...With certain exceptions (eg, yellow fever va...
Specific Vaccinations
...pecific Vaccinatio...
...la and Zoster Vaccines...
...given to immunocompetent patients without evidenc...
...be administered ≥4 weeks before...
...e schedule of VAR, separated by >4 weeks for pat...
...d NOT be administered to highly immunocompromised...
...be considered for patients without evidence of...
...e administered to eligible immunocompromised pa...
...be given to patients ≥60 years of age if it...
...OS should be considered for varicella-positive p...
...hould be administered to patients ≥60 ye...
...S should NOT be administered to highly immun...
...fluenza
24. Annual influenza vaccination with IIV is reco...
...t for patients who are very unlikely to respond...
...have received anti-B cell antibodies...
...ld NOT be administered to immunocompromised...
Special Populations
...al Populations
...genital) Immunodeficiency Disorders...
...rimary Complement Deficiencie...
...nts with primary complement deficienc...
a. 2-5 years old should receive 1 dose of 13-val...
...d with a classical pathway (C1, C2, C3, C4), al...
...ars old with a classical pathway (C1, C2, C3, C4),...
...ose who have previously received 23-valent pneu...
...nts ≥2 years of age with an early classica...
...children age 6 weeks through 18 mont...
...se primary series of quadrivalent mening...
...ersons >55 years of age, administer...
...s 9-23 months of age, administer the dos...
...ith a primary complement component defic...
...tic Cell Deficiencies...
Phagocytic cell deficiencies include CGD (chron...
...ients with phagocytic cell deficiencies shou...
...n 2-5 years of age should receive PCV13 as i...
...‰¥6 years of age with phagocytic cell defi...
...≥2 years of age with phagocytic cell defici...
...bacterial vaccines, such as bacillus C...
35. Live viral vaccines should be administered...
...viral vaccines should NOT be admin...
Innate Cytokine or Cellular Activati...
...in the immune system resulting in defects of cyt...
...atients with innate immune system defe...
...nts with innate immune system defects resulting i...
...9. Specialist advice should be sou...
...Live bacterial vaccines should NOT be admin...
...Live viral vaccines should NOT be adminis...
...or Antibody Deficiencies
...s with immunoglobulin A (IgA) deficienc...
...ildren with SPAD or ataxia-telangiectasia sho...
...rs of age should receive PPSV23 ≥8 weeks after...
...onitoring of vaccine responses can be usef...
...d NOT be administered to IgA-deficient patient...
...Antibody Deficiencies in Patients Rec...
...Inactivated vaccines other than IIV...
...patients with suspected major antibody deficienci...
...can be administered to patients wi...
...Live OPV should NOT be administered t...
...s (other than OPV) should NOT be administered to...
...Immunodeficiencies...
.... For patients with suspected combined i...
...or patients with combined immunodeficiencies...
...ients with combined immunodeficiencies and r...
...n with partial DiGeorge syndrome (pDGS)...
53. Patients with SCID, DiGeorge syndrome with CD3...
...dults, Adolescents, and Children (See Table 2)...
...vated Vaccines...
...(SR, H)2188...
...V13 in patients...
...type b conjugate vaccine (Hib), (S...
...a toxoid, tetanus toxoid, acellular...
...s toxoid, reduced diphtheria toxoid, an...
..., reduced diphtheria toxoid vaccine (Td), (...
hepatitis B vaccine (HepB), (SR, M)...
...tis A vaccine (HepA), (SR, M)21881...
...ated poliovirus vaccine (IPV), (SR, M)...
...ivalent human papillomavirus vaccine (HPV4...
...PCV13 should be administered to HIV-infected...
.... PPSV23 should be administered to HIV-infecte...
...adults with CD4 T-lymphocyte counts of ≥2...
...infected adults with CD4 T-lymphocyte count...
...e given ≥8 weeks after the indicat...
...HIV-infected children who are >59 m...
...recommended for HIV-infected adults. (WR, L)21...
...ed children age 11-18 years should receive...
...er dose (third dose) should be given at age 16 y...
...MCV4 is administered to HIV-infected chil...
...ected patients should receive HepB series,...
...nsideration of high-dose HepB (40 μg/do...
...adolescents.* (WR, L)2...
...to two months after completion, they should...
...vaccination anti-HBs concentration of ≥1...
...inistered (alternative: 1 dose of He...
...HepB (40 μg/dose)* (WR, L)21881...
...ren and high-dose HepB for adolescents*...
...0. HepB containing 20 μg of HBsAg (hepa...
...Internationally adopted HIV-infect...
...PV4 is recommended over bivalent human pap...
...e Vaccines...
...exposed or -infected infants should receive rot...
...HIV-infected patients should NOT receive LAIV. (...
...be administered to clinically stable HIV-infe...
...patients ≥14 years without measles immunity and...
...-infected children with a CD4 T-cell percentag...
...14 years with a CD4 T-cell lymphocyte count o...
...patients should NOT receive quadrivalen...
...ricella-nonimmune, clinically stab...
...ears with ≥15% CD4 T-lymphocyte percentage, (S...
...ars with CD4 T-lymphocyte counts of ≥...
...oses should be separated by ≥3 months...
...Vaccination of Persons With HIV Inf...
...nzae type b conjugate...
...: age
...e 5–18 yc (SR, L)21881...
...age...
...5–18 yc (SR, L)218...
...epatitis...
...la or No ImmunosuppressionU: (SR, M)21...
High-Level ImmunosuppressionbU: age 1 y (SR, M)...
...epatitis...
...ow-Levela or No ImmunosuppressionR: (SR, M)21...
...munosuppressionbR: (SR, M)21881...
...TaP
...la or No ImmunosuppressionU: (SR, M)21881
...ImmunosuppressionbU: (SR, M)21881...
Tdap
...w-Levela or No ImmunosuppressionU: (SR...
...Level ImmunosuppressionbU: (SR, VL...
Td
...ImmunosuppressionU: (SR, L)21881...
...Level ImmunosuppressionbU: (SR, L)21881...
HPV4e
...ow-Levela or No ImmunosuppressionU: age 11...
...-Level ImmunosuppressionbU: age 11-26 y (...
Influenza, inactiv...
...ImmunosuppressionU: (SR, H)21881...
...ImmunosuppressionbU: (SR, H)21881...
...nza, live attenuated...
...a or No ImmunosuppressionX:f (WR, VL)21881...
...gh-Level ImmunosuppressionbX: (W...
MMR, liv...
...-Levela or No Immunosuppres...
...: age 12 mo to 13 y (SR, M)21881
...‰¥14 y (WR, VL)2188...
...-Level Immunosuppres...
...mo to 13 y (SR, M)21881...
...age ≥14 y (SR, M)21881...
...RV, live...
...or No ImmunosuppressionX: (SR, VL)21881...
...gh-Level ImmunosuppressionbX: (SR, VL...
...ningococcal conj...
...la or No ImmunosuppressionU: age 11-18 y...
...gh-Level ImmunosuppressionbU: age 11-18 y...
...ococcal conjugate (PCV13)...
...vela or No Immunosuppressi...
...: age...
...e 5 yh (SR, M)21881...
...6-18 yh (SR, L)218...
...: age ≥19 yi (SR, L)21881
...Level Immunosuppressi...
...: age...
...ge 5 y (SR, M)21881
...6-18 y (SR, L)2188...
...≥19 yi (SR, VL)21881
...polysaccharide (PPSV23)j...
...a or No ImmunosuppressionR: age ≥2 y (SR, M)2188...
...Level Immunosuppressionb
...ge 2-18 y (SR, M)21881...
...lt (CD4 T-lymphocytes...
...rus, inactivated...
...No ImmunosuppressionU: (SR, M)21881...
...Level ImmunosuppressionbU: (SR, M)21881...
...irus, live...
...Levela or No ImmunosuppressionU: (SR, L)2188...
...ImmunosuppressionbU: (WR, VL)...
...ricella, live...
...evela or No Immunosuppression...
...age 1-8 y (SR, H)2...
...¥9 y (SR, VL)21881...
...-Level ImmunosuppressionbX: (SR, M)21881...
...ster, live
...ela or No Immunosuppression...
X: ag...
U: age ≥60 yk, l (WR, L)218...
High-Level ImmunosuppressionbX: (...
...ed—administer if not previously adm...
...h-dose HepB (40 µg) should be considered for ad...
...lescents (WR, L)21881
...referred over HPV2 because of its activity aga...
...patients ≥19 years of age with...
...be administered 8 weeks or longer after i...
...on can be considered for patients...
...ients not vaccinated with varicella vacc...
...ancer (See Tab...
...ts ≥6 months of age with hematological malign...
...umor malignancies (SR, L)2188...
...eiving anti-B cell antibodies* (SR, M)21...
...intensive chemotherapy, such as for indu...
...hould be administered to newly diagnosed adults...
...malignancies (SR, VL)21881...
...n with malignancies (SR, VL)21881...
...s described in recommendations 27...
PPSV23 should be administered to adults and...
...ivated vaccines (other than IIV) reco...
...vaccines administered during cancer chemothera...
...less there is documentation of a protec...
...viral vaccines should NOT be administered during...
...Starting 3 months following cancer chemothe...
...live vaccines VAR, (WR, VL)21881...
...(SR, L)21881...
...RV (WR, VL)21881...
...cording to the CDC annual schedule routinely indic...
...ens included anti-B cell antibodies,...
...3. Vaccination of Patients With Cance...
...fluenzae type b conjug...
...ing ChemotherapyaU: (WR, L)21881...
...g ≥3 Months Postchemotherapy and ≥6 Months Aft...
...patitis A...
...or to or During ChemotherapyaU:...
...3 Months Postchemotherapy and ≥6 Months After A...
...patitis B...
...r to or During ChemotherapyaU: (WR, L)21881...
...3 Months Postchemotherapy and ≥6 Months A...
...SR, M)21881...
...adults (SR, VL)21881...
DTaP, Tdap
...During ChemotherapyaU: (WR, L)2188...
...ing ≥3 Months Postchemotherapy and ≥6 Mon...
...-18 y (SR, M)21881
...th acute lymphoblastic leukemia or lymp...
HPV
...r During ChemotherapyaU: age 11-26...
...¥3 Months Postchemotherapy and ≥6 Months...
...za, inactivated...
Prior to or During ChemotherapyaU (SR, L)...
...rting ≥3 Months Postchemotherapy and ≥6 M...
Influenza, live attenu...
...ng ChemotherapyaX: (WR, VL)21881...
...3 Months Postchemotherapy and ≥6 Months Af...
..., live...
...or During ChemotherapyaX:c (SR, M)2188...
...Months Postchemotherapy and ≥6 M...
...MRV, live...
...to or During ChemotherapyaX:c (SR, M)21881...
...≥3 Months Postchemotherapy and ≥6 Months Aft...
...ingococcal conjug...
...r During ChemotherapyaU (WR, L)21881...
...g ≥3 Months Postchemotherapy and ≥6 M...
...al conjugate-13 (PCV13)...
...or to or During Chemotherapya
...SR, L)2188...
...age ≥6 yd (SR, VL)21...
...Months Postchemotherapy and ≥6 Months Aft...
Pneumococcal polysaccharide (PPSV2...
...o or During ChemotherapyaR: age ≥2 y (SR,...
...tarting ≥3 Months Postchemotherapy and ≥...
...iovirus, inactivated...
...to or During ChemotherapyaU: (WR, L)...
...‰¥3 Months Postchemotherapy and ≥6 M...
...avirus, live...
...or to or During ChemotherapyaX: (SR,...
...nths Postchemotherapy and ≥6 Month...
Varicella, live
...or to or During ChemotherapyaXc (SR, M...
Starting ≥3 Months Postchemother...
...er, live...
...ng ChemotherapyaX:c (SR, VL)21881...
...ing ≥3 Months Postchemotherapy and ≥6...
...recommended—administer if not prev...
...nactivated influenza vaccine (IIV) annu...
...solid tumor malignancies (SR,...
...xcept those receiving anti–B-cell...
...s of inactivated vaccines other than IIV ro...
...owever, vaccines administered while receiving can...
...IIV can be administered ≤3 month...
d For patients ≥19 years of age...
...as been given safely 3 months after completion...
...patients ≥19 years of age who have previo...
...ic Stem Cell Transplant (See Table...
...onors and Patients Before Trans...
...CT donor should be current with rou...
...t MMR, MMRV, VAR, and ZOS administration should b...
Vaccination of the donor for the benefit of...
...Prior to HSCT, candidates should receive va...
...interval to the start of the conditioning regimen...
...≥2 weeks for inactivated vaccines. (S...
...mune HSCT candidates ≥12 months...
...ents Post-transplantation...
...ister 1 dose of IIV annually. (SR, M)21...
to persons ≥6 months of age start...
and starting at 4 months if there is a commun...
...months through 8 years of age who are recei...
...er 3 doses of PCV13 to adults and children startin...
...after HSCT a dose of PPSV23 should be given provid...
...with chronic GVHD a fourth dose of PCV13 ca...
79. Administer 3 doses of Hib start...
...er 2 doses of MCV4 starting 6-12 months after...
...3 doses of tetanus/diphtheria-containin...
For children
...nts 7 years and older, administration...
...administer a dose of Tdap followed by either...
...2 doses of Td. (WR,...
...3 doses of HepB starting at 6-12 months...
...a postvaccination anti-HBs concentra...
...dose of HepB after which anti-HBs is tested*)...
...ose (40 μg)* (WR, L)218...
...ildren and high dose for adolescents* an...
...3. Administer 3 doses of IPV starti...
...ministration of 3 doses of HPV starting at...
...minister live vaccines to HSCT patients w...
...ister a 2-dose series of MMR to measles-seronegati...
...-seronegative children (SR, M)21881...
...Administer a 2-dose series of VAR starting 24...
...ccinations Prior to or After Allogeneic or...
H. influenzae type b conjugat...
...e-HSCTU: (SR, M)21881...
...doses (SR, M)at 6 mo post-tx21881...
...patitis...
...re-HSCTU: (SR, VL...
...CTR: 2 doses (WR, L)at ≥6 mo post-tx21881...
...atitis B...
...TU: (SR, L)21881
...HSCTR: 3 doses (SR, M)at 6–12 mo post-tx21881...
...aP, DT, Td, Tda...
Pre-HSCTU: (SR, L)2188...
...t-HSCT...
R: age...
...e ≥7 y: DTaP* 3 doses (WR, VL)at â...
...se Tdap, followed by either 2 doses DT* or 2...
..., Td (WR, L)21881...
...PV...
...age 11-26 y (SR, VL)21881...
...CTU: 3 doses at ≥6 mo post-tx (W...
...za, inactivated
...re-HSCTU: (SR, L)2...
...t-HSCT...
...≥4 mo post-tx (SR, VL)if community outbr...
...herwise ≥6 mo post-tx (S...
...nfluenza, live atten...
...TX: (WR, VL)21881...
...CTX: (WR, VL)21881...
..., live
...U:a (SR, VL)21881...
...CTX:b (SR, L)21881
...RV, liv...
...CTU:a (WR, VL)218...
...ost-HSCTX: (SR, VL)218...
...coccal conjugate...
...SCTU: (SR, VL)21...
...age 11-18 y: 2 doses (SR, L)at 6-12 mo...
...ococcal conjugate (PCV13)...
...CTR:c (SR, L)21881...
Post-HSCTR: 3 doses (SR, L)at 3-6 mo...
...ccal polysaccharide (PPSV23...
...re-HSCTR:c (SR, VL)21881...
...: ≥12 mo post-tx if no GVHD (SR, L...
...rus, inactivated...
...SCTU: (SR, VL)21881...
...CTR: 3 doses (SR, M)at ≥3 mo post-tx218...
Rotavirus, liv...
...SCTX: (WR, VL)21881...
Post-HSCTX: (WR, VL)...
...cella, live...
...U:a (SR, L)21881...
...ost-HSCTX:d (SR, L)2...
Zoster,...
Pre-HS...
...e 50–59 y* (WR, VL)2188...
...‰¥60 y (SR, L)21881...
...st-HSC...
...50–59 y* (SR, L)2188...
...ge ≥60 y (SR, L)21881...
...€”administer if not previously administ...
...tes to Table 4...
...accines should not be administered unless the vac...
...Administer to adolescents and adults (SR, L)218...
...children (SR, M)2188...
...not previously administe...
...nister if varicella-seronegative, t...
...Consider if the patient is not severely immuno...
...an Transplant (See Table 5)...
...nors and Patients Before Transplantation
...8. Living donors should be current wit...
...MRV, VAR, and ZOS administration should be avoide...
...of donors solely for the recipient’s benefi...
...children with chronic or end-stage kidney, liv...
...ng persons should receive PCV13 as in r...
...1. Adults and children age ≥2 years...
...end-stage kidney disease should recei...
...ildren ≥2 years of age with end-stage heart or...
...and PPSV23 are indicated, PCV13 should b...
92. anti-HBs–negative SOT candidates should re...
and if on hemodialysis and age ≥20 year...
...ination anti-HBs concentration of ≥10 mIU/...
...ative: 1 dose of HepB after which anti-HBs i...
...e* for children (WR, L)21881...
...high dose for adolescents* and adults. (SR, L)21...
...patitis A–unvaccinated, undervaccinated, or...
...≥2 years. (SR, M)should receive a HepA series.2...
...ined HepA-HepB vaccine can be used for S...
...series should be administered to SOT can...
...SOT candidates 6-11 months of age...
...transplantation is delayed (and the child i...
...ould be administered to SOT candidates w...
...e administered to varicella-naive SOT ca...
Optimally, 2 doses should be administered ≥...
...OT candidates age ≥60 years (SR, M...
...positive (as defined in recommendation 22) candid...
...T Recipients...
.... Vaccination should be withheld from SOT...
...xcept that IIV can be administered ≥1 m...
...-appropriate inactivated vaccine series sho...
...V. (SR, M)(Table 5)21881...
...13 should be administered starting 2-6 months...
101. For SOT patients ≥2 years of age, 1 dose o...
...HepB should be considered for chronic hepatitis...
...VAR should generally not be administered...
...pt for VAR in children without evidence of...
...ion should not be withheld because of...
...Vaccinations Prior to or After Solid Organ...
...enzae type b conjugate...
...etransplantU: (SR, M)21881...
...–6 Months PosttransplantU: (SR, M)...
...patitis A
...etransplan...
U: age 12-23 mo (SR, M)218...
...≥2 y (SR, M)21881...
...2–6 Months PosttransplantR: if not...
...epatitis...
...retranspla...
...age 1-18 y (SR, M)21881...
...age ≥18 y (SR,...
...ting 2–6 Months PosttransplantR: if not complet...
...aP, Tdap
...nsplantU: (SR, M)21881
...arting 2–6 Months PosttransplantU...
HP...
...lantU: females age 11-26 y (SR, M)21881...
...€“6 Months Posttransplant...
...les age 11-26 y (SR, M)2...
...age 11-26 y (SR, L)21881...
...nza, inactivate...
...etransplantU: (SR, M)...
...2–6 Months PosttransplantU:b (SR, M...
...nza, live attenuat...
PretransplantX: (WR, L)2188...
...“6 Months PosttransplantX: (WR, L)21881...
..., live
...transplant...
...:c age 6-11 mo (WR, V...
...ge ≥12 mo (SR, M)21881...
...Months PosttransplantX: (SR, L)21881...
...RV, live...
...retransplantU:d (SR, M)2...
...“6 Months PosttransplantX: (SR, L)21881...
Meningococcal conj...
...nsplantU: (SR, M)218...
...Months PosttransplantU: (SR, M)21881...
...occal conjugate (PCV13)...
...etransplan...
U: age
...¥6 ye (SR, VL)21881...
...ing 2–6 Months Posttransplant...
...2-5 y (SR, M)21881...
...y, if not administered pretransplan...
Pneumococcal polysacchar...
...tR: age ≥2 y (SR, M)21881...
...Months PosttransplantR: age ≥2 y, if not adminis...
...irus, inactivated
...retransplantU: (SR,...
...“6 Months PosttransplantU: (SR, M)21881...
...otavirus,...
...nsplantU:c (SR, M)21881...
...g 2–6 Months PosttransplantX: (SR, L)218...
...aricella,...
...retransplan...
R:f age 6-11 mo (WR, V...
U:d (SR, L)21...
...ing 2–6 Months PosttransplantX:g (SR, L)21881...
...ter, live...
...ransplant...
R:h age 50-59 y (WR...
...:i age ≥60 y (SR, M)21881
...Months PosttransplantX: (SR, L)2188...
...d—administer if not previously administer...
...r hepatitis B vaccine for hepatitis B-i...
b IIV may be administered to SOT recipie...
...ly if patient is not immunosuppressed and th...
...≥19 years who have previously receiv...
...ter only if patient is not immunosup...
...Inflammatory Disease Patients Taki...
...05. Inactivated vaccines, including IIV, shou...
...r about to be treated with immunosup...
...PCV13 should be administered to a...
...uld be administered to patients ≥2 year...
...level immunosuppression, (SR,...
...igh-level immunosuppression. (SR, VL)2188...
...receive PPSV23 ≥8 weeks after PCV1...
...should be administered to patients with chronic...
...prior to initiation of immunosuppression, (SR,...
...VAR should be considered for patient...
...OS should be administered to patients wit...
...le being treated with low-dose immunosuppre...
...e who are 50-59 years of age and varicell...
...treated with low-dose immunosuppression.* (...
...live vaccines should NOT be administered to pati...
...patients receiving low-level (WR,...
...-level immunosuppression, (WR, VL)2...
...d MMRV in patients receiving low-level (WR, V...
...high-level immunosuppression. (SR, VL)21881...
...2. Otherwise recommended vaccines,...
...cination of Persons With Chronic Inf...
...uenzae type b conjugate...
...lanned ImmunosuppressionU: (...
...ImmunosuppressionaU: (SR, L)21881...
...l ImmunosuppressionaU: (SR, L)21881...
...epatitis A...
...nned ImmunosuppressionU: (SR, M)21...
...el ImmunosuppressionaU: (SR, L)21881...
...ImmunosuppressionaU: (SR, L)218...
Hepatitis...
...munosuppressionU: (SR, M)21881...
...munosuppressionaU: (SR, L)21881...
...-Level ImmunosuppressionaU: (S...
...aP, Td, Tda...
...ned ImmunosuppressionU: (SR, M)2...
...mmunosuppressionaU: (SR, L)21...
High-Level ImmunosuppressionaU...
...PV...
...nned ImmunosuppressionU: age 11-26 y (SR, M)218...
...suppressionaU: age 11-26 y (SR, L)21881...
...vel ImmunosuppressionaU: age 11-26 y (SR, VL)21881...
Influenza, inac...
...ImmunosuppressionU: (SR, M)21881...
...w-Level ImmunosuppressionaU: (SR, M)2...
...l ImmunosuppressionaU: (SR, M)2...
Influenza, live attenu...
...ImmunosuppressionX: (WR, VL)21881...
...unosuppressionaX: (WR, VL)21881...
...nosuppressionaX: (WR, VL)21881...
...R, live
...ned ImmunosuppressionU:b (SR, M)2188...
...l ImmunosuppressionaX: (WR, VL)2...
...mmunosuppressionaX: (WR, VL)21881
MMRV, li...
...anned ImmunosuppressionU:b (SR...
...munosuppressionaX: (WR, VL)21881...
...unosuppressionaX: (SR, VL)21881...
Meningococcal conjug...
...nned ImmunosuppressionU: (SR, M)2188...
...-Level ImmunosuppressionaU: (SR, M)21881...
...el ImmunosuppressionaU: (SR, L)2...
...mococcal conjugate (PCV13)...
...nosuppressionR:c (SR, M)21881...
...vel Immunosuppressiona...
...: age...
R: age ≥6 yc (SR, VL)2188...
...-Level Immunosuppressiona...
...age...
...age ≥6 yc (SR, VL)21881
...cal polysaccharide (PPSV2...
...munosuppressionR: age ≥2 y (SR, L)2188...
...ImmunosuppressionaR: age ≥2 y (SR, L)2188...
...vel ImmunosuppressionaR: age ≥2 y (SR, VL)...
Poliovirus, inactivate...
...anned ImmunosuppressionU: (SR,...
...ImmunosuppressionaU: (SR, M)21881
...vel ImmunosuppressionaU: (SR, L)21881...
...otavirus, live...
...munosuppressionU: (SR, M)218...
...el ImmunosuppressionaX: (WR, VL)...
...ImmunosuppressionaX: (WR, VL)21881...
...cella, live...
Planned ImmunosuppressionU:d (SR...
Low-Level ImmunosuppressionaX:d...
...vel ImmunosuppressionaX: (SR, M)21881...
...er, live...
...Immunosuppression...
R: age 50-59 y* (WR...
...‰¥60 y (SR, L)2188...
...Immunosuppressiona...
...-59 y* (WR, VL)21881...
...≥60 y (SR, VL)21881...
...nosuppressionaX: (WR, VL)21881...
...ded—administer if not previously administer...
...nts ≥19 years who have previously rec...
...ministration of VAR can be considere...
...recommendations deviate from CDC ACIP recommendat...
...ia or Sickle Cell Diseases (See Table 7...
...splenic patients or those with sickle cell diseas...
except LAIV in patients with sickle cell di...
...14. PCV13 should be administered to asplenic pati...
...V23 should be administered to asplenic patients or...
...of ≥8 weeks after PCV13, and a second...
...3--naive patients ≥2 years of age for whom a spl...
...s following surgery.* (WR, L)21881...
...7. One dose of Hib should be administe...
...coccal vaccine should be administered to...
...n recommendation 29 except that MCV4-...
...ccinate with MCV4 (or MPSV4 for th...
...Barrier Defects (See Table 7)...
...9. Adults and children with profound deafn...
...th a cochlear implant, with profound...
...tients ≥24 months of age with a cochlea...
...nd PPSV23 should be administered ≥2 w...
...able 7. Vaccination of Persons With Asplenia...
...fluenzae type b conjugate...
...splenia or a Sickle Cell...
...age...
...‰¥5 y (WR, L)21881...
...Implantsa or CSF LeakU: (SR, M)2188...
...epatitis...
...or a Sickle Cell DiseaseU: (SR, M)2...
Cochlear Implantsa or CSF LeakU: (SR, M)21...
...atitis B...
...ickle Cell DiseaseU: (SR, M)21881...
...mplantsa or CSF LeakU: (SR, M)21881...
DTaP, Td, ...
...Sickle Cell DiseaseU: (SR, M)21881...
...ntsa or CSF LeakU: (SR, M)21881...
...PV...
...a Sickle Cell DiseaseU: (SR, M)21881...
...Implantsa or CSF LeakU: (SR, M)21...
...za, inactivated...
...nia or a Sickle Cell DiseaseU: (SR,...
...tsa or CSF LeakU: (SR, M)21881...
...a, live attenuated...
...enia or a Sickle Cell DiseaseX: (WR, V...
...lantsa or CSF LeakU: (SR, M)21881...
..., live...
...ia or a Sickle Cell DiseaseU: (S...
...ar Implantsa or CSF LeakU: (SR, M)21...
MMRV, li...
...or a Sickle Cell DiseaseU: (SR, M)21881...
...ochlear Implantsa or CSF LeakU: (SR, M)2...
...ingococcal conjugate...
...enia or a Sickle Cell DiseaseR: age 2-55...
...chlear Implantsa or CSF LeakU:...
...ccal polysaccharide...
...Sickle Cell DiseaseR: age >55 yb (S...
...chlear Implantsa or CSF LeakU: (SR, M)21881
...ccal conjugate (PCV13...
...r a Sickle Cell Disease
...age...
...¥6 yd (SR, VL)21881...
...Implantsa or CSF Leak...
...age...
...age ≥6 yd (SR, L)2...
...cal polysaccharide (PPSV23)...
...ckle Cell DiseaseR: age ≥2 ye (SR,...
...r Implantsa or CSF LeakR: age ≥2 ye (SR...
...ovirus, inactiva...
...ckle Cell DiseaseU: (SR, M)21881...
...lantsa or CSF LeakU: (SR, M)21881...
...irus, live...
...or a Sickle Cell DiseaseU: (SR, M)...
...ochlear Implantsa or CSF LeakU: (SR, M)2...
Varicella, live
...ckle Cell DiseaseU: (SR, M)21881...
...ntsa or CSF LeakU: (SR, M)21881...
...ter, live...
...lenia or a Sickle Cell DiseaseU: (SR, M)21881...
...ar Implantsa or CSF LeakU: (SR, M)2...
...—administer if not previously administered...
...CV13 has not previously been administere...
e Administer 8 or more weeks after indicated...